Thanks for your comments on our review, Neil. [*see note below] Looking at our summaries of the review, I’m sure we could have formulated our key messages in ways that were clearer. However, it is important to point out that the review isn’t concluding that health workers don’t or shouldn’t use mobile phones. It is saying that health workers who use mobile phones to ask for advice and support from health workers may not be more satisfied or have better patient outcomes than health workers who get their advice and support from face-to-face or other non-digital communication, such as landlines.
There are some important caveats to these findings:
* The certainty of the evidence is low (hence the expression “may have little or no impact..” If the review had found more trials, and perhaps better quality trials, this may have changed the findings.
* We searched for studies from as far back as 2000 and several of the included trials were therefore quite old. It’s possible that newer trials would have shown a different result.
We did this Cochrane review to inform a recommendation on provider-to-provider telemedicine. This recommendation was part of the WHO guidelines on mobile phones for health systems strengthening (https://apps.who.int/iris/handle/10665/311980). When making the final recommendation, the guideline panel also looked at evidence from a Cochrane review of qualitative research that explored health workers’ views and experiences of using mobile phones ( https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011942.pub2/...). The findings from this qualitative review offers a number of reasons why mobile phones may not automatically lead to better health worker satisfaction or better patient health. For instance, while the review suggests that health workers often appreciate this opportunity to communicate with each other, health workers seeking advice from other health workers aren’t always met with collaboration and support. In addition, health workers point to problems such as lack of network connectivity and electricity, problems paying for and maintaining phones, concerns about liability and loss of control when receiving advice from others, and concerns about data confidentiality when patient information is shared by phone.
After assessing the evidence, the guideline panel decided to recommend provider-to-provider telemedicine in settings where patient safety, privacy, traceability, accountability and security can be monitored. The guideline panel based this decision on the potential that mobile phones have to improve access to quality care and to reduce the isolation of health workers working in remote settings, and also highlighted the challenges that implementers need to be aware of. As the WHO pointed out when the guidelines were published, “Digital health is not a silver bullet” and “digital interventions depend heavily on the context and ensuring appropriate design” (https://www.who.int/news/item/17-04-2019-who-releases-first-guideline-on...). For mobile phone-based telemedicine to improve patient health, health workers do not only need affordable, well-functioning phones and reliable access to electricity and network connectivity. They also need access to others who are willing and able to answer their phone calls with timely, high-quality advice and support; and health workers need to have the resources to implement this advice.
It's possible that health workers have found their own ways around some of these challenges, and as part of the mHEALTH-INNOVATE project, we are hoping that we can learn from health workers' own informal solutions.
Thanks and best wishes, Claire
Claire Glenton
Senior Researcher, Centre for Epidemic Intervention Research, Norwegian Knowledge Centre | Norwegian Institute of Public Health
Editor, Cochrane Effective Practice and Organisation of Care (EPOC)
Director, Cochrane Norway
Postal address: PO Box 4404, Nydalen, N-0403 Oslo, Norway
Email: Claire.glenton@fhi.no
www.fhi.no
www.cochrane.no
www.cerqual.org
HIFA profile: Claire Glenton is a health systems researcher at the Norwegian Institute of Public Health and editor with the Cochrane Effective Practice and Organisation of Care (EPOC) Group. Claire has a particular interest in systematic review methodology, including methods for disseminating the results of systematic reviews and methods for synthesising qualitative research. She regularly serves as technical advisor on World Health Organization guidelines. She also co-coordinates the GRADE-CERQual Project Group. She is one of the principal investigators of the mHealth-Innovate project, looking at informal use of mobile phones by health workers. She is one of the the principal investigators of the mHEALTH-INNOVATE research project and joint coordinator of the HIFA working group supporting the project.
https://www.hifa.org/support/members/claire-1
https://www.hifa.org/projects/mhealth-innovate-what-can-we-learn-health-...
Email address: claire.glenton AT fhi.no
[*Note from NPW, moderator: Many thanks Claire. For reference, here is the link to the review:
https://www.cochrane.org/CD012927/EPOC_using-mobile-technologies-promote...
and my comments yesterday:
https://www.hifa.org/dgroups-rss/mhealth-innovate-33-how-do-you-use-your... ]
