Effectiveness of Intervention with Health (m-Health) Technology for Health Care Compliance: Literature Review

Journal of a Sustainable Global South, Vol. 4 No. 1, February 2020

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Effectiveness of Intervention with Health (m-Health) Technology for Health Care Compliance: Literature Review

Ni Made Parwati¹, Pande Januraga², Suarjaya³

Doctoral Study Program

Medical Faculty-Udayana University

Jimbaran

parwati.md@gmail.com

School of Public Health

Faculty of Medicine-Udayana University

Jimbaran

Bali Health Office

Denpasar

Abstract

The integration of cellular technology in healthcare (M-Health) has the potential in coping with the constraints of the medical service system and to become a breakthrough to support the patients’ medication adherence. This review was conducted to compare and evaluate the effectiveness of M-Healthin terms of the patients’ medication adherence.The literature review conducting on PubMed, Cochrane Library, Ebsco Health and Taylor & Francis was confined to the articles published between 2010 and 2019. Fifteen articles relating to medication adherence were reviewed, eleven of which employed RCT methods including quasi-experiment that assessed the effectiveness of M-Health to measure the adherence, while four other researches employed qualitative studies to explore patients’ perceptions.The review showed that the intervention of m-Health is effective to drive the compliance of the treatment in accordance with healthcare promotion efforts as well as the prevention, screening and the management of the diseases. Two studies have shown inconsistent results regarding the prevention of obesity and the management of hypertension patients. The development of such model abd the integration of parallel m-Health and healthcare promotion will improve the long-term medication adherence.

Index Terms— effectiveness, compliance, M-health, health care

• I.    Introduction¹

The rapid development of information technology in the digital revolution era has now penetrated the health realm. Mobile Health (m-Health) or cellular health as a subsegment of e-Health comprises medical and public health practices which includes prevention, health promotion, healthcare, or the transmission of information resources, and services related to health using cellular gadgets.1 With the intervention of m-Health, health services are expected to be personal, participatory and cheaper.2 The communities

can access health services and interact with mobile devices through mobile applications3. This study was conducted to provide input related to health innovation in healthcare compliance.

• II.    Methods

• A.    Search Strategy

Literature review uses the database from PubMed, Ebsco Health, Cochrane Library, and Taylor & Francis with the articles analyzed by peer reviewers between 2010 and 2019.

• B.    Inclusion and Exclusion Criteria

utilization of M-Health in public health issues that focused on the intervention for the healthcare compliance.

• C.    Selection Process

Articles are identified by titles and abstracts, which are then screened according to inclusion criteria.

• D.    Design and Synthetic Data

The extraction of the articles in the literature review is shown in Table 1.

TABLE I

Study, Year of publicat ion, Locatio n	Stud y desig n	Sample	Technol y	Interv entio n	Relevant Findings
Margare	RCT	250	SM	Educatio	Weight   loss,
t et al		children	S	n through	The difference
(2016)		aged 18-	and	2	between    the
Australi		35 years	emai	telephone	intervention
a		with over weight	l	calls, text messages , monthly emails. Duration for 6 months	and control groups was 4.3 kg. (SE 1.3) P <0.001, (OR = 3.2 (95% CI: 1.4, 7.3) and 3.4 (1.4, 8.0), p <0.01
Partridg	RCT	250	SMS,	8 weekly	Fruit
e et al		children	email	text	consumption (p
(2017)		aged 19-	and	messages	=0.029),
Sidney		35 years	website	,      113 weekly reminder emails, and access to 114 education al applicati ons and 15 websites Duration: 9 months	maintenancechange  stages (respectively p < 0.001 and p = 0.012).self-efficacy, 8% - 37%  of  the total effect.
Nystrom	RCT	315	Web	Diet	FMI (p = 0.57)
et al		children	based	behavior	changes     in
(2018)		aged 4.5	applicati	with	composite
Sweden		years	on	MINIST OP   or basic pamphlet s, weekly feedback, Duration: 6 months	scores ± standard deviation + 0.53 ± 1.49 units and + 0.35 ± 1.27 units, p = 0.25 between groups
Yousuf	Mix	108	applicati	Smartpho	Adult reference
H. et al	meth	children	on	ne-based	rate (p <0.05)
(2016) South Africa	od	(2-15 years), 598 (1685 years).		hearing screening	(4.3%) in the younger, in the older (13.2%)

Adolfo	RCT	Interventi	SMS	Monthly	Changes    in
Rubinst ein et al (2016) Amerika Latin		on: control 316:321		telephone calls and weekly text messages	systolic blood pressure p = 0.43) or diastolic blood pressure (0 · 01 mm Hg p = 0.99). body weight (–0 · 66 kg [–1.24 –0 · 07]; p = 0 · 04) and high fat and high food intake p = 0 ∙ 008)
Maria	A	Case:	SMS	Automati	Large reduction
Odette	quasi	contr		c Cardio	in fat
Gore et	-	ol		SMS	intake,
al	expe	204: 504		send text	Intervention vs.
(2018)	rime	(over 18		messages	control group
Colorad o	ntal	years) 56 people with acute	Smart phone and	accordin g to schedule	(26.3% vs 10.6%, p = 0.001). Greater program retention (p =
Lakshmi Narayana et al (2018) India	RCT	stroke (40 85 years	wireles s BP monito r	M-healthbased HTN managem ent monitors its own blood pressure every day for 90 days	0.03) In AT, HTN was controlled at 89% (23/26) IA and 58% (14/24) CA, (p = 0.015) m-Health had excellent uses in HTN control
Mauriell		335	applicati	Cessation	The risk was
o et al	(RA	pregnant	on	of risky	significantly
(2016) New York	L)	women		behavior for pregnant women with education through applicati ons on the iPad	less at 1 month (0.85 vs. 1.20, odds      ratio [OR] 1⁄ 4.70) and 4 months postpartum (0.72 vs 0.91, or 1 ⁄ 4 .81).
Johnson et al (2016) Kenya	RCT	5164 married couples	SMS	Survey with text messages through the m4RH system with 3 stages for 6 months	Full access to m4RH increased consumer scores      on contraceptive knowledge tests by 14% (95% confidence interval: 9.9% -18.2%)
Jasemza	RCT	130	applicati	EPPM-	There were no
deh et al (2017) India		pregnant women	n	based cellular telephone interventi	significant differences between   the mean

on	vulnerability
behavior	scores  (p  >
promotio	0.05),    high
n	response, and
pollution	self-efficacy,
protectio	protective
n, short	behavior;
message for 2 months	p <0.05.

Yan	RCT	62 people	WeCha	Weekly	m-Health  can
Guo at		are gay or	t	SMS	be   accepted
al		bisexual		reminder	and   facilitate
(2018)				s, and	access
China				articles three times a week through WeChat for 3 months
Natalie	Qualitati	2 focus	SMS	Receivin	Technology
Leon		groups of		g SMS as	using  text
(2015)		each 11		a	messages is
South		participa		motivatio	acceptable,
Africa		nts		n to	relevant
				remind	and useful,
				obedienc	providing
				e	practical and
	Qualitati		Werele		emotional
		30	ss		support for
Sherida		partisipa	Health		improving
n W		nts	and		compliance
(2016)		FGD	Wellness		behavior
Amerika			Interventi	User
Serikat			n	views in	The design
	Qualita			promotin	of
				g	partnership
				individua	and service
		71	SMS	l	integration
Hirsch		patients		activities	technology
M					increases
(2017)					the
Lesotho				Treatmen	existence of users    for sustainable behavior
				t	change
				reminder s by sms,	SMS
				monthly	messages
				in-depth	support
				interview	compliance
				s	with improved access   to services for people with HIV / TB.

• E.    Intervention Using m-Health

Various innovations have been made by adopting smartphone technology to create health care services in order to easily monitor patients’ health. This modification comes in different forms such as medication reminder

services, motivation, health promotion via SMS, telephone calls, software or applications. SMS intervention requires the most sophisticated hardware that can be used to send simple information to patients on their personal phones. Special software or applications including patient portals, management systems, and other complex communication platforms require commercially available smartphones [1].

• III.    Results

• A.    Characteristics of Study and Intervention

All studies that integrated technology-based interventions in the application of m-Health entirely focused on behavioral changing so that compliance arises in healthcare, especially in the intervention in preventive efforts[2][3][4][5], health promotion for behavioral change interventions [6][7][8], compliance with the treatments of the diseases [9][10][11][12][13][14][15]. Interventions are not limited to the intervention using SMS. There are various technological platforms used to inform patients about healthcare.

Eleven studies have used SMS or e-mails to remind patients about their medication on a daily and weekly basis, encourage them to do physical activity and give them nutritional advice [4][15]. The interventions were carried out for 12 weeks to 6 months, which is later evaluated to find the effects they had. We also found other studies that used website, multimedia and apps, wireless technology, WeChat, Pro Ask [2][3][14]. Four of which delved into the perspective of the community in relation to the experience of using m-Health for health promotion as well as its integration to traditional health services and the identification of risk factors in preventive programs of childhood obesity [16][8].

• B.    Effectiveness of M-Health

We analyzed 11 studies (68.75%) with randomized controlled trial in various disease management strategies that measured the effect of compliance to treatment. We found that there was a statistically significant difference between groups (p<.05 to p<.001) in 5 studies. One study that employed a mixed method in hearing screening showed a significant effect on clinical utility and the development screening conducted by Community Care Workers with continued intervention at home via smartphone. This has shown to have a positive impact on compliance.

Two studies (13.33%) found a tendency of differences in outcomes among groups, but mostly did not reach statistical significance, except for a greater reduction in fat intake as reported in the intervention and control groups (26.3% vs 10.6%, p = 0.001).6 Also, a subset of survey participants who read SMS messages as encouragement showed a greater program retention (p = 0.03). In accordance with Margaret et.al. a weight loss occurred in the intervention group and with the difference of 4.3 kg to the control group, (SE 1.3) P <0.001, (OR = 3.2 (95% CI: 1.4, 7.3) and 3.4

(1.4, 8.0), P <0.01[3][15].

Studies in weight loss showed that there weren’t any statistically significant differences for body composition, food variable, or physical activity variable between the intervention group and the control group [2]. Comparing the common treatment to m-Health-based intervention on people with the risk of cardio metabolic diseases, we found that there wasn’t any change in the blood pressure. Yet, it affected a minor weight loss and gain on a few diet habits [10-11].

Text messaging can be an effective method for increasing the insight of family planning, but perhaps it’s not enough to make a behavioral change. It is necessary to identify barriers to be able to develop the strategy to reduce the risk of infant obesity [5][8] The high response and self-efficacy of both experiment and control groups in the parallel-based cell phone interventions can increase the awareness among pregnant women to develop the protective behavior against air pollution. The results are p<0.05. self-efficacy, 8% -37% of the total effect [1] [5-7]. Four qualitative studies (26.66%) were conducted to find the perception of the community of the advantages of m-Health. They employed interview methods, Focus Group Discussion to inform the community about m-Health.

These studies found that m-Health can sustain the accessibility of information in terms of the punctuality of the treatment. People with HIV/AIDS need the information to improve the quality of life, as strategies to reduce anxiety and depression [8][13].

The content of the SMS, the courteous nature of the messages, the frequency of SMS delivery as well as the relational aspects made the participants feel respected. The sub-groups that benefit the most are those who have struggled with compliance because of high levels of personal stress. The studies showed from monthly in-depth interviews that the participants found SMS reminders important to encourage the compliance [12].

• IV.    Discussion

Short Message Service (SMS) reminders offers the confidentiality of recipients (especially people with HIV / AIDS). SMS reminder is effective in targeting isolated populations in rural areas and those with limited access to health information [14]. Qualitative studies provided feedback to the participants.

In addition, it is important to consider designing voice messages for people with poor literacy. It is also necessary to identify constraints especially those related to areas without internet connection and anticipatory efforts to resolve the situation [9]. It is essential to design m-Health technology with partnership in order to maintain the motivation, attain the behavioral change and a significant and sustainable compliance [16][9]

The users of m-Health argued that the application can be

more effective if it provides various medical information, integrated with traditional health treatments which are parallel with the information of health promotion. It is also necessary to provide a supervision in terms of the roles of m-Health application [9][16].

The increase of the treatment compliance is influenced by the choice of technology platforms with application design modifications that includes motivational texts using multimedia messaging and interactive programs [12]. SMS reminders have a measurable impact and have a greater ability to influence behavior than through radio and television campaigns.

Also, a subset of participants surveyed that saw SMS messages as motivation showed a greater program retention (p = 0.03) on the prevention of cardiovascular disease [3]. There were no significant results between the intervention and control groups in weight loss. This is possibly due to the short duration of interventions which is unable to sustain behavioral changes in weight loss [2]

Utilization of technology in health services requires the infrastructural support, human resources and funds which is why the involvement of stakeholders and policyholders is necessary for the empowerment of the regulations for the implementation. Areas with limited internet coverage need different approaches in terms of tackling the constraint in order to reach all targets. With adequate support, a sustainable service can be achieved.

• V.    Conclusion

Health services through m-Health effectively encourage behavioral change in prevention interventions, health promotion and screening. Various designshave proven to increase people's interest in the use of m-Health.

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