Theories Applied to m-Health Interventions for Behavior Change in Low- and Middle-Income Countries: A Systematic Review

Telemed J E Health. 2018 Oct;24(10):727-741. doi: 10.1089/tmj.2017.0249. Epub 2018 Feb 13.


Background: Recently there has been dramatic increase in the use of mobile technologies for health (m-Health) in both high and low- and middle-income countries (LMICs). However, little is known whether m-Health interventions in LMICs are based on relevant theories critical for effective implementation of such interventions. This review aimed to systematically identify m-Health studies on health behavioral changes in LMICs and to examine how each study applied behavior change theories.

Materials and methods: A systematic review was conducted using the standard method from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. By searching electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]), we identified eligible studies published in English from inception to June 30, 2017. For the identified m-Health studies in LMICs, we examined their theoretical bases, use of behavior change techniques (BCTs), and modes of delivery.

Results: A total of 14 m-Health studies on behavioral changes were identified and, among them, only 5 studies adopted behavior change theory. The most frequently cited theory was the health belief model, which was adopted in three studies. Likewise, studies have applied only a limited number of BCTs. Among the seven BCTs identified, the most frequently used one was the social support (practical) technique for medication reminder and medical appointment. m-Health studies in LMICs most commonly used short messaging services and phone calls as modes of delivery for behavior change interventions.

Conclusions: m-Health studies in LMICs are suboptimally based on behavior change theory yet. To maximize effectiveness of m-Health, rigorous delivery methods as well as theory-based intervention designs will be needed.

Keywords: behavioral health; e-health; m-Health; telehealth; telemedicine.

Publication types

  • Systematic Review

MeSH terms

  • Behavior Therapy / methods*
  • Clinical Trials as Topic
  • Developing Countries*
  • Health Behavior*
  • Humans
  • Models, Psychological
  • Telemedicine / methods*
  • Text Messaging