Introduction:Rates of chronic diseases will continue to rise in developing countries unless effective and cost-effective interventions are implemented. This review aims to discuss the impact of mobile health (m-health) on chronic disease outcomes in low- and middle-income countries (LMIC).Materials and Methods:Systematic literature searches were performed using CENTRAL, MEDLINE, EMBASE, and LILACS databases and gray literature. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to address chronic diseases in adults in low- or middle-income countries. Outcomes measured included morbidity, mortality, hospitalization rates, behavioral or lifestyle changes, process of care improvements, clinical outcomes, costs, patient–provider satisfaction, compliance, and health-related quality of life (HRQoL).Results:From the 1,709 abstracts retrieved, 163 articles were selected for full text review, including 9 randomized controlled trials with 4,604 participants. Most of the studies addressed more than one outcome. Of the articles selected, six studied clinical outcomes, six studied processes of care, three examined healthcare costs, and two examined HRQoL. M-health positively impacted on chronic disease outcomes, improving attendance rates, clinical outcomes, and HRQoL, and was cost-effective.Conclusions:M-health is emerging as a promising tool to address access, coverage, and equity gaps in developing countries and low-resource settings. The results for m-health interventions showed a positive impact on chronic diseases in LMIC. However, a limiting factor of this review was the relatively small number of studies and patients enrolled, highlighting the need for more rigorous research in this area in developing countries.
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References
1.
World Health Organization. Fact Sheets: Chronic Diseases. Geneva: World Health Organization, 2011.
2.
JoshiR, JanS, WuY, MacMahonS. Global inequalities in access to cardiovascular health care: Our greatest challenge. J Am Coll Cardiol, 2008; 52:1817–1825.
3.
MechaelP, BataviaH, KaongaN, et al.Barriers and gaps affecting mhealth in low and middle income countries: Policy white paper. Washington, DC: mHealth Alliance, 2010.
4.
PietteJD, LunKC, MouraLAJr, et al.Impacts of e-health on the outcomes of care in low- and middle-income countries: Where do we go from here?. Bull World Health Organ, 2012; 90:365–372.
5.
Vital Wave Consulting. mHealth for development: The opportunity of mobile technology for healthcare in the developing world. Available at www.vitalwaveconsulting.com/pdf/mHealth.pdf (last accessed March5, 2011).
6.
GermanakosP, MourlasC, SamarasG. A mobile agent approach for ubiquitous and personalized ehealth information systems. Paper presented at the Workshop on Personalization for e-Health of the 10th International Conference on User Modeling, Edinburgh, Scotland, 2005.
7.
Cole-LewisH, KershawT. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev, 2010; 32:56–69.
8.
FjeldsoeBS, MarshallAL, MillerYD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med, 2009; 36:165–173.
9.
KrishnaS, BorenSA, BalasEA. Healthcare via cell phones: A systematic review. Telemed J E Health, 2009; 15:231–240.
10.
Central Intelligence Agency. The World Factbook 2009. Langley, VA: Central Intelligence Agency, 2009.
11.
LasicaJD. The mobile generation. Global transformations at the cellular level. A Report of the Fifteenth Annual Aspen Institute Roundtable on Information Technology. Washington, DC: The Aspen Institute, 2007.
12.
RiceRE, KatzJE. Comparing Internet and mobile phone usage: Digital divides of usage, adoption and dropouts. Telecommun Policy, 2003; 27:597–623.
13.
Plunkett's Research, Ltd. Plunkett's Wireless, WiFi, RFID and Cellular Industry Almanac. Houston, TX: Plunkett's Research, Ltd., 2008.
14.
GarsideJ. More mobile devices than people ‘within five years.’ Available at www.guardian.co.uk/business/2012/jun/06/more-mobile-devices-eople-five-years (last accessed April15, 2013).
15.
Mobile phone access reaches three quarters of planet's population. Available at www.worldbank.org/en/news/2012/07/17/mobile-phone-access-reachesthree-quarters-planets-population (last accessed April15, 2013).
16.
WHO Global Observatory for eHealth. New horizons for health through mobile technologies. Geneva: World Health Organization, 2011.
17.
MaringáG. Paraná e mais 19 estados já têm mais celulares que habitantes. Available at www.gazetamaringa.com.br/online/conteudo.phtml?tl=1&id=1182137&tit=Parana-e-mais-19-estados-ja-tem-mais-celulares-que-habitantes (last accessed November1, 2011).
18.
ChanCV, KaufmanDR. A technology selection framework for supporting delivery of patient-oriented health interventions in developing countries. J Biomed Inform, 2010; 43:300–306.
19.
Pop-ElechesC, ThirumurthyH, HabyarimanaJP, et al.Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: A randomized controlled trial of text message reminders. AIDS, 2011; 25:825–834.
20.
CrankshawT, CorlessIB, GiddyJ, NicholasPK, EichbaumQ, ButlerLM. Exploring the patterns of use and the feasibility of using cellular phones for clinic appointment reminders and adherence messages in an antiretroviral treatment clinic, Durban, South Africa. AIDS Patient Care STDS, 2010; 24:729–734.
21.
MasilulekeP. Project Masiluleke. A breakthrough initiative to combat HIV/AIDS utilizing mobile technology & HIV self-testing in South Africa. Available at http://poptech.org/system/uploaded_files/27/original/Project_Masiluleke_Brief.pdf (last accessed October23, 2011).
22.
Joint United Nations Program on HIV/AIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic. Geneva: UNAIDS, 2010.
23.
StroupDF, BerlinJA, MortonSC, et al.Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group. JAMA, 2000; 283:2008–2012.
24.
LiberatiA, AltmanDG, TetzlaffJ, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med, 2009; 6:e1000100.
25.
MoherD, LiberatiA, TetzlaffJ, AltmanDG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med, 2009; 6:e1000097.
26.
International Monetary Fund. World economic outlook (WEO) tensions from the two-speed recovery: Unemployment, commodities, and capital flows. WEO presents the IMF staff's analysis and projections of economic developments at the global level. Available at www.imf.org/external/pubs/ft/weo/2011/01/index.htm (last accessed May11, 2011).
27.
HigginsJ, GreenS, (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March2011]. London: The Cochrane Collaboration, 2011. Available at www.cochrane-handbook.org (last accessed March15, 2013).
28.
CiapponiA, GlujovskyD, BardachA, García MartíS, ComandeD. EROS: A new software for early stage of systematic reviews. HTAi 2011Conference Health Technology Assessment International (HTAi). Rio de Janeiro: Health Technology Assessment International, 2011:95.
29.
GlujovskyD, BardachA, García MartíS, ComandeD. New software for early stage of systematic reviews. In: XVIII Cochrane Colloquium. The Joint Colloquium of the Cochrane & Campbell Collaborations. Keystone, CO: The University of Colorado Denver, 2010.
30.
CiapponiA, GlujovskyD, BardachA, García MartíS, ComandeD. EROS: A new software for early stage of systematic reviews [abstract]. Value Health, 2011; 14(7):A564.
31.
Review Manager (RevMan) [computer program]. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
32.
OstojicV, CvoriscecB, OstojicSB, ReznikoffD, Stipic-MarkovicA, TudjmanZ. Improving asthma control through telemedicine: A study of short-message service. Telemed J E Health, 2005; 11:28–35.
33.
LiuWT, HuangCD, WangCH, LeeKY, LinSM, KuoHP. A mobile telephone-based interactive self-care system improves asthma control. Eur Respir J, 2011; 37:310–317.
34.
RamachandranK, HusainN, MaikhuriR, SethS, VijA, KumarM, SrivastavaN, PrabhakaranD, AiranB, Srinthath ReddyK. Impact of a comprehensive telephone-based disease management programme on quality-of-life in patients with heart failure. Natl Med J India, 2007; 20:67–73.
35.
WojcickiJM, LadyzynskiP, KrzymienJ, et al.What we can really expect from telemedicine in intensive diabetes treatment: Results from 3-year study on type 1 pregnant diabetic women. Diabetes Technol Ther, 2001; 3:581–589.
36.
ShettyAS, ChamukuttanS, NandithaA, RajRK, RamachandranA. Reinforcement of adherence to prescription recommendations in Asian Indian diabetes patients using short message service (SMS)—A pilot study. J Assoc Physicians India, 2011; 59:711–714.
37.
BalsaA, GandelmanN. The impact of ICT on health promotion: A randomized experiment with diabetic patients. Research Department Publication 4703. Washington, DC: Research Department, Inter-American Development Bank, 2010.
38.
ChenZW, FangLZ, ChenLY, DaiHL. Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: A randomized controlled trial. J Zhejiang Univ Sci B, 2008; 9:34–38.
39.
LeongKC, ChenWS, LeongKW, et al.The use of text messaging to improve attendance in primary care: A randomized controlled trial. Fam Pract, 2006; 23:699–705.
40.
LiewSM, TongSF, LeeVK, NgCJ, LeongKC, TengCL. Text messaging reminders to reduce non-attendance in chronic disease follow-up: A clinical trial. Br J Gen Pract, 2009; 59:916–920.
41.
CarJ, Gurol-UrganciI, de JonghT, Vodopivec-JamsekV, AtunR. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev, 2012; 7:CD007458.
42.
de JonghT, Gurol-UrganciI, Vodopivec-JamsekV, CarJ, AtunR. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev, 2012; 12:CD007459.
43.
HershWR, HelfandM, WallaceJ, et al.Clinical outcomes resulting from telemedicine interventions: A systematic review. BMC Med Inform Decis Mak, 2001; 1:5.
44.
MurrayE, BurnsJ, SeeTS, LaiR, NazarethI. Interactive health communication applications for people with chronic disease. Cochrane Database Syst Rev, 2005;(4):CD004274.
45.
TomasiE, FacchiniLA, MaiaMF. Health information technology in primary health care in developing countries: A literature review. Bull World Health Organ, 2004; 82:867–874.
46.
WhittakerR, BorlandR, BullenC, Lin RueyB, McRobbieH, RodgersA. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev, 2009;(4):CD006611.
47.
HasvoldPE, WoottonR. Use of telephone and SMS reminders to improve attendance at hospital appointments: A systematic review. J Telemed Telecare, 2011; 17:358–364.
48.
ClarkRA, InglisSC, McAlisterFA, ClelandJG, StewartS. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: Systematic review and meta-analysis. BMJ, 2007; 334:942.
49.
QiangC, YamamichiM, HausmanV, AltmanDG. Mobile applications for the health sector. Washington, DC: ICT Sector Unit, World Bank, 2011.
50.
CollinsF. How to fulfill the true promise of “mhealth”: Mobile devices have the potential to become powerful medical tools. Sci Am, 2012; 307:16.
51.
GlassmanA, ChalkidouK, GiedionU, et al.Priority-setting institutions in health. Recommendations from a Center for Global Development Working Group. Global Health, 2012; 7:13–34.
52.
TomlinsonM, Rotheram-BorusMJ, SwartzL, TsaiAC. Scaling up mhealth: Where is the evidence?. PLoS Med, 2013; 10:e1001382.
53.
International Diabetes Federation. IDF Diabetes Atlas, 5th ed. Brussels: International Diabetes Federation, 2012.
54.
GemmillM. Research note: Chronic disease management in Europe. London: Directorate-General “Employment, Social Affairs and Equal Opportunities” Unit E1—Social and Demographic Analysis, European Commission, 2008.
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