Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis

What is the aim of this review?

The aim of this Cochrane Review of qualitative research was to explore how health workers view and experience the use of mobile phones and tablets when delivering primary healthcare services. To answer this, we analysed 43 studies about health workers' views and experiences of mobile health (mHealth) programmes.

Key messages

Health workers welcomed the benefits of mHealth, and described how they used mobile phones to improve their work and relationships with each other and with clients. However, they also experienced challenges, including poor network coverage and access to electricity. People implementing mHealth programmes should try to address these challenges and build on health workers' positive experiences.

What was studied in this review?

Health workers often use mobile phones and tablets to provide services. It is important to understand what health workers think about these devices, as this can affect the quality of services. We looked for studies that explored health workers' views and experiences of using mobile devices in primary care.

What are the main findings of this review?

We sampled 43 of the 53 included studies in this review. Most were from low‐ or middle‐income countries, and included both lay health workers and health professionals. Many used mobile phones or tablets when delivering health care to mothers, children or newborns. Many of the mobile devices had software that helped health workers follow the correct steps when providing services. Health workers also used mobile phones to communicate with clients, and to record clients' health information.

We have moderate or high confidence in the following findings.

mHealth changed how health workers worked with each other : health workers appreciated being more connected to colleagues, and thought that this improved co‐ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face‐to‐face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching".

mHealth changed how health workers delivered care : health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult‐to‐reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but others saw mHealth as creating more work.

mHealth led to new forms of engagement and relationships with clients and communities : health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face‐to‐face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones.

Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity : some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user‐friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges.

How up‐to‐date is this review?

We searched for studies published up to January 2018.