London School of Hygiene & Tropical Medicine

More than two-thirds of the world's population now owns a mobile phone. Researchers from the School, led by Dr Caroline Free reviewed health interventions that have used mobile technology. As well as identifying areas where mobile technology have been most successful, they also call for more rigorous studies in low- and middle-income settings, where mobile health could make a large impact.

Dr Caroline Free, senior lecturer in epidemiology at the London School of Hygiene & Tropical Medicine, said: "Our systematic review shows there is good evidence that text messaging interventions can increase adherence to anti-retroviral medication and can increase smoking cessation. The effects of mobile phone based interventions appear promising in some other areas, but further high quality trials are required to establish their effects."

The first article reviewed 75 trials of mobile technology interventions for patients with the aim to change health behaviour or improve disease management. 72 of these trials had been conducted in high-income countries. Three trials showed clear benefits: two developed in the UK to help smokers quit, and one in Kenya that helped HIV–positive patients to take their medications accurately. The other trials showed modest or no benefits.

The second publication reviewed 32 trials that evaluated the effectiveness of mobile technology for healthcare providers or services, none of which were conducted in low-income countries.

The researchers found that while some interventions designed to provide support for healthcare providers did improve aspects of clinical diagnosis and management, other interventions were less successful. Notably, the use of mobile photos sometimes resulted in incorrect diagnoses compared with face-to-face diagnosis. SMS-based appointment reminders were found to be better than no reminders but not better than reminders by phone or mail.

Given the potential benefits of mobile technology and the limited evidence to date, the authors stress that additional testing is needed, especially in low- and middle-income settings where the control group of  'standard care' might be very different from the standard care available in high-income countries.

Publications

• Free C, Phillips G, Galli L, Watson L, Felix L, et al. (2013) The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review. PLoS Med 10(1): e1001362. doi:10.1371/journal.pmed.1001362
• Free C, Phillips G, Watson L, Galli L, Felix L, et al. (2013) The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis. PLoS Med 10(1): e1001363. doi:10.1371/journal.pmed.1001363