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mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review
  1. Jocelyn Anstey Watkins1,
  2. Jane Goudge2,
  3. Francesc Xavier Gómez-Olivé3,
  4. Caroline Huxley1,
  5. Katherine Dodd1,
  6. Frances Griffiths1,2
  1. 1 Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
  2. 2 Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  3. 3 MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Jocelyn Anstey Watkins; jotawatkins{at}


Background Routine monitoring by patients and healthcare providers to manage chronic disease is vital, though this can be challenging in low-resourced health systems. Mobile health (mHealth) has been proposed as one way to improve management of chronic diseases. Past mHealth reviews have proposed the need for a greater understanding around how the theoretical constructs in mHealth interventions actually work. In response, we synthesised evidence from primary studies on monitoring of chronic diseases using two-way digital text or voice communication between a patient and health worker. We did this in order to understand the important considerations for the design of mHealth interventions.

Method Articles retrieved were systematically screened and analysed to elicit explanations of mHealth monitoring interventions. These explanations were consolidated into programme theory and compared with existing theory and frameworks. We identified variation in outcomes to understand how context moderates the outcome.

Results Four articles were identified—monitoring of hypertension and HIV/AIDS from: Kenya, Pakistan, Honduras and Mexico and South Africa. Six components were found in all four interventions: reminders, patient observation of health state, motivational education/advice, provision of support communication, targeted actions and praise and encouragement. Intervention components were mapped to existing frameworks and theory. Variation in outcome identified in subgroup analysis suggests greater impact is achieved with certain patient groups, such as those with low literacy, those with stressful life events or those early in the disease trajectory. There was no other evidence in the included studies of the effect of context on the intervention and outcome.

Conclusion mHealth interventions for monitoring chronic disease in low-resource settings, based on existing frameworks and theory, can be effective. A match between what the intervention provides and the needs or social factors relevant to specific patient group increases the effect. It was not possible to understand the impact of context on intervention and outcome beyond these patient-level measures as no evidence was provided in the study reports.

  • systematic review
  • health systems

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  • Handling editor Valery Ridde

  • Contributors JAW led the review, the analysis and drafted the paper with support throughout from FG, who also helped define the scope of the review. CH assisted with methodological expertise at the start of the review. JG and FXG-O read various iterations during the review process, giving guidance and advice. KD quality checked the extracted data. All authors provided feedback on the drafts and read and approved the final manuscript.

  • Funding This review contributed to a PhD thesis called ‘The Vutivi study’ (, fully funded by the UK’s Economic and Social Research Council (ESRC ES/J500203/1). GE Healthcare Ltd. contributed funding towards research fieldwork costs for the Vutivi Study and played no role in shaping the research for the PhD.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data will be made available on request.