Special to Dispatch from Hima Batavia

Last fall, under the direction of Dr. Patricia Mechael at The Earth Institute at Columbia University, our team of mHealth interns conducted a review of evidence-based studies on mobile health, or mHealth.  The product of that work is being released today as part of the mHealth Alliance thought leadership series, and tied to the USAID, mHealth Alliance and SHOPS eConference on mobile health, family planning and maternal and child health.

mHealth is the use of mobile and wireless technologies to support the achievement of public health and health service delivery activities. This includes the use and capitalization of mobile phones’ core utility of voice and text as well as more complex mobile and wireless remote patient monitoring systems. The purpose of the review was to improve our understanding of the policy barriers and research gaps that inhibit the scaling and sustainability of mHealth in low and middle-income countries (LMICs).

After reviewing nearly 2,994 peer-reviewed publications and secondary sources, the consensus was that there was no shortage of mHealth literature. It was only after digging deeper to identify studies assessing mHealth’s impact on health outcomes in LMICs that a gap in the literature became evident.

Surprisingly, for an emerging field focused on the use of mobile technologies to address public health challenges, measuring health outcomes was the exception rather than the rule. Conversely, studies (mostly from the field of computer science) concentrated on the usability and adoption of mobile technologies in healthcare settings, and the feasibility of implementing a program given contextual nuances and patient and provider attitudes. While important, the evidence required to advance mHealth beyond small-scale pilot projects is missing.

As a result, we reassessed our criteria and expanded the scope to include examples of mHealth interventions in high-income countries with transferable lessons for LMICs. Interestingly, we found that high-income countries were using mHealth as a monitoring and treatment compliance tool for chronic diseases. As some LMICs begin to experience an epidemiological shift, lessons and examples of these mHealth implementations will be valuable.

Understanding the reasons for the gaps in the literature became more apparent during our round-table discussion held at Columbia University in March 2010. Holly Ladd of AED-SATELLIFE reasoned that often before mHealth studies go through the process of execution, aggregation, analysis, writing and publication, the technology environment has changed. We found this to be accurate, as many studies available in the mHealth literature related to LMICs focused on mobile technologies such as PDAs. Given the pace of mobile technology advancement, discussions suggesting alternative means to traditional long-term randomized control trials (standard in public health for new interventions) for building the mHealth evidence base are needed. 

mHealth is a disruptive innovation and has great potential to strengthen health systems. Electronic health records and point-of-care support tools on mobile phones  can help improve quality of care and health outcomes with the capacity to capture data that when aggregated can inform district-level health programming.

This type of macro-solution demands the assembly of governments, policy makers, practitioners, researchers, funders, medical professionals, and users to find common ground and realize the real potential of mHealth.  Consortiums such as the mHealth Alliance and Digital Health Initiative are critical forces helping to set an agenda that will mobilize stakeholders for collaborative discussions and strategies to progress mHealth within both eHealth and mServices forward.

Perhaps the most glaring finding of our targeted review was the sector’s inclination to operate in silos. Divisions were found among the types of professionals working in the field (i.e. public health researchers, practitioners, computer scientists), the types of mHealth interventions (i.e. treatment compliance, disease surveillance, data collection) and the types of diseases (i.e. HIV/AIDS, diabetes, malaria).

The fragmentation within the mHealth and broader eHealth field is the greatest barrier for implementations to reach scale and sustainability.   For this, an enabling policy environment that links technology to health priorities and defines information and communication system architecture elements and standards, will help to guide and drive donor, industry, and NGO activities in an additive fashion that truly leverages the power and potential of mobile technologies and supporting infrastructures.

 

Hima Batavia is an mHealth intern at The Earth Institute at Columbia University and a Research Officer at the Mclaughlin-Rotman Centre for Global Health

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