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Table 2 Using Telephones as a Healthcare Intervention: Mobile/Wireless Communication

From: Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries?

Country Indication/Disease Intervention Results Reference/Comments
Denmark Asthma Observational study: SMS Text: asthma "diary". Patients received 4 SMS messages/day, including a medication reminder, a request to enter peak flow, data on sleep loss, and medication dosage. Participants were asked to reply to a minimum of 3 of the messages per day. Diary inputs were collected in a database. N = 12. Duration = 2 months SMS collection of asthma diary data is "feasible" half the participants reported more than about two thirds of the requested diary data. [28] "The combination of SMS data collection and a traditional Web page for data display and system customization may be a better and more usable tool for patients than the use of Web-based asthma diaries which suffer from high attrition rates"
Italy Quality of Life Questionnaire Feasibility study. Questionnaire delivered as display on mobile phone, answered with keypad. N = 97. Duration = 12 days Fifty six (58%) attempted the questionnaire, and all of these 56 completed it. patients who refused to participate were older, had fewer years of education and were less familiar with new communications technology (mobile phone calls, mobile phone SMS, internet, email). [29]
United States HIV Feasibility study: Automated two-way messaging system to improve ARV adherence. N = 25. 17,440 messages and 14,677 replies (84%). Duration = 208 days (median) "...high satisfaction with the messaging system ... it helped with medication adherence." Participants reported missing one or more doses on 36% of 743 queries. [30]
Tenerife Diabetes Feasibility study: PC Web browser or a mobile phone capable of working with the WAP protocol to transmit blood chemistry data to clinic. N = 12. Duration = 9 months Patients used system every 2.0 days and doctors reviewed data every 4.0 days Seventy five percent expressed a preference for sending their data via the mobile phone SMS [31]
Hong Kong Various Wireless Application Protocol (WAP)-based telemedicine system for patient-monitoring WAP 1.1 phone used at 1800 MHz by circuit-switched data (CSD) to connect to the content server through a WAP gateway, which was provided by a mobile phone service provider in Hong Kong. "Data were successfully retrieved from the database and displayed on the WAP phone. " [32]
Japan Body weight monitoring Feasibility study: Mail function of the mobile phone for use in maintaining body weight reduction as the achievement target. N = 136. Duration = 4 months Subjects informed on body weight reduction knowledge and practice once/day via mailing " [T]endency for reduced body weight was found in 63 (46%) of 136 adults. Average body weights were significantly reduced (P < 0.001) from 73.2 kg to 71.1 kg (males), and from 58.8 kg to 57.6 kg (females) [33]
Korea Diabetes Pre-post study. Internet/SMS texting. N = 185. Participants sent self-measured blood glucose levels, medication, dosages, meal, and exercise to their provider. Laboratory tests including lipid profiles and glycated hemoglobin (HbA1c), and a survey of satisfaction before and after study period. Duration = 3 months. The mean HbA1c improved from 7.5 +/- 1.5 to 7.0 +/- 1.1% after using the management program (P = 0.003). [34]
Spain Hypertension RCT: Comparative, controlled, multicenter, randomized cluster study. SMS texting to patients re: compliance. Control group received usual interventions; intervention group received messages and reminders sent to their mobile phones 2 days per week. N = 104. Duration = 4 months No effect on compliance. 85.1% (CI, 74.9%-95.3%) in the control group and 84.4% in the intervention group (CI, 70.7%–95.3%) (P = NS). NO effect on control of hypertension [35]
United States Hospice patients Feasibility study: alphanumeric paging system as a memory enhancer for various therapeutic regimens Compliance rose from a mean of 56 percent to 96 percent when the system was used. [36] Unclear from abstract which regimens were affected
Scotland Asthma Observational study. N = 30. Mobile phone text message service consisting of daily reminders to use an inhaler, health education tips, and safety messages. There were no adverse safety events, and the service was technically reliable. "Compliance with using an inhaler may have favorably changed in response to the service." [37] Only anecdotal evidence to support the conclusion
United States Smoking cessation Web and cell phone technologies to deliver a smoking-cessation intervention. N = 46. At 6-week follow-up, 43% had made at least one 24-hour attempt to quit, and 22% were quit – based on a 7-day prevalence criterion. [38] Duration of intervention unknown
Croatia Asthma RCT: GSM mobile telephone SMS texting study All subjects received asthma education, self-management plan, and standard treatment. All measured PEF three times daily and kept a symptom diary. In the study group, therapy was adjusted weekly by an asthma specialist according to PEF values received daily via SMS from the patients N = 16. Duration = 16 weeks. There was NO significant difference between the groups in absolute PEF. NO significant difference between the groups in daily consumption of inhaled medicine, forced vital capacity, or compliance. Additional cost of follow-up by SMS was Euros 1.67/patient/week (equivalent to approximately $1.30 per 1 Euro), and SMS transmission required 11.5 minutes. Controls had significantly higher scores for cough (1.85 +/- 0.43 vs. 1.42 +/- 0.28, p < 0.05) and night symptoms (1.22 +/- 0.23 vs. 0.85 +/- 0.32, p < 0.05). [39] Study group of 40 patients is needed to achieve the power of 80% within the 95% confidence interval.
Spain Cardiovascular disease Feasibility study. Patients provided with portable recording equipment and a cellular phone that supported data transmission [electrocardiogram (EKG)] and wireless application protocol (WAP) N = 89. Mean length of participation = 50.1 days. A total of 2168 EKGs (mean duration transmission = 2 min/30 s; network errors < 0.1%) and 4011 short messages (none lost, in 95% of cases 30 s < delay < 1 min) were transmitted. [40]
Finland Diabetes Non-randomized, controlled study: Transmission of glucose values by cellular phone in the treatment of type 1 diabetic patients. SMS message sent to the patients 1/week giving instructions v. controls receiving standard treatment without instructions 1/week. N = 100 consecutive patients/controls Duration = 1 year "The phone system was not associated with overall improvement in HbA1c, probably due to the patients' low measurement activity." [41] "Sophisticated electronic systems are not beneficial to all patients, but should be restricted to those having high motivation to use them."
Spain Vaccination rates Hepatitis A and B Whether reminder of the next vaccine dose sent by SMS increase compliance with hepatitis A + B and hepatitis A vaccination schedule. SMS sent to the vaccinee's mobile phone. Trained health-care workers entered the data into a computer to generate text messages reminding vaccinees of their scheduled doses. For the second hepatitis A + B dose, compliance in the study group (Message Groups) was slightly improved (88.4%: 83–92%) over two separate controls 80.7%: 76–84%) and 77.2%: 73–80%). For hepatitis A vaccine, compliance rates for the second dose were 27.7%:24–32%) and improved over controls 16.4%:14.4–18.6%) and 13.2%: 11.6–14.9) [42]
South Africa Tuberculosis SMS text messaging to improve DOTS using a modified Medication Event Monitoring System ® (MEMs) bottle cap that sends a signal to a mobile service provider. Adherence not measured [43–44]
South Africa HIV Cell Life® project, has developed software and data management systems that let clinic workers use their mobile phones to monitor patients' treatment. Information collected is sent to a central database Data published at the Civil Engineering Department of The University of Cape Town. [45]
  1. RCT = randomised controlled trial; CT = controlled trial