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 study | Relationships | Fit | Visibility | Capability | Opportunity | Motivation |
| Lester et al 44 (Kenya) | Provision of support communication, Observation, Reminders | Weekly 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 applicable | If 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 actions | Health 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 information | Relationship 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 monitoring | Intervention 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. |