There may really be an app for everything.
Cell phones are being used to perform echo cardiograms by American primary care physicians. Pregnant women in Bangladesh are receiving text message reminders to improve maternal health. Here’s a story from SciDev today about using phones to diagnose malaria.
The rapidly expanding use of mobile phones in health applications, aka mHealth, is widely touted as a global revolution unfolding. It may yet be, but where’s the evidence in support of the claims?
It is expected that 80% of the people living on the African continent will have access to mobile phones by the end of this year. This technological leap means that information can be communicated to more people in places that were previously hard to reach, or completely isolated. The diffusion of this technology has not been lost on governments, NGOs and the private sector. All are seeking ways to improve health services using phones.
A pair of studies published earlier in the year looked at the evidence base for mHealth interventions. Both found reason for optimism about the benefits of employing mobile technologies in health, but agreed that the evidence base was far too weak.
In the first study, Caroline Free led a review of studies on mHealth interventions that targeted healthcare consumers. The findings were encouraging, but demanded more data. “Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services,” wrote the authors.
Free led the second study which also did a meta-analysis of mHealth technologies in support of healthcare service delivery. Again, the available research showed that the interventions provide modest benefits. And they also said that there is a need for higher quality trials.
The information from studies is important because they help to make the case for new policies, explained Patty Mechael, Head of the mHealth Alliance. “If you’re going to make a policy recommendation, then we do need some comparative effectiveness research to help illustrate what it is we are gaining or losing by doing things in this different way,” she said.
Being a that mHealth is still relatively new, the burden of proof is as high as is for other health recommendations. That means that the developers of the technologies and the implementers of programs must think about how to make the case to policymakers in a given country. “When we come on stage with a new mHealth innovation, there is little reason to think we can move the elephant that is public policy without a similar threshold of evidence,” explained Aelin Labrique, researcher with Johns Hopkins University.
Labrique says that mHealth has evolved over the past three years. It is now thought of as a way to make established interventions operate more efficiently and cost less. One example of this in action is WellDoc. The platform, developed by Dr Ryan Sysko, uses mobile technologies to help patients manage their chronic diseases such as diabetes.
A two year-long randomized control study proved that mHealth’s efficacy and ability to save money in the patient blood glucose control. This data let the organization go to health insurance companies, Medicare and Medicaid to make the argument that they should be covering the service.
Randomized control trials (RCTs) have emerged over the past few years as the ‘gold standard’ for evaluating whether a program has a measurable impact. Long used do evaluate medicines, the RCT gained prominence thanks to the evaluations by development economists in Western Kenya in the early 2000s. The rise of the RCT has been met with some push back. Critics argue that the results may not be applicable to any circumstance other than what was evaluated. With so many influences, it is hard to know exactly what is causing something to work or fail. Furthermore, RCTs are expensive and timely, both things that all organizations do not have.
Despite their problems, Labrique and Mechael agree with the studies led by Free that more rigorous data is needed. Labrique summed it in an article in the International Journal of Medical Informatics saying, “As the evidence base continues to be strengthened using both conventional and novel methods of evaluation, the gradual adoption of mHealth into mainstream health systems can be expected.”