Summary
Background: With the continuous and enormous spread of mobile technologies, mHealth has evolved
as a new subfield of eHealth. While eHealth is broadly focused on information and
communication technologies, mHealth seeks to explore more into mobile devices and
wireless communication. Since mobile phone penetration has exceeded other infrastructure
in low and middle-income countries (LMICs), mHealth is seen as a promising component
to provide pervasive and patient-centered care.
Objectives: The aim of our research work for this paper is to examine the mHealth literature
to identify application areas, target diseases, and mHealth service and technology
types that are most appropriate for LMICs.
Methods: Based on the 2011 WHO mHealth report, a combination of search terms, all including
the word “mHealth”, was identified. A literature review was conducted by searching
the PubMed and IEEE Xplore databases. Articles were included if they were published
in English, covered an mHealth solution/intervention, involved the use of a mobile
communication device, and included a pilot evaluation study. Articles were excluded
if they did not provide sufficient detail on the solution covered or did not focus
on clinical efficacy/effectiveness. Cross-referencing was also performed on included
articles.
Results: 842 articles were retrieved and analyzed, 255 of which met the inclusion criteria.
North America had the highest number of applications (n=74) followed by Europe (n=50),
Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America
(n=3) had the least number of studies. The majority of solutions addressed diabetes
(n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors
(n=16), and maternal and child’s health (MCH) (n=11). Fewer solutions addressed asthma
(n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic
obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2).
Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu,
ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each).
The remainder of solutions (n=14) did not focus on a certain disease. Most applications
fell in the areas of health monitoring and surveillance (n=93) and health promotion
and raising awareness (n=88). Fewer solutions addressed the areas of communication
and reporting (n=11), data collection (n=6), tele-medicine (n=5), emergency medical
care (n=3), point of care support (n=2), and decision support (n=2). The majority
of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone
calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video
(n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering
from small sample sizes and short study durations. Problems addressed by solutions
included travel distance for reporting, self-management and disease monitoring, and
treatment/medication adherence.
Conclusions: SMS and app solutions are the most common forms of mHealth applications. SMS solutions
are prevalent in both high and LMICs while app solutions are mostly used in high income
countries. Common application areas include health promotion and raising awareness
using SMS and health monitoring and surveillance using mobile apps. Remaining application
areas are rarely addressed. Diabetes is the most commonly targeted medical condition,
yet remains deficient in LMICs.
Keywords
mHealth - low and middle income countries - mobile health solutions
