Mobile health interventions for improving maternal and child health outcomes in South Africa:a systematic review

Background:Maternal and child health(MCH)remains a significant public health concern globally despite previous efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive breastfeeding,child vaccination and supplements have been rolled out to improve MCH outcomes.However,inadequate maternal healthcare,socioeconomic factors,obstetric haemorrhaging,complications of hypertension during pregnancy,lack of maternal information,poor universal health coverage and uptake of MCH services exacerbate maternal mortality and child mortality rates,especially in resource-constrained areas in many sub-Saharan African countries including South Africa.Objective:This study aimed to review mobile health(mHealth)interventions deployed to improve maternal and child health outcomes.Methods:The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable,prominent electronic databases(Google Scholar,Scopus,PubMed,Embase,CINAHL,Web of Science,etc.).A total of 26 papers were selected and analyzed.Results:The findings revealed several mHealth interventions such as MomConnect,Mobile Alliance for Maternal Action,NurseConnect,ChildConnect,CommCare,Road to Health Application and Philani Mobile Video Intervention for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services.However,inadequate digital infrastructure,digital divide,resistance to change,inadequate funding,language barriers,short message service and data costs,lack of digital skills and support,compatibility,scalability and interoperability issues,legislative and policy compliance,lack of mHealth awareness,data security and privacy concerns hinder uptake and utilisation of mHealth interventions.There is a need to scale up and sustain mHealth interventions and update existing regulatory framework,policies and strategies.Conclusion:mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services.Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues.

Association between glucose levels of children with type 1 diabetes and parental economic status in mobile health application

BACKGROUND The glycemic control of children with type 1 diabetes(T1D)may be influenced by the economic status of their parents.AIM To investigate the association between parental economic status and blood glucose levels of children with T1D using a mobile health application.METHODS Data from children with T1D in China's largest T1D online community,Tang-TangQuan■.Blood glucose levels were uploaded every three months and parental economic status was evaluated based on annual household income.Children were divided into three groups:Low-income(<30000 Yuan),middle-income(30000-100000 Yuan),and high-income(>100000 yuan)(1 Yuan=0.145 United States Dollar approximately).Blood glucose levels were compared among the groups and associations were explored using Spearman’s correlation analysis and multivariable logistic regression.RESULTS From September 2015 to August 2022,1406 eligible children with T1D were included(779 female,55.4%).Median age was 8.1 years(Q1-Q3:4.6-11.6)and duration of T1D was 0.06 years(0.02-0.44).Participants were divided into three groups:Low-income(n=320),middle-income(n=724),and high-income(n=362).Baseline hemoglobin A1c(HbA1c)levels were comparable among the three groups(P=0.072).However,at month 36,the low-income group had the highest HbA1c levels(P=0.036).Within three years after registration,glucose levels increased significantly in the low-income group but not in the middle-income and high-income groups.Parental economic status was negatively correlated with pre-dinner glucose(r=-0.272,P=0.012).After adjustment for confounders,parental economic status remained a significant factor related to pre-dinner glucose levels(odds ratio=13.02,95%CI:1.99 to 126.05,P=0.002).CONCLUSION The blood glucose levels of children with T1D were negatively associated with parental economic status.It is suggested that parental economic status should be taken into consideration in the management of T1D for children.

Study on Influencing Factors of Mental Health of Mobile Young White-Collar Workers in China

Mobile young white-collar workers not only have the characteristics of mobile young people,but also have the characteristics of general white-collar workers.Under the influence of both,their mental health may be suffering from“double disadvantage”.So,based on an ecological model of the stress process,this paper tries to use the data of the questionnaire on the mental health of mobile young white-collar workers in Zhejiang Province to explore the influence of some factors in the middle workplace and residence place on the mental health of micro individuals.The results show that:(1)The working environment with high control and low freedom and the workplace discrimination against the mobile status will have a negative impact on the mental health of mobile young white-collar workers;(2)Financial anxiety in daily life will lead to a decline in the mental health level of mobile young white-collar workers;(3)Good organizational support and neighborhood social relations can significantly relieve life pressure,so as to effectively improve the mental health of mobile young white-collar workers.It can be seen that we also need to pay more attention to the mental health of mobile young white-collar workers in order to improve their situation.

Research progress on the health status and community management service needs of mobile elderly people

The health status of the floating elderly population and the need of community management services are complex and important problems.Owing to the change of living environment and the insecure medical care,the mobile elderly people have more health and psy-chological problems compared to the rest of the elderly population.Therefore,the community should take a variety of measures to meet their needs and help them to better adapt to the new living environment,and maintain their physical and mental health.This paper aims to summarize recent studies on the physical and emotional health problems of mobile elderly people and related community management service needs.

The Effects of Accumulated Short Bouts of Mobile-Based Physical Activity Programs on Depression,Perceived Stress,and Negative Affectivity among College Students in South Korea:Quasi-Experimental Study

Regular physical activity(PA)is known to enhance multifaceted health benefits,including both physical and mental health.However,traditional in-person physical activity programs have drawbacks,including time constraints for busy people.Although evidence suggests positive impacts on mental health through mobile-based physical activity,effects of accumulated short bouts of physical activity using mobile devices are unexplored.Thus,this study aims to investigate these effects,focusing on depression,perceived stress,and negative affectivity among South Korean college students.Forty-six healthy college students were divided into the accumulated group(n=23,female=47.8%)and control group(n=23,female=47.6%).The accumulated group engaged in mobile-based physical activity,following guidelines to accumulate a minimum of two times per day and three times a week.Sessions were divided into short bouts,ensuing each bout lasted at least 10 min.The control group did not engage in any specific physical activity.The data analysis involved comparing the scores of the intervention and control groups using several statistical techniques,such as independent sample t-test,paired sample t-tests,and 2(time)×2(group)repeated measures analysis of variance.The demographic characteristics at the pre-test showed no statistically significant differences between the groups.The accumulated group had significant decreases in depression(t_(40)=2.59,p=0.013,Cohen’s D=0.84)and perceived stress(t_(40)=2.06,p=0.046,Cohen’s D=0.56)from the pre-to post-test.The control group exhibited no statistically significant differences in any variables.Furthermore,there were significant effects of time on depression scores(F1,36=4.77,p=0.036,η_(p)^(2)=0.12)while significant interaction effects were also observed for depression(F_(1,36)=6.59,p=0.015,η_(p)^(2)=0.16).This study offers informative insights into the potential advantages of mobile-based physical activity programs with accumulated periods for enhancing mental health,specifically in relation to depression.This study illuminates the current ongoing discussions on efficient approaches to encourage mobile-based physical activity and improve mental well-being,addressing various lifestyles and busy schedules.

Impact of mobile health and medical applications on clinical practice in gastroenterology

Mobile health apps (MHAs) and medical apps (MAs) are becoming increasinglypopular as digital interventions in a wide range of health-related applications inalmost all sectors of healthcare. The surge in demand for digital medical solutionshas been accelerated by the need for new diagnostic and therapeutic methods inthe current coronavirus disease 2019 pandemic. This also applies to clinicalpractice in gastroenterology, which has, in many respects, undergone a recentdigital transformation with numerous consequences that will impact patients andhealth care professionals in the near future. MHAs and MAs are considered tohave great potential, especially for chronic diseases, as they can support the selfmanagementof patients in many ways. Despite the great potential associated withthe application of MHAs and MAs in gastroenterology and health care in general,there are numerous challenges to be met in the future, including both the ethicaland legal aspects of applying this technology. The aim of this article is to providean overview of the current status of MHA and MA use in the field ofgastroenterology, describe the future perspectives in this field and point out someof the challenges that need to be addressed.

Improving cirrhosis care: The potential for telemedicine and mobile health technologies

Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failurefrom successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.

An mHealth intervention to improve medication adherence among patients with coronary heart disease in China: Development of an intervention

Objectives:With this study,we aimed to develop a mobile technology(mHealth)intervention to improve medication adherence among patients with coronary heart disease(CHD).Methods:The study was conducted in two phases with CHD patients from a Cardiology Department of a hospital located in China.Each phase was independent from the other.Phase 1 tested the integration of the two apps-"WeChat"and"BB Reminder"-as an mHealth intervention.All participants received the same educational materials via WeChat every two days.Participants in the experimental group received a reminder from BB Reminder for every dose of their medications.The duration of Phase 1 was 30 days for each participant.Phase 2 refined the intervention,in which educational materials were sent every five days rather than every two days,and medication-taking reminders were sent daily rather than every dose.Results:In Phase 1,an mHealth intervention was developed by integrating two mobile apps.In Phase 2,medication adherence increased at 30-day follow-up in both groups compared to baseline.At the 30-day follow-up,the mean of the decrease in medication non-adherence score in the experimental group(M=1.35,SD=2.18,n=36)was more than the decrease in control group(M=0.69,SD=1.58,n=36),which means the medication adherence improved more in the experimental group.Conclusion:The feasibility of using mHealth to remind CHD patients to take their medications is high.

The Clinical Study of a New Management Model Using Mobile Health for Senile Hypertension

Objective: To evaluate a new management model using mobile health for senile hypertension. Methods: This medical service combined traditional medical treatment with Mobile Health. We use it to explore a new and effective model of elderly hypertension management and the most effective and lowest cost management crowd. According to the randomized controlled design of trial, 105 old hypertensive patients participated in the study voluntarily in the Qingdao Municipal Hospital were randomly divided into the experimental group (75 cases) and control group (30 cases). Experimental group is divided into geriatric specialist group (25 cases), general practitioner group (25 cases) and nurse group (25 cases). Blood pressure was administered in experimental (with the new model) and control groups (with the traditional model) for 2 months to compare their blood pressure and the decrease of them. Results: Blood pressure was compared between the two groups before and after administration. The systolic blood pressure (SBP) of experimental group is 162.44 ± 13.970 mmHg before administration. SBP of experimental group is 147.69 ± 13.509 mmHg after administration, the difference is statistically significant (P = 0.000). The diastolic blood pressure (DBP) of experimental group is 91.58 ± 10.822 mmHg before administration. DBP of experimental group is 84.64 ± 10.412 mmHg after administration, P = 0.003. SBP of control group is 159.93 ± 15.238 mmHg before administration. The systolic blood pressure of control group is 152.33 ± 14.115 (mmHg) after administration. P is 0.167 (P > 0.05). The difference was not statistically significant. DBP of control group is 94.73 ± 12.401 (mmHg) before administration. DBP of control group is 90.60 ± 11.115 (mmHg) after administration. P is 0.345 (P > 0.05). The difference was not statistically significant. The decrease of SBP of geriatric specialist group, general practitioner group and nurse group is 18.40 ± 11.764 mmHg, 14.47 ± 9.44 mmHg, 10.80 ± 6.026 mmHg. The difference was not statistically significant (P > 0.05). The decrease of DBP of geriatric specialist group, general practitioner group and nurse group is 9.33 ± 7.451 mmHg vs. 5.33 ± 6.287 mmHg vs. 6.13 ± 5.069 mmHg (P > 0.05). Conclusion: The new model is effective and it works well for controlling blood pressure of elderly hypertensive patients. Especially with the doctors and patients’ families, the management effect has been obviously improved. Medical interventions make the new model more scientific. The management of geriatric specialists, general practitioners and nurses is equally valid.

Use of Mobile Health Applications and the Self-Management of Cancer: A Gendered Approach

The growing use of mobile health applications for health purposes increased the expectations about their effectiveness. The study examines the effectiveness of mobile health applications on the self-management behaviors of 168 individuals diagnosed with cancer. The results of a secondary analysis indicate that using extensively mobile health applications significantly increases women’s health empowerment attitudes—reaching health decisions, changing their approach to health concerns, seeking additional health consultation. However, the use of mobile health applications does not increase the likelihood of adopting self-management behaviors. The study indicates that the effectiveness of mobile health applications in self-management practices is contingent upon a set of personal characteristics and the level of technology skills.

A Study of Address Shortage in a Tree Based ZigBee Network for Mobile Health Applications

There are increasing demands for mobile health applications. This paper reports the development of a mobile health profile which dedicates to mobile applications. The mobile health profile is developed in association with the ZigBee Health Care profile and the IEEE 11073 standard which is normally applied to non-mobile applications. Since mobile sensors have to be carried by patients, the mobile health profile must facilitate mobility. In this investigation, a ZigBee fixed-mobile network (ZFMN) is defined and developed to supplement the ZigBee Health Care Profile for patient monitoring. The mobility study of ZigBee is performed using a random waypoint OPNET simulation model. In a ZFMN, the critical issue of address shortage is identified and discussed. It is analyzed that the problematic address shortage in a ZFMN may generate a huge amount of orphaned end devices and thus the packet drop percentage may potentially rise to 70%, rendering the network unable to function properly. Without introducing additional governing schemes, it is evaluated that the communication of the entire ZigBee network may paralyze. Further vigorous test are performed (by OPNET) on the communication capability of ZFMN when devices are randomly moving and sending data in 1s. It is vital to point out that under the adverse condition of address shortage, the performance of a ZFMN is still encouraging as long as the packet drop percentage has been kept below 3% before running out of address. The conclusion drawn in this analysis is that the packet drop percentage should be kept below 3% to provide a satisfactory QoS for an effective mobile health application using ZFMN such as patient monitoring. Such finding is also important for other future mobile application design of ZigBee. The address shortage issue is left as an open problem that needs attention for a resolution.

Multifactorial study of mobile phone dependence in medical students: Relationship to health-related lifestyle, Type A behavior, and depressive state

We investigated factors contributing to mobile phone dependence. To 139 medical students, we administered a self-reporting questionnaire designed to evaluate mobile phone dependence, health-related lifestyle, patterns of behavior, and depressive state. Multivariate logistic regression analysis revealed that scores for poor health-related lifestyle, Type A behavior pattern, and presence of depression are independently associated with degree of mobile phone dependency. These findings suggest that persons with an unhealthy lifestyle, Type A behavior traits, or depression might benefit from mobile phone use guidance.

Mobile technology for health care in rural China

With the proliferation of mobile technologies in China,the Chinese mobile medical applications market is growing rapidly.This may be particularly useful for Chinese rural populations who have limited access to quality medical care where mobile technologies can reach across geographic and socioeconomic boundaries and potentially increase access to care and improve health outcomes.

Nursing and mHealth

Innovations in mobile health(mHealth)technology offer applications to promote wellness management and health behavior change outside of formal clinical settings.Nurses can help to move mHealth into mainstream health care by understanding its potential to change the landscape of health intervention delivery,incorporating mHealth into patients'day to day preventive care strategies,and supporting the science of mHealth's effectiveness.

A systematic review of the effect of mobile health on cardiac rehabilitation among coronary heart disease patients

Objective： Mobile health （mHealth） provides an innovative and effective approach to promote prevention and management of coronary heart disease. However, the magnitude of its effects is unclear. The aim of this systematic review was to examine the impact of mHealth-based cardiac rehabilitation outcomes among coronary heart disease patients. Methods： Medline, CINAHL, Embase, PubMed, Google Scholar, NICE, and Cochrane library were searched for randomized controlled trials published between January 2002 and March 2017 which compared mHealth with conventional cardiac rehabilitation programs among coronary heart disease patients. Results： Eight articles were included in this review. The impact of mHealth interventions on physical activity, medicine adherence, smoking cessation, level of anxiety, and quality of life was inconsistent among the articles. Conclusions： Further research is needed to conclusively determine the impact of mHealth interventions on cardiac rehabilitation outcomes. The limitations of the included studies （e.g., inadequate sample size, failure to address the core components of cardiac rehabilitation programs, and lack of theory-based design） should be taken into account when designing future studies.

Online and Offline Android Based Mobile Application for Mapping Health Facilities Using Google Map API. Case Study: Tanzania and Kenya Borders

The evolution of technology in 1990s resulted in the enormous growth of smartphones and the propagation of mobile applications (App) that marked new opportunities for healthcare centers and medical education. Apps have altered health services from patient’s health monitoring to specialist’s appointments and consultations from specialized health facilities. It can be argued that a healthy society can bring forth sustainable economic development to its full potential while an unhealthy society cannot. However, a free movement of people, labour and right to residence which was built across East Africa (EA) borders enabled Tanzania and Kenya borders to have enormous interactions. Subsequently, increase the risk of highly communicable diseases such as Tuberculosis and Sexually transmitted infections in such a way that medical attention is unavoidable along the borders. Statistically, Android Operating System (OS) owns 83% of Africa’s mobile OS market. In addition, 25,794,560 internet users reported by Tanzania Communications Regulatory Authority (TCRA) together with the 22.86 million internet users provided by Kenya Digital which is equivalent to 46% and 43% of internet penetration in year 2020, disclose the need for Android mobile application for mapping health facilities both online and offline using Google map API, which will solve residents’ need to healthcare services on the presence or shortage of internet connections;using either Swahili or English language via Smartphone devices. The App incorporates Monitoring and Evaluation (M & E) tool for tracking application usage which will ease Admin’s task to generate daily and monthly reports in Excel and Comma-Separated Values (CSV) formats. The developed system received positive feedback from EA citizens and residents in the Arusha region and Namanga border crossing where 90.2% of the system evaluation conducted between Dec 2020 and Apr 2021 agreed upon App usage.

Research Priorities for mHealth and Innovative Strategies in Sexual and Reproductive Health and Rights in the WHO Africa Region

Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. Methods: We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. Results: Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. Conclusions: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstrated with more relevant and quality research on mHealth and innovative strategies priorities identified.

Impact of Mobile Telephone on Maternal Health Service Care: A Case of Njoro Division

Every minute a woman dies due to pregnancy related complications globally, and half of these deaths occur in the developing countries. Despite knowing the main causes of these deaths, maternal mortality has remained high especially in Sub-Saharan Africa with 536,000 deaths annually. One of the main challenges is access to maternal health services. This study aims at assessing whether mobile telephone will improve uptake of selected maternal health services by expectant mothers at Njoro and Nessuit Health centers in Njoro Division, Nakuru. A total of 397 women were recruited between April 2012 and July 2012 and randomly categorized into two groups for follow up. One group of 191 women were routinely given prompts and advice about their health and scheduled visits while the other group of 206 women were allowed to continue with routine antenatal visits with no mobile telephone support. The results show 7.4% of those followed up had less than 4 antenatal visits while 18.6% of those not followed up had less than 4 visits P value 0.002 which shows there was a significantly higher proportion of women on follow up who had more than 4 antenatal visits. There was a significantly higher proportion of women on follow up who received diet and place of delivery counseling, malarial prophylaxis, iron and vitamin supplements and deworming drugs. There was however no difference in those who received tetanus toxoid and HIV counseling. 88.0% of the cases on follow up gave birth in a hospital as compared to 72.8% of those not on follow up with a P value of 0.000 which indicates strong association. Overall hospital delivery was 80.1% for this group a value much higher than national figures of 44%. Women provided with mobile telephone support are more likely to follow the scheduled antenatal advice and use the services as recommended than those who do not receive any support. Therefore mobile telephone should be used routinely to improve antenatal service uptake and communication with health providers.

Prospects for Mobile Health in Pakistan and Other Developing Countries

Pakistan is a developing country with more than half of its population located in rural areas. These areas neither have sufficient health care facilities nor a strong infrastructure that can address the health needs of the people. The expansion of Information and Communication Technology (ICT) around the globe has set up an unprecedented opportunity for delivery of healthcare facilities and infrastructure in these rural areas of Pakistan as well as in other developing countries. Mobile Health (mHealth)—the provision of health care services through mobile telephony—will revolutionize the way health care is delivered. From messaging campaigns to remote monitoring, mobile technology will impact every aspect of health systems. This paper highlights the growth of ICT sector and status of health care facilities in the developing countries, and explores prospects of mHealth as a transformer for health systems and service delivery especially in the remote rural areas.

Implicit, Context Management Systems for Mobile Health Services

Objectives: In this paper data flow and executive model of Mobile Health services risk management by the use of context aware systems are provided. Materials and Methods: Mobile health (M-Health) refers to using portable electronic devices having application for delivering health services and patient’s information management. M-Health can offer various services remotely in prevention, detection, control, and treatment of disease or in the conditions of disaster for a patient or an environment. These services can have more acceptable quality by the help of Context Aware Systems which are defined as the capacity of computing equipment for detection, feeling, interpreting, and replying to user’s local environmental aspects and computing equipment itself. In this paper, executive model is offered for managing services of M-Health based on context aware systems. One of the supplies of developing a context aware system is having a clear and well-defined definition of context and developing appropriate context information provider. In order to deliver high quality and well-managed M-Health services in the form of context aware systems, having clinical risk management plan is necessary. Conclusions: M-Health services need to develop appropriate communication strategies for interacting with stockholders at each stage of clinical risk management process. Risks, which are primarily resides in service providers, communicating channels or service receiver sides, can be well identified and managed using clinical risk management, M-Health and context aware systems. Thereby, these systems can offer qualified and precise services.