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Dear editor: During the Covid-19 pandemic, Mexico transformed hospitals that normally treated patients with chronic diseases into centers to treat Covid-19,1 potentially displacing the care of patients with cancer. Mobile health (mHealth) could relieve health systems in low- and middle-income countries (LMIC) such as Mexico by offering an alternative to face-to-face contact at every stage of cancer care.2
The increasing burden of cancer and limited capacity for in-person care call for solutions that integrate public health and clinical professionals along the natural history of the disease. A potential channel for this integration is mHealth, which has been successfully implemented in high-income countries but data on its relevance and feasibility in LMICs are less known.3 We present an overview of mHealth in Mexico (table I) and we call for reproducibility and transparency to maximize its potential benefits in cancer research.
Table I Identified mobile health initiatives in Mexico, 2007-2019
|
Project name |
Location, year |
Responsible institution |
Topic |
Functionalities |
Purpose of the mHealth initiative |
|
Identified in the peer-reviewed literature | |||||
|
S.N. |
National |
National Institute of Public Health, Mexico |
Epidemiologic surveillance |
SMS |
Surveillance of influenza outbreaks. |
|
2009 | |||||
|
S.N. |
Mexico, France, Australia 2013 |
IPADE business school |
Smoking cessation |
SMS |
To assess smokers’ perceptions, motivations, and intentions towards using an SMS-assisted smoking cessation intervention. |
|
mSalUV |
Veracruz, 2014 |
Institute of Public Health, University of Veracruz, Mexico |
Diabetes |
SMS |
To develop and assess the acceptability of an SMS-based system for sending medication and appointment reminders to patients with diabetes. |
|
S.N. |
Mexico City, 2018 |
National Institute of Respiratory Diseases, Mexico |
HIV |
SMS |
To describe a systematized process to design, validate and test a set of SMS to improve treatment adherence and appointment attendance among HIV positive individuals. |
|
S.N. |
Chiapas, 2013 |
Partners in Health, Mexico |
Medical prescription |
App |
To assess the perceived-usefulness of an mHealth tool that guides community health workers (CHWs) through algorithm-based medication dosing. |
|
Prevencanadol |
Spain and Mexico, 2013 |
Monterrey Institute of Technology and Advanced Studies |
Cancer prevention |
SMS |
To assess participants’ enrollment and adherence to an online program aimed to prevent cancer risk behaviors using an educational website and mobile phones. |
|
VidaNET |
Mexico City, 2010 |
Carlos Slim Foundation for Health, Mexico |
HIV |
SMS |
To increase adherence by HIV/AIDS patients to antiretroviral drug regimens. |
|
CardioNET |
Mexico City, 2011 |
Carlos Slim Foundation for Health, Mexico |
Cardiovascular disease |
SMS |
To provide patients with heart-healthy, anti-obesity messages. |
|
Project Dulce |
Baja California, 2014 |
Autonomous University of Baja California, MexicoScripps Whittier Diabetes Institute, USA |
Diabetes |
App |
To integrate the usual care in the clinic with self-management and peer-led education using and app and SMS. |
|
SMS | |||||
|
Remote glucose monitoring | |||||
|
S.N. |
Mexico City, 2017 |
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán |
Cancer treatment |
App |
To monitor the potential adverse events among older adults receiving chemotherapy for solid tumors using daily steps measured with a mobile phone app. |
|
Mobile Airways Sentinel Network |
Spain, Argentina and Mexico, 2019 |
Allergic Rhinitis and its Impact on Asthma Initiative |
Allergic diseases |
App |
To monitor symptoms from asthma and allergic rhinitis using a mobile phone app-based diary. |
|
iBeni |
Hidalgo, 2018 |
Hidalgo State Autonomus University, México |
Cognitive decline |
App |
To provide cognitive stimulation for the elderly through a mobile phone app. |
|
Chaak |
Yucatán, 2013 |
Colorado State University, USA |
Dengue control |
Mobile app coupled with computer database management system |
To monitor dengue vectors at their early stages of development for surveillance of potential outbreaks. |
|
Yucatán State Autonomous University, México | |||||
|
Identified in other sources through a systematic search (websites and press releases) | |||||
|
Zumbido |
Mexico, 2007 |
The SHM Foundation |
HIV |
SMS |
To create and promote social relationships for those living with HIV/AIDS that could have the potential to lead to significant positive health outcomes including emotional support, improving the participants’ knowledge about accessing health services, and helping them to adhere to medical treatment. |
|
e-Decídete |
Morelos, 2017 |
National Institute of Public Health, Mexico |
Smoking cessation |
SMS |
To provide educational information, behavioral strategies, motivational and supportive messaging, and to prompt to use pharmacotherapy to support smoking cessation. |
|
Amanece |
Mexico, 2015 |
Carlos Slim Foundation for Health, Mexico |
Prenatal care |
App |
To support community health worker to identify risk factor for pregnancy complications. |
|
Qué pasa si te pasa |
Ciudad de México, Estado de México, 2017 |
National Institute of Psychiatry, Mexico |
Substance abuse |
App |
To educate adolescents about the risks and consequences of substance abuse. |
|
Deslixate |
Mexico City, 2018 |
National Autonomous University of Mexico |
Dyslexia |
App |
To identify signs suggestive of dyslexia in children and adolescents. |
|
PreB |
Morelos, 2017 |
National Institute of Public Health, Mexico |
Adolescent pregnancy |
App |
To educate and provide customized information to adolescents on sexual and reproductive health. |
|
Salud Móvil |
México, 2017 |
Mexican Foundation for Health |
Diabetes, overweight and obesity |
SMS |
To promote lifestyle changes among people with type 2 diabetes, overweight or obesity. |
|
MiSalud, Prospera Digital |
México, 2017 |
Digital strategy, Mexican Government |
Child and maternal health |
SMS and Facebook messenger |
To provide educational information to pregnant women or mothers of children aged 0-2 years. |
mHealth: mobile health; SMS: Short Message Service; S.N.: sine nomine (without a name)
Cancer research in Mexico could follow the example of successful experiences in the areas of maternal care where the government has developed, implemented, and evaluated mHealth interventions like Prospera Digital.4 This experience follows the recommendation of prototyping and evaluating interventions within a particular sector of a national health system.3 However, full implementation of mHealth for cancer at a national scale would face additional local barriers requiring fine-tuning of the technology. Moreover, given the complexity of cancer management, mHealth interventions in this field could require inter-institutional and public-private partnerships.
mHealth interventions for cancer research in Mexico should also build upon previous experiences in high-income countries.5 However, leapfrogging mHealth from other areas may be insufficient by itself. Cancer researchers must consider human-centered design applied to local contexts to maximize the value of mHealth.3 Unfortunately, Mexican experiences provided little to no description of the context in which the implementation of mHealth technologies took place which could undermine the reproducibility of their findings. Similarly, there is scatter information regarding the behavior change theory among the mHealth experiences. Further research using mHealth for cancer in Mexico must therefore be transparent regarding the behavior change frameworks used to develop the technologies.5 When researchers involve cancer patients from the design of mHealth solutions, users benefit the most.5 Therefore, community involvement should permeate the development and reporting of cancer mHealth solutions.
For cancer mHealth technologies to become integrated into the healthcare system, they should be rigorously assessed. Once the solution has been properly designed and tested, a report should communicate its findings to the scientific community. This report could align with the Mobile Health Evidence Reporting and Assessment checklist (mERA),6 which recognizes aspects unique to mHealth. Some of these features are the description of the technology platform, delivery, content, contextual adaptability, and data security. Innovators in mHealth may argue that publishing such reports in the peer-review literature could delay the translation of their findings from research to the clinical setting. However, if they want the scientific community and the public to understand the value of their products, they should consider alternatives to peer-review, including pre-publishing services such as medRxiv (https://www.medrxiv.org/).7 Finally, mHealth products must provide enough information to patients, institutions, and clinicians so that they can choose among the numerous available solutions. To make an informed decision, potential users need to know about the data safety, effectiveness, design process of the product, and its integration with the healthcare system.8 Therefore, this information must be public and accessible to potential users.9
