mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review

Abstract

BackgroundRoutine monitoring by patients and healthcare providers to manage chronic disease is vital, though this can be challenging in low-resourced health systems. Mobile health (mHealth) has been proposed as one way to improve management of chronic diseases. Past mHealth reviews have proposed the need for a greater understanding around how the theoretical constructs in mHealth interventions actually work. In response, we synthesised evidence from primary studies on monitoring of chronic diseases using two-way digital text or voice communication between a patient and health worker. We did this in order to understand the important considerations for the design of mHealth interventions.MethodArticles retrieved were systematically screened and analysed to elicit explanations of mHealth monitoring interventions. These explanations were consolidated into programme theory and compared with existing theory and frameworks. We identified variation in outcomes to understand how context moderates the outcome.ResultsFour articles were identified—monitoring of hypertension and HIV/AIDS from: Kenya, Pakistan, Honduras and Mexico and South Africa. Six components were found in all four interventions: reminders, patient observation of health state, motivational education/advice, provision of support communication, targeted actions and praise and encouragement. Intervention components were mapped to existing frameworks and theory. Variation in outcome identified in subgroup analysis suggests greater impact is achieved with certain patient groups, such as those with low literacy, those with stressful life events or those early in the disease trajectory. There was no other evidence in the included studies of the effect of context on the intervention and outcome.ConclusionmHealth interventions for monitoring chronic disease in low-resource settings, based on existing frameworks and theory, can be effective. A match between what the intervention provides and the needs or social factors relevant to specific patient group increases the effect. It was not possible to understand the impact of context on intervention and outcome beyond these patient-level measures as no evidence was provided in the study reports.

Using Targeted mHealth Messages to Address Hypertension and Diabetes Self-Management in Cambodia: Protocol for a Clustered Randomized Controlled Trial

“…We will have >99% power to detect differences in efficacy analyses. We believe that these are realistic goals based on results of other rigorous mHealth studies in LMIC [24]. Power calculations were completed using STATA (StataCorp College Station).…”

Intervention through Short Messaging System (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics–results of a pilot study

“…better visual impact and personal connectivity. SMS and phone calls were found to be the two widely used and feasible intervention strategies adopted to educate patients about self-management of chronic diseases [30][31][32]. However, it is unknown which of these two modes have…”

Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review

“…Fortunately, there is greater awareness of mediating interventions to support caregivers who are providing care for relatives with a chronic illness or disability [ 17 ]. Various interventions have been geared toward caregivers of persons presenting with dementia [ 14 , 18 , 19 ], cancer [ 20 , 21 ], HIV [ 22 , 23 ], chronic diseases [ 24 - 26 ], maternal and child health [ 27 , 28 ], and long-term conditions in children [ 29 , 30 ]. Various authors [ 31 , 32 ] claim that there is limited research available that focuses on families caring for adolescents with mental health needs, while Cardamone-Breen et al [ 33 ] stated there is a scarcity of parental interventions to prevent them from internalizing the mental health issues of adolescents.…”