Table 4

Mechanisms of change (RFV and COM-B mechanisms) evident in all four included empirical studies on mHealth in Kenya, South Africa, Honduras and Mexico and Pakistan

RFV and
COM-B mechanisms by study author
Intervention components used in each studyRelationshipsFitVisibilityCapabilityOpportunityMotivation
Lester et al 44 (Kenya)Provision of support communication, Observation, RemindersWeekly communication between patient and nurse. Importance of personal contact for motivation.Text message support service and reminder message as addition to everyday routine with patients who were already phone users.Receiving the reminder to self-report adherence to HIV treatment increases the awareness of the disease.Not applicableIf illiterate, the HIV patient must be assisted by literate partner (if willing to disclose their status/and that they are on long term treatment). Respond with that they are doing well or have a problem to the nurses.Regular communication with health worker motivates patient to remember to take their treatment and keep on top of their disease.
Bobrow et al 45 (South Africa)Reminders, Targeted actionsHealth worker relationship with patient. Just by receiving the message gives the patient feeling someone cares.Text message as additional reminder system. Function to reschedule appointment automatically via free return text message.Follow adherence advice from the text message. Text message increased disease awareness, provided tips for health and helped to develop and reinforce more robust reminder systems.As above—be comfortable with the technology to access and read text- messages.Opportunity to make changes to clinic times.Motivation to read the content of the messages and act on it: adhere.
Piette et al 43 (Honduras and Mexico)Observation, Reminders, Motivating education/advice informationRelationship between patient and the kit sent to the health worker.Fits into their everyday lives because the kit is at home and is purposely intended for this intervention.It requires logging blood pressure every day, so it is very regular and this interaction makes the hypertension visible in the person’s life.The person needs to understand how to use the new technology in their home and the confidence to use the kit and keep using it. They must buy-in to why it is helping them to self-manage.Allows for the opportunity for social support and a choice to actually receive the support.Motivates person to reduce salt intake— powerful messages related to behaviours change.
Kamal et al 42 (Pakistan)Reminders, Motivating education/advice information,
Praise and encouragement
Patient must respond to the health worker to inform them they have taken their medication. Patient receives timely, customised messages.The response is yes or no, so is quick and will not take much of the patient’s time.By having to take the medication and then action this by sending a message, it creates disease visibility. The information messages ‘take two servings of fruit’ encourage the patient to make healthy choices since they are managing/preventing future strokes.The patient must have the capability to respond to the cue to action.The patient must have the opportunity to reply including the comprehension or social support.The patient must have the motivation to respond to the health worker each day.
Summary of mechanisms that fire to cause/enable change and patient’s engagement in chronic disease monitoringIntervention must allow for a relationship to form between the patient and the health worker to produce motivation.Intervention must fit well in the patient’s life and their individual needs.Intervention makes the disease visible.Patient need personal capability to respond to the mechanisms of change.Patient is offered the opportunity for support which may motivate them.Patient needs motivation to self-monitor.