A systematic review of healthcare provider-targeted mobile applications for non-communicable diseases in low- and middle-income countries

Mobile health (mHealth) interventions hold promise for addressing the epidemic of noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs) by assisting healthcare providers managing these disorders in low-resource settings. We aimed to systematically identify and assess provider-facing mHealth applications used to screen for, diagnose, or monitor NCDs in LMICs. In this systematic review, we searched the indexing databases of PubMed, Web of Science, and Cochrane Central for studies published between January 2007 and October 2019. We included studies of technologies that were: (i) mobile phone- or tablet-based, (ii) able to screen for, diagnose, or monitor an NCD of public health importance in LMICs, and (iii) targeting health professionals as users. We extracted disease type, intervention purpose, target population, study population, sample size, study methodology, technology stage, country of development, operating system, and cost. Our initial search retrieved 13,262 studies, 315 of which met inclusion criteria and were analyzed. Cardiology was the most common clinical domain of the technologies evaluated, with 89 publications. mHealth innovations were predominantly developed using Apple’s iOS operating system. Cost data were provided in only 50 studies, but most technologies for which this information was available cost less than 20 USD. Only 24 innovations targeted the ten NCDs responsible for the greatest number of disability-adjusted life years lost globally. Most publications evaluated products created in high-income countries. Reported mHealth technologies are well-developed, but their implementation in LMICs faces operating system incompatibility and a relative neglect of NCDs causing the greatest disease burden.


PC
A general-purpose computer equipped with a microprocessor and designed to run especially commercial software (such as a word processor or Internet browser) for an individual user Other wireless devices Blue Box device, Bluetooth enabled monitoring system, digital camera, UWB P410 Radar Module, wireless bio patch Development Stage

Proof of Concept/Proof of Principle
Evidence that shows that a (…) design idea, technology etc. will work, usually based on an experiment or a pilot project.
In development Technology in the process of being prepared, developed or completed.
Prototype A first full-scale and usually functional form of a new type or design of a construction Pilot A small-scale preliminary study conducted to evaluate feasibility, duration, cost, adverse events, and improve upon the study design prior to performance of a full-scale research project or technology deployment.

Validation Trial/Test in Clinical Trial
A scientifically controlled study of the safety and effectiveness of a therapeutic agent (such as a drug or vaccine) using consenting human subjects Available/Developed Technologies that have undergone development and trials and are currently available to be used by practitioners, including those available at virtual application stores for purchase or free download. Not specified Study does not state the stage of development.
Operating System iPhone Operating System Mobile operating system created and developed by Apple Inc. exclusively for its hardware.

MultiPhone Operating System
Applicable to technologies that work on multiple operating systems Others Includes HTML5, MIDiet Implementation of JM2E using NetBeans 5.5, Symbian, Tiny OS Platform Not specified Not detailed in the study Use of Accessories Yes/No Use or not of accessories additional to the mobile technology to achieve its purpose (i.e., electrodes, cellphone attachments, small screens, blood pressure cuffs, additional light sources, straps or bands, lenses, headphones) Cost Ranges of $ 0-20 USD, 21-100 USD, >100 USD, or Not specified or not costing assigned yet. Some costs in different currencies were converted to USD dollars using Google at April 2021 rates of conversion. Including several countries in the same study, either as collaborators or as study settings.

Year of Publication
Year Ranges 2006Ranges -2008Ranges , 2009Ranges -2011Ranges , 2012Ranges -2014Ranges , 2015Ranges -2017Ranges , 2018Ranges -2020 Study Design Randomized Clinical Trials A study design that randomly assigns participants into an experimental group or a control group. As the study is conducted, the only expected difference between the control and experimental groups in a randomized controlled trial (RCT) is the outcome variable being studied.

Observational Cohort Studies/Case Control Studies
Studies where researchers observe the effect of the studied technology without trying to change who is or isn't exposed to it.

Case Series/Case Reports
A detailed report of the implementation of a technology in the diagnosis, monitoring or screening of an individual patient. A case series is group of case reports involving patients that were assisted in the diagnostic process by the same technology. Diagnostic Accuracy Study A study that provides evidence on how well a technology correctly identifies or rules out disease and informs subsequent decisions about treatment for clinicians, their patients, and healthcare providers. Qualitative Studies that collected and analyzed non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences.

Technical Description/Testing
A technical description describes a technology in terms of its function, organization, parts and details, without using a study design framework to do so.