Background
Significance of this study
Methods
Literature search strategy and criteria for study selection
Data collection and analysis
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Strengths: internal factors referring to outcomes, project drivers, reasons for success.
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Weaknesses: internal factors referring to project limitations and challenges.
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Opportunities: external factors such as areas of potential for mHealth implementation, facilitators of mHealth projects, etc.
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Threats: external factors such as potential for failure, external barriers and limitations.
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Project sustainability: mid- and long term results and impacts.
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Project integration into the health system: relevance of the design, involvement of key stakeholders, compatibility to existing government policies and management information systems.
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Technology/existing infrastructure: cost, usage and acceptance, network coverage, electricity and other infrastructure.
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Project management process: related resources required for project implementation.
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Scale-up and replication: requirements for scaling-up projects at a regional or national level.
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Legal issues, regulations and standards: in-country regulations, laws or standards that influence mHealth projects.
Factors | Strengths | Weaknesses | Opportunities | Threats |
---|---|---|---|---|
Mid-and long-term results/project sustainability
| -Potential to enhance timeliness in reporting health and stock data in rural and remote areas [34] | |||
-Improved patient-health worker and clinic staff-health worker communication [31] | -Lack of stock management resulting in patients untreated [49] | |||
-mHealth projects are regarded as innovative and current data collection methods tend to have poor quality [47] | -Use of mobile technology for research is recent [22] | |||
-Reported patient anxiety due receiving information [61] | -Dependency in donor funding and limited funding opportunities may limit long-term sustainability [56] | |||
-Supports efficient stock management, local drug distribution, counting and ordering accuracy, and supply chain monitoring [22] | ||||
-Provide health education [39] | ||||
Integration into the health system
| -Support patient management [20] | -Unclear roles, responsibilities, actions, boundaries and responses needed at different levels of healthcare system (government) for project implementation and scale-up [45] | -Existing communication gap between health workers, managers and patients [63] | |
-Weak routine health, logistics, and surveillance data reporting systems [62] | -Current care delivery processes will need to be redesigned (e.g. change to electronic records and data) [22] | |||
-Most pilot projects are started by implementing organisations themselves rather than integrated to the health system [45] | -Monitoring and evaluation of programmes may be done with collection of electronic information[62] | -Costs of mHealth implementation may affect patient treatment costs [55] | ||
-mHealth projects are unlikely to prove effective in poorly performing systems [63] | -Improved adherence to clinical guidelines by health workers is required [52] | -Unknown health systems complexities for large scale implementation of mHealth projects [55] | ||
-High government commitment, existing governmental eHealth strategy [47] | ||||
-Availability of local private providers willing to set up the mHealth system [47] | ||||
-Increased participation of local health staff in active case detection in surveillance systems (e.g. malaria) [49] | ||||
Project management process
| -Support provision of user and staff training [52] | -Implementation needs to become multidisciplinary [44] | -Challenge of management of mHealth projects remain underestimated [26] | |
-Available funding from larger programmes (e.g. PEPFAR mobile clinic) [62] | ||||
-Reporting transparency for donors and stakeholders [37] | ||||
-Low capacity and administrative challenges for data collection [49] | ||||
-Research is needed to optimize project delivery and intervention targets [31] | ||||
Legal issues, regulations and standards
| -Coded information contributes to data security and confidentiality [63] | Not mentioned | -No minimum number of critical surveillance parameters to be reported has been established [34] | |
-Integration of SMS guidelines into healthcare process delivery [50] | -Lack of published data on feasibility and acceptability of confidentiality methods [62] | |||
Technology and infrastructure
| -Limited text capacity of mobile phones and text messages (e.g. up to 160 char.) [18] | -High phone theft and limited electricity to charge phones [38] | ||
-SMS-based software and delivery systems can be updated and review for future developments [24] |
-Dependency on network coverage [19] | |||
-The lack of other communication technologies (e.g. internet) offers opportunities to mobile phones [55] | ||||
-Staff may not use the mobile phones appropriately or handle them with care [57] | ||||
-Software may not be adaptable or flexible, and are still subject to human error [63] | ||||
Scale-up and replication
| -Allows monitoring and impact assessment prior to scaling-up [27] |
-Cost-effective implementation of m-Health programmes (e.g. lower running costs) [59] |
-Unknown cost-effectiveness of deployment and maintenance [56] | |
-Low replication costs and highly adaptable to specific cultural contexts [51] | -Open source programmes may support implementation of mHealth in low-resource settings [22] | -MoH guidance and policies, and government financial support are lacking and are required for scaling-up [49] | ||