Mobile health

# Overview
Mobile health, also called mHealth, is a component of eHealth. To date, no standardized definition of mHealth has been established...the Global Observatory for eHealth (GOe) defined mHealth or mobile health as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices. mHealth involves the use and capitalization on a mobile phones core utility of voice and short messaging service (SMS) as well as more complex functionalities and applications including general packet radio service (GPRS), third and fourth generation mobile telecommunications (3G and 4G systems), global positioning system (GPS), and Bluetooth technology.
In an age where technology plays a significant role in all aspects of our lives, it seems reasonable to believe that mHealth will become an integral part of our healthcare.
One observational study showed that the vast majority of the patients have a smartphone and have an interest in utilizing it to improve their health, even in a population with lower socioeconomic status where access may be of concern.
A possible limitation is accuracy of the accelerometer of smartphones to estimate energy expenditure by the wearer.
Usability and functionality of apps has been questioned.
Effectiveness may be helped by gamification.

# Effectiveness
Complex trials are being started.

## Patient compliance
Regarding medication compliance:
Mobile phone strategies may or may not improve medicine adherence:
- Regarding primary prevention of cardiovascular disease, mobile phone-based interventions have low-quality evidence of increasing compliance with medications
- Regarding medication adherence, text messaging approximately doubles the odds of adherence according to a meta analysis of 16 randomized control trials of patients with chronic disease. The review concluded that this intervention improved adherence rates from 50% to 67.8% or an absolute increase of 17.8%.  More recent trails confirm benefit.
- Regarding physical activity, a 2018 proof of concept randomized controlled trial found fitness trackers target behavioral changes to including goal setting, and social support and comparison as motivators within the concept of social cognitive therapy allowing planning, problem solving and behavioral practice.  Counseling with motivational interviewing is necessary in addition to the fitness tracker to increase behaviors. These results are similar to a prior systematic review of overweight people.

## Patient engagement
mHealth may increase patient engagement. One prospective randomized control trial found that the participants utilizing a mobile application to track their chronic disease had improvement in health self-management as compared to the the control participants who were not utilizing a mobile application.

## Patient outcomes
There is not yet strong evidence that mobile phone messaging interventions improve health outcomes, but they may improve a patients ability to self-manage their disease.
- A Cochrane Review published in 2012 of four studies that utilized mobile phone messaging interventions in the management of chronic diseases (diabetes mellitus, hypertension, and asthma) demonstrated that there was no significant difference in glycemic control, blood pressure control or FVC/FEV1 values between intervention and control groups. The reviewed study that focused on asthma did however find that there was a significant difference in the pooled asthma symptom score, favoring the text messaging intervention over usual care. All four reviewed studies showed evidence of either improved disease self-monitoring or better medication adherence with the utilization of mobile phone messaging interventions.
Regarding coronary artery disease, a randomized controlled trial found reduction of risk factors associated with using mobile health.
Regarding hypertension, a randomized controlled trial found no benefit.
Meta-analyses published in 2019, including a review of randomized trials published through May, 2017 and an AHRQ technical brief of any study design published through July, 2017 found benefit from mHealth when augmented by health care providers or study personnel,
- A trial omitted from the above reviews also found greater hemoglobin A1c decline.
- A ore recent trail also found reduction in HbA1c

### Physical activity
mHealth increases physical activity per a systematic review in 2020 and earlier in 2016. Text messaging may give short term improvement.
Performance feedback provided from mobile devices about progress towards goals may increase motivation according to trials and reviews.

### Weight loss and obesity
A systematic review for the Community Guide found that electronic activity monitors increase physical activity.
Regarding MyFitnessPal, a randomized control trial in 2014 of 212 patients with a body mass index >25 kg/m^2 aimed at evaluating the efficacy of the application MyFitnessPal for weight loss in the primary care setting demonstrated that the application did not result in increased weight loss compared to usual care. Although it must be noted that most participants didnt use the application after the first month of the study; 94 participants logged on in the first month compared to only 34 in the sixth month. A second randomized controlled trial was also negative.
A pilot randomized control trial in 2013 found that a smartphone app may improve adherence and total weight loss after 6 months when compared to a website monitoring group. 128 overweight individuals were randomized to receive a weight management intervention delivered by smartphone app, website, or paper diary. The smartphone app intervention, My Meal Mate (MMM), was developed by the research team using an evidence-based behavioral approach.
- Trial retention was 93% in the smartphone group, 55% in the website group, and 53% in the paper diary group at 6 months.
- Adherence means were 92 days in the smartphone group, 35 days in the website group, and 29 days in the paper diary group.
- Mean weight loss and BMI reduction, respectively, at 6 months were -4.6 kg and -1.6 kg/m2 in the smartphone group, -2.9 kg and -1.0 kg/m2 in the paper diary group, and -1.3 kg and -0.5 kg/m2 in the website group.

# Diagnostic assistance
A smartphone camera may be able to use photoplethysmography to detect atrial fibrillation according to initial research.