Two systematic reviews by Caroline Free and colleagues from the London
School of Hygiene & Tropical Medicine are published in PLOS Medicine this
week and examine the evidence on whether mobile technology can help
improve health behaviors, improve disease self-management, or help
health care delivery processes. The researchers report that while mobile
technology-based interventions have shown moderate benefits in a few
specific contexts, not all outcomes are beneficial. Moreover, rigorous
studies in low- and middle-income settings - where experts agree that
mobile health has tremendous potential--largely do not exist.
In the first article, the scientists systematically searched for and analyzed all reported controlled trials of mobile technology interventions for health-care consumers with the aim to change health behavior or improve disease management. They identified 75 trials, of which 72 had been conducted in high-income countries. Three trials with low risk of bias showed clear benefits: two trials tested interventions developed to help smokers quit (both conducted in the UK), and one trial in Kenya examined an intervention that helped HIV-positive patients to take their medications accurately, which in turn improved their HIV viral load. The other trials showed modest or no benefits.
In the second publication, the researchers systematically reviewed trials that evaluated the effectiveness of mobile technology-based interventions for health care providers or services. They identified 32 trials of interventions designed to support communication among health care providers and 10 trials of interventions targeting communication between health services and health care consumers (appointment reminders and information regarding test results). None of those trials were conducted in low-income countries (though a recent update of the search identified one recently published trial from Kenya). The researchers found that while some interventions designed to provide support for health care providers modestly improved aspects of clinical diagnosis and management, other interventions were less successful. Most notably, the use of mobile technology-based photos for diagnosis sometimes resulted in incorrect diagnoses compared with face-to-face-diagnosis. SMS-based appointment reminders were better than no reminders but not better than reminders by phone or mail.
Given the much-heralded potential benefits of mobile health and the limited evidence available to date, the authors stress that additional rigorous tests of mobile health interventions are needed, especially tests in low- and middle-income settings, where the control group of "standard care" might be very different from the standard care available in high-income countries.
In the first article, the scientists systematically searched for and analyzed all reported controlled trials of mobile technology interventions for health-care consumers with the aim to change health behavior or improve disease management. They identified 75 trials, of which 72 had been conducted in high-income countries. Three trials with low risk of bias showed clear benefits: two trials tested interventions developed to help smokers quit (both conducted in the UK), and one trial in Kenya examined an intervention that helped HIV-positive patients to take their medications accurately, which in turn improved their HIV viral load. The other trials showed modest or no benefits.
In the second publication, the researchers systematically reviewed trials that evaluated the effectiveness of mobile technology-based interventions for health care providers or services. They identified 32 trials of interventions designed to support communication among health care providers and 10 trials of interventions targeting communication between health services and health care consumers (appointment reminders and information regarding test results). None of those trials were conducted in low-income countries (though a recent update of the search identified one recently published trial from Kenya). The researchers found that while some interventions designed to provide support for health care providers modestly improved aspects of clinical diagnosis and management, other interventions were less successful. Most notably, the use of mobile technology-based photos for diagnosis sometimes resulted in incorrect diagnoses compared with face-to-face-diagnosis. SMS-based appointment reminders were better than no reminders but not better than reminders by phone or mail.
Given the much-heralded potential benefits of mobile health and the limited evidence available to date, the authors stress that additional rigorous tests of mobile health interventions are needed, especially tests in low- and middle-income settings, where the control group of "standard care" might be very different from the standard care available in high-income countries.
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