Healthcare via Cell Phones: A Systematic Review
Abstract
Regular care and informational support are helpful in improving disease-related health outcomes. Communication technologies can help in providing such care and support. The purpose of this study was to evaluate the empirical evidence related to the role of cell phones and text messaging interventions in improving health outcomes and processes of care. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to provide care and disease management support. Searches identified 25 studies that evaluated cell phone voice and text messaging interventions, with 20 randomized controlled trials and 5 controlled studies. Nineteen studies assessed outcomes of care and six assessed processes of care. Selected studies included 38,060 participants with 10,374 adults and 27,686 children. They covered 12 clinical areas and took place in 13 countries. Frequency of message delivery ranged from 5 times per day for diabetes and smoking cessation support to once a week for advice on how to overcome barriers and maintain regular physical activity. Significant improvements were noted in compliance with medicine taking, asthma symptoms, HbA1C, stress levels, smoking quit rates, and self-efficacy. Process improvements were reported in lower failed appointments, quicker diagnosis and treatment, and improved teaching and training. Cost per text message was provided by two studies. The findings that enhancing standard care with reminders, disease monitoring and management, and education through cell phone voice and short message service can help improve health outcomes and care processes have implications for both patients and providers.
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The mobile technologies that teens use daily, namely cell phones, instant messaging, and text messaging, have already produced multiple improvements in their health care, such as increased medication adherence, better disease understanding, and fewer missed appointments.
“The mobile technologies that teens use daily, namely cell phones, instant messaging, and text messaging, have already produced multiple improvements in their health care, such as increased medication adherence, better disease understanding, and fewer missed appointments. 14”
From The Impact of Social Media on Children, Adolescents, and Families (2011) · cites this paper as [14]
Mobile phone communication is less expensive than landline telephones or standard Internet.
“Communication by mobile phone is less expensive than alternative options such as landline telephones or standard Internet (1, 7).”
From Text messaging as a tool for behavior change in disease prevention and management (2010) · cites this paper as [7]
In high-income countries, interventions have included test results or instructions to adjust medication.
“In high-income countries, interventions have included these aspects of care.18 22 23”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [22]
Three systematic reviews found reminders for disease monitoring improve healthcare processes, but with education through voice call and text messages, both health outcomes and care processes improve.
“Three systematic reviews found reminders for disease monitoring improve healthcare processes but with education through voice call and text messages, both health outcomes and care processes improve.18 22 23”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [22]
Nineteen reviews included both type 1 and 2 diabetes in their analyses, or included RCTs that did not differentiate.
“In total, 19 reviews included both type 1 and 2 diabetes in their analyses, or included RCTs that did not differentiate [16,22,25,27,28,31,32,34-40,44,45,47,50,51].”
Three 1-star narrative syntheses suggested improved outcomes with mobile phone interventions.
“Three 1-star narrative syntheses suggested improved outcomes with mobile phone interventions [32,35,36], but others showed no overall benefit from teleconsultations [47,51] or telemonitoring [34,39].”
Eight reviews assessed the impact on asthma control through symptom scores, quality of life, or unscheduled health care.
“A total of 8 reviews assessed the impact on asthma control through symptom scores, quality of life, or unscheduled health care [20,24,27,28,36,61-63].”
Three 1-star reviews, all with narrative syntheses, concluded that further evaluation was needed before conclusions could be reached.
“Three 1-star reviews, all with narrative syntheses, concluded that further evaluation was needed before conclusions could be reached [28,36,61], while 1 other, focused on mobile interventions in developing countries, found evidence for improved symptom scores in a single RCT [20].”
Supported education and information interventions were particularly effective in the context of diabetes, with 9 larger systematic reviews showing evidence of improvement in HbA1c.
“Supported education and information interventions were particularly effective in the context of diabetes, with 9 larger systematic reviews showing evidence of improvement in HbA1c [27,30,35-37,40,44-46].”
Monitoring and feedback was associated with improved clinical outcomes in diabetes and heart failure.
“This was the most commonly described telehealth component in the included systematic reviews and was associated with improved clinical outcomes in diabetes and heart failure [33,35,36,38,42,44,54,58]; however, findings for asthma and COPD were mostly neutral or inconsistent [61-63,65,66,68,69].”
Text messaging can produce effective behavior change results across diverse youth populations using relatively short behavioral interventions.
“Collectively, such research has demonstrated that text messaging can produce effective behavior change results across diverse youth populations using relatively short behavioral based interventions (Fjeldsoe, Marshall, & Miller, 2009; Krishna, Boren, & Balas, 2009).”
From Substance use recovery outcomes among a cohort of youth participating in a mobile-based texting aftercare pilot program (2014) · cites this paper as Krishna, Boren, & Balas, 2009
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“Lines of evidence of the effectiveness of mHealth solutions in LMICs have been inconsistent in systematic reviews (Bärnighausen et al., 2011; Bloomfield et al., 2014; Catalani et al., 2013; Cole-Lewis and Kershaw, 2010; Fjeldsoe et al., 2009; Free et al., 2013; Krishna et al., 2009; Mbuagbaw et al., 2015; Velthoven et…”
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- Authors
- Krishna, S., Boren, S. A., & Balas, E. A.
- Affiliations
- Saint Louis University (US)
- Harry S. Truman Memorial Veterans' Hospital (US)
- Old Dominion University (US)
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2009-04
- Volume
- 15
- Issue
- 3
- Pages
- 231-240
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- OpenAlex
- W2094377001
- Cited by
- 882
- References
- 44
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 24 · 2023: 25 · 2022: 28 · 2021: 43 · 2020: 48 · 2019: 53 · 2018: 70 · 2017: 73 · 2016: 81 · 2015: 68 · 2014: 109 · 2013: 93 · 2012: 77
- FWCI
- 9.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS010472)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Physical Sciences › Computer Science › Information Systems › Mobile Learning in Education
- Keywords
- mobile devices, text messaging intervention, mobile health, voice mail, medication adherence, disease management, smoking cessation, diabetes mellitus, asthma, HbA1c, self-efficacy, stress, physical activity, health education, appointment reminders, health outcomes, process of care
- MeSH terms
- Health Promotion, Humans, Outcome and Process Assessment, Health Care, Patient Education as Topic, Self Care, Telemedicine, Disease Management, Cell Phone
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