Background
Methods
C-M-O | Operational definition |
---|---|
Context | This is defined as the prevailing conditions and circumstances within which patients and/or healthcare providers behave or decide to use mobile phone-based health interventions for the treatment and care of non-communicable diseases in sub-Saharan Africa. For example: - Patient/provider predisposing characteristics (age, gender, etc.) - Patient/provider needs - Patient/provider enabling resources |
Mechanism | The factors or active ”ingredients” of a mobile phone-based health intervention which directly/indirectly influence both intended and unintended health outcomes and/or outputs of the treatment and care of non-communicable diseases in a well-defined context in sub-Saharan Africa. For example: - How easy to use the patients and healthcare providers find the mobile technology involved in the intervention - How useful patients and healthcare providers perceive the mHealth intervention to be over alternative programs and forms of accessing healthcare |
Outcome | This constitutes the sustained use of mHealth interventions and — in turn — better patient access to care |
Scoping the literature and searching for relevant studies
Inclusion and exclusion criteria
Identifying candidate theories
Data extraction, analysis, and synthesis
Results
Search results and study characteristics
The contribution of mHealth to improved treatment and care for patients with NCDs
From candidate theories toward a framework for understanding mHealth interventions
Main findings from the literature
Patient | (First-contact) providera
| Specialized providerb
| ||||
---|---|---|---|---|---|---|
Mechanism | Perceived usefulness | Perceived ease of use | Perceived usefulness | Perceived ease of use | Perceived usefulness | Perceived ease of use |
Context | ||||||
Predisposing characteristics | • Cultural and social acceptance (familiarity/usage of mobile technologies) [38, 40, 41, 46, 53, 55] • Age group (middle/older) [51] | Suitability and simplicity for: • (Older) age group [55] • (Poor) socio-economic backgrounds [50] • Not physically active [50] | • Positive attitude (enthusiastic, motivated, empathetic, interest, dedication, volunteer) [38, 40, 52] • Prerequisite knowledge (to provide adequate information) [47] | • Simple, relevant, combination of local content and language (interface) [42] | • Positive attitude (positive perception and trust of new technology) [52] • Basic knowledge (about the technology) [52] | • Accessible location of technical support (in-country or local software developers) [52] • Understandable language of communication (among users and software developers) [52] |
Need | - | - | • Lack of human resources (limited specialists, trained or skilled personnel, unequal distributions of professionals, over-burdened workload) [20, 36, 38‐41, 43, 45, 47] • Lack of necessary systems and infrastructure (health facility, referral system, transport) [38] | |||
Enabling resources | • Assistance/support (spouse, partner, friend, family member) [51] | • Telecommunication networks (functioning, stable, accessible, available, low-cost) [36, 39, 42, 47] • Tolerable burden of workload [40] | • Access to phone networks (in underserved communities) [20] |
Predisposing characteristics
Need
Enabling resources
Discussion
Summary of main findings
Strengths and implications for policy makers and program managers
Patient context factors |
• The personal characteristics of patients, which predispose them to utilize the services provided by the intervention. For example: a. Enthusiasm to use mobile phone/device b. Educational/literacy level c. Age (may be more sustainable among middle/older age groups) d. Local content/language of locality e. Cultural and social acceptance • The needs of patients to access the required healthcare services. For example: a. Disease severity and comorbidities b. Barriers to accessing care/information • The necessary enabling (personal and community) resources to facilitate the implementation of the intervention. This includes: a. Access to mobile phone/device (essential)
b. Stable and accessible communication networks and technology infrastructure (essential)
c. Convenience and privacy (essential)
d. Socio-technical support (essential)
e. Affordable services (critical)
f. Awareness raising (for increased participation)
|
Provider context factors |
• The personal characteristics of healthcare providers, which predispose them to deliver health services through a mHealth intervention. For example: a. Experience and competence b. Positive attitude toward technology c. Basic knowledge of the technology involved d. Fluency in language of locality e. Understandable language of communication among users and technical support team (software developers)
• The needs of healthcare providers to deliver the required healthcare services. For example: a. Characteristics of disease conditions (extent, severity)
b. Characteristics of diagnostic and treatment tasks c. Burden of workload d. Adequacy of referral and transport systems • The necessary enabling (personal and community) resources to facilitate the utilization of the intervention. This includes: a. Access to mobile phone/device and stable networks (in underserved communities)
b. Easy portability and operability (features, apps, functionalities, etc.)
c. Available basic infrastructural resources (good roads, ambulance services)
d. Suitability and equivalence to existing/alternative care processes (attractive)
e. Tolerable burden of workload and incentives (essential)
f. Maintenance-technical support (essential)
g. Continuous training and sensitization h. Low operating costs and available funds/logistics i. Policy and regulation (network/data protection, staff job descriptions, and contracts, etc.)
|