The Impact of mHealth Interventions: Systematic Review of Systematic Reviews

Abstract

BackgroundMobile phone usage has been rapidly increasing worldwide. mHealth could efficiently deliver high-quality health care, but the evidence supporting its current effectiveness is still mixed.ObjectiveWe performed a systematic review of systematic reviews to assess the impact or effectiveness of mobile health (mHealth) interventions in different health conditions and in the processes of health care service delivery.MethodsWe used a common search strategy of five major scientific databases, restricting the search by publication date, language, and parameters in methodology and content. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist.ResultsThe searches resulted in a total of 10,689 articles. Of these, 23 systematic reviews (371 studies; more than 79,665 patients) were included. Seventeen reviews included studies performed in low- and middle-income countries. The studies used diverse mHealth interventions, most frequently text messaging (short message service, SMS) applied to different purposes (reminder, alert, education, motivation, prevention). Ten reviews were rated as low quality (AMSTAR score 0-4), seven were rated as moderate quality (AMSTAR score 5-8), and six were categorized as high quality (AMSTAR score 9-11). A beneficial impact of mHealth was observed in chronic disease management, showing improvement in symptoms and peak flow variability in asthma patients, reducing hospitalizations and improving forced expiratory volume in 1 second; improving chronic pulmonary diseases symptoms; improving heart failure symptoms, reducing deaths and hospitalization; improving glycemic control in diabetes patients; improving blood pressure in hypertensive patients; and reducing weight in overweight and obese patients. Studies also showed a positive impact of SMS reminders in improving attendance rates, with a similar impact to phone call reminders at reduced cost, and improved adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decrease of viral load.ConclusionsAlthough mHealth is growing in popularity, the evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist. Exceptions include the moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. Most studies were performed in high-income countries, implying that mHealth is still at an early stage of development in low-income countries.

Mobile Applications for Multiple Sclerosis: a Focus on Self-Management

“…Considering the chronic nature of multiple sclerosis and importance of self-management in its control (17), the emerging trend observed in developing m-health apps seems to be in a right direction. Since m-health tools have the potential to better facilitate adherence of patients with chronic diseases to treatment and management regimens (29-31), the observed increase in the number of such apps for self-management of multiple sclerosis can lead to more involvement of the patients in managing their conditions. In addition, considering the fact that the attitude of people with MS is positive on the use of Smartphone technology for health care purposes (32, 33), this can be promising for the success of MS self-management apps.…”

An approach to revising mHealth interventions for children and families: A case example in sickle cell disease

“…With the increasing availability of mHealth interventions for health behavior change (Marcolino et al, ), approaches to guide the revision of existing interventions are needed. During the review of literature, no approaches were identified that outline consideration for mHealth interventions targeted for use by children and their families.…”

“…Mobile health, or mHealth, is defined as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices” (World Health Organization, , p. 6). mHealth may overcome barriers to care and improve resource delivery in difficult‐to‐reach populations; thus, mHealth is a useful avenue for delivering health behavior change interventions (Marcolino et al, ; Thirumurthy & Lester, ). Furthermore, mHealth interventions have been shown to improve symptom outcomes, quality of life, healthcare utilization, and medication adherence in populations with chronic conditions (Marcolino et al, ) and have the potential for monitoring and implementing disease management plans in chronic conditions (Nilsen et al ).…”

Mobile apps for multiple sclerosis: a focus on self-management (Preprint)

“…Considering the chronic nature of multiple sclerosis and importance of self-management in its control [17], the emerging trend observed in developing m-health apps seems to be in a right direction. Since m-health tools have the potential to better facilitate adherence of patients with chronic diseases to treatment and management regimens [29][30][31], the observed increase in the number of such apps for self-management of multiple sclerosis can lead to more involvement of the patients in managing their conditions. In addition, considering the fact that the attitude of people with MS is positive on the use of Smartphone technology for health care purposes [32,33], this can be promising for the success of MS self-management apps.…”