JMIR Publications

ABSTRACT

Background:

mHealth interventions can produce both intended and unintended effects. Examining these unintended effects helps to create a more complete and objective understanding of mHealth interventions and can reduce potential harm to participants. Existing studies on the unintended effects, which were published several years ago, tend to have either a general focus on health information technology or a specific focus on healthcare providers, thereby excluding other key stakeholders (e.g., patients, community health workers). Additionally, these studies did not systematically outline the causes of the unintended effects or strategies for their prevention.

Objective:

To address this gap, this systematic review, guided by the ecological framework, aims to systematically identify the unintended effects of mHealth interventions, create a typology for them, investigate the reasons for their occurrence, describe how they were detected, and propose ways to prevent or lessen them.

Methods:

Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a systematic review was performed to examine the unintended effects of health interventions that use mobile technology.

Results:

A total of 15 articles were included in the review. An ecological typology of mHealth Unintended Effects (mHUE) was developed, which includes 26 distinct effects (e.g., silencing and boomerang). The majority of these unintended effects (n = 20) occur at the individual level and span physical/behavioral (n = 7), psychological (n = 8), cognitive (n = 4), and financial (n = 1) domains. Three effects occur at the interpersonal level, and another three at the community/institutional level. Most of the identified effects (n = 22) were negative. Potential causes for these effects include the improper use of mHealth technology, poorly designed interventions, the application of unsuitable intervention mechanisms, or a misalignment between the untended outcomes and the socio-cultural context. Strategies and recommendations (e.g., considering the context such as cultural norms) were suggested to help prevent or reduce the unintended effects.

Conclusions:

The unintended effects detailed in the mHUE typology were heterogenous and depend on context. These effects can influence individuals across different domains, and also affect unintended people within the ecological system. As most of the unintended effects are negative, if they are not monitored, mHealth interventions designed to empower participants could paradoxically disempower them (e.g., decreasing self-efficacy for disease management, undermining patient control and engagement). The mHUE typology, together with the proposed recommendations and strategies, can be used as a guide to enhance the planning, design, implementation, and post-implementation evaluation on mHealth interventions. Future research should concentrate on understanding the specific mechanisms behind these unintended effects.