Two new reports from the mHealth Alliance highlight the lack of quality evidence and rigorous research for mobile health. According to the reports, the evidence base supporting mHealth is "underdeveloped and young," with some in the development and global health communities "demanding more research evaluating if and how mHealth improves impact in global health programs."
The first report provides an in-depth assessment of the needs and gaps in the current evidence for mHealth by using maternal, newborn and child health (MNCH) as a case study. The report's review of the currently available literature and the conversations with key informants, particularly those in the research community, indicates that there is a "paucity of mHealth for MNCH studies that employed what researchers typically consider standard criteria for rigor and quality study designs," the report states.
Moreover, the report reveals that the "current body of evidence in mHealth and MNCH represented in peer-reviewed and grey literature tends to focus more on interventions aimed to decrease maternal mortality, particularly reminders for antenatal appointments, and less on interventions aimed to improve newborn and child health." The report's literature review and landscape scan of studies looking at the role of mHealth in a number of MNCH intervention areas shows that prevention-of-mother-to child transmission of HIV coverage stands out as one of the most significant gaps.
Nevertheless, the report finds that the frequency of mHealth studies using rigorous methodologies, such as randomized control trials and detailed study protocols, is increasing and suggests that current gaps in mHealth should be viewed as opportunities for future research. And, despite the fact that a number of the key informants who were interviewed expressed a desire for more evidence linking mHealth with health outcomes, the report concludes that the "landscape scan revealed that more studies are using health outcome indicators as primary or secondary measurement units."
Among the report's recommendations: stakeholders who use evidence, particularly those who influence the research agenda, need to advocate, promote, mandate and ultimately fund activities that would close the identified evidence gaps. In addition, the report recommends greater efforts should be made to identify, capture and disseminate evidence, focusing on the numerous studies and projects in mHealth and MNCH that exist but are not reflected in the literature nor widely shared with the global health community.
The MNCH report also states that the technical and research communities that have been driving the mHealth agenda ought to frame the evidence in language that resonates with the global health community, paying particular attention to the global health trends that have become priorities to major donors.
The second mHealth Alliance report provides an analysis of the mHealth ecosystem, including the adoption rate of mHealth as part of health strategies, funding of mHealth by leading global health donors, quantity and quality of mHealth evidence, as well as the mHealth Alliance's performance and contribution to the mHealth community.
The report notes that sub-Saharan Africa has the highest number of identified mHealth projects compared to Asia and Latin America, though there is limited presence of formal mHealth policies globally. At the outcome level, the mHealth Alliance evaluation also identifies a "dearth" in the quantity and rigor of evidence for mHealth.
Another recent study concludes that opportunities exist for mHealth to play a critical role in low- and middle-income countries where community health workers deliver integrated community case management to children sick with malaria, pneumonia and diarrhea. Nevertheless, the review found very few formal outcome evaluations of mHealth in these countries and despite "vast documentation of project process evaluations," there were few studies demonstrating an impact on clinical outcomes.