On one hand these type of mHealth platforms allow data collection that’s meaningful to people, as well as services and systems. In developing country contexts this has often never been collected before except through specific population health surveys.
On the other hand, lots of health systems and major philanthropic funders are talking about using this data for linkage and data mining. They’re also talking about developing algorithms to guide care and risk stratification. Again, this is mostly being done with a focus on care in developing countries, but also developed ones too.
I’m ambivalent about this. The potential to actually capture data and to harmonise/minimise variation in care could be quite profound and far-reaching.
I just don’t trust algorithms though, largely because they reproduce our biases. I’m worried that investment might be in device-driven care rather than developing local workforces.
We identified (1) computerised decision support, (2) feedback and benchmarking on diabetes care quality, (3) culturally tailored programs (usually delivered by community health workers), and (4) enhanced practice nurse involvement in diabetes care as interventions that had a positive impact across several outcome measures. These outcomes included:
clinical outcomes (blood pressure, and body mass index, or weight)
biochemical outcomes (glycosylated haemoglobin [HbA1c], lipid profile, or renal function)
psychological outcomes (anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, or self-care)
health-related quality of life measures from participant self-report.
The evidence about the use of decision aids (e.g. when to commence statins) was equivocal in terms of their impact on HbA1c, lipid profile and renal function. One high quality integrated care study on a virtual clinic, which brought together nurses, diabetologists and GPs, showed improvements in blood pressure but not renal function. No single intervention improved all the outcome measures that were considered.
Faruqi, N. et al. (2019) ‘Primary health care provider–focused interventions for improving outcomes for people with type 2 diabetes: a rapid review’, Public Health Research and Practice, 29(4), p. e29121903. doi: 10.17061/phrp29121903.