Features, outcomes, and challenges in mobile health interventions for patients living with chronic diseases: A review of systematic reviews

Highlights

• A review of systematic reviews of mHealth interventions for chronic diseases was conducted.

• Mixed evidence regarding the superior effectiveness of mHealth compared to standard care was shown.

• Personalized goal setting was found to be an integral component of most effective interventions.

• There was health professional involvement at different levels and frequency in the majority of effective interventions.

Abstract

Background

Mobile health (mHealth) technology has the potential to play a key role in improving the health of patients with chronic non-communicable diseases.

Objectives

We present a review of systematic reviews of mHealth in chronic disease management, by showing the features and outcomes of mHealth interventions, along with associated challenges in this rapidly growing field.

Methods

We searched the bibliographic databases of PubMed, Scopus, and Cochrane to identify systematic reviews of mHealth interventions with advanced technical capabilities (e.g., Internet-linked apps, interoperation with sensors, communication with clinical platforms, etc.) utilized in randomized clinical trials. The original studies included the reviews were synthesized according to their intervention features, the targeted diseases, the primary outcome, the number of participants and their average age, as well as the total follow-up duration.

Results

We identified 5 reviews respecting our inclusion and exclusion criteria, which examined 30 mHealth interventions. The highest percentage of the interventions targeted patients with diabetes (n = 19, 63%), followed by patients with psychotic disorders (n = 7, 23%), lung diseases (n = 3, 10%), and cardiovascular disease (n = 1, 3%). 14 studies showed effective results: 9 in diabetes management, 2 in lung function, and 3 in mental health. Significantly positive outcomes were reported in 8 interventions (n = 8, 47%) from 17 studies assessing glucose concentration, one intervention assessing physical activity, 2 interventions (n = 2, 67%) from 3 studies assessing lung function parameters, and 3 mental health interventions assessing N-back performance, medication adherence, and number of hospitalizations. Divergent features were adopted in 14 interventions with significantly positive outcomes, such as personalized goal setting (n = 10, 71%), motivational feedback (n = 5, 36%), and alerts for health professionals (n = 3, 21%). The most significant found challenges in the development and evaluation of mHealth interventions include the design of studies with high quality, the construction of robust interventions in combination with health professional inputs, and the identification of tools and methods to improve patient adherence.

Conclusions

This review found mixed evidence regarding the health benefits of mHealth interventions for patients living with chronic diseases. Further rigorous studies are needed to assess the outcomes of personalized mHealth interventions toward the optimal management of chronic diseases.

Introduction

Chronic non-communicable diseases such as diabetes, lung diseases, cardiovascular disease and mental disorders, are by far the leading causes of mortality in the world, killing 40 million people each year, equivalent to 70% of all deaths globally [1]. Patients with chronic conditions are in need of support to cope with their disease and take actions related to change of their behavior and lifestyle, thereby improving their health status and everyday wellness [2]. However, the institution-based model of healthcare faces enormous challenges imposed by such a disease burden, and its cost-effectiveness has come under question [3].

Mobile health (mHealth) technology has recently been shown to provide useful means of daily self-management of chronic diseases by the patients themselves [4], or remote medical management [5]. The enormous processing, sensing and communication capabilities of mobile devices (e.g., smartphones and tablet computers) along with their wide availability and uptake, have allowed their use as the main technology for provision of pervasive health services [6]. In this regard, several research works have shown the value of mobile devices in facilitating patient independent living and improving quality of life [[7], [8], [9]].

As the peer-reviewed literature on mHealth grows exponentially, there is a substantial need to develop an evidence base for the effectiveness of mHealth [10]. In this direction, we present a review of systematic reviews of mHealth for patients living with chronic non-communicable diseases, aiming to explore the features and outcomes of mHealth interventions, and synthesize recent research evidence along with the associated challenges in this rapidly developing field. The review focuses on the study of an emerging class of networked electronic interventions [11], which use advanced technical capabilities of mobile phones (e.g., native or Internet-linked apps, interoperation with sensors, communication with clinical platforms, etc.) for chronic disease management according to the definition by WHO [12], and therefore it has a different scope from other reviews which consider the typical operation of mobile phones through voice or short messaging service (SMS) only [[13], [14], [15]]. Furthermore, this review targets at several chronic conditions rather than a single disease [16], in order to obtain a broader view of the diverse characteristics of mHealth interventions. By systematically identifying the current state of application of mHealth interventions, their effectiveness and shortcomings, this review will improve the understanding of researchers, engineers, clinical practitioners, and policy makers toward better designed, developed, and impactful interventions.