Scaling Up mHealth: Where Is the Evidence? PLoS Med essay (c/o HIFA2015)

Dear HIFA members,

An essay in the open-access journal PLoS Medicine discusses the evidence base for mHealth and makes recommendations for scale-up. Below is the citation, summary points, selected extracts and recommendations for scale-up. The full text is available here:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001382

Best wishes,
Neil Pakenham-Walsh
HIFA moderator
[ HIFA2015: Healthcare Information For All by 2015 ]

CITATION: Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC (2013) Scaling Up mHealth: Where Is the Evidence? PLoS Med 10(2): e1001382. doi:10.1371/journal.pmed.1001382

SUMMARY POINTS
- Despite hundreds of mHealth pilot studies, there has been insufficient programmatic evidence to inform implementation and scale-up of mHealth.
- We discuss what constitutes appropriate research evidence to inform scale up.
- Potential innovative research designs such as multi-factorial strategies, randomized controlled trials, and data farming may provide this evidence base.
- We make a number of recommendations about evidence, interoperability, and the role of governments, private enterprise, and researchers in relation to the scale up of mHealth.

SELECTED EXTRACTS:
'A recent World Bank report tracked more than 500 mHealth studies, and many donor agencies are lining up to support the 'scaling up' of mHealth interventions [7]. Yet, after completion of these 500 pilot studies, we know almost nothing about the likely uptake, best strategies for engagement, efficacy, or effectiveness of these initiatives...  mHealth is in a period very similar to the early days of the Internet: not creating robust, interoperable platforms will ensure failure for mHealth initiatives to be scaled to improve health outcomes for at least the next decade.'

RECOMMENDATIONS FOR SCALE UP OF MHEALTH
- Existing standards for research should be reconsidered in order to provide guidance as to when scale up is appropriate.
- mHealth interventions should be guided by a plausible theory of behaviour change and should use more than one technique depending on the targeted behaviour [38].
- We need to establish an open mHealth architecture based on a robust platform with standards for app development which would facilitate scalable and sustainable health information systems.
- Implementation strategies such as factorial designs that are able to test the multiple features of interventions must be explored, in order to provide the necessary evidence base.
- Scale-up of mHealth in LAMICs should be preceded by efficacy and effectiveness trials so that they are founded on an appropriate evidence base.
Governments, funders, and industry must cooperate in order to set standards to create a self-governing commercially viable ecosystem for innovation.