mHealth for Integrated People-Centred Health Services in the Western Pacific: A Systematic Review

OBJECTIVE: This review aimed to examine how mobile health (mHealth) to support integrated people-centred health services has been implemented and evaluated in the World Health Organization (WHO) Western Pacific Region (WPR).

METHODS: Eight scientific databases were searched. Two independent reviewers screened the literature in title and abstract stages, followed by full-text appraisal, data extraction, and synthesis of eligible studies. Studies were extracted to capture details of the mhealth tools used, the service issues addressed, the study design, and the outcomes evaluated. We then mapped the included studies using the 20 sub-strategies of the WHO Framework on Integrated People-Centred Health Services (IPCHS); as well as with the RE-AIM (Reach, effectiveness, adoption, implementation and maintenance) framework, to understand how studies implemented and evaluated interventions.

RESULTS: We identified 39 studies, predominantly from Australia (n = 16), China (n = 7), Malaysia (n = 4) and New Zealand (n = 4), and little from low income countries. The mHealth modalities included text messaging, voice and video communication, mobile applications and devices (point-of-care, GPS, and Bluetooth). Health issues addressed included: medication adherence, smoking cessation, cardiovascular disease, heart failure, asthma, diabetes, and lifestyle activities respectively. Almost all were community-based and focused on service issues; only half were disease-specific. mHealth facilitated integrated IPCHS by: enabling citizens and communities to bypass gatekeepers and directly access services; increasing affordability and accessibility of services; strengthening governance over the access, use, safety and quality of clinical care; enabling scheduling and navigation of services; transitioning patients and caregivers between care sectors; and enabling the evaluation of safety and quality outcomes for systemic improvement. Evaluations of mHealth interventions did not always report the underlying theories. They predominantly reported cognitive/behavioural changes rather than patient outcomes. The utility of mHealth to support and improve IPCHS was evident. However, IPCHS strategy 2 (participatory governance and accountability) was addressed least frequently. Implementation was evaluated in regard to reach (n = 30), effectiveness (n = 24); adoption (n = 5), implementation (n = 9), and maintenance (n = 1).

CONCLUSIONS: mHealth can transition disease-centred services towards people-centred services. Critical appraisal of studies highlighted methodological issues, raising doubts about validity. The limited evidence for large-scale implementation and international variation in reporting of mHealth practice, modalities used, and health domains addressed requires capacity building. Information-enhanced implementation and evaluation of IPCHS, particularly for participatory governance and accountability, is also important.