Many digital projects in health are set up just to tell people things. Also, in maternity care, they are often set up just to tell mothers things. These approaches miss a key finding in the research: that digital communication should be social. It is about communication between people, not just broadcasting things.
M-health programmes in maternity care, using digital communications and phones, are proliferating across the world. Most projects are small, being developed in isolation from each other, mostly in low and middle-income economies. Research and evaluation is urgently required to determine better what works and what does not (van Heerden et al. 2012; Tomlinson et al. 2013).
Existing research into these programmes is starting to reach some initial conclusions.
- There is sufficient evidence to merit the expansion of M-health programmes – they have positive effects on the uptake of health services (Higgs et al. 2014).
- M-health programmes should be driven by health organisations, not private IT suppliers, though partnership with private suppliers is welcome and very valuable (Tomlinson et al. 2013). M-health programmes should involve the front-line providers of care in the community, such as midwives and nurses (Speciale & Freytsis 2013).
- M-health programmes should be integrated with health service provision, ensuring sharing of information across channels. In so doing, careful attention needs to be given to patient privacy and data security (van Heerden et al. 2012; Labrique et al. 2013).
- Careful consideration must be given to the cost-effectiveness of m-health programmes (van Heerden et al. 2012).
- Local adaptation is very important (Rotheram-Borus et al. 2012).
A particularly important finding is emerging. The simple provision of information is of limited value (Tonlinson et al. 2013). Effective m-health programmes combine good information with interactivity, support with problem solving and the building of social support – links with family, peers and health workers (Briscoe & Aboud 2012; Rotheram-Borus et al. 2012).
“Mobile technologies offer the opportunity to support families directly in managing their own health, while linking their self-management efforts to healthcare providers and other resources” (Rotheram-Borus et al. 2012).
Many maternity m-health projects do not do this, focusing instead on the individual mother. Examples are Text4Baby.com in US and MobileMamaAlliance.org, a US export to Africa. There are far fewer m-health projects that include fathers and they tend to focus on humour and are often patronizing and extend stereotypes that limit both mothers and fathers (Niela-Vilen et al. 2014; Johnson 2014).
Higgs ES et al. (2014), Understanding the role of mHealth and other media interventions for behavior change to enhance child survival and development in low-and middle-income countries: An evidence review, Journal of Health Communication 19
Labrique, Alain B et al. (2013), mHealth innovations as health system strengthening tools: 12 common applications and a visual framework, Global Health: Science and Practice 1.2
Luecken LJ, Lin B, Coburn SS, MacKinnon DP, Gonzales NA & Crnic KA (2013), Prenatal stress, partner support, and infant cortisol reactivity in low-income Mexican American families, Psychoneuroendocrinology 38(12)
Rotheram-Borus MJ, Tomlinson M, Swendeman D, Lee A & Jones E (2012), Standardized functions for smart-phone applications: examples from maternal and child health, International Journal of Telemedicine and Applications
Speciale AM &Freytsis M (2013), mHealth for midwives: A call to action, Journal of Midwifery & Women’s Health
Tomlinson M, Rotheram-Borus MJ, Swartz L & Tsai AC (2013), Scaling Up mHealth: Where Is the Evidence? PLoS Med 10(2)
van Heerden A, Tomlinson M & Swartz L (2012), Point of care in your pocket: a research agenda for the field of m-health, Bulletin of the World Health Organization 90
Photo: ICT4D.at. Creative Common.