L'Engle Kelly, Plourde Kate F, Zan Trinity
School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117, USA.
Research Utilization, Global Health Population and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701, USA.
Mhealth. 2017 Mar 23;3:11. doi: 10.21037/mhealth.2017.02.06. eCollection 2017.
The research base recommending the use of mobile phone interventions for health improvement is growing at a rapid pace. The use of mobile phones to deliver health behavior change and maintenance interventions in particular is gaining a robust evidence base across geographies, populations, and health topics. However, research on best practices for successfully scaling mHealth interventions is not keeping pace, despite the availability of frameworks for adapting and scaling health programs.
m4RH-Mobile for Reproductive Health-is an SMS, or text message-based, health information service that began in two countries and over a period of 7 years has been adapted and scaled to new population groups and new countries. Success can be attributed to following key principles for scaling up health programs, including continuous stakeholder engagement; ongoing monitoring, evaluation, and research including extensive content and usability testing with the target audience; strategic dissemination of results; and use of marketing and sustainability principles for social initiatives. This article investigates how these factors contributed to vertical, horizontal, and global scale-up of the m4RH program.
Vertical scale of m4RH is demonstrated in Tanzania, where the early engagement of stakeholders including the Ministry of Health catalyzed expansion of m4RH content and national-level program reach. Ongoing data collection has provided real-time data for decision-making, information about the user base, and peer-reviewed publications, yielding government endorsement and partner hand-off for sustainability of the m4RH platform. Horizontal scale-up and adaptation of m4RH has occurred through expansion to new populations in Rwanda, Uganda, and Tanzania, where best practices for design and implementation of mHealth programs were followed to ensure the platform meets the needs of target populations. m4RH also has been modified and packaged for global scale-up through licensing and toolkit development, research into new business/distribution models, and serving as the foundation for derivative NGO and quasi-governmental mHealth platforms.
The m4RH platform provides an excellent case study of how to apply best practices to successfully scale up mobile phone interventions for health improvement. Applying principles of scale can inform the successful scale-up, sustainability, and potential impact of mHealth programs across health topics and settings.
推荐使用手机干预措施促进健康的研究基础正在迅速发展。尤其是利用手机提供健康行为改变及维持干预措施，在不同地域、人群和健康主题方面正获得强有力的证据支持。然而，尽管有适用于调整和推广健康项目的框架，但关于成功推广移动医疗干预措施的最佳实践的研究却未能跟上步伐。
m4RH（生殖健康移动服务）是一项基于短信的健康信息服务，始于两个国家，在7年时间里已针对新的人群和新的国家进行了调整和推广。成功归因于遵循推广健康项目的关键原则，包括持续让利益相关者参与；进行持续监测、评估和研究，包括与目标受众进行广泛的内容和可用性测试；战略性地传播结果；以及将营销和可持续性原则应用于社会倡议。本文探讨了这些因素如何促成了m4RH项目的纵向、横向及全球推广。
m4RH在坦桑尼亚展示了纵向推广情况，在那里，包括卫生部在内的利益相关者的早期参与推动了m4RH内容的扩展以及国家级项目覆盖范围的扩大。持续的数据收集为决策提供了实时数据、关于用户群体的信息以及经过同行评审的出版物，从而获得了政府认可并实现了合作伙伴交接，以确保m4RH平台的可持续性。m4RH通过向卢旺达、乌干达和坦桑尼亚的新人群扩展实现了横向推广和调整，在这些地方遵循了移动医疗项目设计和实施的最佳实践，以确保该平台满足目标人群的需求。m4RH还通过许可和工具包开发、对新业务/分销模式的研究以及作为衍生的非政府组织和准政府移动医疗平台的基础，进行了修改和打包以便全球推广。
m4RH平台提供了一个关于如何应用最佳实践成功推广手机干预措施促进健康改善的绝佳案例研究。应用推广原则可为移动医疗项目在不同健康主题和环境下的成功推广、可持续性及潜在影响提供指导。
