The impact of mHealth on nurses and midwives

Most nurses and midwives are familiar with health apps, but possibly not the broader scope and meaning of mobile health or mHealth. Health applications offer health- and wellness-related services for smartphones, tablets, personal computers, and other communication devices [1], whereas mHealth is a general term for the use of mobile and wireless technologies to improve health [2]. Given widespread mobile phone use, even in least developed countries, mHealth is a popular option for preventive and maintenance healthcare services, as well as public health initiatives such as disease surveillance and epidemic outbreak tracing.

The most popular categories of health applications include sports and fitness activity tracking, diet and nutrition, weight loss coaching, medication tracking, sleep cycle, stress and relaxation, meditation, menstrual period tracking, pregnancy, and hospital selectin and appointment tracking [1]. mHealth is used to provide education and awareness, assist with diagnostic and treatment support, enable remote data collection, facilitate remote monitoring and telehealth, and support chronic disease management and medication compliance [1]. According to Samples et al. [3, p. 330], nurses and midwives can assist mHealth to become mainstream healthcare by “understanding its potential to change the landscape of health intervention delivery, incorporating mHealth into patients’ day-to-day preventive care strategies, and supporting the science of mHealth’s effectiveness’.

The global mHealth market captured USD 23 billion in 2017 [1], rose to USD 40.05 billion in 2020 among a pandemic backdrop [4], and is expected to grow 17-18% annually in the next five years [4]. The plethora of mHealth solutions have increased exponentially in the last five years and are now targeting the longstanding issues in healthcare that are apparent to nurses and midwives – improved data management, enhanced communication between clinician and recipient of care, reduced hospital admissions, increased medication regime adherence, and remote monitoring [1]. mHealth capabilities can not only assist care delivery but also enhance the provision of education to future nurses and midwives [D]. Mayer et al. [6] highlight that as nurses and midwives are the last segment of the healthcare workforce in most countries and are employed in most healthcare settings, mHealth holds great potential for this cohort.

A few recent publications address the use of mHealth by nurses and midwives:

• A qualitative study exploring how a mHealth intervention might support midwives in the management of women with pre-eclampsia in rural and remote locations [7]
• The potential impact of wearable devices in postoperative monitoring [8]
• Midwives’ views towards women using mHealth and eHealth to self-monitor their pregnancy [9]
• What is the clinical value of mHealth for patients? [10]
• mHealth for midwives: a call to action [11]
• Engaging nurses in the design and adoption of mHealth tools for care coordination [12]

Health professionals do not commonly prescribe health apps, for a variety of reasons – security and sustainability concerns, unknown integration with existing infrastructure, unknown benefits realisation, and a lack of confidence and validated certification [6,13]. Despite its popularity, mHealth has limited evidence for efficacy, although positive outcomes have been reported in individuals with a range of chronic diseases such as pulmonary disorders, heart failure, hypertension, and diabetes, in addition to reducing hospitalisation and death and improving general quality of life [14]. More studies are needed to establish the efficacy and economic advantages of this technological intervention, and nurses and midwives need to be at the decision making table to ensure these tools benefit the recipients of their care and align with workflow.

Some current examples available in clinical interaction include:

• Tympa Health – developed by ENT surgeons, this tool combines an otoscope micro-suction with a hearing test that can be used by a variety of health professionals
• HearScope – a TGA-approved digital otoscope with artificial intelligence (AI) image classification used in 85 countries that enables an ear examination with telehealth.
• There are a range of apps available that assist in more accurately determining if wounds are healing or not. Each time wound care is attended, a photo is taken with a smartphone app that measures and maps the wound, including the depth of the wound. Over time, the app shows the wound healing or not healing. There are some versions of this type of app that can integrate with clinical software solutions in use in aged care settings. An example is Silhouette – an imaging device for clinical trials on skin disruption and wound treatments.
• PainChek – a pain assessment tool available from a smartphone using AI technology to analyse facial recognition. This tool is currently used in aged care settings.
• Lumify – an imaging device that provides ultrasound capabilities via a smartphone.
• Diabetes Manager by WellDoc – collects data, provides analyses, and also provides personalised coaching, as well as offering users with alerts to check manual follow-ups and real-time tracking for those who need to review blood glucose information.
• Palliaged – assists nursing working in residential aged care community care, and general practice to care for older people with palliative care needs. It highlights a care framework built around three care processes that nurses can quickly navigate around – advance care planning, palliative care cases conference, and a care plan for the dying person.
• Ask Annie – Dementia Australia has developed this paid smartphone app that provides practical, accessible, and flexible training and support for at-home and community care workers. The app offers 10-15 minute ‘micro-lessons’ based on the real-life scenarios of those caring for people living with dementia.
• Home Quarantine SA – uses geo-location and facial recognition software to track those in quarantine who are required to check in every day. This app has been trialled to decrease the need for interstate and returning travellers to quarantine in hotel or medi-hotel facilities, and NSW Health is planning to adopt a version of this technology (Pulse+IT, 23 September 2021).

Dr Jen Bichel-Findlay, October 2021

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