Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda.
Institute of International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität Zu Berlin, Berlin, Germany.
Implement Sci. 2024 Oct 14;19(1):72. doi: 10.1186/s13012-024-01400-9.
Although mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions.
We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions.
We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged.
The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings.
移动医疗（mHealth）干预措施已显示出改善健康结果的潜力，但大多数措施很少能推广应用。现有的 mHealth 研究大多是规模较小、短期的、由捐助者资助的试点研究，其有效性的证据有限。为了促进推广，已经提出了几个框架来增强健康干预措施的通用实施。然而，在资源匮乏的环境中，针对 mHealth 干预措施在常规护理中的实施和整合，缺乏特定的关注。我们的范围综述旨在综合并开发一个框架，以指导 mHealth 干预措施的实施和整合。
我们在 PubMed、Google Scholar 和 ScienceDirect 数据库中搜索了 2000 年 1 月 1 日至 2023 年 12 月 31 日发表的与临床干预措施实施和整合相关的理论、模型和框架。研究包括以下内容：i）同行评议并发表于 2000 年至 2023 年之间，ii）明确描述了临床干预措施实施和整合框架，或 iii）全文可获取并以英文发表。我们整合了来自综述框架的不同领域和结构，以开发一个新的 mHealth 干预措施实施和整合框架。
我们确定了八篇符合条件的论文，其中包含八个框架，涵盖了 102 个实施领域。没有一个确定的框架是专门针对资源匮乏环境中 mHealth 干预措施的整合。与培训领域相关的两个结构（技能传授和干预意识）、来自结构重组领域的四个结构（技术和后勤支持、确定承诺的员工、监督和重新设计）、激励领域的两个结构（货币激励和非货币激励）、来自授权领域的两个结构（组织授权和政府授权）以及来自整合领域的两个结构（合作和常规工作流程）。因此，一个新的框架（TRIMI）出现了，该框架概述了五个主要领域——培训、结构重组、激励、授权和整合，与资源匮乏环境中 mHealth 干预措施的整合和实施有关。
TRIMI 框架为资源匮乏环境中 mHealth 干预措施的实施和整合缺陷提供了一个现实和可行的解决方案。
