JMIR Publications

ABSTRACT

Background:

During the last decade there has been an upsurge in the use of mobile technologies to improve the delivery of health services that aim to change the health outcomes of populations around the world. This study centers specifically in the use of mobile technologies (mHealth) such as short message services (SMS), calls, and apps to change the health behaviors and the health outcomes of populations in developing countries. Research supports that the use of these types of mHealth applications generates improvements in health outcomes such as maternal and infant mortality, treatment adherence, immunization rates, prevention of communicable diseases, and more. However, it is also evident that in developing countries, there are significant barriers to successfully implement, sustain, and expand mHealth initiatives that have the potential to improve the health of vulnerable populations. A literature review has been conducted to document the factors that impede the successful implementation of mHealth interventions that aim to improve health outcomes of a population in diverse developing countries around the world.

Objective:

This study aims to define the barriers to the use of mHealth in improving the health outcomes in developing countries.

Methods:

The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and conducted a literature review using PubMed and CINAHL. The search criteria derived from the primary objective of the study. The final matrix of the articles from PubMed and CINAHL was prepared using exhaustive terms search that includes mHealth, text messaging, and developing countries with all their respective MESH terms. The search includes specific limiters such as publication date, English language, and full text. At least two authors thoroughly reviewed each article’s abstract to verify the articles were germane to this study’s objective. Then, after several consensus meetings to confirm the articles met the study criteria, the researchers produced a final group for analysis of 30 articles (n= 30).

Results:

Researchers reviewed 2,453 studies. After applying filters and conducting consensus meetings, 30 articles fully met the inclusion criteria. According to the analysis, there is extensive use of mHealth initiatives to address maternal health, prenatal care, infant care, HIV/AIDS prevention, treatment adherence, cardiovascular disease, diabetes, and health education, etc. The articles in the group for analysis represent studies from several developing countries in Africa, Asia, and Latin America. From each article, the researchers recorded the health outcome improved, the mHealth technology used, and the barriers to the successful implementation of the intervention in a developing country. The most prominent health outcomes improved with mHealth were infectious diseases and maternal health, accounting for a combined 66.7% of the total studies in the group for analysis. The most frequent mHealth technology used was SMS, accounting for 60% of the studies. A total of 80 individual barriers were identified within the studies and grouped into 10 main categories. The top three barrier categories are deficient intervention design, inadequate financial support, and limited infrastructure which together accounted for 34 individual barriers.

Conclusions:

This systematic review sheds light into the most prominent health outcomes that can be improved with mHealth technology interventions in developing countries. The barriers identified will provide the leaders of future intervention projects a solid foundation for the design of those interventions; thus, increasing the chances of long-term success. Authors suggest that in order to overcome the top three barriers, project leaders that wish to implement mHealth interventions need to establish partnerships with local governments and non-governmental organizations to secure funding, leadership, and the required infrastructure.