JMIR Publications

ABSTRACT

Background:

mobile health (mHealth) interventions have potential to improve health outcomes in low- and middle-income countries (LMIC) by aiding health workers strengthen service delivery, and patients and communities manage and prevent diseases. It is crucial to understand how best to implement mHealth within already burdened health services, to maximally improve health outcomes and sustain the intervention in LMIC.

Objective:

We aimed to identify key barriers to and facilitators of the implementation of mHealth interventions for infectious diseases in LMIC, drawing on a health systems analysis framework.

Methods:

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to select qualitative or mixed methods studies reporting on determinants of already implemented infectious disease mHealth interventions in LMIC. We searched MEDLINE, Embase, PubMed, CINAHL, Social Science Citation Index and Global Health. We extracted characteristics of the mHealth interventions and implementation experiences, followed by an analysis of determinants using the Tailored Implementation of Chronic Diseases Framework.

Results:

We identified 10494 titles for screening, among which 20 studies met our eligibility criteria. Nine studies examined mHealth smartphone applications, and 11 examined Short Messaging Services interventions. The interventions addressed HIV (n=7), malaria (n=4), tuberculosis (n=4), pneumonia (n=2), dengue (n=1), HPV (n=1), COVID-19 (n=1) and respiratory illnesses or childhood infectious diseases (n=2), with two studies addressing multiple diseases. Ten interventions were intended for use by health workers and the remainder targeted patients, at-risk individuals or community members. Access to reliable technological resources, familiarity with technology and training and support were key determinants of implementation. Additional themes included mHealth intervention design affecting ease of use, or users forgetting to use the mHealth interventions.

Conclusions:

Limitations in the design of mHealth technologies are barriers to widespread adoption, in addition to infrastructure and other health system challenges. Understanding the interaction between mHealth interventions, its implementation, and health systems will improve their uptake in LMIC.