Mobile consulting (mConsulting) and its potential for providing access to quality healthcare for populations living in low-resource settings of low- and middle-income countries

Abstract

Objective The poorest populations of the world lack access to quality healthcare. We defined the key components of consulting via mobile technology (mConsulting), explored whether mConsulting can fill gaps in access to quality healthcare for poor and spatially marginalised populations (specifically rural and slum populations) of low- and middle-income countries, and considered the implications of its take-up. Methods We utilised realist methodology. First, we undertook a scoping review of mobile health literature and searched for examples of mConsulting. Second, we formed our programme theories and identified potential benefits and hazards for deployment of mConsulting for poor and spatially marginalised populations. Finally, we tested our programme theories against existing frameworks and identified published evidence on how and why these benefits/hazards are likely to accrue. Results We identified the components of mConsulting, including their characteristics and range. We discuss the implications of mConsulting for poor and spatially marginalised populations in terms of competent care, user experience, cost, workforce, technology, and the wider health system. Conclusions For the many dimensions of mConsulting, how it is structured and deployed will make a difference to the benefits and hazards of its use. There is a lack of evidence of the impact of mConsulting in populations that are poor and spatially marginalised, as most research on mConsulting has been undertaken where quality healthcare exists. We suggest that mConsulting could improve access to quality healthcare for these populations and, with attention to how it is deployed, potential hazards for the populations and wider health system could be mitigated.

Mobile consulting (mConsulting) as an option for accessing healthcare services for communities in remote rural areas and urban slums in low- and middle- income countries: A mixed methods study

“…However, we exclude, from our definition of mConsulting, scenarios where a health worker separately seeks advice about a patient from a colleague, in the absence of the patient. 7 During a pandemic, a clear benefit of mConsulting is that it reduces the need for physical contact and thereby protects frontline health workers, patients and vulnerable populations. Although a rapid acceleration of mConsulting is to be expected during the COVID-19 crisis, it is not a new form of clinical communication.…”

“…We draw on our conceptual framework (elaborated in Griffiths et al, 2020) for understanding mConsulting as a two-way, complex adaptive system that connects patients and healthcare providers across a digital communication platform 7 . Complex adaptive systems are self-regulating, context-bound and unpredictable.…”

“…System change is generated by the extent to which interconnected elements (people, organisations and policies) adapt and learn. 8 Because mConsulting draws together digital, social and physical worlds, in ways that disrupt conventional understandings of time and place, it 'has the potential to precipitate nonlinear change and feedback that could result in significant change' 7 . For poor and spatially-marginalised communities with limited healthcare options, mConsulting has the potential to improve access to quality services, even though there may be unintended barriers and challenges 7 .…”

“…8 Because mConsulting draws together digital, social and physical worlds, in ways that disrupt conventional understandings of time and place, it 'has the potential to precipitate nonlinear change and feedback that could result in significant change' 7 . For poor and spatially-marginalised communities with limited healthcare options, mConsulting has the potential to improve access to quality services, even though there may be unintended barriers and challenges 7 . Following Levesque et al (2013), we define access as 'the possibility to identify healthcare needs, to seek healthcare services, to reach the healthcare resources, to obtain or use health care services, and to actually be offered services appropriate to the needs for care" 9 .…”

“…This timeframe coincides with the emergence of WHO guidance on digital interventions for health systems 11 and recognises the rapidly changing nature of digital technology. Building on our previous reviews of two-way digital clinical communication [12][13][14][15][16][17][18] , with added parameters for LMIC contexts, we identified seven systematic reviews [19][20][21][22][23][24][25] and five empirical studies [26][27][28][29][30] involving mConsulting in LMICs, as per our definition 7 (see, Appendix 1, for our search strategy).…”