Shades of grey: Beyond peer-reviewed literature for mHealth evidence

An exciting resource is being developed by the Center for Communication Programs at Johns Hopkins University's Bloomberg School of Public Health. It's an online mHealth evidence database that aims to catalog, categorize and grade all of the known peer-reviewed and grey literature on mHealth in high-, middle- and low-income countries. 

That's a tall order, to be sure, and while the public website is still in alpha version (the beta version will be launched in a matter of weeks), after talking to James BonTempo, the Center's Director of ICT & Innovation, I'm convinced that this USAID-funded project is the sorely needed kind of global database for mHealth evidence.

What will differentiate the mHealth evidence database from existing mHealth registries and repositories, such as PubMed, that are limited to just peer-reviewed literature, is grey literature, which is emerging as an untapped resource. While some of the current mHealth evidence resides in the peer-reviewed literature, as BonTempo argues, much of it (in many cases, the most timely and relevant aspects) resides in the grey literature--such as evaluations, project reports, white papers, blog posts, discussion boards, etc.

Because grey literature is a source of data that does not employ peer review, critics have questioned the validity of its data. There is certainly a snobbery in some circles about studies published in peer-reviewed journals. However, BonTempo points to a World Health Organization task force that is developing creative ways to analyze non-peer reviewed literature and resources, and is coming up with a rubric for determining whether grey literature could qualify as an mHealth evidence source.

"We expect to potentially be learning and leveraging from that process to help understand when a source of grey literature could be elevated to a status of evidence," he states. "We do see there's a huge potential in grey literature."   

It's interesting to note that some of BonTempo's colleagues at Johns Hopkins did a search on the U.S. federal database using the keywords "mHealth", "mobile" or "cell AND phone" to obtain 1,678 results of studies, of which 215 unique mHealth studies were identified. The results were published in a letter to the editor of the International Journal of Medical Informatics

According to the article, of the 215 mHealth studies, 81.8 percent used a classical randomized trial design and 40 new studies were added to the database between May and November 2012 alone. Based on these results, the authors posit that the field is entering a "new 'era' where a body of rigorous evaluation of mHealth strategies is rapidly accumulating," and that the "transition into an era of evidence-based mHealth supports our position that innovation in this domain can be evaluated with the same rigor as other public health strategies."

When it comes to mobile healthcare, there is certainly strong evidence that is statistically significant but there are also "grey" areas that must be considered. However, the grey literature can no longer be ignored or discounted out of hand as sources of evidence. To do so would be to turn our backs on what could potentially turn out to be very valuable sources of mHealth evidence. - Greg (@Slabodkin