Table 1.

Advantages and Disadvantages of Three Mobile Health Technologies for Improving Cardiovascular Disease Prevention and Management

	Automated Calls or IVR	Text Messaging or SMS	Smartphones and Online Tools
Cost to the Patient	Some patients using cell phones must pay minute charges to receive a call.	Some patients using cell phones must pay to respond to text messages.	Smartphones and data plans are prohibitively expensive for some patients, especially in LMICs.
Literacy Requirements	Literacy not required since information is conveyed aurally.	Some reading is required although texts can be written at a low literacy level.	Some information is text, although graphics, audio, and video can be used.
Complexity of the Interaction	Extensive dialogues are possible. Longer messages may be cumbersome and patients cannot review information at a later time.	Only short, simple messages can be sent via SMS with very little patient-response data or dialogue.	Smartphones can send complex multi-media messages and collect detailed information via forms.
Other Patient Requirements	Must have good hearing and be able to respond to questions via a touch-tone phone.	May need to be able to send texts, with fine motor control and good vision.	Must be able to navigate a touch screen. Some systems also require texting.
Potential Reach	Can be used with all standard cell phones as well as land-line phones.	Can be used with all standard cell phones.	Limited to patients who can access and use a Smartphone. Many functions also require Internet access.
Evidence for Impact	Multiple studies show impacts on behaviors and some health outcomes.	Multiple studies show impacts on behaviors and some health outcomes.	Evidence base is weak for impacts on behaviors and outcomes.

IVR: Interactive voice response/automated calls; SMS: Short messaging service or text messaging; LMIC: Low- and middle-income countries.