JMIR Publications

ABSTRACT

Background:

Migrants may face significant delays and barriers in accessing health care, especially those who do not speak fluently the language of the host country. Some applications (apps) or electronic tools have been specifically developed to be used in medical consultations to facilitate the dialogue between health care professionals and migrants with low language proficiency, as well as apps to promote health amongst migrants.

Objective:

We conducted a systematic review to examine the evidence related to the development, adaptation, acceptability and effectiveness of electronic tools designed to help health care providers communicate with, or promote health amongst, migrants having a low proficiency in the language of the country of origin and/or low health literacy.

Methods:

We conducted a search of three scientific publications databases: Pubmed, Scopus and Embase. The study selection was performed by two researchers independently. We collected data about: general information about the app, information about health literacy and cultural adaptation, information about the development of the app, evidence about the app’s acceptability/efficacy and information about the apps’ use. Data was collected by two researchers independently and results were compared for triangulation and synthesis. Results were reported according to the PRISMA checklist.

Results:

We included 61 articles presenting a total of 48 applications. About one third of them (N=16) were designed solely to facilitate the interaction between migrants and a health care provider during a consultation, while the remaining two thirds (N=32) were designed to promote health amongst migrants with a language barrier. Thirty-two applications (67%) had their acceptability evaluated. Amongst them, 78% reported an overall good or very good acceptability, 3% reported an adequate acceptability. Half of the applications had their efficacy evaluated. Amongst them, for 5 of them the study was ongoing (21%); half had significant positive results, with 12% having had partially positive results meaning that the application showed significant efficacy in some measured outcomes but not all; and 8% applications had non-significant results.

Conclusions:

Overall the applications included had good levels of acceptability, while only half had their efficacy evaluated. In those evaluations, the endpoints used are mostly related to reported behavior change and knowledge improvement, which is common for evaluations of health promotion programs. In the future, it is inevitable that more health applications will be created. Thus, it is essential that applications that claim to have a public health objective undergo a rigorous evaluation of their acceptability, efficacy and actual use. Indicators of outcomes, such as changes in health status, or access to care should be reported in future studies, beyond only reported changes in behavior and knowledge. This systematic review has helped us note the characteristics associated with improved acceptability and efficacy, which can be helpful for the development of future applications.