Bassi Abhinav, John Oommen, Praveen Devarsetty, Maulik Pallab K, Panda Rajmohan, Jha Vivekanand
George Institute for Global Health, India, New Delhi, India.
University of New South Wales, Sydney, Australia.
JMIR Mhealth Uhealth. 2018 Oct 26;6(10):e11440. doi: 10.2196/11440.
With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems.
We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature.
A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools.
The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease-focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories.
In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes.
随着印度手机用户数量呈指数级增长，大量公共卫生举措正在利用信息技术和移动设备提供医疗服务。鉴于在这些举措上投入了大量的财力和人力，确定它们在加强医疗系统中的作用很重要。
我们进行这项综述，以确定印度已发表的移动健康（mHealth）或远程医疗举措在加强卫生系统方面的当前作用。该综述根据疾病领域、地理分布和目标用户对这些举措进行分类，并评估现有文献的质量。
检索文献，以确定1997年1月至2017年6月期间来自印度的mHealth或远程医疗文章。检索的电子书目数据库和登记处包括MEDLINE、EMBASE、乔安娜·布里格斯研究所数据库和印度临床试验登记处。世界卫生组织卫生系统构建模块框架被用于根据已发表举措在卫生系统中的作用对其进行分类。使用Cochrane偏倚风险评估和美国国立卫生研究院的工具对所选文章进行质量评估。
综合检索策略共产生2150条引用，其中纳入318篇文章（原始研究文章 = 125篇；综述、系统架构、案例研究和观点文章 = 193篇）。2012年后出现了急剧增长，主要由以非传染性疾病为重点的文章推动。大多数原始研究在印度南部各邦开展，查谟和克什米尔以及印度东北部没有发表文章。服务提供是57.6%（72/125）所选文章的主要重点。这些文章中的大多数关注卫生系统的1个（36.0%，45/125）或2个（45.6%，57/125）领域，最常见的是服务提供和卫生人力。举措通常将客户教育用作改善卫生系统的工具。超过91.2%（114/125）缺乏样本量合理性说明的研究采用了便利抽样。所选试验（n = 11）的方法严谨性被评估为较差，因为大多数研究在至少2个类别中存在高偏倚风险。
总之，mHealth举措在印度越来越多地被用于改善医疗服务提供。我们的综述突出了当前证据基础质量较差，迫切需要开展有针对性的研究，以生成关于旨在加强卫生系统的mHealth干预措施的疗效、用户可接受性和成本效益的高质量证据。一种务实的方法是将实施研究纳入现有以及拟议的数字健康举措中，以支持就具有战略重要性的结果生成加强卫生系统的证据。
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