Despite hundreds of mobile health pilot studies, there has been "insufficient programmatic evidence to inform implementation and scale-up of mHealth," according to an article in PLoS Medicine.
After more than 500 pilot studies tracked by the World Bank, the article concludes that "we know almost nothing about the likely uptake, best strategies for engagement, efficacy, or effectiveness of these initiatives." As a result, the authors say mHealth interventions "lack a foundation of basic evidence, let alone a foundation that would permit evidence-based scale up." For example, they cite the fact that in Uganda in 2008 and 2009 about 23 of 36 mHealth initiatives did not move beyond the pilot phase.
Nevertheless, industry representatives continue to push for mHealth "scale up" which is a cause for concern, warn the authors, especially since "private enterprise has a quite different understanding of what scale up means, with growing market share, rather than improved health outcomes, at the core of their mission." At a recent mHealth conference in South Africa, the authors point out, there were repeated calls from industry for scale up of mHealth initiatives across low- and middle-income countries.
However, two recent reviews also published in PLoS Medicine found little evidence that mobile phone technology is having a great impact on managing disease in developing countries. The problem is a lack of rigorous studies in low- and middle-income environments. As the reviews point out, most existing evidence on the success of mHealth comes from trials performed in the developed world and is of poor quality.
Although "enthusiasm for effective mHealth interventions in sub-Saharan Africa is high," the latest PLoS Medicine article states that "little is known about their efficacy or effectiveness." The authors assert that most randomized trials of mHealth interventions to date have employed text message reminder systems.
"The scatter-shot approach to piloting mHealth projects in the absence of a concomitant programmatic implementation and evaluation strategy may dampen opportunities to truly capitalize on the technology," the article states.
To remedy the problem, the authors recommend:
- Existing standards for research should be reconsidered in order to provide guidance as to when scale up is appropriate.
- mHealth interventions should be guided by a plausible theory of behaviour change and should use more than one technique depending on the targeted behavior.
- Establish an open mHealth architecture based on a robust platform with standards for app development which would facilitate scalable and sustainable health information systems.
- Implementation strategies such as factorial designs that are able to test the multiple features of interventions must be explored, in order to provide the necessary evidence base.
- Scale-up of mHealth in low- and middle-income countries should be preceded by efficacy and effectiveness trials so that they are founded on an appropriate evidence base.
- Governments, funders, and industry must cooperate in order to set standards to create a self-governing commercially viable ecosystem for innovation.
To learn more:
- read the journal article