Adepoju Ibukun-Oluwa Omolade, Albersen Bregje Joanna Antonia, De Brouwere Vincent, van Roosmalen Jos, Zweekhorst Marjolein
Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Institute of Tropical Medicine, Maternal and Reproductive Health Unit, Department of Public Health, Antwerp, Belgium.
JMIR Mhealth Uhealth. 2017 Mar 23;5(3):e38. doi: 10.2196/mhealth.7185.
In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established.
The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa.
A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA.
We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training.
The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings.
为了在资源匮乏地区提供高质量的医疗服务，移动医疗（mHealth）正越来越多地被采用。例如，在资源丰富地区，移动医疗在通过数据收集、决策算法和循证指南促进循证临床决策方面的作用已得到确立。然而，移动临床决策支持系统（mCDSS）在非洲等资源匮乏地区的具体采用程度以及在此类地区使用该系统所吸取的经验教训尚未明确。
本研究的目的是综合关于在非洲使用移动医疗进行即时决策支持并提高医护人员医疗服务质量的证据。
对4个同行评审数据库和1个灰色文献数据库进行了范围综述。未设置日期限制，但仅选择英文文章。两名评审员使用预先确定的标准筛选文章并提取数据。使用Microsoft Excel和MAXQDA对文章进行分析。
我们保留了22篇文章，这些文章代表了撒哈拉以南非洲7个国家的11项不同研究。干预措施主要集中在孕产妇健康领域，范围从简单的短信（短消息服务，SMS）到复杂的多组分干预措施。尽管医护人员普遍支持移动临床决策支持系统并认为其有用，但对工作量增加和工作流程改变的担忧阻碍了其可持续性。移动临床决策支持系统使用的促进因素和障碍包括技术和基础设施支持、所有权、卫生系统挑战以及培训。
在撒哈拉以南非洲使用移动临床决策支持系统表明移动医疗取得了进展，尽管其对服务提供质量的影响尚未得到充分探索。所吸取的经验教训有助于为未来技术支持的医疗服务提供的研究、政策和实践提供参考，尤其是在资源匮乏地区。
