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Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


1


Title:

Mobile
devices and
applications for health; an exploratory review of the
current evidence

with public health perspective



Running
Title:

Mobile devices and applications for health



Authors:



1.
Alireza Ahmadvand, MD

Researcher, Knowledge Utiliza
tion Research Center (KURC)

Student Member of the Iranian Epidemiological Association

PhD Candidate of Epidemiology
,
Department of Epidemiology and Biostatistics

School of Public Health
,
Tehran University of Medical Sciences

Tehran, Iran

Mobile
:

+98 (912)
5503390

Tel/Fax:
+98 (21) 88
975658
-
60

Email:

ahmadvand.ar
@
gmail.com



2.
Ahmad
Fayaz
-
B
akhsh, MD
, MSc, PhD

(Corresponding Author)

Lecturer in Health Information Systems

Assistant Professor, Department of Health Care Management

School of Public Health and Sc
hool of Allied Medical Sciences

4
th

Floor, School of Public Health New Building, Tehran University of Medical Sciences
Main Campus Poursina St., Tehran, IRAN

Tel:

+98 (
912
) 3277218

Fax:

+98 (
21
) 88989129

Email:

fayaz@tums.ac.ir

Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


2

Abstract


Objective

Advanc
es in m
obile phone technology

help in assessment, education
and
service
provision for the benefit of public health. Mobile h
ealth
solutions have
been successful in
transformation of service delivery


especially in resource
-
poor settings
. But challenges
ar
ise from “
patchwork of incompatible applications serving narrow, albeit valuable,
needs
”.


Materials and Methods

To assess the available evidence on advantages of m
obile devices and applications for
the
purpose of
health

improvement, considering a public h
ealth perspective. We reviewed 25
articles (out of 43) published in PubMed, Web of Science, Scopus, and Ovid from 2010
backwards according to their study design, population, objectives and findings. We then
classified them according to World Health Organiz
ation’s health system building blocks,
objectives, and roadmaps.


Results

Research experiences are still passing through their developmental phases and need much
harmonization to health system at large. The range of subjects that had been experienced
in ad
dition to the study designs varied widely. A substantial lack of higher
-
level evidence
exists, especially in the form of well
-
designed trials.


Conclusion

It is the responsibility of healthcare researchers to advocate for better study types and also
a requ
irement for experts from other disciplines to get more insight into the nature of
health system when planning a research on mobile health.


Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


3

Introduction

The art and science of using information technology
for

the benefit of
public health needs
and priorit
ies
has now passed its 16 years of age.
In 1995, t
he academic
discipline of
public health informatics
was proposed with the objectives of
fostering
better
communication, data
exchange, and also the development of practical
tools
to
portray
new
kno
wle
dge

fo
r the benefit of health improvement
(1)
.


A

few years later,
Yasnoff

et al.
implied that
in order for
public health professionals
to
provide
opportunities for health improvement

with

the help of
public health informatics
,
information technology must be app
lied systematically to research and then to practice of
public health.

Nevertheless, they

were not surprised
that
the earliest adoptions
of
technologies
and
also
frequent

development of
information and surveillance systems
have
taken place by
public health

professionals

themselves

(2)
.

It did not take much time for a

national agenda for public health informatics

to be proposed in which
the

key themes

(containing
74 recommendations) highlighted the importance of coordinated activities
and programs
among all
stakeholders,
especially for practice

and research

(3)
.


Since
the beginning of the 21
st

century in which public health informatics has been
an

emerging


profession

(4)
, a great deal of change h
as happened
, both in public health and

in the information te
chnology enterprise
s
;
in particular,
speedy
development of m
obile
phone technology


as part of the information technology area


which is believed to help
in
assessment, education, and
service provision for the benefit of
public health
(5)
.

With
the effor
ts of many researchers, academic and industrial organizations, international
institutions, and
many other aficionados, the area of M
obile
H
ealth or mHealth
has
developed gradually

with much overlap with public health informatics.
Scientific
evidences incre
asingly show that mHealth has been successful in transformation of
service delivery



especially in resource
-
poor settings


because of lower costs and
higher versatility of applications
(6)
.
But the
challenge

of
harmoniz
ing
activities still
remains; as Es
trin et al. mentioned that
mHealth
had
come into sight as
a

patchwork of
incompatible applications serving narrow, albeit valuable, needs

(7)
.


Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


4

With these facts in mind, we aimed
to assess the available published evidence
on the
advantages

of m
obile devi
ces and applications for
the purpose of
health

improvement, in
accordance
with

a
public health perspective
. We tried to
determine if we
could

categorize
past and recent

experiences according to what
are

known
globally
as the health system
structure, functi
ons, objectives, and principles.


Materials and Methods

W
e decided to consider a broad research scope and an exploratory

perspective on
reviewing the
subject
. We followed these steps
adopted from

the guidelines for a
systematic literature review accustomed

to our research purpose: determining research
area
(
s
)
; conducting search based on the agreed upon keywords; reviewing and selecting
relevant studies; extracting key information; and summarizing results with implications
for addressing challenges, and also

further research.


Search strategy

Our
research area
was the use of
mobile phone
(
devices
)

and /or
applications
(softwares)
that
has

been studied in a real health
-
related
context
.

We used these
keywords separately
and in combination: (
mobile phone

OR
cell

phone
OR
cellular phone OR
portable phone
OR

mobile device

OR mHealth
) AND (
health

OR
public health OR
disease
OR
diagnosis

OR
treatment
OR
prevention
).
As we were engaged in an academic health organization,
we sought to search
for stud
ies in these
biomed
ical
research
databases

till the end of
2010
: PubMed
, Web of Science, Scopus, and Ovid with
out any limitations on country
and
language.


It was an assumption for us

to include wide
-
ranging study designs (e.g. case studies,
descriptive studies, or
trials
)

a
nd preliminary pilot search
ing

with
above
-
mentioned
keywords,
convinced us to continue
to
do so
.
Bibliographies of more recent studies were
assessed
for need to add other extra published evidences
.

Search results were entered in
an EndNote
X3
library file
(EndNote, Thompson Reuters, California, USA) and full
-
text
version of the articles were added to the library.


Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


5

We planned for two
-
stage selection process

by two
experts in this field
; at first, one
reviewer selected the relevant studies based on title, abs
tract, and the
general

nature of
the subject. Second, these s
earch results were
assessed

by two reviewers in
dependently

in
two separate sessions;
afterward
,
the two reviewers

had
a joint meeting
to
finalize the
select
ion, come to consensus on their perspec
tives

and categorize the articles
based on
title, abstract,
access to full
-
text,
and the overall quality of the evidence.


For the purpose of categorization and assessing the relevance of published ev
idence to
health system, w
e used
the

classic
World Healt
h Organization’s
report
named

Everybody’s Business; Strengthening Health Systems
t
o Improve Health Outcomes;
W
HO
’s Framework
f
or Action
”.
In this classic report,
WHO
defined
six building blocks

for health system,
namely, “
service delivery; health workforc
e; information; medical
products, vaccines and technologies; financing; and leadership and governance
(stewardship)

. The overall goals and outcomes
of health system were

i
mproved
h
ealth
(
l
evel and
e
quity)
;

r
esponsiveness
;

s
ocial and
f
inancial
r
isk
p
rotec
tion
;

and
i
mproved
e
fficiency

. Moreover,

a
ccess
;

c
overage
;

q
uality
;

and
s
afety”
were
the roadmaps to
depart from
those
building blocks
in order to
reach
destination
s (“outcomes”)

(8)
.


Then w
e planned for two
-
stage reading, extracting, and categorizing
p
rocess
according to
health system characteristics.
Every article was read and classified according to WHO’s
Framework,

based on
its
title, abstract,
keywords,
findings, authors’ messages
and
overall
nature of the
evidence
.
Just explicit
(not implicit) mess
ages, objectives, and findings were
used in categorization the
specific
research experience in what
are defined
as building
blocks, objectives, and roadmaps
.


Results

After the
first and
second
rounds of
selection, 43
and
25

articles were included in our
r
eview process

respectively
.

We based our
final
review
on the remaining
25

articles
which dated from the end of 2010 backward
s
.


Table 1

shows the
summary extracts of
target group
s
, s
ample
s
ize
, s
tudy
d
esign
,
o
bjective
s
, and also m
ain
f
inding(s)

of
25

revie
wed articles in chronological order.

Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


6



The n
umber
s

of
published
research experiences
(out of
25
) that could explicitly be
classified under
six
health system building blocks

were

as follow:
service delivery

[
16
;
64.0%
]
; health workforce

[
13
; 52.0%
]
; informa
tion

[
13
; 52.0%
]
; medical products,
vaccines and technologies

[
8
; 32.0%
]
; financing

[
0
; 0.0%
]
; and leadership and
governance (stewardship)

[
2
; 8.0%
]
.


The numbers of published experiences
pertinent

to
overall
health system
goals and
outcomes
were as follow
:
improved health (level and equity)

[
16
; 64.0%
;
(
level: 16,
equity: 0
)]
; responsiveness

[
11
; 44.0%
]
;

social and financial risk protection

[
5
; 20.0%
]
;
and improved efficiency

[
12
; 48.0%
]
.


And last, but not least, the numbers of
available

published
evidenc
e unambiguously
related

to overall health system
roadmaps

were as follow:
access
[
11
; 44.0%
]
; coverage
[
10
; 40.0%
]
; quality
[
18
; 72.0%
]
; and safety
[
5
; 20.0%
]
.


Discussi
on

Medium
-

to high
-
quality studies addressing real experiences on mobile phone
devices
and
applications for health dated back to 2002
(9)
; in spite of the fact that one could track
research experiences on “computer” software development
for health
(not just mobile
phone softwares) to earlier years
(34)
. Published experiences rapidly rose fro
m 2005
onwards with the most medium
-

to high
-
quality, larger
-
scale experiences published from
2008 to 2010. It seemed that the overall quality of published evidence
s

had increased in
recent years.


We
are

not surprised (and i
t
is

really obvious from
target

group
s
, s
tudy
d
esign
s,
o
bjective
s, and also m
ain
f
indings

of the reviewed evidences
)

that the
need for
harmonization and coordination
of research experiences on mobile phones and
applications for public health is tremendously necessary. The range of subje
cts that have
been experienced
vary widely; from evaluating
a dietary assessment method

in college
students
(9)
,

to
the possibility
of diagnosing
malaria and tuberculosis
(25)

to
help
a
Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


7

surgeon evaluate microsurgical flaps

(26)
.

Moreover, c
onsidering study

designs,
a
substantial

lack of higher
-
level
evidence exists,
e
specially in the form of well
-
designed

trials.
Because of the inter
-
disciplinary nature of mHealth experiences,
we think that
it is
the responsibility of
healthcare
resear
chers to advocate
for
better study types

and also
a
requirement for experts from other disciplines to try to

get more insight
in
to
the
nature of
health system
when
planning
a research on
mobile devices and applications in
health
(20)
.


Many of the published evidences
were

about

the
mobile
systems and infrastructures. This
finding
emphasize
s

the fact
that the mHealth experiences
are still passing through their
developmental phases and specifically, they are in need of
reliable
and inter
-
operable
infrastructures in order to
set th
e stage for further and higher
-
level research projects;
especially
i
n

a real clinical or populatio
n
-
based
setting

(13)
.

This also highlights an
important gap
; these experiences may not have considered (and reported) public health
system perspectives explic
itly.
This fact

is evident from the number of articles that can be
categorized under financing
(0), leadership and gove
rnance (2), and also equity (0); the
areas to be discovered by future mobile application researchers interested on these kinds
of outcome
s
.


It was obvious in our extraction process that the more recent the research experience

was
,
the more informative the published material
was
.

It was much easier to find the explicit
messages of researchers in latest experiences
regarding the health syste
m building blocks,
objectives, and roadmaps

(29, 32, 33)
. This may be because of the relative
pressure on
researchers
in recent years
to adjust their activities (or at least their reporting) to what
really matters for
diverse

health system stakeholders; no
t just
the researchers.


One of the best examples of developing a mobile solution for public
health

was the
experience
reported by
Meankaew

et al
(32)

who
evaluate
d

the effectiveness of
using
cell
-
phones
preventing
malaria
.
We think two main reasons might
have an effect on this
good
impression

in our mind
: first,
researchers have

selected one of the major public
health problem
s

for which there are well
-
known
prevention and treatment programs.
Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


8

Second,
researchers
have
r
u
n this
project
with the support of
WHO

and the Bill &
Melinda Gates Foundation
; two international organizations
with
specific
public health
goals
to which researchers are required to adjust their experiences

(35)
.


Our study has a few limitations: first, we have just assessed international bio
medical
research databases;

results of
many research experiences might have been published in
other forms.

It is possible
to
do
a similar project using more extensive databases,
especially the ones that are outside the focus of researchers in health care.

Second,
because of the scarcity of
experiences published in peer
-
reviewed journals, we have
assessed divers
e

types of articles and research designs
;
but the quality and credibility of
these evidences vary to some extent. This challenge needs to be
kept in

mind when
one
tr
ies

to interpret and compare the findings
from
similar articles.

It seems that by better understanding
of health care system and its characteristics,
both
public health professionals and mobile technology experts, can shed more light on
re
quirements of planning good research experiences on mobile phones for health.



Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


9

Acknowledgments

We wish to acknowledge
the
students of Health Information System

course, class of
2011. Their comments and enthusiasm helped us
a lot
in completing
this projec
t.


Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


10

Author Disclosure Statement

Alireza Ahmadvand

No competing financial interests exist
.


Ahmad Fayaz
-
B
akhsh

No competing financial interests exist.





Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


11

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Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
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13

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Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


14

Reprint requests

may be
directed to
:


Ahmad Fayazbakhsh
, MD

Lecturer in Health Information Syst
ems

Assistant Professor, Department of Health Care Management

School of Public Health and School of Allied Medical Sciences

4
th

Floor, School of Public Health

New Building, North Door of Tehran University of
Medical Sciences Main Campus

Poursina St., Tehra
n, IRAN

Tel:

+98 (0) 91 23 277 218

Fax:

+98 (0) 21 88 989 129

Email:

fayaz@tums.ac.ir


Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


15

Table 1.

Target group
s
, s
ample
s
ize
, s
tudy
d
esign
, o
bjective
s, and also m
ain
f
indings

of the 25
published articles reviewed on m
obile devices and applications for public health in
chronological order.


Author, Year

Target Group
(s)

Sample Size

Study Design

Objective

Main
Finding(s)

Wang et al.,
2002
(9)

College
students
majoring in
food and
nutrition

40 students
(divided into
two

groups)

Cross
-
sectional

To evaluate a
dietary
assessment
method in terms
of reliability and
validity; a digital
camera with a
mobile phone
card attachment
was applied

Dietary
assessment
method
helpfully
measured
dietary intakes
of individuals
for various
nutrients

Hameed 2003
(10)

Systems and
infrastructures

N/A

Narrative
review

To discuss
mobile
technology and
its application,
considering
possible
advantages of its
integration into
existing
information
systems of United
Kingdom’s health
care service

'Mob
ility' that
comes as an
extra component
from mobile
technology has
added
-
values to
information
systems of
United
Kingdom’s
health care
services, and
ultimately the
health of
patients

Smith
-
Jackson

et al. 2003
(11)

Disabled
Persons

Not so clear

Qualitative

study; Semi
-
structured
interviews and
a focused
group
discussion

To develop and
use “Needs
Analysis and
Requirements
Acquisition
(NARA)
framework”;
NARA helps to
extract user needs
to design a cell
phone to be
usable by
disabled persons

NARA is both a
cos
t
-
effective
and an
uncomplicated
framework to
develop user
needs and
requirements

Yu et al. 2004
(12)

Personal
Digital
Assistants
(PDAs)

N/A

Narrative
review; as
conference
proceedings

To discuss on
limitations of
PDAs (and how
to defeat them),
requiremen
ts for
the development
of mobile health
application; based
Minimum data
entry in text
format and high
frequency of
recording,
streamlines data
management on
PDAs by
Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


16

Author, Year

Target Group
(s)

Sample Size

Study Design

Objective

Main
Finding(s)

on re
-
engineering
a usual desktop
software as an
application on
PDA

implemented
softwares.
These can make
best use of
health
applications on
PDAs

Jones et al.
2005
(13)

Systems and
infrastructures

N/A

Narrative
review; as
conference
proceedings

To explore
mHealth systems
for patients and
health
professionals
based on personal
Body Area
Network
s
(BANs)

The BAN
system extends
the healthcare
providers’
information
system
enterprises; but
it should be
assessed by
(clinical) trials

Kopec et al.
2005
(14)

Medical
professionals,
students, as
well as the
general public

N/A

Narrative
review; based
on a

case
study

To integrate a
newly
-
developed,
comprehensive,
web
-
based
learning system
on HIV/AIDS
(named
SmartTutor) to
mobile devices

SmartTutor was
well received by
students (in
early
evaluations) and
helped in their
learning
practices
considerably

Kotan
i et al.
2005
(15)

Elderly
population in a
rural practice

16 elderly
people

Cross
-
sectional

To assess the
value of getting
photos by a
mobile
-
phone’s
digital camera in
assessing daily
-
life activities of
the elderly for
better home care

The values of
this m
ethod are:
“mobility”,
“easy
operation”,
“simple
transference”,
“monitoring of
photo data by
the phone
retrieval
database”

Morris et al.
2006
(16)

Military health
care providers

N/A

Narrative
review; based
on a case
study

To discuss the
Battlefield
Medica
l
Information
System
developed
innovatively to
reduce health care
providers’
medical errors
and ultimately,
improve quality
of care

Because of
advantages in
the field, the
proposed system
was used
extensively to
develop an
electronic health
record to
suppo
rt a
longitudinal
record with all
components of
the military
healthcare
system

Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


17

Author, Year

Target Group
(s)

Sample Size

Study Design

Objective

Main
Finding(s)

Holzinger et
al. 2007
(17)

Systems and
infrastructures

N/A

Perspective;
based on case
studies

To discuss
experiences in
developing an
application for
“randomization”
in biomed
ical
research; the
application was
developed for
both mobile and
desktop platforms

The results from
development of
this application
in health care
can be used and
expanded to
other mobile
applications

Holzinger

et
al. 2008
(18)

Medical
professionals
(spec
ifically
doctors and
nurses) in the
hospital
environment

N/A

Perspective;
based on
qualitative
study

To provide a
synopsis of the
process of design,
development, and
also
implementation
of mobile
applications in
addition to
experiences
gained during the
p
rocess;
applications were
intended to be
used within the
clinical
environment

In the filed of
medicine and
health care,
“User
-
Centered
Development
(UCD)” is a
necessary, but
not sufficient,
requirement in
planning for
“developing
mobile, cross
-
platform, an
d
future
-
proof
applications”

Holzinger et
al. 2008
(19)

Hospital nurses

N/A

Perspective;
based on
qualitative
study

To discuss on
practical issues
related to design
and
implementation
of a prototype
solution for
PDAs to help
nurses provide
“interactive
t
ransport work
lists”

Because the
PDA user
interface could
be customized
according to the
end
-
users’
needs, nurses
utilized the
PDA with no
more problems
in comparison
to usual desktop
interfaces

Khambati et
al. 2008
(20)

Systems and
infrastructures

N/A

Pe
rspective

To explain “a
novel prototype
environment for
visually modeling
health care plans”
and describe
“automated plan
and mobile
device
application code
generation”

Key challenges
occur because
health plans
need meta
-
models,
customization
for individua
l
patients and
supporting
mobile device
applications.
These have
huge effects on
Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


18

Author, Year

Target Group
(s)

Sample Size

Study Design

Objective

Main
Finding(s)

applications
engineering.

Laakko

et al.
2008
(21)

Systems and
infrastructures

N/A

Perspective

By demonstrating
usage in a Tele
-
ECG case as an
example in health
and wellness
a
rea, to develop
an interoperable
and user
-
friendly
mobile
application cost
-

and time
-

effectively; this
application tried
to promote
connectivity
between
professionals,
patients and
devices

The general
function of
Tele
-
ECG
platform was
shown. It can be
use
d as a
foundation for
other specific
applications.

Lee

et al. 2008
(22)

Systems and
infrastructures

N/A

Perspective;
based on
qualitative
study

By promoting
connectivity
between
professionals and
enabling them, to
offer an
environment for
development of
“personalized
mobile phone u
-
healthcare
applications” in
relation to
specific patient's
health and disease
condition

The suggested
environment
was helpful in
developing
“personalized
mobile u
-
healthcare
applications”
and it was quite
sufficient

Zhang

et a
l.
2008
(23)

Engineering
and health
science faculty
and students

N/A

Perspective;
based on
qualitative
study

To encourage
mobile
technology for
the development
of applications to
“collect, transmit,
analyze and store
health data” in an
inter
-
disciplinary
fashion

Natural sciences
and business
administration
are other fields
that can benefit
from the
expanded
version of this
experienced
model of mobile
technology in
healthcare. The
added value of
inter
-
disciplinary
approach lies in
its
Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


19

Author, Year

Target Group
(s)

Sample Size

Study Design

Objective

Main
Finding(s)

“revolutionary
learnin
g
environment”

Ahtinen

et al.
2009
(24)

Working
-
age
citizens

Not directly
specified

Qualitative
study

following a
before
-
after
clinical trial
with
interviews,
questionnaires
to assess user
experience,
supplemented
by actual logs
from mobile
applications
u
sage

To study three
mobile wellness
applications
named the
Wellness Diary,
Mobile Coach
and SeltRelax in
relation to these
criteria:
“usefulness,
perceived
usability, usage
habits and
motivational
factors”

After 2 months
of continued
use, practical
usage
habits
emerged. To
promote speedy
changes in
habits for long
-
term use of
future health
and wellness
applications,
“adaptability,
versatility,
guidance and
usability” must
be considered in
development
process

Breslauer

et
al. 2009
(25)

Light
microscopy for

Plasmodium
falciparum
and
Mycobacterium
tuberculosis

N/A

Before
-
after
trial

To demonstrate
the potential for
“mobile phone
-
mounted light
microscope” for
imaging of
P.
falciparum
-
infected and
sickle red blood
cells and also
M.
tuberculosis
-
infected sputum

samples in
fluorescence in a
real clinical
setting

This
telemedicine
system via
mobile phone
was inexpensive
especially when
coupled with
automated
image analysis.
Developing
countries (with
many rural
areas), can
benefit from
their extensive
mobile phone

infrastructure to
compensate for
scarcities of
laboratory
facilities.

Knobloch

et
al. 2009
(26)

Reconstructive
and plastic
surgeons

A 58
-
year
-
old woman

Case report

To help the
surgeon evaluate
microsurgical
flaps every hour
in the first 48
hours after
re
constructive
surgery by using
multimedia
messaging
(MMS) service to
After office
hours, this cell
phone
-
based
MMS proved its
feasibility and
accuracy in
giving more
comprehensive
postoperative
assessment of
th
e flap to the
Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


20

Author, Year

Target Group
(s)

Sample Size

Study Design

Objective

Main
Finding(s)

transfer images
taken by a mobile
phone camera

surgical
consultant

Poh

et al.
2009
(27)

Systems and
infrastructures

N/A

Case study; as
conference
proceedings

To develop and
evaluate wearable
sensor earphones
integrated with a
mobile platform
for easy
assessment of
cardiovascular
function

Preliminary
results indicated
the high degree
of accuracy of
this system at
rest (with an
average error of
0.63%)

Altini

et al.
2010
(28)

Systems and
infrastructures

N/A

Case study; as
conference
proceedings

To present a
Body Area
Network (BAN)
gateway t
o
promote
connectivity
between
professionals,
patients and
devices; using
Android mobile
phones for
applications
related to
ambulatory
electrocardiogram
(ECG)
monitoring

The software
architecture on
the mobile
phones enabled
data display,
processing or
sen
ding to a
remote server
by wireless
local area
network or 3
rd

generation
mobile
networks. The
system also
allowed to send
alerts
automatically by
SMS and email
based on
defined
thresholds for
measured
parameters

Boyer

et al.
2010
(29)

N/A

N/A

Narrative
re
view

For the benefit of
drug abusers and
HIV patients, to
explain mobile
technologies that
integrate personal
sensing with
wireless
connectivity to
help intervene in
risky behaviors

To improve
risky behaviors
in substance
abuse and
increase the
compliance
of
HIV patients to
anti
-
retroviral
therapy, this
new personal
sensing
technology
incorporated
into mobile
platforms has
great potential;
especially when
considering
Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


21

Author, Year

Target Group
(s)

Sample Size

Study Design

Objective

Main
Finding(s)

expansion of
clinic
-
based
interventions
and
understanding
“true behavior
modifications”

Gi
ridher

et al.
2010
(30)

N/A

N/A

Case study

To analyze 2
health
-
related
applications
(namely,
CalorieMeter and
Cheer Up) based
on Mobile Phone
Template
applications
ideology. This
ideology helps
“easy
transformation of
one application to
another and
support
s gaining
control over
regional
languages”

CalorieMeter
gave the
possibility of
keeping track of
day
-
by
-
day
calorie intakes;
Cheer Up
helped people
with depression
diagnose their
symptoms and
feelings, seek
(and curb the
stigma of asking
for)
psychological

help.

Template
Ideology helped
the applications
to become
independent
from age,
language, social,
educational, and
also regional
obstacles

Halko et al.
2010
(31)

Not directly
specified

240
participants

Cross
-
sectional

To explore the
inter
-
relationship
of

personality
types and
persuasive
technologies in
the context of
mobile
application
development for
health promotion

Significant
relationship
between
personality and
persuasive
technologies can
guide the
development of
mobile
applications

Meankaew

et
al.
2010
(32)

Malaria
patients and
malaria
healthcare
providers

534 malaria
patients

Before
-
after
clinical trial

Among an under
-
served
population, to
assess the
effectiveness of
integrating cell
-
phone use into a
routine malaria
prevention and
The “module for
disease and
treatment
monitoring of
malaria
(DTMM)”


as
part of the
routine malaria
prevention and
Mobile devices and applications for health; an exploratory review of the current evidence with public health persp
ective


22

Author, Year

Target Group
(s)

Sample Size

Study Design

Objective

Main
Finding(s)

control program
i
n order to
improve case
management

control program


was integrated
and functioned
successfully

Morris

et al.
2010
(33)

Employees at a
firm

8 participants

Cross
-
sectional

To examine the
potentials of
mobile phone
technologies to
broaden access to
cognitive
behavioral
therapy (CBT)
and to provide in
-
the
-
moment
support

For people who
may not have
easy access to
psychotherapies,
mobile phone
app
lications
hold promise for
delivering
access to state
-
of
-
the
-
art
therapies “in a
non
-
stigmatizing
fashion”

N/A: not applicable