Assessing mHealth: Opportunities and Barriers to Patient Engagement

mHealth—the practice of medicine and public health through the use of mobile devices—presents an opportunity to revolutionize the health care system both in the U.S. and globally. Cell phones, tablet computers, and other wireless devices all play a role in shaping mHealth. mHealth is often presented as a low-cost option for increasing communication between patients and providers, including the sharing of data—also referred to as patient health information (PHI)—and the integration of monitoring devices to achieve broad population health benefits and the potential to decrease or mitigate rising health care costs.¹ There is currently limited evidence about how well and under what circumstances mobile phones (and other mobile/wireless devices) compare with or enhance current means to improve health and health care.² Despite a lack of robust empirical evidence, a number of programs throughout the world and the United States have embraced the mobile device as a platform to engage and educate patients, especially in populations where medical afflictions occur in disparate proportion to the rest of society. These programs, which use short message service (SMS or texting) to share information, are only now being assessed for efficacy in reaching certain disparate populations and for how they can be integrated into the contemporary health care system. A number of polices are already in place to engage and reduce disparities and some of these provide important opportunities to leverage the power of mHealth to achieve their objectives. However, as technologies continue to rapidly evolve, policymakers, clinicians, and academics are lagging further behind the technology curve in assessing the potential of these new technologies to reduce disparities through increased empowerment via education or engagement and improved health outcomes.

International mHealth development has focused primarily on engaging rural populations through cellular phones. Mobile devices provide the ability to share information quickly and without the need for additional robust infrastructure. In addition, mobile technologies promise to allow for more care in rural communities through communication with remote providers and through education of the layperson on basic care techniques. The majority of these initiatives aim to improve population health based on simple texts or SMS.

The advent of smartphones has provided an avenue into a wide assortment of households. Among the most used technologies used is the SMS text, developed in 1984 and utilized by physicians for decades for communication regarding patient maters. Despite a long history of use by physicians, SMS texts are only now being assessed as an effective tool for direct patient engagement. There are also a number of application- (or app-) based software interventions aimed at using advanced mobile devices to engage, educate, or inform patients or caregivers. While there is an increased cost associated with using smartphones as a platform, these devices are gaining market share among disparate populations or communities of color.³ There are a number of opportunities to analyze existing policies to promote population health and decrease care disparities and find ways to improve them through inclusion of mobile technology. There is an urgent need to assess quickly and appropriately mHealth technologies to ensure that new technologies are incorporated in a cost-effective, evidence-based manner with patients across all populations.

Access

The prevalence of mobile devices is a key factor to their attractiveness as platforms to educate and engage low-income or rural families. As of 2009, 90% of the world’s population had access to a cell phone signal and there were over 4 billion cell phone subscriptions worldwide, with adoption growing rapidly in developing countries.⁴ Access to technology has remained an important component of international development theory⁵ and improved health care outcomes.⁶ Therefore, the effective and efficient use of health IT (HIT)—a term that encompass both mHealth and non-mHealth-related technologies—remains a vital tool in achieving the goals of health care reform to increase health care access, to improve care delivery, to engage in culturally competent outreach and education, and to enhance workforce development and training.⁷ As with almost every technology, concerns also...