JMIR Publications

ABSTRACT

Background:

Community Health Workers (CHWs) have become essential to the promotion of healthy behaviors, yet their work is complicated by challenges both within and beyond their control. Rising penetration of ‘smart’ technology in low and middle-income countries (LMICs) facilitates the use of portable electronic devices in the field. We therefore examine to what extent mobile health (mHealth) in the form of smart devices may enhance delivery of public health messages in CHW-client interactions, thereby inducing client behavior change.

Objective:

To explore how smart devices used for health promotion affect both CHWs and their clients in the field.

Methods:

We conducted a structured search of PubMed and LILACS databases using subject heading terms in four categories: technology user; technology device; use of technology; and outcome. Eligibility criteria included publication since January 2007, CHWs delivering a health message aided by a smart device, and face-to-face communication between CHWs and clients. Eligible studies were analyzed qualitatively.

Results:

We identified 12 eligible studies, ten of which used qualitative or mixed methods approaches. We found that smart devices mitigate challenges encountered by CHWs by improving their knowledge, motivation and creativity (e.g., through self-made videos), their status within the community, and the credibility of their health messages. The technology often stimulated interest in both CHW and clients, and locally produced media content was strongly embraced. Yet, the effect of smart devices on the quality of CHW-client interactions was inconclusive – interactions suffered from increased CHW passivity in communication and technological difficulties. Only one study considered client health behavior change as an endpoint.

Conclusions:

Smart mobile devices may augment CHWs’ field performance and enhance face-to-face interactions with clients, yet they also generate new challenges. The available evidence is scarce, mostly qualitative, and focused on a limited range of health outcomes. Future research should include larger scale interventions across a wide range of health outcomes and feature client health behavior change as an endpoint.