@article{29247,
  keywords = {Mhealth, Communities, Africa, Interventions, Mobile health},
  author = {Kruijf J and Krah E},
  title = {Exploring the ambivalent evidence base of mobile health (mHealth): A systematic literature review on the use of mobile phones for the improvement of community health in Africa.},
  abstract = {<p>Background: Africa is labelled the world{\textquoteright}s fastest-growing {\textquoteleft}mobile region{\textquoteright}. Considering such growth and the fragility of the continent{\textquoteright}s healthcare, mHealth has flourished. This review explores mHealth for community health in Africa in order to assess its still ambivalent evidence base.<br />
Methods: Using PubMed, Web of Science, OvidSP and Google Scholar. A systematic review was conducted of one decade (2005{\textendash}2015) of peer-reviewed literature on mHealth in Africa. Data analysis focused on qualifications of success and failure. Impact evaluations of project assessments (n = 65) were complemented with general analyses/overviews of mHealth{\textquoteright}s effectiveness (n = 35).<br />
Results: Review of these texts reveals ambivalence in the appraisal of mHealth; essentially, the critical stance in general analyses/overviews is absent from project assessments. Especially weak evidence concerning sustainability and scalability is stressed in overviews. Project assessments are more optimistic. Their analysis suggests a causal connection between simplicity and success. Effective interventions are thus characterized by straightforward design and modest objectives. Greatest impediments of impact are general technology-related issues and intervention inappropriateness due to insufficient understanding of beneficiaries and specific context of use (circumstantial complications).<br />
Conclusion: Distinguishing between these two categories of complications helps to break the deadlock that marks the mHealth debate and add nuance to claims that mHealth{\textquoteright}s evidence<br />
base is weak. Constructive realism {\textendash} rather than unfounded optimism or pessimism without nuance {\textendash} should guide the design of interventions. Besides anticipative of technology-related complications, such realism must lead to either basic interventions or to smart mHealth shaped by deep understanding of the context of implementation<br />
\&nbsp;</p>
},
  year = {2016},
  journal = {Digital Health},
  volume = {2},
  pages = {1{\textendash}20},
  doi = {10.1177/2055207616679264},
  language = {eng},
}