Table 3

Intervention components described in relation to established theory in all four included empirical studies on mHealth in Kenya, South Africa, Honduras and Mexico and Pakistan

Components of the interventionExample to explain the intervention components from study interventionsEstablished theory that relates to one of more of the intervention componentsTypes of intervention components used by each study author in the design of their mHealth intervention
Form of communication

  1. Two-way communication

  2. Whether the communication and response from the health system is automated or not (is there a real person engaging with the patient)

  3. Importance of personal contact for motivation and support

This two-way communication which is automated or not may enable the provision of support. Support is the content which flows through the channel of communication and is separate from type of communication.
Patient receives tailored digital counselling and feedback after submitting clinical measurements. This enables the establishment of a relationship with health worker and increases the access to the support.
The text message or voice call motivates the patient by informing them to eat more vegetables or reduce salt intake. The desire to carry out the behaviour change or adherence to treatment motivated by their beliefs, expectations and feelings.

  1. Health Communication Theory/Access Framework 62: whereby using mHealth enhances access to support from a health worker.

  2. Information-Motivation-Strategy Model 63: whereby adherence to treatment requires patients to have (1)Information, (2) Motivation and (3) Strategies to adhere to treatment giving the patient the incentive to behave appropriately and according to their regimen.

  3. Theory of Interpersonal Relationships 64: whereby interpersonal interactions between the patient and the health worker can help with task engagement. This theory seeks to understand which characteristics strengthen the bonds between people, encourage empathy and trust and create a sense of well-being after a close interaction to influence human motivation. The stronger the motivation, the stronger the relationship becomes, because empathy and care can derive from the interpersonal processes.

 Two-way communication: Kamal, Lester, Piette, Bobrow
Automated: Bobrow, Kamal
Real person: Lester, Piette
Activities that communication channel is used for:

  1. Observation

  2. Providing information

 Observation: Patient is observed indirectly and must regularly send clinical readings. If the patient is being observed this acts as persuasion to maintain monitoring as they are now accountable to someone.
Information: The text message or voice call contains disease-specific information aimed at increasing knowledge. Increasing patient knowledge through mobile information reminder or learning messages through recommendations.

  1. Communication for Persuasion 65: whereby the patient can be persuaded by a role model whim they feel accountable to.

  2. Health Belief Model 66: whereby a patient needs sufficient motivation to make the health issue relevant, the belief it is a serious problem and to follow a recommendation to reduce that threat.

 Observation: Lester, Piette
Different types of information

  1. Reminders

  2. Education/advice

  3. Targeted actions

  4. Praise and encouragement

 Reminders: Reminder messages to attend clinic appointments to improve retention to care.
Reminder messages to take medication to increase adherence.
Reminder can act as a cue to action to stimulate the patient into action.
Reminders can help to reinforce the patients’ thoughts and feelings that lead to their decisions (attitude towards behaviour).
Education/advice: If a patient listens to educational advice given by a health professional via text or voice, it is possible that if the patient is capable of understanding what they have read or heard, they can then follow the advice to change their behaviour.
Targeted actions: Digital mobile decision-support is likely to aid the accomplishment of goals. Setting a goal such as taking medication or observing a mood state.
Praise and encouragement: The text message or voice call is intended to promote good healthily behaviour and making the patient feel optimistic ’You are doing well'. If a patient receives a call or message about adopting a healthy lifestyle, this promotes a behavioural change.

  1. Theory of Planned Behaviour 67: whereby the patient is made aware of their thoughts and feelings that lead to decisions.

  2. Cognitive Load Theory 68: whereby the demands of a certain task on the patient accounts for their own beliefs, expectations and goals on their own load perceptions.

  3. Goal Setting Theory 69: whereby the difficulty of the task is mediated because the patient is working towards a goal. Feedback is also useful.

  4. Self-Regulation Theory 70: whereby attitude change can result when the patient realises and observes their own behaviours, which can include monitoring their mood.

 Reminders: Kamal, Lester, Piette, Bobrow
Education/advice: Piette, Kamal
Provision of support communication: Lester
Targeted actions: Bobrow
Praise and encouragement: Kamal