Mobile Health (mHealth) in the Developing World: Two Decades of Progress or Retrogression

Mobile healthcare, or mHealth, is one of the key pillars of information and communication technologies for healthcare that consists of telemedicine, telehealth, eHealth, and mHealth. In the past two decades, mobile health has become a transformative concept for healthcare delivery innovations on a global scale. The success was based on the market-driven strategies that utilised the advances in mobile communications, computing, and sensor technologies, especially in recent years. Those market-driven mobile health systems were also closely associated with the global proliferation of smartphones, and based on the correlated usage principle of the smartphone applications for healthcare and wellbeing. However, the global commercial success of the smartphone-based mHealth model was not widely translated into successful scaled-up and tangible healthcare benefits, especially in low- and-middle income countries, compared to the consumer mobile health markets. The numerous healthcare challenges in the developing world remained largely untackled by the existing mobile health systems and models. The much-hyped transformative benefits of these systems remain largely unfulfilled. For two decades since the inception of this concept, the majority of the population in resource-limited healthcare settings still remain in poorer health and live in worsened conditions, with limited if any access to basic healthcare services. The much-hyped mobile health services that promised transforming these fragile and limited healthcare conditions, did not come to wider fruition globally. The COVID-19 pandemic, with its devastating human and economic impact worsened this status. An overview of the origin and the basic principles of mobile health, its current landscape and status in the developing world is presented. The impact of the smartphone-centric model that dominated the landscape of mobile health systems in these countries is discussed, and a critical view on the limitation of this mobile health model adopted widely in these settings is provided.

COVID-19 as a Catalyst for Telehealth Growth in India: Some Insights

Telehealth is being rapidly embraced to deal with the COVID-19 health crisis across the world. Despite being a biggest exporter of software services, India has not been a big adopter of telehealth. However, the COVID-19 pandemic has compelled the Indian government to assess the current assets and facilitate the establishment and use of telehealth throughout the country. Different telehealth initiatives are being undertaken in the existing public and private healthcare institutions and patients are increasingly embracing the services. We briefly highlight the potential role played by the start-ups in addressing the challenges.

Citizens Participating in their Healthcare – Challenges for Nurses

In Finland, health and welfare is taken care under the common health and social services system that consists of independent private, public and third sector actors. Through taxation, municipalities finance most of the healthcare and the government provides additional support. Functionality and effectiveness of the overall system is vitally important to guarantee today’s good healthcare services. For instance, in social services and healthcare, digital health supports the quality of life, care, dignity and sovereignty. The necessary technology is equally, fairly and easily accessible due to the widespread technological infrastructure. For example, in healthcare, use of technology is agreed with the citizen when preparing the healthcare service plan. The documentation of patient data is carried out virtually at all levels of care. Technology offers options that can paradoxically mean both freedom and slavery depending on how and where technology is used, and who has the right to use it. Furthermore, the digital divide has narrowed, but it still exists. Due to the ageing of people, there is a growing need for healthcare staff who are digitally knowledgeable in order to support citizens and their families in health issues. When studying different digital health related strategies from 1995 to 2020, the vital role of healthcare staff is recognised and their technological competence and skills need to be updated along with the development of technology. During the last decade, in the latest strategies, the role of the citizen as a key part of the healthcare service chain has grown significantly. Simultaneously, the development of a digital society offers possibilities to participate and the advanced digital expertise of citizens promotes their participation in healthcare. In principle, everyone has possibilities to access health data and gather health related data via Internet databases. This article discusses the elements of citizen or patient and nurse interactions, and how and whether this challenges nurses.

Predicting the Future of Healthcare and eHealth with the Futures Wheel Method

By using information and communication technology (ICT), eHealth is a key enabler in improving healthcare, specifically its efficiency, productivity, quality, and patient satisfaction. Whilst eHealth applies technical developments to healthcare services, it is also about managing, finding, using, recording, and transmitting information to support health-related decisions. Moreover, eHealth encompasses a broad approach and commitment to improving healthcare through networking and co-operation. Thus healthcare providers need to have sufficient tools to predict and involve the possible futures of healthcare, specifically in the context of continuous eHealth development, implementation and innovations. This paper introduces the Futures Wheel (FW) method, describes the process for its use and some of its outcomes as a tool by which to achieve these goals. Based on experiences from over 60 FW working groups, the authors suggest that the FW method helps to see the possible futures of healthcare and eases the necessary adaptation inherent in eHealth. The FW method provides information and knowledge that professionals can utilise both to influence their future and to gain knowledge about alternative futures. The FW method is suggested for healthcare professionals who want to predict alternative futures of healthcare and eHealth in order to make important decisions that may have far-reaching consequences.

Telehealth Nursing Research: Adding to the Evidence-base for Healthcare

This paper reviews recent, nurse-led telehealth research with the goal of describing research findings that provide evidence for practice. Methods: Using an iterative search method, of eight electronic databases, 84 nurse-led research papers were separated into intervention research, systematic reviews and meta-analyses, and descriptive research. The main emphasis was on full text analysis of the intervention research. Results: Fifteen intervention research papers reported findings related to cardiovascular disease, diabetes mellitus, older age, young adults, early adolescents, children with special health care needs, people with a stoma, post-partum mothers and nurses. Also reviewed for useable evidence for practice were 10 systematic reviews, two meta-analyses and two papers that described reviews plus meta-analyses. Resuts: Fifty-five papers with descriptive designs are briefly described. Nurse-led intervention research is increasing knowledge about the use of telehealth technology and applications in care delivery. People with healthcare needs do better with individual attention and increased follow-up. People have a tolerance for technology used with them to advance their quality of life and healing but there is a point at which too much technology is overwhelming. Clinical research is a challenge due to the number of extraneous variables that are difficult to control and that can affect a person’s response to the research intervention. Conclusion: Continuation of nurse-led telehealth intervention research will help to ensure that technology used to support and advance care delivery will be evidence-based.

GUEST EDITORIAL: Special Theme Nurses and Midwives in eHealth

Document submitted as Editorial for Special Theme Nurses and Midwives issue

Developing a Cohort Web Application: Real-time Monitoring of Breastfeeding Indicators

Investing in the development of methodologies for timely intervention in breastfeeding practices that provide improved indicators and prolong breastfeeding duration positively impacts the health of women and children. Aim: To develop children cohort data capture interface of a national reference institution for high foetal, neonatal and child risk from birth, covering all hospitalisation up to the second year of life for real-time monitoring of breastfeeding indicators and prevalence. Methods: Four primary criteria were considered: data security (specific permissions for different profiles and encryption of sensitive data), researcher time streamlining, data quality and construction of data export auxiliary tools. Results: A web-based tool for data collection using a mobile device or computer was developed. The tool successfully allowed the ongoing collection for a defined population cohort of measures related to breastfeeding: maternal factors, child-related factors, health service issues, nipple use, introduction of fluids and other processed foods, as well as breastfeeding practice. Conclusion: The developed product enables the validated extraction and collation of data from existing electronic records and other sources for the monitoring of breastfeeding practices. Such data can be used to refine guidelines and individual behaviour to maximise the benefits of breastfeeding and avoid early weaning.