Methodological challenges in systematic reviews of mHealth interventions: survey, expert workshop, and recommendations
2University of Maryland School of Medicine, Cochrane Complementary Medicine, USA
3Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, University of Maryland School of Medicine, Cochrane Complementary Medicine, Switzerland
Background: Mobile health (mHealth) is the use of mobile technology, such as smartphones, tablets, and wearables, to support and improve health. The mHealth field is rapidly growing and will play an essential role in healthcare in the coming years. Systematic reviews (SRs) are vital for evaluating health interventions and ensuring that resources are used effectively to improve healthcare outcomes. However, systematic reviewers following traditional SR methods may face specific methodological challenges when evaluating mHealth interventions.
Objectives: O1) Identify methodological challenges specific to SRs of mHealth interventions. O2) Discuss a group of prioritised challenges. O3) Provide recommendations for overcoming those prioritised challenges.
Methods: Three-phase NIH-funded project (Cochrane Complementary Medicine Field: Resource for Research (2R24AT001293)). O1) Online survey to collect methodological challenges specific to SRs of mHealth interventions. O2) Online workshop with experts. O3) Development of recommendations via consensus.
Results: O1) Survey (n= 51 authors of SRs of mHealth interventions). The methodological aspects most frequently rated by experienced reviewers as more challenging in SRs of mHealth interventions were 1) keeping the SR up to date (88%) and 2) issues of intervention integrity (the degree to which the mHealth intervention was delivered as intended). The main intervention integrity challenges were defining intervention intensity (80%), assessing intervention integrity (78%), dealing with continuously evolving interventions (74%), extracting the mHealth intervention details (68%), incorporating co-interventions into analyses (65%), and defining the intervention in the review protocol (64%). O2) Two-hour online workshop: eleven experts discussed how to address updating and integrity challenges. O3) Preliminary recommendations for updating SRs of mHealth interventions and addressing mHealth intervention integrity are being developed. Examples of recommendations: a) develop taxonomies and standardised data extraction forms to capture critical mHealth intervention integrity information; and b) adapt SR processes to deliver timely review updates for the dynamic mHealth apps market.
Conclusions: SRs of mHealth interventions present specific methodological challenges, such as those related to the mHealth intervention integrity and keeping the SR up to date. This project developed recommendations to overcome methodological challenges specific of mHealth SRs. Patient or healthcare consumer involvement: Not foreseen.