title: Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review.
abstract: OBJECTIVE
  Given the large-scale adoption and deployment of mobile phones by health services and frontline health workers (FHW), we aimed to review and synthesise the evidence on the feasibility and effectiveness of mobile-based services for healthcare delivery.
  
  
  METHODS
  Five databases - MEDLINE, EMBASE, Global Health, Google Scholar and Scopus - were systematically searched for relevant peer-reviewed articles published between 2000 and 2013. Data were extracted and synthesised across three themes as follows: feasibility of use of mobile tools by FHWs, training required for adoption of mobile tools and effectiveness of such interventions.
  
  
  RESULTS
  Forty-two studies were included in this review. With adequate training, FHWs were able to use mobile phones to enhance various aspects of their work activities. Training of FHWs to use mobile phones for healthcare delivery ranged from a few hours to about 1 week. Five key thematic areas for the use of mobile phones by FHWs were identified as follows: data collection and reporting, training and decision support, emergency referrals, work planning through alerts and reminders, and improved supervision of and communication between healthcare workers. Findings suggest that mobile based data collection improves promptness of data collection, reduces error rates and improves data completeness. Two methodologically robust studies suggest that regular access to health information via SMS or mobile-based decision-support systems may improve the adherence of the FHWs to treatment algorithms. The evidence on the effectiveness of the other approaches was largely descriptive and inconclusive.
  
  
  CONCLUSIONS
  Use of mHealth strategies by FHWs might offer some promising approaches to improving healthcare delivery; however, the evidence on the effectiveness of such strategies on healthcare outcomes is insufficient.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Johns Hopkins Global mHealth Initiative, Baltimore, MD, USA.
authors.forename: Smisha
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Henry B
authors.initials: HB
authors.lastname: Perry
authors.affiliation: mPowering Frontline Health Workers, mPowering Frontline Health Workers, Washington, D.C.
authors.forename: Lesley-Anne
authors.initials: LA
authors.lastname: Long
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Johns Hopkins Global mHealth Initiative, Baltimore, MD, USA.
authors.forename: Alain B
authors.initials: AB
authors.lastname: Labrique
mesh_terms: D040421:Cell Phone; D003153:Community Health Services; D020000:Decision Support Systems, Clinical; D003695:Delivery of Health Care / Q000379:methods*; D003906:Developing Countries; D006282:Health Personnel / Q000193:education*; D006801:Humans; D017216:Telemedicine; D060145:Text Messaging
keywords: agents de santé communautaires; community health workers; health personnel; mHealth; mobile health; personal sanitario; personnel de santé; salud móvil; santé mobile; trabajadores sanitarios comunitarios