George Washington University School of Public Health and Health Services (Sherry), Journal of Health Communication: International Perspectives (Ratzan)
This editorial speaks to need for significantly more evidence of intervention efficacy and how increased mHealth intervention development can serve that need.
As stated here: "In the early days of innovation, design, and new programming, anecdote commonly precedes evidence. While more evidence is essential to better guide innovation, raising the evaluation bar too high or too early risks favoring the (unevaluated) status quo. To make their best contribution to the field, evaluators will need a strategy to get out ahead of the design process. For their part, implementers and policymakers need to acknowledge that most mHealth interventions are still in an experimental phase and should be rolled out hand-in-hand with an appropriate level of quasi-experimental design and monitoring."
Recent directions in the field of mHealth include the following:
- Extending or connecting existing health resources by making human contact more efficient, and integrating within broader systems. "Successful interventions include: improving diagnosis and compliance with treatment guidelines; improving patient information that leads to more selective service utilization; and increasing administrative efficiencies that lead to greater client satisfaction and confidence."
- Mining of large-scale datasets that include temporal, demographic, and geospatial information - "untapped as an eHealth/mHealth strategy."
- Continuing development of integrated "decision systems with diagnostic devices, triage of messages, linkage with drug delivery, and therapeutic interventions and monitoring, linking patient and provider."
Challenges and risks include: divergent views of local challenges and opportunities by front-line public health workers and the mHealth programme designers; a tendency to practice public health at increasing distances from the communities, possibly exacerbated by mHealth applications; and mHealth programme development in low-resource settings, in light of service fluctuations and bandwidth limitations, lack of eHealth infrastructure, and fewer service providers to connect together.
The editorial concludes that: "A successful strategy will need to envision the development of thousands of locally relevant interventions of modest impact rather than simply rely on the eventual emergence of a limited number of high-impact global interventions capable of carrying the field. The unanswered question remains not if, but rather how fast and how efficiently mHealth will realize its transformative potential. Innovation and evaluation in synergy can help to drive that transformation - safeguarding evidence-based interventions from being upended by the unsubstantiated anecdote, while enabling the innovation process to change the status quo."
Journal of Health Communication, Volume 17, Supplement 1, May 2012, pages 1-3, accessed on August 9 2012.