1 Department of Public Health Science, Graduate School of Public Health, Seoul National University , Seoul, South Korea .
2 Center for Global Health Research, Graduate School of Public Health, Seoul National University , Seoul, South Korea .
Telemed J E Health. 2018 Oct;24(10):727-741. doi: 10.1089/tmj.2017.0249. Epub 2018 Feb 13.
Recently there has been dramatic increase in the use of mobile technologies for health (m-Health) in both high and low- and middle-income countries (LMICs). However, little is known whether m-Health interventions in LMICs are based on relevant theories critical for effective implementation of such interventions. This review aimed to systematically identify m-Health studies on health behavioral changes in LMICs and to examine how each study applied behavior change theories.
A systematic review was conducted using the standard method from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. By searching electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]), we identified eligible studies published in English from inception to June 30, 2017. For the identified m-Health studies in LMICs, we examined their theoretical bases, use of behavior change techniques (BCTs), and modes of delivery.
A total of 14 m-Health studies on behavioral changes were identified and, among them, only 5 studies adopted behavior change theory. The most frequently cited theory was the health belief model, which was adopted in three studies. Likewise, studies have applied only a limited number of BCTs. Among the seven BCTs identified, the most frequently used one was the social support (practical) technique for medication reminder and medical appointment. m-Health studies in LMICs most commonly used short messaging services and phone calls as modes of delivery for behavior change interventions.
m-Health studies in LMICs are suboptimally based on behavior change theory yet. To maximize effectiveness of m-Health, rigorous delivery methods as well as theory-based intervention designs will be needed.
最近，移动技术在高收入和中低收入国家（LMICs）中的应用在医疗保健领域（m-Health）呈现出显著的增长。然而，人们对这些国家的 m-Health 干预措施是否基于对这些干预措施的有效实施至关重要的相关理论知之甚少。本综述旨在系统地识别针对 LMICs 中健康行为变化的 m-Health 研究，并研究每个研究如何应用行为改变理论。
采用系统综述标准方法，按照《系统评价和荟萃分析的首选报告项目》（PRISMA）指南进行。通过搜索电子数据库（MEDLINE、EMBASE 和 Cochrane 中央对照试验注册中心[CENTRAL]），我们从成立到 2017 年 6 月 30 日，确定了发表在英语期刊上的符合条件的研究。对于在 LMICs 中确定的 m-Health 研究，我们检查了它们的理论基础、行为改变技术（BCT）的使用和传递模式。
共确定了 14 项关于行为变化的 m-Health 研究，其中只有 5 项研究采用了行为改变理论。最常被引用的理论是健康信念模型，该模型在三项研究中得到了采用。同样，研究也只应用了有限数量的 BCT。在确定的七种 BCT 中，最常用的是用于药物提醒和预约的社会支持（实际）技术。LMICs 的 m-Health 研究最常用的传递模式是短消息服务和电话来进行行为改变干预。
LMICs 的 m-Health 研究在很大程度上尚未基于行为改变理论。为了最大限度地提高 m-Health 的效果，需要严格的传递方法以及基于理论的干预设计。
