An umbrella review of mHealth tool implementation strategies: a 6-step guide to optimize patient, caregiver and clinician use

Context: mHealth refers to the use of mobile and wireless technologies to support the achievement of health objectives. Targeted users of mHealth tools include clinicians, patients, and caregivers. In clinical settings, uptake of mHealth tools has varied, with limited use explained, in part, by suboptimal adaptation of the tool and the implementation processes.

Objectives: 1) Understand how to influence mHealth tool use among patients, caregivers, and clinicians, 2) Develop mHealth tool implementation guidance.

Study Design and Analysis: Umbrella review with qualitative synthesis.

Setting or Dataset: Literature reviews (qualitative, quantitative, or mixed methods) identified through a librarian-assisted data base search. Two independent reviewers selected publications about strategies, recommendations, facilitators, or barriers of mHealth tool implementation in OECD countries.

Intervention/Instrument: Data describing factors that influence clinician and patient/caregiver use of mHealth tools were extracted. A thematic analysis guided by the Consolidated Framework for Implementation Research and the Effective Practice and Organization of Care strategies was conducted.

Results: From the 8244 records identified, 201 were selected for full text reading. Ultimately, the synthesis included 29 reviews (16 systematic, 10 scoping, 1 rapid, 2 other). They addressed mHealth tools in general (n=17), patient portals (n=6), electronic Patient Reported Outcome Measures (n=5), or chatbots (n=1), from the perspectives of patient/caregiver users (n=14), clinician users (n=5), or both (n=10). The synthesis culminated in 6 iterative implementation steps: Collaborate with interested parties; Adapt the tool to address user needs and preferences; Plan how mHealth tool use will integrate into user routines; Provide ongoing training and technical support; Promote the tool; Evaluate the implementation and revisit previous steps as needed. Strategies to operationalize each step are described. The importance of each step for increasing mHealth tool use among patients, caregivers, and clinicians is explained.

Conclusions: Results provide a comprehensive process to adapt and implement mHealth tools in clinical settings. The rationale for each implementation step highlight why each step is crucial to the implementation success. The resulting interactive mHealth implementation guide, replete with detailed examples, can be a valuable resource to integrate mHealth into clinical practice.