Standardized Functions for Smartphone Applications: Examples from Maternal and Child Health

Table 1

mHealth applications for maternal and child health by foundational functions.

Program	Description	Function
		Inform	Train	Monitor	Shape	Support	Link
Target group: mothers/families only
text4baby [27]; United States; Sponsor: Johnson & Johnson; Outcome Data: Y	Family member texts “Baby” to 511411 and receives prompts to enter the baby’s expected due date and postal code. Program sends several free text messages each week tailored to the baby’s stage of development and toll-free telephone numbers to link to free and low-cost services associated with message topic based on mother’s location.	×					×
Diabetes Buddies [57]; South Africa; Sponsor: University of California/University of Western Cape/Women for Peace; Outcome Data: Y	Twelve-session curriculum, with weekly sessions on nutrition, exercise, disease self-management, managing negative emotions, and coping with stress. Participants used mobile phones to call and text one another. Project leaders sent daily texts to provide nutrition guidance and to prompt participants to exercise.	×		×	×	×
Wired Mothers [65]; Zanzibar, Tanzania; Sponsor: DANIDA; Outcome Data: Y	Used to link pregnant women to healthcare system via mobile phones, increase accountability for clinic attendance, provide educational SMS, and access to emergency services.	×		×	×	×	×
Better Border and Healthcare Program [66]; Thai-Myanmar border; Sponsor: Microsoft Research; Outcome Data: Y	Automated SMS-based reminders for prenatal care visits. Combined web-based and mobile technology to generate appointments for healthcare personnel performing home visits to cross check, identify, and update the mother and child health indicators at healthcare facilities and household locations.			×	×	×	×
Baby is on its way [67]; Serbia; Sponsor: Ministry of Health/Medicomark; Outcome Data: N	SMS messages corresponding to the mothers' stage of pregnancy with health support.	×				×
CELLPHONES4HIV [68]; South Africa; Sponsor: CellLife/Vodacom/; USAID/PEPFAR/Raith/; Johns Hopkins/Right to Care; Outcome Data: Y	10-week program with bulk-delivered SMS messages for prevention and treatment of HIV/AIDS. Information is provided on health education, linkage to care, increasing “treatment literacy.”	×			×	×	×
Project Masihambisane [69]; South Africa; Sponsor: UCLA/HSRC/NIH; Outcome Data: Y	Women with HIV invited to attend four antenatal and postnatal small group sessions. Mobile phones used to collect and upload numeric, voice, and text-based data.			×
OG Miner [70]; South Africa; Sponsor: nexGIN RC; Outcome Data: Y	Data mining system that provides accurate classification of pregnant women at high risk for obstetrical complications.	×		×		×	×
IVR mobile phone quizzes [71]; Bangladesh; Sponsor: BRAC/Dimagi/World Bank; Outcome Data: N	Short audio courses with interactive quizzes covering health information such as clinician-assisted birth, proper hand-washing techniques, and HIV-transmission knowledge. Courses build on one another in a soap-opera format with recurring characters. Passing a quiz at the end of the course is incentivized by free airtime delivered to the caller's phone.	×			×
Safe Motherhood Project [72]; Senegal; Sponsor: WAHA International; Outcome Data: N	Use of donated prepaid mobile phones to allow mothers to contact hospitals for referral during delivery, coupled with motorbike ambulances to transport women to these services.						×
ChildCount [73]; Kenya; Sponsor: UNICEF; Outcome Data: Y	Pilot program using SMS messaging to help community health workers monitor child health outcomes.			×	×	×	×
Phones for Health [74]; Rwanda; Sponsor: GSMA; Outcome Data: N	Mobile phone system linking community health workers to HIV patients. Allowed workers to collect and retrieve patient information.			×		×	×
Manoshi [75]; Bangladesh; Sponsor: BRAC/Gates Foundation; Outcome Data: N	Project aimed to decrease death and illness among infants and mothers in urban slums of Bangladesh. Allowed community health workers to upload data from field areas to central database to link with doctors for specific medical advice.	×		×			×
Target group: providers only
Philani Paraprofessionals [76]; South Africa; Sponsor: UCLA/Philani Program/Stellenbosch University/NIH; Outcome Data: Y	Community health workers used mobile phones to collect data, monitor and support intervention delivery, and increase accountability through geo-timestamps.			×		×
RESCUER [77]; Uganda; Sponsor: World Bank; Outcome Data: Y	The RESCUER project was designed to link the traditional rural community health providers with the formal health delivery system, such that when an obstetric emergency occurs in a village, a traditional birth attendant calls for assistance from the nearest health unit.					×	×
HealthLine [78]; Pakistan; Sponsor: Microsoft Research; Outcome Data: Y	Speech-based telephone system targeted towards CHWs who have low levels of literacy. Provides CHWs with important health information, using spoken prompts, to support home visits.	×	×			×
Mobile Midwives [79]; Aceh Besar, Indonesia; Sponsor: World Vision; Outcome Data: Y	Midwives provided with mobile phones and phone credit to link with healthcare systems. Outcomes include increased accuracy of data collection and an increase of midwives linking with health centers for professional advice.	×	×	×		×	×
Cell-PREVEN [80]; Ucayali, Peru; Sponsor: UN Foundation/Vodafone Foundation; Outcome Data: Y	Health workers in a remote geographical area were given basic mobile phones to collect and report data to a centralized database using an interactive voice response system.			×		×	×
Ca:Sh [81]; Haryana, India; Sponsor: Dimagi/All India; Institutes of Medical Science; Outcome Data: Y	Mobile phones used for data collection on immunization, demographic changes, and prenatal care. Electronic health records made available via mobile phone.			×		×	×
Sisu Samrakshak [82]; Andhra Pradesh, India; Sponsor: UNICEF; Outcome Data: Y	Mobile technology used to monitor nutrition and maternal/child health.			×
SMS2Printer [83]; Mozambique; Sponsor: Clinton Health Access Initiative; Outcome Data: N	System designed to accelerate return of results by allowing labs to print any test results from health centers with network coverage. Expanded program from initial successful pilot program.	×		×			×
Rwanda RapidSMS [84]; Rwanda; Sponsor: UNICEF/WHO; Outcome Data: Y	Tools on mobile devices helped CHWs track pregnant women's progress, identify risk factors, monitor antenatal care, and communicate with clinics and hospitals to improve emergency response times.	×	×	×	×	×	×
Health at Home/Kenya [85]; Kenya; Sponsor: AMPATH; Outcome Data: N	Data collection tool for collecting health outcome data, recording test results, and HIV counselling and testing. Uses GPS technology to identify family’s location and allows quicker data transmission.			×		×	×
CycleTel [86]; India; Sponsor: USAID/FrontlineSMS; Outcome Data: N	Pilot study using Standard Day Method to deliver fertility information to women via mobile phone technology. Allows women to know which days they are able to get pregnant with linkage to family planning services.	×		×	×	×
SMS Alerts for Infant Vaccinations [87]; India; Sponsor: Information Kerala Mission; Outcome Data: N	SMS system to inform parents on vaccination details and dates is linked to health center kiosks.	×		×			×
Target group: providers and mothers
Smartphone-based fetal monitors [47]; Australia; Sponsor: Microsoft; Outcome Data: N	Free software downloaded to mobile phones allows women to track fetal activity (kicks, heartbeat) through low-cost fetal monitors and transmit the data to midwives and obstetricians at urban and regional health centers.			×			×
MAPEDIR [88]; Madhya Pradesh, India; Sponsor: UNICEF; Outcome Data: N	Investigative tool for why women are dying in pregnancy linked with 24-hour Janani Suraksha Obstetrician Helpline.	×		×	×	×
SMS prenatal support for pregnant women [89]; Bangkok, Thailand; Siriraj Hospital/Mahidol University; Outcome Data: Y	Prenatal health support via text messaging for women receiving care at a clinic.					×
JiVita [90]; Bangladesh; Sponsor: Johns Hopkins University; Outcome Data: Y	Most recent version of the JiVita program uses mobile phone technology to link mothers and families to sources of care and decrease pregnancy-related complications.	×		×		×	×
Mobile phones to coordinate ambulance [54]; Gambia; Sponsor: WHO; Outcome Data: Y	Emergency ambulance service links the community with hospitals. Traditional birth attendants and village health workers were equipped with mobile phones to coordinate care. Pregnant women were high utilizers of the emergency ambulance.					×	×
Lady Health Workers [91]; Pakistan; GSMA/Mobilink/UNFPA/; Ministry of Health; Outcome Data: Y	Linking mothers with Lady Health Workers through the use of Mobilink mobile phone technology to provide emergency care to rural areas.			×		×	×
D-tree [37]; Tanzania; UNICEF; Outcome Data: NA	Software allows screening, examination, counseling, and treatment of malnutrition through calculations of target weights and measurements. Supports communication between health workers and mothers with information available via mobile phone.	×		×	×		×
MoTeCH [30]; Ghana; Mailman School of Public Health/Grameen/Gates Foundation; Outcome Data: Y	Mobile Midwives provides expecting/new mothers accurate health information and reminders of upcoming clinic checkups. Option of text or spoken word, and language choices. Nurse Support allows nurses to search for patients with upcoming appointment dates and patient updates, such as new defaulters or recent deliveries. Patient information can be entered into mobile phones and used to generate reports and coordinate care.	×		×	×		×