Table 2.
Descriptive themes identified regarding ethical, legal, regulatory, and sociocultural concerns of mobile health (mHealth) interventions and mobile phone data use.
| Studies and countries | Domain of concern | mHealth intervention | Key recommendation | |
| Adequate informed consent | ||||
|
|
Uganda [34,35], Kenya [36] | Cannot consent due to failed understanding of technology | Computer-assisted personal interviewing, mobile phone surveys, telemedicine | Participants’ inadequate understanding of the capabilities of mHealth interventions; thus, the question of whether they understood sufficiently to properly consent was raised |
|
|
Tanzania and Uganda [37] | Consent must be a prerequisite to mHealth interventions | Image-based mHealth app | Not provided |
|
|
Kenya [38] | Consent needed for different types of prevention of mother-to-child transmission information | SMS text messaging | Not provided |
| Privacy and confidentiality | ||||
|
|
Uganda [39-48] | Password/PINa protection | SMS text messaging, mobile job aid, mobile phone tool | Use of PIN and passwords offers protection of confidentiality. However, the mere presence of passwords may arouse suspicion by intimate partners and others |
|
|
Kenya [38,49-53] | Phone theft, data breaches | Smartphone app | Not provided |
|
|
Tanzania [16,18,54,55] | Phone sharing | Smartphone app | Not provided |
| Data security and protection | ||||
|
|
Tanzania [56-58] | Data breaches, phone theft, access rights to protect client data | Smartphone app, mobile job aid, mobile app | mHealth interventions should have an eye toward maternal perception of data security, and with prior and ongoing consultation with community members. Locking phones with a password improves the ability of CHWsb to maintain confidentiality of their clients’ information, particularly for women who did not want to disclose their use of family planning to their husband or other family members |
|
|
Kenya [50,59] | Phone theft | SMS text messaging, smartphone ophthalmic exam | Not provided |
|
|
Uganda [34,35] | Mobile phone numbers linked to national ID cards | Computer-assisted personal interviewing, interactive voice survey | Not provided |
| Sociocultural | ||||
|
|
Tanzania [56,60] | Breach of pregnancy-related information | Mobile phone app | Support from male heads of household may be important in implementing successful mHealth interventions |
|
|
Uganda [43] | Gender dynamics, delivery of interactive voice survey in voice of opposite sex | Interactive voice survey, SMS messaging | Preference of male or female voices for phone call interventions may vary based on the patient’s gender |
| Regulatory/legal | ||||
|
|
Tanzania [56] | Data protection legislation | Mobile phone app | Data protection legislation is needed in regions where local dynamics are important when protecting individuals’ health data |
|
|
Uganda [35] | National ethics guidelines | Interactive voice survey | Not provided |
aPIN: personal identification number.
bCHW: community health worker.