mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review.
mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review.
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DOI：
10.2196/mhealth.7185
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发表时间：
2017-03-23
影响因子：
5
通讯作者：
Zweekhorst, Marjolein
中科院分区：
文献类型：
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作者：
Adepoju, Ibukun-Oluwa Omolade;Albersen, Bregje Joanna Antonia;Zweekhorst, Marjolein
背景：为了在资源贫乏的环境中提供高质量的医疗服务，移动医疗（mHealth）正越来越多地被采用。例如，在资源丰富的环境中确立了移动医疗通过数据收集、决策算法和循证指南促进循证临床决策的作用。然而，移动临床决策支持系统（mCDSS）在诸如非洲等资源贫乏地区的具体采用程度以及在这些地区使用这些系统的经验教训还有待确定。目的：本研究的目的是综合非洲卫生保健工作者在护理点决策支持和提高护理质量方面使用移动医疗的证据。方法：对4个同行评议文献数据库和1个灰色文献数据库进行范围综述。没有日期限制，但只选择英文文章。使用预先建立的标准，2名审稿人筛选文章并提取数据。使用Microsoft Excel和MAXQDA对文章进行分析。结果：我们保留了22篇文章，代表了7个撒哈拉以南非洲国家的11项不同研究。干预措施主要在产妇保健领域，范围从简单的短信到复杂的多部分干预措施。虽然卫生工作者普遍支持mCDSS，并认为它们是有用的，但对工作量增加和工作流程改变的担忧阻碍了可持续性。促进和阻碍mCDSS使用的因素包括技术和基础设施支持、所有权、卫生系统挑战和培训。结论：mCDSS在撒哈拉以南非洲的使用表明移动医疗取得了进展，尽管其对服务提供质量的影响尚未得到充分探索。吸取的经验教训有助于为未来的研究、政策和实践提供信息，以促进技术支持的卫生保健服务，特别是在资源贫乏的环境中。
BACKGROUND: In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established.OBJECTIVE: The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa.METHODS: A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA.RESULTS: We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training.CONCLUSIONS: The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings.