J. Med. Internet Res. - Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review.

Tópicos

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Resumo

CKGROUND: Mobile health (mHealth) describes the use of portable electronic devices with software applications to provide health services and manage patient information. With approximately 5 billion mobile phone users globally, opportunities for mobile technologies to play a formal role in health services, particularly in low- and middle-income countries, are increasingly being recognized. mHealth can also support the performance of health care workers by the dissemination of clinical updates, learning materials, and reminders, particularly in underserved rural locations in low- and middle-income countries where community health workers deliver integrated community case management to children sick with diarrhea, pneumonia, and malaria.OBJECTIVE: Our aim was to conduct a thematic review of how mHealth projects have approached the intersection of cellular technology and public health in low- and middle-income countries and identify the promising practices and experiences learned, as well as novel and innovative approaches of how mHealth can support community health workers.METHODS: In this review, 6 themes of mHealth initiatives were examined using information from peer-reviewed journals, websites, and key reports. Primary mHealth technologies reviewed included mobile phones, personal digital assistants (PDAs) and smartphones, patient monitoring devices, and mobile telemedicine devices. We examined how these tools could be used for education and awareness, data access, and for strengthening health information systems. We also considered how mHealth may support patient monitoring, clinical decision making, and tracking of drugs and supplies. Lessons from mHealth trials and studies were summarized, focusing on low- and middle-income countries and community health workers.RESULTS: The review revealed that there are very few formal outcome evaluations of mHealth in low-income countries. Although there is vast documentation of project process evaluations, there are few studies demonstrating an impact on clinical outcomes. There is also a lack of mHealth applications and services operating at scale in low- and middle-income countries. The most commonly documented use of mHealth was 1-way text-message and phone reminders to encourage follow-up appointments, healthy behaviors, and data gathering. Innovative mHealth applications for community health workers include the use of mobile phones as job aides, clinical decision support tools, and for data submission and instant feedback on performance.CONCLUSIONS: With partnerships forming between governments, technologists, non-governmental organizations, academia, and industry, there is great potential to improve health services delivery by using mHealth in low- and middle-income countries. As with many other health improvement projects, a key challenge is moving mHealth approaches from pilot projects to national scalable programs while properly engaging health workers and communities in the process. By harnessing the increasing presence of mobile phones among diverse populations, there is promising evidence to suggest that mHealth can be used to deliver increased and enhanced health care services to individuals and communities, while helping to strengthen health systems.

Resumo Limpo

ckground mobil health mhealth describ use portabl electron devic softwar applic provid health servic manag patient inform approxim billion mobil phone user global opportun mobil technolog play formal role health servic particular low middleincom countri increas recogn mhealth can also support perform health care worker dissemin clinic updat learn materi remind particular underserv rural locat low middleincom countri communiti health worker deliv integr communiti case manag children sick diarrhea pneumonia malariaobject aim conduct themat review mhealth project approach intersect cellular technolog public health low middleincom countri identifi promis practic experi learn well novel innov approach mhealth can support communiti health workersmethod review theme mhealth initi examin use inform peerreview journal websit key report primari mhealth technolog review includ mobil phone person digit assist pdas smartphon patient monitor devic mobil telemedicin devic examin tool use educ awar data access strengthen health inform system also consid mhealth may support patient monitor clinic decis make track drug suppli lesson mhealth trial studi summar focus low middleincom countri communiti health workersresult review reveal formal outcom evalu mhealth lowincom countri although vast document project process evalu studi demonstr impact clinic outcom also lack mhealth applic servic oper scale low middleincom countri common document use mhealth way textmessag phone remind encourag followup appoint healthi behavior data gather innov mhealth applic communiti health worker includ use mobil phone job aid clinic decis support tool data submiss instant feedback performanceconclus partnership form govern technologist nongovernment organ academia industri great potenti improv health servic deliveri use mhealth low middleincom countri mani health improv project key challeng move mhealth approach pilot project nation scalabl program proper engag health worker communiti process har increas presenc mobil phone among divers popul promis evid suggest mhealth can use deliv increas enhanc health care servic individu communiti help strengthen health system

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