Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 8, 2025
Open Peer Review Period: Jul 24, 2025 - Sep 18, 2025
Date Accepted: Apr 14, 2026
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
mHealth in home-based palliative care: A realist review of contextual factors and mechanisms of action that influence outcomes
ABSTRACT
Background:
The increasing prevalence of chronic illness presents a significant global health challenge, due to growing end-of-life suffering. Palliative care is now an essential health service under Universal Health Coverage. Its integration into primary healthcare and use of mHealth have been recommended to improve access.
Objective:
To synthesise evidence on how mHealth interventions in home-based palliative care work, for whom, and in what context.
Methods:
This realist review searched global evidence from eight electronic databases and incorporated expertise from international palliative care professionals. Bronfenbrenner’s ecological systems theory was applied to examine mHealth's contextual influences on home-based palliative care and to demonstrate interactions of factors in the system. Context-mechanism-outcome configurations were developed and iteratively tested to refine the programme theory.
Results:
A total of 1,894 records were identified, with 296 articles retained for full-text screening, and 93 studies included in the final synthesis. The context-mechanism-outcome configurations reveal that proper orientation for patients and families, along with clear guidelines for healthcare professionals, can alleviate concerns about mHealth’s suitability in palliative care. Addressing technological barriers requires investments in infrastructure and user-friendly designs. Engaging diverse stakeholders ensures mHealth meets user needs and is integrated into systems. mHealth enhances access to care through better coordination and empowering users with adequate information to manage symptoms independently.
Conclusions:
mHealth interventions can enhance home-based palliative care but must align with local contexts. It is recommended that mHealth interventions ensure safety and comfort, technology competence, tailored communication, empowerment of end-users, family involvement, healthcare worker motivation, and system integration.
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.