Mobile health interventions for HIV/STI prevention among youth in low- and middle-income countries (LMICs): a systematic review of studies reporting implementation outcomes

Abstract Background Advances and proliferation of technologies such as mobile phones may provide opportunities to improve access to HIV/STI services and reach young people with high risk for HIV and STI. However, the reach, uptake, and sustainability of mobile health (mHealth) HIV/STI interventions targeting young people aged 10–24 years in low- and middle-income countries (LMICs) are largely unknown. To address this gap and to inform implementation science research, a review was conducted to summarize what is known, and what we need to know about implementing mhealth interventions for HIV/STI prevention targeting young people in LMICs. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this review. Drawing upon Proctor’s eight implementation outcome measures, we evaluated the acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability of m-health HIV/STI interventions targeting young people in LMICs. The search was performed from September 2020–January 2021 and updated on March 1, 2021, in Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, SCOPUS, Global Health, and Web of Science. Eligible studies were required to include an HIV/STI prevention outcome, target young people aged 10–24 years, include a comparison/control group, and reporting of atleast one implementation outcome as outlined by Proctor. Results A total of 1386 articles were located, and their titles and abstracts were screened. Of these, 57 full-text articles were reviewed and subsequently, and 11 articles representing 6 unique interventions were included in the systematic review. Acceptability 6 (100%), appropriateness 6 (100%), and feasibility 5(83%) were the most frequently evaluated implementation outcomes. Adoption 2 (33%), fidelity 1 (17%), and cost 1 (17%) were rarely reported; penetration and sustainability were not reported. Conclusions This review contributes to implementation science literature by synthesizing key implementation outcomes of mHealth HIV/STI interventions targeting young people in LMICs. Future research is needed on m-health HIV/STI implementation outcomes, particularly the penetration, cost, and long-term sustainability of these interventions. Doing so will enhance the field’s understanding of the mechanisms by which these interventions lead or do not lead to changes in high HIV/STI risk and vulnerability among young people in LMICs.

Download Full-text

The Impact of Cash Transfers on Mental Health in Children and Young People in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3742275 ◽

2020 ◽

Author(s):

Annie Zimmerman ◽

Emily Garman ◽

Mauricio Avendano ◽

Ricardo Araya ◽

Sara Evans-Lacko ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Young People ◽

Meta Analysis ◽

Cash Transfers ◽

Middle Income ◽

Children And Young People ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

Download Full-text

A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries

BMC Public Health ◽

10.1186/1471-2458-13-835 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 153

Author(s):

Margaret M Barry ◽

Aleisha M Clarke ◽

Rachel Jenkins ◽

Vikram Patel

Keyword(s):

Mental Health ◽

Systematic Review ◽

Health Promotion ◽

Young People ◽

Mental Health Promotion ◽

Middle Income ◽

Middle Income Countries ◽

Health Promotion Interventions ◽

Low And Middle Income

Download Full-text

Implementation outcomes of policy and programme innovations to prevent obstetric haemorrhage in low- and middle-income countries: a systematic review

Health Policy and Planning ◽

10.1093/heapol/czaa074 ◽

2020 ◽

Author(s):

Nessa Ryan ◽

Dorice Vieira ◽

Dena Goffman ◽

Evan M Bloch ◽

Godwin O Akaba ◽

...

Keyword(s):

Systematic Review ◽

Implementation Strategies ◽

Skills Training ◽

Practical Implementation ◽

Middle Income ◽

Middle Income Countries ◽

Implementation Outcomes ◽

Obstetric Haemorrhage ◽

Prevention Programmes ◽

Low And Middle Income

Abstract Globally, obstetric haemorrhage (OH) remains the leading cause of maternal mortality. Much of the associated mortality is ascribed to challenges surrounding deployment of innovations rather than lack of availability. In low- and middle-income countries (LMICs), where the burden is highest, there is a growing interest in implementation research as a means to bridge the ‘know–do’ gap between proven interventions and their reliable implementation at scale. In this systematic review, we identified and synthesized qualitative and quantitative data across the implementation outcomes of OH prevention innovations in LMICs using a taxonomy developed by Proctor et al. We also identified service outcomes for the included innovations, as well as implementation strategies and implementation facilitators and barriers. Eligible studies were empirical, focused on the implementation of OH prevention programmes or policies and occurred in an LMIC. Eight databases were searched. Two authors independently assessed studies for selection and extracted data; the first author resolved discrepancies. Narrative synthesis was used to analyse and interpret the findings. Studies were predominantly focused in Africa and on primary prevention. Interventions included prophylactic use of uterotonics (n = 7), clinical provider skills training (n = 4) and provision of clinical guidelines (n = 1); some (n = 3) were also part of a multi-component quality improvement bundle. Various barriers were reported, including challenges among intervention beneficiaries, providers and within the health system; however, studies reported the development and testing of practical implementation solutions. These included training and monitoring of implementers, community and stakeholder engagement and guidance by external mentors. Some studies linked successful delivery to implementation outcomes, most commonly adoption and acceptability, but also feasibility, penetration and sustainability. Findings suggest that innovations to prevent OH can be acceptable, appropriate and feasible in LMIC settings; however, more research is needed to better evaluate these and other under-reported implementation outcomes.

Download Full-text

What role do mHealth interventions play in changing gender relations? A systematic review of qualitative findings. (Preprint)

10.2196/preprints.32330 ◽

2021 ◽

Author(s):

Elizabeth K Kirkwood ◽

Caitlin Clymer ◽

Kheminda Imbulana ◽

Sumaya Mozumder ◽

Michael John Dibley ◽

...

Keyword(s):

Systematic Review ◽

Mobile Technology ◽

Mobile Health ◽

Gender Relations ◽

Health Interventions ◽

Middle Income ◽

Mhealth Intervention ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

BACKGROUND The rapid, widespread growth of mobile technologies, in low-and-middle-income countries, can offer groundbreaking ways to disseminate public health interventions. However, gender-based inequalities present a challenge for women to access mobile technology. Research has shown that mHealth interventions can impact gender relations in positive and negative ways, yet few mHealth programs use a gender sensitive lens when designing, implementing, or analyzing programs. OBJECTIVE This systematic review aims to identify and summarize the findings of qualitative research studies which explore the impact of mobile health interventions on gender relations as a result of participating in such initiatives in low-and-middle income countries. METHODS We performed a systematic literature review to examines empirical evidence of changes in gender relations attributed to their participation in an mHealth intervention in a low-and-middle income country. Peer-reviewed articles included needed to evaluate an mHealth intervention and were published between 2013 and 2020. Articles were excluded that used mHealth that solely targeted health workers, did not assess a specific intervention or used mobile technology for data collection only or were formative or exploratory in nature. The search terms were entered into four key electronic databases, Medline, Excerpta Médica Database (EMBASE), PsycINFO, and Scopus generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report themes emerged from our data. RESULTS From the 578 full text articles retrieved, fourteen articles were eligible for inclusion. None of the articles appraised gender from the outset. Articles uncovered findings on gender relations through the course of the intervention or post program evaluation. Most studies took place in Sub-Saharan Africa with the remainder in South and South East Asia. Articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found mHealth programs could enhance spousal communication, foster emotional support between couples, improve women’s self-efficacy and autonomy in seeking health information and services, and increase involvement in health-related decision making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision makers and exacerbating relationship problems. CONCLUSIONS These results suggest given the rapid, persistent upscale of mobile health interventions in low-and-middle income settings, it is imperative to design interventions that consider the impact they may have on power dynamics and gender relations. Future research is needed to fill evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and need to actively participate and be empowered by mHealth interventions. CLINICALTRIAL The systematic review is registered with Prospero (CRD42021218001)

Download Full-text