A mixed methods systematic review of success factors of mhealth and telehealth for maternal health in Sub-Saharan Africa

Abstract

Access to health care is still limited for many women in sub-Saharan Africa (SSA), while it remains an important determinant of maternal mortality and morbidity. Information and communication technologies (ICTs), such as mhealth and telehealth, can help to facilitate this access by acting on the various obstacles encountered by women, be they socio-cultural, economic, geographical or organizational. However, various factors contribute to the success of mhealth and telehealth implementation and use, and must be considered for these technologies to go beyond the pilot project stage. The objective of this systematic literature review is to synthesize the empirical knowledge on the success factors of the implementation and use of telehealth and mhealth to facilitate access to maternal care in SSA. The methodology used is based on that of the Cochrane Collaboration, including a documentary search using standardized language in six databases, selection of studies corresponding to the inclusion criteria, data extraction, evaluation of study quality, and synthesis of the results. A total of 93 articles were identified, which allowed the inclusion of seven studies, six of which were on mhealth. Based on the framework proposed by Broens ., we synthesized success factors into five categories: (I) technology, such as technical support to maintain, troubleshoot and train users, good network coverage, existence of a source of energy and user friendliness; (II) user acceptance, which is facilitated by factors such as unrestricted use of the device, perceived usefulness to the worker, adequate literacy, or previous experience of use ; (III) short- and long-term funding; (IV) organizational factors, such as the existence of a well-organized health system and effective coordination of interventions; and (V) political or legislative aspects, in this case strong government support to deploy technology on a large scale. Telehealth and mhealth are promising solutions to reduce maternal morbidity and mortality in SSA, but knowledge on how these interventions can succeed and move to scale is limited. Success factors identified in this review can provide guidance on elements that should be considered in the design and implementation of telehealth and mhealth for maternal health in SSA.

Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study

“…The use of mobile phones could potentially promote health and gender equity [ 5 , 6 ] and enhance community empowerment [ 7 , 8 ]. Short message service (SMS) text messaging, in particular, has been shown to be a simple and effective intervention for improving health service delivery in pregnant women [ 9 , 10 ], infectious disease cases [ 11 , 12 ], weight loss cases [ 13 ], and diabetes cases [ 14 ] and increasingly for smoking cessation support [ 15 - 18 ]. SMS text messages can present timely cues, behavioral reinforcement, and social support [ 19 ] all through an inexpensive delivery medium.…”

Mobile Health Intervention in the Maternal Care Pathway: Protocol for the Impact Evaluation of hAPPyMamma

“…First, there is scarce empirical evidence of the real potential of mHealth in improving women's access to care, their literacy and self-management skills, and quality of services along the maternal pathway [9]. This is particularly true for western countries because the literature focuses on the impact of technologies in developing countries [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. In high-income countries, technology-supported interventions targeted at pregnant women and new mothers are often aimed at improving their lifestyle-related behaviors [9,51].…”

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“…medical consumables; effective referral structures) are necessary. 71 Interventions failing to take both motivational and health system factors into account may fall short of expectations.…”