In place of a JIDC Postcard this week, the fabulous Derek Ng has written a piece on mHealth. The potential of mobile phones to deliver health advice and/or information is exciting. I already see many people using this technology here in Canada. For instance, many of my pregnant friends receive weekly up-dates on the progression of their pregnancies on their mobile phones. Although powerful, challenges for implementing these technologies do exist. In this Blog Post Derek has reviewed the compelling advances in mHealth as well as discussing the challenges.
What are your thoughts on mHealth and how well do you think it will be accepted in your area? Are you using mHealth technologies in your area? Or are you trying to implement a new mHealth technology? If you have comments or would like to share your experiences in mHealth we would like to hear from you. Particularly I am interested in the use of mobile devices to track infectious disease outbreaks.
The advent of mobile phones has made it considerably easier for people to communicate regardless of where they were in the world. By the mid-2000s, these phones were becoming increasingly powerful with miniaturized computer chip technology that made it possible for users to complete more complex tasks. The mobile phone has evolved from a device that was essentially a phone that individuals could use away from home to something more resembling a handheld computer – an aptly named “smartphone.” Today, users can perform tasks beyond that of simply calling and texting, such as e-mailing, surfing, video recording, word processing and more. The integration of computer-like capabilities to the phone has also resulted in the development of applications that can be designed to perform specialized tasks. One interesting twist in the mobile world is that of mobile health (mHealth).
What is mHealth?
The World Health Organization (WHO) defines mHealth as “the use of mobile and wireless technologies to support the achievement of health objectives,” where the WHO has published a write-up on mHealth. The concept of mHealth has already caught on with cell phone applications that assist health-care providers by providing up-to-date lists of drugs, information on diseases and so forth. This has already aided physicians in supplementing their point-of-care service. It is also available on the outpatient or receiving end of health care by providing patients with schedules for medications or how to eat or exercise better. The possibilities appear to be even more promising as mobile technologies are still rapidly advancing. Although we can see real applications and benefits for this technology in industrialized countries, the same remains to be seen for developing countries as well.
Cell phone usage in developing countries has skyrocketed in the past and continues to do so in areas such as South America, Africa and Asia . The technology has helped countries without infrastructure to bypass the need to construct landlines which were previously required for telephony to occur. By constructing modern radio towers instead, these countries can leapfrog the older and more expensive telephone technology, which has resulted in countries that possess a well-established mobile network despite lacking paved roads, electricity or landline internet connections . This situation has allowed for an unprecedented number of individuals who are now connected to each other, as well as the internet. One key aspect about this far-reaching technology is that it has been made very affordable in these areas. For example, China and India have over 800 million cell phone subscribers each, whereas in contrast, Canada has 24 million active cell phone accounts . When I visited China, I spent about 20 Canadian dollars on a prepaid plan that offered me more minutes and data usage than I could use in a month. In Canada, my cell phone plan is often over 50 dollars a month.
An advantage of mHealth is that it can be utilized to allow a broad base of users (many of which are already subscribed to a cell phone plan) to be instantly informed on wide range of issues. These topics could range from outbreak detection and notification, drug or therapy adherence (such as that seen in TB treatment), HIV awareness, and so forth. For example, Grand Challenges Canada is promoting innovative ways in which to solve global health issues . Furthermore, the use of mHealth to improve healthcare has been reported in countries such as Kenya and Cameroon [3–8]: some articles of which are Open Access, Implementing medical information systems in developing countries, what works and what doesn’t by Fraser 2010, The Cameroon mobile phone SMS (CAMPS) trial: a protocol for a randomized controlled trial of mobile phone text messaging versus usual care for improving adherence to highly active anti-retroviral therapy by Mbuagbaw et al., 2011, and Global Networking of Cancer and NCD Professionals Using Internet Technologies: The Supercourse and mHealth Applications by Linkov et al., 2010.
Two interesting proposals of the Canadian Rising Stars in Global Health from Grand Challenges Canada we recently came across here at the JIDC were ‘using mobile phone text messaging to reduce maternal and infant death in rural areas in China’ and ‘mHealth for Maternal and Newborn Health: Clinical decision support for community health workers in Western Kenya’. The first idea, proposed by Ri-Hua Xie from the Ottawa Hospital Research Institute and University of Ottawa, is to deliver educational material from the World Health Organization to expecting mothers who might not have received the information otherwise. Her proposal aims to reduce both maternal and infant deaths, by connecting healthcare providers to expecting and new mothers in rural areas. You can watch a video describing her idea here.
The latter proposal by Astrid Christoffersen-Deb at the University of Toronto is in collaboration with Moi University Schoolof medicine inKenya. She would like to provide citizens with a unique barcode and identifying health card, which can be scanned by a community health worker. This provides the workers access to electronic medical records for sending and receiving information to and from medical facilities. You can watch a video describing Astrid’s idea here.
Thus far about 80% of all WHO member states offer at least one mHealth service – the majority of which are in higher-income countries. The highest reported rate of mHealth use was in countries inEurope, whereas Africa was least active. The majority or about two-thirds of projects in mHealth are still in a pilot stage, which poses some problems in its widespread implementation.
The challenges in implementing mHealth
However, not everyone is as optimistic about the impact of mobile phones in these countries. In fact, mHealth faces several barriers, despite the many promising ideas outlined earlier. Some issues include the lack of convincing studies that outline a positive benefit for the cost of implementing mHealth. The studies also need to show more evidence that mHealth can improve health outcomes. In countries where funding is already limited, the governments may decide to fund other important health care programs whose outcomes are better established. There is also a lack of standardization because some of the studies have been launched to tackle one specific problem in that one region. The WHO is currently developing a tool kit that may offer a standardized set of guidelines for using mHealth in the future.
The future of mHealth and summary
mHealth offers a promising way to deliver different health care programs and services to the individuals who have traditionally had difficulty accessing such resources. With the increasing capabilities of mobile technology and its penetration into remote and rural areas, we can look forward to emerging fields within mHealth. Ideally such applications (some of which previously mentioned) would benefit both health-care providers and patients alike. Health-care providers may see advanced telehealth technologies for communicating with experts for assistance in complex or difficult procedures outside of sophisticated care facilities, such as in remote or underserviced areas. An extension of this is that it could also allow physicians to more easily follow-up and monitor their patients. Yet another application branching from this is education of citizens for public health purposes.
With any new emerging technology, it is important to assess its benefits and risks. Studies must be made to produce a standardized set of guidelines – an undertaking which is already in progress through the WHO. Following such guidelines, it would also be useful to validate the technology according to the needs of an individual country and its citizens, since disease burdens and health-care services would vary.
While the verification of the benefits of mHealth and whether it is a valuable investment over other health services in countries where resources are already limited are important considerations, there appears to be a potential for mHealth to make a significant impact on health care in the future
What are your thoughts on mHealth?
Please feel free to leave a comment.
1. World Health Organization W (2011) mHealth New horizons for health through mobile technologies.
2. 2011 July) Grand Challenges Canada. http://www.grandchallenges.ca/.
3. Chang LW, Kagaayi J, Arem H, Nakigozi G, Ssempijja V, Serwadda D, Quinn TC, Gray RH, Bollinger RC, Reynolds SJ (2011) Impact of a mHealth Intervention for Peer Health Workers on AIDS Care in Rural Uganda: A Mixed Methods Evaluation of a Cluster-Randomized Trial. AIDS Behav . 10.1007/s10461-011-9995-x [doi].
4. Tamrat T, Kachnowski S (2011) Special Delivery: An Analysis of mHealth in Maternal and Newborn Health Programs and Their Outcomes Around the World. Matern Child Health J . 10.1007/s10995-011-0836-3 [doi].
5. Mbuagbaw L, Thabane L, Ongolo-Zogo P, Lester RT, Mills E, Volmink J, Yondo D, Essi MJ, Bonono-Momnougui RC, Mba R, Ndongo JS, Nkoa FC, Ondoa HA (2011) The Cameroon mobile phone SMS (CAMPS) trial: a protocol for a randomized controlled trial of mobile phone text messaging versus usual care for improving adherence to highly active anti-retroviral therapy. Trials 12: 5. 1745-6215-12-5 [pii];10.1186/1745-6215-12-5 [doi].
6. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA (2010) Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 376: 1838-1845. S0140-6736(10)61997-6 [pii];10.1016/S0140-6736(10)61997-6 [doi].
7. Fraser HS, Blaya J (2010) Implementing medical information systems in developing countries, what works and what doesn’t. AMIA Annu Symp Proc 2010: 232-236.
8. Linkov F, Padilla N, Shubnikov E, Laporte R (2010) Global Networking of Cancer and NCD professionals using internet technologies: the Supercourse and mHealth applications. J Prev Med Public Health 43: 472-478. 201011472 [pii];10.3961/jpmph.2010.43.6.472 [doi].
9. RI-HUA XIE, Canadian Grand Challenges (2011 July) USING MOBILE PHONE TEXT MESSAGING TO REDUCE MATERNAL AND INFANT DEATHS IN REMOTE AREAS IN CHINA. http://www.grandchallenges.ca/canadianrisingstars_round1grantees/rihuaxie_en/.
10. ASTRID CHRISTOFFERSEN-DEB, Canadian Grand Challenges (2011 July) MHEALTH FOR MATERNAL AND NEWBORN HEALTH: CLINICAL DECISION SUPPORT FOR COMMUNITY HEALTH WORKERS IN WESTERN KENYA. http://www.grandchallenges.ca/canadianrisingstars_round1grantees/astridchristoffersendeb_en/.