Prevention of sexually transmitted diseases (STDs) is critical. Despite developing treatment and prevention programs, sexually transmitted infections (STIs) are essential in developing acute and chronic diseases. Because "eHealth" (electronic-Health) has excellent potential for disseminating health information to the public regarding STDs, we aimed to identify and review all published articles focusing on preventing STIs. After constructing the design and answering population, intervention, comparison, and outcome questions, two authors conducted a systematic literature search in four online databases in January 2022. The screening process and data extraction were conducted by two authors independently, and then, a quality assessment was performed. After removing duplicates, and two rounds of shortlisting, 16 articles were included for data extraction out of 5113 entries. Included studies were of different designs and assessed six preventive outcomes categories, with condom use being the most frequent result among studies. We also extracted implementation outcomes and reviewed them. Included studies with 13,137 participants have provided reasonable evidence of the effectiveness of different types of eHealth in improving STI prevention interventions. Although this systematic review was not without limitations, it can no longer be ignored that eHealth modes offer many opportunities to prevent STDs, especially among the young population.
BACKGROUND: Globally, reproductive health programs have used mHealth to provide sexual and reproductive health (SRH) education and services to young people, through diverse communication channels. However, few attempts have been made to systematically review the mHealth programs targeted to improve young people SRH in low-and-middle-income countries (LMICs). This review aims to identify a range of different mHealth solutions that can be used for improving young people SRH in LMICs and highlight facilitators and barriers for adopting mHealth interventions designed to target SRH of young people.
METHODS: Databases including PubMed, CINAHL Plus, Science Direct, Cochrane Central, and grey literature were searched between January 01, 2005 and March 31, 2020 to identify various types of mHealth interventions that are used to improve SRH services for young people in LMICs. Of 2948 titles screened after duplication, 374 potentially relevant abstracts were obtained. Out of 374 abstracts, 75 abstracts were shortlisted. Full text of 75 studies were reviewed using a pre-defined data extraction sheet. A total of 15 full-text studies were included in the final analysis.
RESULTS: The final 15 studies were categorized into three main mHealth applications including client education and behavior change communication, data collection and reporting, and financial transactions and incentives. The most reported use of mHealth was for client education and behavior change communication [n = 14, 93%] followed by financial transactions and incentives, and data collection and reporting Little evidence exists on other types of mHealth applications described in Labrique et al. framework. Included studies evaluated the impact of mHealth interventions on access to SRH services (n = 9) and SRH outcomes (n = 6). mHealth interventions in included studies addressed barriers of provider prejudice, stigmatization, discrimination, fear of refusal, lack of privacy, and confidentiality. The studies also identified barriers to uptake of mHealth interventions for SRH including decreased technological literacy, inferior network coverage, and lower linguistic competency.
CONCLUSION: The review provides detailed information about the implementation of mobile phones at different levels of the healthcare system for improving young people SRH outcomes. This systematic review recommends that barriers to uptake mHealth interventions be adequately addressed to increase the potential use of mobile phones for improving access to SRH awareness and services.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018087585 (Feb 5, 2018).
CONTEXT: Mobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions.
EVIDENCE ACQUISITION: This was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non-patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018.
EVIDENCE SYNTHESIS: Most of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%).
CONCLUSIONS: Reports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability.
Text messaging is an increasingly popular communication tool in health interventions, but has been little studied in maternal and infant health. This literature review evaluates studies of text messaging that may be applied to the promotion of maternal and infant health. Articles from peer-reviewed journals published before June 2012 were included if they were experimental or quasi-experimental studies of behaviors endorsed either by the American College of Obstetrics and Gynecology, the American Pediatrics Association, or the United States Preventive Services Task Force; included reproductive age women (12-50 years) or infants up to 2 years of age; and were available in English. Qualitative studies of text messaging specific to pregnant women were also included. Studies were compared and contrasted by key variables, including: design, time-period, study population, and results. Forty-eight articles were included, 30 of which were randomized controlled trials. Interventions vary greatly in effectiveness and soundness of methodology, but collectively indicate that there is a wide range of preventative behaviors that text message interventions can effectively promote, including smoking cessation, diabetes control, appointment reminders, medication adherence, weight loss, and vaccine uptake. Common methodological issues include not accounting for attention affect and not aligning text message content to measured outcomes. Those interventions that are based on an established theory of behavior change and use motivational as opposed to informational language are more likely to be successful. Building on the growing body of evidence for text message interventions reviewed here, as well as the growing popularity of text messaging as a medium, researchers should be able to use this technology to engage difficult to reach populations.
BACKGROUND: A growing body of research has employed mobile technologies and geographic information systems (GIS) for enhancing health care and health information systems, but there is yet a lack of studies of how these two types of systems are integrated together into the information infrastructure of an organization so as to provide a basis for data analysis and decision support. Integration of data and technical systems across the organization is necessary for efficient large-scale implementation.
OBJECTIVE: The aim of this paper is to identify how mobile technologies and GIS applications have been used, independently as well as in combination, for improving health care.
METHODS: The electronic databases PubMed, BioMed Central, Wiley Online Library, Scopus, Science Direct, and Web of Science were searched to retrieve English language articles published in international academic journals after 2005. Only articles addressing the use of mobile or GIS technologies and that met a prespecified keyword strategy were selected for review.
RESULTS: A total of 271 articles were selected, among which 220 concerned mobile technologies and 51 GIS. Most articles concern developed countries (198/271, 73.1%), and in particular the United States (81/271, 29.9%), United Kingdom (31/271, 11.4%), and Canada (14/271, 5.2%). Applications of mobile technologies can be categorized by six themes: treatment and disease management, data collection and disease surveillance, health support systems, health promotion and disease prevention, communication between patients and health care providers or among providers, and medical education. GIS applications can be categorized by four themes: disease surveillance, health support systems, health promotion and disease prevention, and communication to or between health care providers. Mobile applications typically focus on using text messaging (short message service, SMS) for communication between patients and health care providers, most prominently reminders and advice to patients. These applications generally have modest benefits and may be appropriate for implementation. Integration of health data using GIS technology also exhibit modest benefits such as improved understanding of the interplay of psychological, social, environmental, area-level, and sociodemographic influences on physical activity. The studies evaluated showed promising results in helping patients treating different illnesses and managing their condition effectively. However, most studies use small sample sizes and short intervention periods, which means limited clinical or statistical significance.
CONCLUSIONS: A vast majority of the papers report positive results, including retention rate, benefits for patients, and economic gains for the health care provider. However, implementation issues are little discussed, which means the reasons for the scarcity of large-scale implementations, which might be expected given the overwhelmingly positive results, are yet unclear. There is also little combination between GIS and mobile technologies. In order for health care processes to be effective they must integrate different kinds of existing technologies and data. Further research and development is necessary to provide integration and better understand implementation issues.
OBJECTIVES: Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP.
METHODS: A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping.
FINDINGS: Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs.
CONCLUSION: There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.
INTRODUCTION: Research has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster women's empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities.
METHODS: A systematic literature review was conducted to examine the empirical evidence of changes in men and women's interactions as a result of mHealth interventions. To be eligible, studies had to have been published in English from 2002 to 2012, conducted in a developing country, included an evaluation of a mobile health intervention, and presented findings on resultant dynamics between women and men. The search strategy comprised four electronic bibliographic databases in addition to a manual review of the reference lists of relevant articles and a review of organizational websites and journals with recent mHealth publications. The methodological rigor of selected studies was appraised by two independent reviewers who also abstracted data on the study's characteristics. Iterative thematic analyses were used to synthesize findings relating to gender-transformative and non-transformative experiences.
RESULTS: Out of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couple's health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased women's decision-making, social status, and access to health resources. However, programmatic experiences by design may inadvertently reinforce the digital divide, and perpetuate existing gender-based power imbalances. Domestic disputes and lack of spousal approval additionally hampered women's participation.
CONCLUSION: Efforts to scale-up health interventions enhanced by mobile technologies should consider the implementation and evaluation imperative of ensuring that mHealth programs transform rather than reinforce gender inequalities. The evidence base on the effect of mHealth interventions on gender relations is weak, and rigorous research is urgently needed.
Prevention of sexually transmitted diseases (STDs) is critical. Despite developing treatment and prevention programs, sexually transmitted infections (STIs) are essential in developing acute and chronic diseases. Because "eHealth" (electronic-Health) has excellent potential for disseminating health information to the public regarding STDs, we aimed to identify and review all published articles focusing on preventing STIs. After constructing the design and answering population, intervention, comparison, and outcome questions, two authors conducted a systematic literature search in four online databases in January 2022. The screening process and data extraction were conducted by two authors independently, and then, a quality assessment was performed. After removing duplicates, and two rounds of shortlisting, 16 articles were included for data extraction out of 5113 entries. Included studies were of different designs and assessed six preventive outcomes categories, with condom use being the most frequent result among studies. We also extracted implementation outcomes and reviewed them. Included studies with 13,137 participants have provided reasonable evidence of the effectiveness of different types of eHealth in improving STI prevention interventions. Although this systematic review was not without limitations, it can no longer be ignored that eHealth modes offer many opportunities to prevent STDs, especially among the young population.
