Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Australia.
JMIR Mhealth Uhealth. 2019 Oct 7;7(10):e14877. doi: 10.2196/14877.
The ubiquitous presence and functionality of mobile devices offers the potential for mobile health (mHealth) to create equitable health opportunities. While mHealth is used among First Nations populations to respond to health challenges, the characteristics, uptake, and effectiveness of these interventions are unclear.
This review aimed to identify the characteristics of mHealth interventions (eg, study locations, health topic, and modality) evaluated with First Nations populations and to summarize the outcomes reported for intervention use, user perspectives including cultural responsiveness, and clinical effectiveness. In addition, the review sought to identify the presence of First Nations expertise in the design and evaluation of mHealth interventions with First Nations populations.
The methods of this systematic review were detailed in a registered protocol with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019123276). Systematic searches of peer-reviewed, scientific papers were conducted across 7 databases in October 2018. Eligible studies had a primary focus on mHealth interventions with experimental or quasi-experimental design to respond to a health challenge with First Nations people from Canada, Australia, New Zealand, and the United States. Two authors independently screened records for eligibility and assessed risk of bias using the Joanna Briggs Institute checklists. Data were synthesized narratively owing to the mix of study designs, interventions, and outcomes. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Searches yielded 1053 unique records, after review and screening, 13 studies (5 randomized controlled trials and 8 quasi-experimental designs) were included in the final analysis. Studies were conducted in Australia (n=9), the United States (n=2), and New Zealand (n=2). The most common health challenge addressed was mental health and suicide (n=5). Intervention modalities included text messaging (n=5), apps (n=4), multimedia messaging (n=1), tablet software (n=1), or a combination of short messaging service (SMS) and apps (n=1). Results showed mixed engagement with the intervention (n=3); favorable user perspectives, including acceptability and cultural appropriateness (n=6); and mixed outcomes for clinical effectiveness (n=10). A diverse range of risks of bias were identified, the most common of which included a lack of clarity about allocation and blinding protocols and group treatment for randomized controlled trials and a lack of control group and single outcome measures for quasi-experimental designs. First Nations expertise informed all mHealth studies, through authorship (n=8), affiliation with First Nations bodies (n=3), participatory study design (n=5), First Nations reference groups (n=5), or a combination of these.
mHealth modalities, including SMS and apps, appear favorable for delivery of health interventions with First Nations populations, particularly in the area of mental health and suicide prevention. Importantly, First Nations expertise was strongly embedded within the studies, augmenting favorable use and user engagement. However, evidence of efficacy is limited.
移动设备无处不在的存在和功能为移动医疗（mHealth）创造公平的健康机会提供了潜力。虽然 mHealth 被用于 First Nations 人群来应对健康挑战，但这些干预措施的特征、采用情况和效果尚不清楚。
本综述旨在确定针对 First Nations 人群评估的 mHealth 干预措施的特征（例如，研究地点、健康主题和模式），并总结干预措施使用、用户观点（包括文化适应性）和临床效果的报告结果。此外，本综述还旨在确定 First Nations 专业知识在设计和评估针对 First Nations 人群的 mHealth 干预措施中的存在情况。
本系统综述的方法在国际前瞻性系统评价注册中心（PROSPERO，CRD42019123276）的注册方案中进行了详细描述。2018 年 10 月，对 7 个数据库进行了同行评审的科学论文的系统搜索。符合条件的研究主要关注 mHealth 干预措施，采用实验或准实验设计，以应对加拿大、澳大利亚、新西兰和美国 First Nations 人群的健康挑战。两名作者独立筛选记录的资格，并使用 Joanna Briggs 研究所检查表评估偏倚风险。由于研究设计、干预措施和结果的多样性，数据以叙述方式进行综合。该综述按照系统评价和荟萃分析报告的首选报告项目进行报告。
搜索产生了 1053 条独特记录，经过审查和筛选，最终有 13 项研究（5 项随机对照试验和 8 项准实验设计）纳入最终分析。研究在澳大利亚（n=9）、美国（n=2）和新西兰（n=2）进行。最常见的健康挑战是心理健康和自杀（n=5）。干预手段包括短信（n=5）、应用程序（n=4）、多媒体短信（n=1）、平板电脑软件（n=1）或短信服务（SMS）和应用程序的组合（n=1）。结果显示混合参与干预（n=3）；用户观点有利，包括可接受性和文化适宜性（n=6）；临床效果的结果好坏参半（n=10）。确定了各种不同程度的偏倚风险，最常见的是缺乏关于随机对照试验的分配和盲法方案以及组治疗的透明度，以及缺乏对照组和单一结果测量的准实验设计。First Nations 专业知识通过作者身份（n=8）、与 First Nations 机构的联系（n=3）、参与式研究设计（n=5）、First Nations 参考小组（n=5）或这些的组合，强烈融入了所有 mHealth 研究。
包括短信和应用程序在内的 mHealth 模式似乎有利于为 First Nations 人群提供健康干预措施，特别是在心理健康和自杀预防领域。重要的是，First Nations 专业知识在研究中得到了强有力的体现，提高了良好的使用和用户参与度。然而，疗效证据有限。
