Figure 3.
Final framework. The final framework depicts a progressive dynamic process of how mHealth influences performance within a complex context (concentric circles C1 and C2). The implemented technology (I) inevitably introduces an additional layer of context by providing infrastructural support, training, technical components, and tools. O1, O2, and O3 are the outcomes of adoption/utilization, competence, and performance, respectively. Utilization is the continued use of the adopted mHealth device by health workers (A). M1, M2, or M3 are explanatory mechanisms related to outcomes O1, O2, and O3, respectively. The bullet points highlight some factors that facilitate (+) or inhibit (−) outcomes at various stages. The framework evolved through the review process: compare initial framework (Figure 1), framework in progress (supplementary file 2) and final framework (Figure 3).
ICT: Information and communication technology; mHealth: mobile health.
*Utilization of health services by pregnant women was not explored in this review. However, the framework recognizes the demand-side component of maternal health services which might explain how mHealth influences health worker performance.