advanced search

<< Back To Home

A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries

Monday, 18th of July 2016

A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries

• Victor Stephani¹Email authorView ORCID ID profile,
• Daniel Opoku¹ and
• Wilm Quentin¹

BMC Public HealthBMC series – open, inclusive and trusted201616:572

DOI: 10.1186/s12889-016-3226-3

©  The Author(s). 2016

Published: 15 July 2016

Excerpts below; full text is at http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3226-3

Abstract

Background

The reasons of deaths in developing countries are shifting from communicable diseases towards non-communicable diseases (NCDs). At the same time the number of health care interventions using mobile phones (mHealth interventions) is growing rapidly. We review studies assessing the health-related impacts of mHealth on NCDs in low- and middle-income countries (LAMICs).

Methods

A systematic literature search of three major databases was performed in order to identify randomized controlled trials (RCTs) of mHealth interventions. Identified studies were reviewed concerning key characteristics of the trial and the intervention; and the relationship between intervention characteristics and outcomes was qualitatively assessed.

Results

The search algorithms retrieved 994 titles. 8 RCTs were included in the review, including a total of 4375 participants. Trials took place mostly in urban areas, tested different interventions (ranging from health promotion over appointment reminders and medication adjustments to clinical decision support systems), and included patients with different diseases (diabetes, asthma, hypertension). Except for one study all showed rather positive effects of mHealth interventions on reported outcome measures.

Furthermore, our results suggest that particular types of mHealth interventions that were found to have positive effects on patients with communicable diseases and for improving maternal care are likely to be effective also for NCDs.

Conclusions

Despite rather positive results of included RCTs, a firm conclusion about the effectiveness of mHealth interventions against NCDs is not yet possible because of the limited number of studies, the heterogeneity of evaluated mHealth interventions and the wide variety of reported outcome measures. More research is needed to better understand the specific effects of different types of mHealth interventions on different types of patients with NCDs in LaMICs.

Background

As a result of increasing life-expectancy and growing welfare in low and middle income countries (LaMICs), there is a steady shift away from communicable to non-communicable diseases (NCDs) [1, 2, 3]. NCDs pose a major threat to public health in LaMICs. In 2010, NCDs already accounted for half of Disability Adjusted Life Years (DALYs) lost and for 58 % of all deaths in these countries [4]. It is predicted that this number will increase to 70 % of all deaths in 2020 [5]. The economic cost of the NCDs burden for LaMICs are estimated to reach US$21 trillion by 2030 [3].

The ability of LaMICs to provide treatment and care for the increasing number of patients with NCDs is limited by insufficient health care infrastructure, especially in rural areas [6]. At the same time there is a rapidly growing, hidden infrastructure: 90 % of the worlds population now lives within reach of a mobile phone signal [7] and the developing world has the fastest-growing cellphone subscriber market in the world [8, 9] with a mobile-cellular subscription rate of almost 90 % in 2013 [10].

The number of health care interventions using mobile phones (short mHealth interventions) is growing rapidly [11]. In particular in LaMICs, mHealth is perceived to have great potential for improving health care provision for both communicable and non-communicable diseases [12]. Most of the available literature on mHealth interventions is focused on communicable diseases (such as HIV and Malaria) or on maternal care [13]. However, the number of studies focusing on mHealth for patients with NCDs has considerably increased over the last few years. In fact, two thirds of all articles on the topic have been published between 2012 and 2015 (based on a Web of Science search with the keywords TS = (mHealth OR “mobile Health” or tele*) AND TS = (“developing”) AND TS = (NCD OR “non-communicable diseases”). Yet, evaluations of mheatlh interventions often do not follow rigorous scientific standards of randomized controlled trials (RCTs), and consequently, they carry a relatively high risk of bias [14].

Two reviews are available that have included studies analyzing certain aspects of mHealth interventions for NCDs in LaMICs: Beratarrechea et al. [15] evaluated text and automated voice interventions for chronic diseases in the developing world and Bloomfield et al. [16] performed a review of mHealth interventions against NCDs focusing only on Sub-Saharan African countries. However, as Beratarrechea et al. [15] did not focus specifically on NCDs and because Bloomfield et al. [16] focused exclusively on Sub-Saharan Africa, a comprehensive overview of the effectiveness of mHealth interventions for improved treatment and care of patients with NCDs living in LaMICs remains unavailable.

The aim of this study was 1) to systematically review the available evidence generated by randomized controlled trials (RCTs) of mHealth interventions for people with NCDs living in LaMICs, and 2) to assess the relationship between intervention characteristics and reported health-related outcomes. We focused on RCTs since they remain the gold standard for evidence of effectiveness of health interventions [17].