Finding 1 Through being connected to other health workers and across various healthcare services, health workers appreciated that mobile devices allowed them to better co‐ordinate the delivery of care.	Barnabee 2014; Chang 2011; Hampshire 2016; Henry 2016; Huq 2014; Khan 2015; Lodhia 2016; Madon 2014; Messinger 2017; Murray 2011; Mwendwa 2016; Quinn 2013; Ramirez 2017; Rothstein 2016; Schoen 2017; Toda 2017; van der Wal 2016; Watkins 2018	Minor concerns regarding methodological limitations because the majority of studies had no to minor methodological limitations	No or very minor concerns regarding coherence	Minor concerns regarding adequacy because of thin data found in the studies	Moderate concerns regarding relevance because of the limited range of contexts in which the studies were conducted	Moderate confidence	Due to no/very minor concerns regarding coherence, minor concerns regarding adequacy, and methodological limitations, and moderate concerns regarding relevance
Finding 2 Lower‐level health workers valued being able to reach higher‐level health workers via mobile devices, and perceived the advice and support they received as improving their care and as satisfying to clients. When higher‐level professionals responded in anger, it made lower‐level health workers reluctant to call them.	Ayiasi 2015; Chang 2011; Cherrington 2015; Hampshire 2016; Huq 2014; Khan 2015; Lodhia 2016; Madon 2014; Messinger 2017; Mwendwa 2016; Quinn 2013; Toda 2017; van der Wal 2016; Watkins 2018	Moderate concerns regarding the methodological limitations because the majority of studies had insufficient information on the data collection and analysis methods, and author reflexivity	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, but moderate concerns regarding methodological limitations
Finding 3 When higher‐level health workers failed to respond and support lower‐level workers through mobile devices, lower‐level staff had negative perceptions of these devices. One study emphasised the importance of having health professionals' buy‐in with mobile health to ensure that mobile devices were optimally used to support lay health workers.	Cherrington 2015; Huq 2014; Mwendwa 2016; Quinn 2013; Toda 2017; van der Wal 2016	Minor concerns regarding the methodological limitations because a few studies had insufficient information on the data collection and analysis methods	No/very minor concerns regarding coherence	Moderate concerns regarding adequacy because it is supported by only a few studies with thin data	No/very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence and relevance, minor concerns regarding methodological limitations, but moderate concerns regarding adequacy
Finding 4 The use of mobile devices allowed some health workers to feel connected to their peers within their own organisations. However, others preferred face‐to‐face communication with their peers.	Barnabee 2014; Hampshire 2016; Henry 2016; Jennings 2013; Madon 2014; Valaitis 2005; van der Wal 2016; Watkins 2018	Minor concerns regarding methodological limitations due to inconsistency regarding methodological reporting in a few studies	No or very minor concerns regarding coherence	Moderate concerns regarding adequacy because the richness of the data are inconsistent across the studies	Minor concerns regarding relevance because data from four studies are pilot studies with its associated focused support to participants which is not true to real life	Moderate confidence	Due to no/very minor concerns regarding coherence, minor concerns regarding methodological limitations and relevance, and moderate concerns regarding adequacy
Finding 5 Some health workers relayed that mobile devices improved their reporting to supervisors and encouraged them to report more truthfully. Others compared mobile device‐facilitated supervision to "big brother watching". Some supervisors thought that mobile devices allowed them to better identify staff who needed support.	Barnabee 2014; Chang 2011; Jennings 2013; Madon 2014; Medhanyie 2015; Mwendwa 2016; Schoen 2017; Toda 2017; Valaitis 2005; van der Wal 2016	Moderate concerns regarding the methodological limitations because of inconsistent support of the included data for this finding	No/very minor concerns regarding coherence	Minor concerns regarding adequacy because some of the data are supported by one study only	Minor concerns regarding relevance because the perceptions are mostly from lay health workers	Moderate confidence	Due to no/very minor concerns regarding coherence, minor concerns regarding relevance and adequacy, and moderate concerns regarding methodological limitations
Finding 6 Health workers had positive experiences with using instant messaging through WhatsApp. This application was seen as cheap and suitable for a range of activities, such as communicating with peers and posting photos as evidence of work done.	Hampshire 2016; Henry 2016; Schoen 2017	Serious concerns regarding the methodological limitations because the study contributing most to the finding had a poor description of the context, sampling of participants, data collection and analysis.	No/very minor concerns regarding coherence	Serious concerns regarding adequacy because the finding is supported by only three studies	Moderate concerns regarding relevance because the finding is based on only three studies, with two of them being from Sub‐Saharan Africa	Very low confidence	Due to serious concerns regarding methodological limitations and adequacy, moderate concerns regarding relevance, and no/very minor concerns regarding coherence
Finding 7 Even when health workers received messages that were automated, rather than sent directly from a manager or supervisor, this was still experienced and responded to, as a kind of supervision. Some lower‐level health workers experienced it as supportive to their work, while others felt guilty for not providing correct care as per these messages.	Cherrington 2015; Ilozumba 2018; Jones 2012; Mwendwa 2016	Minor concerns regarding methodological limitations because though all research components are presented it is not described in sufficient detail	No/very minor concerns regarding coherence	Moderate concerns regarding adequacy because it is thin data	Moderate concerns regarding relevance because most of the data relate to lay health workers only, mostly from one study	Low confidence	Due to moderate concerns regarding relevance and adequacy, minor concerns regarding methodological limitations, and no/very minor concerns regarding coherence
Finding 8 The task optimisation enabled through mHealth interventions was widely valued by health workers.	Barnabee 2014; Chang 2011; Ilozumba 2018; Khan 2015; Kolltveit 2017; Lodhia 2016; Praveen 2014	Moderate concerns regarding the methodological limitations because in two supporting studies it was not clear how participants were selected, poor data collection description, and limited researcher reflexivity. In addition, we have only positive perceptions, which raises a concern about possible bias	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, but moderate concerns regarding methodological limitations
Finding 9 At times, health workers used their mobile devices to access the Internet for health information, and found it useful when they were with clients who needed the information. This interaction also included health workers providing clients with additional information beyond the healthcare intervention. But, if the only way that health workers could access online information, required them to use their own money to purchase data, then this could be prohibitive to them accessing such information.	Bacchus 2016; Hampshire 2016; Schoen 2017; Watkins 2018	Minor concerns regarding methodological limitations as the majority of studies had no to minor methodological limitations	No/very minor concerns regarding coherence	Serious concerns regarding adequacy because of very thin data	Minor concerns regarding relevance due to a limited number of countries in which the studies were conducted	Low confidence	Due to no/very minor concerns regarding coherence, minor concerns regarding methodological limitations and relevance, and serious concerns regarding adequacy
Finding 10 mHealth held the promise of increasing service efficiency for many health workers, but the experience of whether this promise was borne out in practice, varied in the accounts of health workers. It was experienced as efficient if it improved feedback, speed and workflow, but inefficient when the technology was slow and time consuming. Some were concerned that if mHealth was too efficient, making work faster, that this may justify staff cutbacks.	Ayiasi 2015; Barnabee 2014; Chang 2011; Cherrington 2015; Coetzee 2017; Garg 2016; Ginsburg 2016; Hampshire 2016; Hao 2015; Huq 2014; Jennings 2013; Jones 2012; Kolltveit 2017; Lodhia 2016; Madon 2014; Medhanyie 2015; Messinger 2017; Mwendwa 2016; Praveen 2014; Ramirez 2017; Rothstein 2016; Schoen 2017Schoen 2017; Toda 2017; Valaitis 2005; van der Wal 2016; Watkins 2018	Minor concerns regarding methodological limitations because 10 of the studies were pilot studies, which could bias the perceptions given the intensified support that is standard in pilot studies	Minor concerns regarding coherence given there were only two studies reporting negative perceptions	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns relevance and adequacy, and minor concerns regarding methodological limitations and coherence
Finding 11 Health workers frequently reported mobile devices as overcoming the difficulties of rural and geographically challenging contexts when it made it possible for them to provide health care without having to travel. Some reported that reducing travel time allowed them more time with their clients.	Chang 2011; Hampshire 2016; Hirsch‐Moverman 2017; Lodhia 2016; Messinger 2017; Mwendwa 2016; Quinn 2013; Rothstein 2016; Toda 2017; Valaitis 2005	Minor concerns regarding methodological limitations because more than half of the studies had poorly described data collection and analysis methods	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	Minor concerns regarding relevance as the finding is primarily applicable to only rural and geographically challenging contexts	High confidence	Due to no/very minor concerns regarding coherence and adequacy, and minor concerns regarding methodological limitations and relevance
Finding 12 Health workers appreciated the portability and work schedule flexibility of mobile devices.	Hampshire 2016; Murray 2011; Nguyen 2015; Orchard 2014; Ramirez 2017; Schoen 2017; Toda 2017; Valaitis 2005; van der Wal 2016	Moderate concerns regarding the methodological limitations because the majority of studies had insufficient, poorly described methods and data collection; the data in one study was hand recorded, and no ethical approval was described in another	No or very minor concerns regarding adequacy	No or very minor concerns regarding adequacy	No or very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence, relevance, adequacy, but moderate concerns regarding methodological limitations
Finding 13 Through mHealth, health workers were able to use treatment and screening algorithms that were loaded onto mobile devices. Their perceptions of using these electronic algorithms ranged from finding it easy and useful, to threatening their clinical competency, and an information overload. There were also some concerns that erroneous data entry may lead to wrong treatment guidance.	Ginsburg 2016; Ilozumba 2018; Lodhia 2016; Mitchell 2012; Mwendwa 2016; Nguyen 2015; Orchard 2014; Ramirez 2017; Rothstein 2016; Shao 2015; Surka 2014; Tewari 2017; van der Wal 2016	Minor concerns regarding methodological limitations given that the majority of studies had no or minor limitations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, and minor concerns regarding methodological limitations
Finding 14 Using mobile devices to record routine client or surveillance data, was mostly perceived by health workers and their managers as helpful for decision making, and increasing community and health worker appreciation of these data.	Khan 2015; Lodhia 2016; Madon 2014; Murray 2011; Nguyen 2015; Ramirez 2017; Rothstein 2016; Schoen 2017; Toda 2017	Moderate concerns regarding methodological limitations because half of the studies had insufficient information on the context, data collection and analysis methods, and potential bias because of how the data were collected	No or very minor concerns regarding coherence	No or very minor concerns regarding adequacy	No or very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, but moderate concerns regarding methodological limitations
Finding 15 In most cases health workers perceived mobile health as more advantageous than paper. However, some continued to prefer paper.	Bacchus 2016; Coetzee 2017; Ginsburg 2016; Madon 2014; Mitchell 2012; Mwendwa 2016; Nguyen 2015; Rothstein 2016; Schoen 2017; Surka 2014; Toda 2017; Valaitis 2005; van der Wal 2016; Vedanthan 2015; Watkins 2018	Minor concerns regarding methodological limitations given that the majority of studies had no or minor limitations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, and minor concerns regarding methodological limitations
Finding 16 mHealth interventions sometimes required health workers to perform tasks that were peripheral to regular service delivery, such as registering clients onto the system. These more menial tasks were sometimes regarded as undermining to professional staff.	Hirsch‐Moverman 2017; Medhanyie 2015; Murray 2015; Wolff‐Piggott 2018	Serious concerns regarding the methodological limitations because two of the included studies had poor descriptions of the context, data collection and analysis methods	Moderate concerns regarding coherence because part of the finding is not coherent across the supporting studies	Serious concerns regarding adequacy because of a limited number of studies with very thin data	Moderate concerns regarding relevance because of the limited number of settings in which the studies were conducted	Very low confidence	Due to serious concerns regarding methodological limitations and adequacy, and moderate concerns regarding coherence and relevance
Finding 17 Some health workers experienced the use of mHealth as generating an extra workload when, for instance, it resulted in reaching more clients needing care, or having to maintain both a mobile health and paper system. Some workers disliked this, particularly when their superiors did not perceive their mobile health work as part of their job description. Others did not object to the additional work, yet others wanted to be remunerated.	Chang 2011; Hao 2015; Kolltveit 2017; Lodhia 2016; Murray 2015; Mwendwa 2016; Praveen 2014; Rothstein 2016; Shao 2015; Wolff‐Piggott 2018	Minor considerations regarding methodological limitations as the majority of studies had no to minor methodological limitations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding coherence, relevance and adequacy, and minor concerns regarding methodological limitations
Finding 18 Through mobile devices, health workers and clients could communicate directly with each other, which health workers reported as improving care and their relationship with clients. When clients initiated the contact, health workers felt that clients took ownership of their health. Health workers felt that some clients still warrant face‐to‐face contact.	Barnabee 2014; Chang 2011; Cherrington 2015; Garg 2016; Hirsch‐Moverman 2017; Huq 2014; Jennings 2013; Lodhia 2016; Messinger 2017; Schoen 2017; van der Wal 2016; Watkins 2018	Minor concerns regarding methodological limitations as only one of the studies had serious methodological limitations because of poorly described methods and study context	No/very minor concerns regarding coherence	Moderate concerns regarding adequacy because evidence on clients appreciation and perceived impact on health worker‐client relationship was limited	No or very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence and relevance, minor concerns regarding methodological limitations, and moderate concerns regarding adequacy
Finding 19 Health workers were aware of the importance of protecting confidential client information when using mobile devices, and the confidentiality risks in cases of stolen phones and using their SIM cards in colleagues' phones. Health workers were alert to clients' concerns when they shared personal information concerning stigmatised issues, such as HIV/AIDS and interpersonal violence, and suggested ways to keep the information confidential. They emphasised building a trusting relationship with clients prior to using the devices.	Bachus 2016; Coetzee 2017; Garg 2016; Hirsch‐Moverman 2017; Lodhia 2016; Murray 2015; Mwendwa 2016; Rothstein 2016; Valaitis 2005; Wolff‐Piggott 2018	No/very minor concerns regarding methodological limitations as most of the studies had no to minor methodological limitations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/minor concerns regarding methodological limitations, coherence, relevance, and adequacy
Finding 20 Health workers were concerned that concentrating too much on the mobile technology during client consultations could be to the detriment of their service and interaction with clients.	Bacchus 2016; Schoen 2017; Vedanthan 2015	Minor concerns regarding methodological limitations because two of the three studies had no to minor methodological limitations	No/very minor concerns regarding coherence	Serious concerns regarding adequacy because the finding is based on only three studies	Moderate concerns regarding relevance: though there is a range from contexts where the studies were conducted, the finding is based on only three studies, representing limited settings	Low confidence	Due to serious concerns about adequacy, moderate concerns regarding relevance, minor concerns regarding methodological limitations, and no/very minor concerns regarding coherence
Finding 21 Health workers had differing reactions to being contactable via mobile devices during and outside of working hours: some felt it was useful, some were ambivalent about it, and others objected to it. Workers suggested setting boundaries to protect themselves from this.	Chang 2011; Cherrington 2015; Hampshire 2016; Huq 2014; Jennings 2013; Schoen 2017; Valaitis 2005	No or very minor concerns regarding methodological limitations	No/very minor concerns regarding coherence	Moderate concerns regarding adequacy because of a limited number of studies and thin data	Minor concerns regarding relevance because the supporting data are limited in the range of specific health issues	Moderate confidence	Due to no/very minor concerns regarding methodological limitations and coherence, minor concerns regarding relevance, and moderate concerns regarding adequacy
Finding 22 Health workers experienced the use of mobile technology to provide health care, as being met with both trust and skepticism from clients and the communities they served. They described how trust or skepticism in the device was translated into trust or skepticism of their service when using the device. Some found that using mobile devices raised their social status with clients, and even their families. Others were concerned that using expensive equipment would emphasise inequity between themselves and clients.	Ayiasi 2015; Barnabee 2014; Cherrington 2015; Coetzee 2017; Ginsburg 2016; Ilozumba 2018; Jones 2012; Khan 2015; Lodhia 2016; Madon 2014; Mitchell 2012; Mwendwa 2016; Valaitis 2005; van der Wal 2016	Minor concerns regarding methodological limitations as only a few studies had insufficient information on author reflexivity, participant selection, study limitations, and ethical considerations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, and minor concerns regarding methodological limitations
Finding 23 Health workers experienced clients as having an opinion not only about their use of mobile devices, but as having an opinion on the devices themselves, which influenced how they responded to care delivered with the support of these devices. Health workers ascribed clients' enthusiasm for mobile devices as due to these clients' perception of the devices as prestigious, offering trustworthy information, and providing confidentiality. They perceived clients as more receptive when these clients were familiar with the devices used. There were concerns that clients who felt that the use of these devices during care was too time consuming, and would respond negatively to its use.	Bacchus 2016; Garg 2016; Ginsburg 2016; Ilozumba 2018; Jones 2012; Khan 2015; Messinger 2017; Mitchell 2012; Schoen 2017; Shao 2015; Valaitis 2005; van der Wal 2016; Vedanthan 2015; Westergaard 2017	Moderate concerns regarding the methodological limitations, as the majority of studies had no or very minor methodological concerns, however substantial supporting data came from a study with serious methodological concerns	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence, relevance and adequacy, but moderate concerns regarding methodological limitations
Finding 24 Some interventions required clients to have phones as well as health workers. Health workers described this as challenging for multiple reasons, including clients not having phones, changing their phone numbers regularly, not knowing how to use a phone, being a target of crime because of possession of the phone, and women being prohibited from accessing phones. Health workers suggested competitive pricing to increase clients' access to phones, and to issue clients with phones.	Chang 2011; Hirsch‐Moverman 2017; Huq 2014; Murray 2015; Tewari 2017; van der Wal 2016; Wolff‐Piggott 2018	Minor concerns regarding methodological limitations, as only one study had serious methodological limitations with inadequate descriptions of context, data collection and analysis methods	No/very minor concerns regarding coherence	Minor concerns regarding adequacy because of the limited number of studies and thin data	Moderate concerns regarding relevance because of the limited range of settings and health worker categories	Moderate confidence	Due to no/very minor concerns regarding coherence, minor concerns regarding methodological limitations and adequacy, and moderate concerns regarding relevance
Finding 25 Health workers were ambivalent about interventions that required clients to use the health workers' mobile devices during consultations. Their optimism was tempered by concern that there was a loss of meaningful engagement with clients.	Bacchus 2016; Coetzee 2017	No/very minor concerns regarding methodological limitations	No/very minor concerns regarding coherence	Serious concerns regarding adequacy because the finding is based on only two studies	Moderate concerns regarding relevance as none of the two studies were conducted in low‐ and lower‐middle‐income countries, and only reported lay health workers' perceptions	Low confidence	Due to serious concerns regarding adequacy, moderate concerns regarding relevance, and no/very minor concerns regarding methodological limitations and coherence
Finding 26 Health workers reported that their access to mobile devices was beneficial to clients and communities who were too poor to own mobile phones.	Chang 2011; van der Wal 2016	Moderate concerns regarding the methodological limitations because of poorly described data collection and analysis methods in the one study contributing most of the data	No or very minor concerns regarding coherence	Serious concerns regarding adequacy because the finding is based on very thin data	Serious concerns regarding relevance because the finding is based on only two studies, which also limits the study contexts	Very low confidence	Due to serious concerns regarding relevance and adequacy, moderate concerns regarding methodological limitations, and no/very minor concerns regarding coherence
Finding 27 Health workers felt that health promotion and educational messaging directed at clients using mobile health interventions, impacted positively on clients' health behaviours, but cautioned against repetitive showing of health promotion videos. In one instance, issuing clients with mobile phones led to increased use of healthcare services.	Bacchus 2016; Barnabee 2014; Chang 2011; Coetzee 2017; Ginsburg 2016; Huq 2014; Ilozumba 2018; Jones 2012; Lodhia 2016; Madon 2014; Murray 2011; Praveen 2014; van der Wal 2016	No/very minor concerns regarding the methodological limitations because the majority of studies had no to minor methodological limitations	No/very minor concerns regarding coherence	Moderate concerns regarding adequacy as some studies had thin data with limited discussion of health worker perceptions	No/very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding methodological limitations, coherence, and relevance, but moderate concerns regarding adequacy
Finding 28 Some health workers accepted bearing the costs of mHealth interventions themselves, but were dissatisfied when phone credit to use the phones was not paid on time. Health workers felt that clients appreciated it when health workers called them, as it saved them costs.	Hampshire 2016; Khan 2015; Messinger 2017; Quinn 2013; van der Wal 2016; Watkins 2018; Wolff‐Piggott 2018	Minor concerns regarding methodological limitations because most of the studies has no or minor concerns	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding relevance and adequacy, and minor concerns regarding methodological limitations and coherence
Finding 29 Health workers' digital literacy impacted on their experience and perceptions of the use of mobile devices in health service delivery: being digitally literate resulted in positive experiences and perceptions, whilst low digital literacy caused concerns about job security and embarrassment when making mistakes in front of clients. For some workers, prior exposure to mobile devices did not affect their perceptions and use of mobile health. Some turned their lack of digital literacy into building a relationship with clients by asking clients to show them how to use the devices. Not using the devices often enough, resulted in loss in digital literacy	Bacchus 2016; Cherrington 2015; Coetzee 2017; Ginsburg 2016; Hao 2015; Hirsch‐Moverman 2017; Ilozumba 2018; Kolltveit 2017; Madon 2014; Mitchell 2012; Murray 2011; Mwendwa 2016; Nguyen 2015; Praveen 2014; Quinn 2013; Shao 2015; Surka 2014; Valaitis 2005; van der Wal 2016; Watkins 2018	Moderate concerns regarding methodological limitations because half of the studies had moderate concerns of which three had serious methodological limitations. The limitations included poorly described data collection and analysis methods, and in one study there were concerns that the data collection method could have biased participant responses	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, but moderate concerns regarding methodological limitations
Finding 30 Health workers expressed a need for training and familiarity with mobile devices to overcome their initial anxiety in using the devices. Peer training from technologically proficient colleagues was experienced as valuable. In several cases, health workers wanted refresher training and pointed to the importance of training replacement staff. Not having mentors who used mobile devices, impacted negatively on lower‐level workers' ability to learn how to use these devices.	Coetzee 2017; Ginsburg 2016; Ilozumba 2018; Kolltveit 2017; Lodhia 2016; Madon 2014; Murray 2011; Mwendwa 2016; Nguyen 2015; Praveen 2014; Rothstein 2016; Tewari 2017; Toda 2017; van der Wal 2016; Vedanthan 2015	Minor concerns regarding methodological limitations because the majority of studies had no or minor methodological limitations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, and minor concerns regarding methodological limitations
Finding 31 All categories of health workers required technical support to solve user problems. At times, face‐to‐face support was provided, but technical support from proficient colleagues was useful too. Having technical problems solved through real‐time improvements worked well for some health workers, while others suggested a help function be added to the devices.	Cherrington 2015; Garg 2016; Hao 2015; Ilozumba 2018; Kolltveit 2017; Lodhia 2016; Madon 2014; Murray 2011; Mwendwa 2016; Rothstein 2016; Toda 2017; van der Wal 2016	Minor concerns regarding methodological limitations as most studies had no to minor methodological limitations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, and minor concerns regarding methodological limitations
Finding 32 Health workers highlighted that mobile technology applications should be user‐friendly, easy to learn, and improve the quality of their care. When the applications were not easy to use, health workers became frustrated and reluctant users of mobile devices.	Ginsburg 2016; Khan 2015; Kolltveit 2017; Lodhia 2016; Mwendwa 2016; Praveen 2014; Ramirez 2017; Rothstein 2016; Schoen 2017; Toda 2017; van der Wal 2016	Minor concerns regarding methodological limitations because only a few studies had insufficient information about the data collection and analysis methods, and author reflexivity	No/very minor concerns regarding coherence	No very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, and minor concerns regarding methodological limitations
Finding 33 Health workers held mixed views on choosing between tablets and smartphones. Some felt that the type of content on the device was more important than the device itself. However, other health workers preferred tablets over smartphones, mainly because the bigger size of the screen was perceived as easier for client engagement.	Schoen 2017; Shao 2015	Minor concerns regarding the methodological limitations because of limited description of the data analysis	No/very minor concerns regarding coherence	Serious concerns regarding adequacy because the finding is based on only two studies	Serious concerns regarding relevance because the finding is based on only two contexts	Very low confidence	Due to serious concerns regarding relevance and adequacy, minor concerns regarding methodological limitations, and no/very minor concerns regarding coherence
Finding 34 Some health workers felt that sustainable, at scale mHealth programmes required approval and stewardship from political leaders, such as ministries of health. Leadership interest in mHealth interventions was described as motivating to health workers. Health workers suggested that such leaders should be engaged early and continuously throughout the programme, and be provided with evidence of effectiveness, so as to secure their support. The lack of high‐level stewardship impacted negatively on the mHealth programme.	Ginsburg 2016; Kolltveit 2017; Lodhia 2016	No/very minor concerns regarding methodological limitations	No/very minor concerns regarding coherence	Serious concerns regarding adequacy because the finding is based on only four studies	No/very minor concerns regarding relevance	Low confidence	Due to serious concerns regarding adequacy, and no/very minor concerns regarding methodological limitations, coherence and relevance
Finding 35 Health worker accounts pointed to the strong influence of the health systems and social context in which the intervention was embedded. Contextual and systems issues such as difference in language use between clients and health workers, gender discrimination, discomfort with professional hierarchies, poverty, resource constraints, staff attrition, and more, all of which were external to the technology and the physical device, influenced how health workers experienced mHealth and the use of mobile devices for service delivery, in their different contexts.	Chang 2011; Huq 2014; Khan 2015; Kolltveit 2017; Lodhia 2016; Praveen 2014; Rothstein 2016; Shao 2015; Tewari 2017; Toda 2017; van der Wal 2016; Wolff‐Piggott 2018	No/very minor concerns regarding methodological limitations	Moderate concerns regarding coherence because we may be over‐interpreting health workers' perceptions	Moderate concerns regarding adequacy because some of the supporting quotes speak indirectly to the finding	No/minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding methodological limitations and relevance, but moderate concerns regarding coherence and adequacy
Finding 36 It was important for health workers that mobile health interventions be integrated with other existing electronic health information systems. This interoperability made it more likely that mobile devices would be integrated into standard care practices, while the absence of integration frustrated health workers.	Garg 2016; Ginsburg 2016; Lodhia 2016; Rothstein 2016	No/minor concerns regarding methodological limitations	No/very minor concerns regarding coherence	Moderate concerns regarding adequacy because one study had thin data, and the finding is based on only four studies	Moderate concerns regarding relevance because two of the four studies were conducted in the same country	Moderate confidence	Due to no/very minor concerns regarding methodological limitations and coherence, but moderate concerns regarding relevance and adequacy
Finding 37 Health workers offered programmatic and implementation recommendations to improve mobile health interventions. The most cited of these was that the interventions be expanded to other settings and services, beyond what they were using it for as described in the studies. Other recommendations included raising community awareness about mHealth programmes, being involved in developing programmes, and appointing a 'mobile health champion'. Workers also suggested that those collecting surveillance data, must be informed of how the data are used.	Bacchus 2016; Barnabee 2014; Ginsburg 2016; Hao 2015; Khan 2015; Kolltveit 2017; Lodhia 2016; Madon 2014; Medhanyie 2015; Mitchell 2012; Murray 2015; Mwendwa 2016; Rothstein 2016; Schoen 2017; Toda 2017; van der Wal 2016	Moderate concerns regarding methodological limitations: though the majority of studies had no to minor methodological limitations, there were three studies with moderate limitations and two with serious limitations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding, coherence, relevance, and adequacy, and moderate concerns regarding methodological limitations
Finding 38 Health workers had several technical recommendations to improve mobile health devices, for instance solar panels to counter poor electricity access and using photos to track clients' recovery from illness. Other recommendations included using sturdier devices, bigger screens, and having common applications, such as work scheduling on the devices.	Coetzee 2017; Henry 2016; Lodhia 2016; Praveen 2014; Quinn 2013; Schoen 2017	Minor concerns regarding methodological limitations because the majority of studies had no to minor methodological limitations	No/very minor concerns regarding coherence	Minor concerns regarding adequacy because of thin data found in the studies	Moderate concerns regarding relevance because of the limited range of contexts in which the studies were conducted	Moderate confidence	Due to no/very minor concerns regarding coherence, minor concerns regarding adequacy, and methodological limitations, and moderate concerns regarding relevance
Finding 39 The main challenges health workers experienced in using mobile devices, were poor network connectivity, access to electricity, and the costs to recharge devices. Solutions offered, included using solar panels, using the powered‐up phone of a colleague, or reverting back to the paper‐based system. Sometimes poor connectivity resulted in client dissatisfaction because it created delays in receiving health care. Health workers' commitment to their clients motivated them to cope with these and other challenges.	Chang 2011; Ginsburg 2016; Hampshire 2016; Ilozumba 2018; Khan 2015; Lodhia 2016; Madon 2014; Mwendwa 2016; Nguyen 2015; Praveen 2014; Quinn 2013; Schoen 2017; Toda 2017; van der Wal 2016; Watkins 2018	Minor concerns regarding methodological limitations as the majority of papers had no to minor methodological limitations	No/very minor concerns regarding coherence	No/very minor concerns regarding adequacy	No/very minor concerns regarding relevance	High confidence	Due to no/very minor concerns regarding coherence, relevance, and adequacy, and minor concerns regarding methodological limitation
Finding 40 Health workers expressed dissatisfaction with mobile devices when technology changes were too rapid, showed a dislike for typing, and were concerned that mHealth impersonalised their interaction with clients. Since these dissatisfactions were only infrequently raised within the data set, it is unclear if these perceptions reflect wider experience.	Bacchus 2016; Hao 2015; Schoen 2017; Valaitis 2005	Minor concerns regarding the methodological limitations because only one study had poorly described methods	No / very minor concerns regarding coherence	Serious concerns regarding adequacy because of a small number of studies and very thin data. In addition, each reason for dissatisfaction was only reported in one study	Moderate concerns regarding relevance because the supporting data come from a limited number of contexts	Low confidence	Due to serious concerns regarding adequacy, moderate concerns regarding relevance, minor concerns regarding methodological concerns, and no/very minor concerns regarding coherence
Finding 41 Health workers discussed challenges, beyond network and electricity issues, that sometimes were just an annoyance or a concern, but at other times also impeded their mHealth activities, and their ability to provide a service assisted by the use mobile devices. These included damaged devices, loss and theft of devices, having to carry two devices, not being able to readily buy phone credit when needed, not being able to send long messages because of character limitations, and the limitations of the language capabilities of their devices.	Chang 2011; Cherrington 2015; Coetzee 2017; Hampshire 2016; Hao 2015; Ilozumba 2018; Lodhia 2016; Medhanyie 2015; Murray 2015; Mwendwa 2016; Praveen 2014; Quinn 2013; Rothstein 2016; Toda 2017; Valaitis 2005; van der Wal 2016	Minor concerns regarding the methodological limitations because a few studies had poor descriptions of the data collection and analysis methods	No/very minor concerns regarding coherence	Moderate concerns regarding adequacy because some studies lack depth in the discussion, and had very thin data	No/very minor concerns regarding relevance	Moderate confidence	Due to no/very minor concerns regarding coherence and relevance, minor concerns regarding methodological limitations, and moderate concerns regarding adequacy
Finding 42 Health workers complained when the tasks asked of them in mHealth interventions were felt to be beyond their clinical capacity, and when support from higher‐level workers was absent.	Orchard 2014; Praveen 2014	Moderate concerns regarding the methodological limitations because one of the supporting studies had serious concerns because the methods were poorly described	No/very minor concerns regarding coherence	Serious concerns regarding adequacy because of the limited number of studies and thin data in one study	Serious concerns regarding relevance as the data contributing to the findings were conducted in a high‐ and a middle‐ income country, respectively. In one study, the participants were receptionists, whom we do not assume to act as health workers in general	Very low confidence	Due to serious concerns regarding relevance and adequacy, moderate concerns regarding methodological limitations, and no/very minor concerns regarding coherence