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Health programs, especially in low- and middle-income countries, have been integrating mHealth interventions at an unprecedented rate. There are now more than 1,000 mHealth products and services around the world, according to the GSMA mHealth Tracker. mHealth provides exciting opportunities for increasing access to health care for underserved populations. Consider that by the end of 2013, there were nearly 7 billion mobile subscriptions worldwide, with most of the growth in the past decade occurring in low- and middle-income countries.
One of the key articles in the current issue of Global Health: Science and Practice (GHSP) shows how mHealth interventions can transform the role of community health workers (CHWs) in the health system, from passive recipients of information with little influence to active information agents who seek and provide information to improve health services.
Campbell and colleagues synthesize K4Health’s experience of providing CHWs in Malawi with mobile phones and essential family planning/reproductive health and HIV/AIDS information to strengthen knowledge exchange. The project used an innovative participatory evaluation method called Net-Map to evaluate the mobile phone initiative. At baseline and endline, CHWs and district health personnel discussed information needs and gaps and the roles of different actors in their information networks. They depicted these linkages and levels of influence on 3-dimensional maps. Before the mobile phone intervention, CHWs were not mentioned as actors in the information network and had virtually no influence in the network. After the mobile phone intervention, CHWs appeared on the maps as both recipients and providers of information, with significant connections to colleagues, beneficiaries, supervisors, and district health facilities. In addition to improving knowledge exchange, the mobile phone intervention also had direct effects on the use of the health services, for example, by reducing commodity stockouts.
The current GHSP issue also provides answers to whether SMS versus voice messaging is more successful in delivering health information through mobile phones. Crawford et al. tested the two modes to deliver maternal, neonatal, and child health information to pregnant women and caregivers of children under one, as well as a third alternative of delivering voice messages to a “community” phone for people who didn’t own a personal mobile phone. Delivery success—and intended or actual behavior change—was highest among SMS subscribers. But providing the different delivery modes—namely, voice messaging retrieved through community phones—provided more people in the community with access to the intervention who otherwise would not have been able to benefit from the mHealth intervention.
These articles contribute to the evidence base and learning around mHealth, but a big debate in the field is how to move successful pilots to scale. Is formal intervention research needed? While formal research definitely has a role to play, an editorial from GHSP argues that such research might take too long to carry out in a field where technology changes so rapidly and situations vary so widely. The editorial champions a “diffusion of innovation” model to promote successful mHealth interventions in this rapidly changing field. Such a model allows knowledge of successful innovations to diffuse swiftly through less formal channels, with people adapting the innovations to their specific situations.
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We are also accepting submissions for our second volume. Read our Instructions for Authors and submit your manuscripts for consideration. Unlike other journals, there are no fees to submit or publish your articles in GHSP. In addition, we focus on publishing articles with practical, program-implementation experiences with details on how activities were actually conducted—the kind of implementation detail that most other journals tend to shy away from.