A systematic review and qualitative evidence synthesis of factors affecting mHealth adoption in India.

mHealth implementations are increasing in low- and middle-income countries to strengthen health systems and improve health outcomes. Following the proliferation of mobile internet use, Indian health systems have deployed mHealth widely. However, there is little evidence that mHealth has improved health outcomes in India across settings and at scale. The aim of this study was to review current evidence on perceptions and experiences of end users of mHealth in India and synthesize qualitative data to determine the factors influencing mHealth use to inform mHealth design, development, and implementation. A systematic review and qualitative synthesis of studies on mHealth in India was conducted by searching the Web of Science, Medline and CINAHL databases for qualitative studies on mHealth users including both health system beneficiaries and healthcare personnel. Findings from the studies were synthesized using thematic synthesis. The synthesis generated the themes of the Environment, the Users and the mHealth system. The data indicate that mHealth use improves when the environment supports its use; when users are motivated and have the ability to use mHealth systems; and when mHealth systems are aligned with the environmental context and fulfill users' needs and desires. mHealth adoption in India can be improved through human centered design and by addressing the disparities in digital literacy between socio economic strata. These approaches are required to close the design reality gaps facing mHealth systems, to improve mHealth implementation for health system strengthening, and therefore, to improve health outcomes in India.