Telehealth Interventions Designed for Women: an Evidence Map
Telehealth employs technology to connect patients to the right healthcare resources at the right time. Women are high utilizers of healthcare with gender-specific health issues that may benefit from the convenience and personalization of telehealth. Thus, we produced an evidence map describing the quantity, distribution, and characteristics of evidence assessing the effectiveness of telehealth services designed for women.
We searched MEDLINE® (via PubMed®) and Embase® from inception through March 20, 2018. We screened systematic reviews (SRs), randomized trials, and quasi-experimental studies using predetermined eligibility criteria. Articles meeting inclusion criteria were identified for data abstraction. To assess emerging trends, we also conducted a targeted search of ClinicalTrials.gov.
Two hundred thirty-four primary studies and three SRs were eligible for abstraction. We grouped studies into focused areas of research: maternal health (n = 96), prevention (n = 46), disease management (n = 63), family planning (n = 9), high-risk breast cancer assessment (n = 10), intimate partner violence (n = 7), and mental health (n = 3). Most interventions focused on phone as the primary telehealth modality and featured healthcare team-to-patient communication and were limited in duration (e.g., < 12 weeks). Few interventions were conducted with older women (≥ 60 years) or in racially/ethnically diverse populations. There are few SRs in this area and limited evidence regarding newer telehealth modalities such as mobile-based applications or short message service/texting. Targeted search of clinical.trials.gov yielded 73 ongoing studies that show a shift in the use of non-telephone modalities.
Our systematic evidence map highlights gaps in the existing literature, such as a lack of studies in key women’s health areas (intimate partner violence, mental health), and a dearth of relevant SRs. With few existing SRs in this literature, there is an opportunity for examining effects, efficiency, and acceptability across studies to inform efforts at implementing telehealth for women.
We would like to thank Megan Von Isenburg for the assistance with the literature search and retrieval, Jennifer McDuffie for the support in conducting this project during all phases, Angela Zoss for the data visualization assistance, and Liz Wing for the editorial assistance. We also thank the study participants who volunteered to be a part of the research described here. Additionally, we would like to thank the following key stakeholders and technical expert panel members for their feedback during the development and execution of this project: Lori Bastian, Alicia Christy, Kathy Frisbee, Sally Haskell, Jan Lindsay, Nancy Maher, Carolyn Turvey, and Alan West.
Drs. Zullig and Goldstein are supported by Veterans Affairs (VA) Health Services Research and Development (HSR&D) Career Development Awards (CDA) (CDA 13-025 and CDA 13-263, respectively). Dr. Dedert is supported by a CSR&D Service of the VA Office of Research and Development Career Development Award (Number 1IK2CX000718). Dr. Bosworth is supported by a VA HSR&D Research Career Scientist (RCS) Award (RCS 08-027). Dr. Whited is supported by a VA HSR&D Award (SD 16-192). This work was supported by the Center of Innovation for Health Services Research in Primary Care (CIN 13-410) at the Durham VA and the VA Evidence-based Synthesis Program (ESP 09-010). The primary source of funding for this work was the VA Evidence-based Synthesis Program (ESP 09-010). This work was also supported by the Center of Innovation for Health Services Research in Primary Care (CIN 13-410).
Compliance with Ethical Standards
Conflict of Interest
Dr. Whited is a co-editor of Teledermatology: A User’s Guide published by Cambridge University Press and receives royalties based on sales. All other authors declare no conflicts of interest.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the United States government, or Duke University.
- 1.U.S. Department of Health and Human Services. Health Resources & Services Adminstration: Telehealth Programs. Available at https://www.hrsa.gov/rural-health/telehealth/index.html. Accessed 17 July 2018.
- 3.Agency for Healthcare Research and Quality (AHRQ). National Health IT Day. June 7, 2006. Available at: https://archive.ahrq.gov/news/sp060706.htm. Accessed 17 July 2018.
- 9.Miake-Lye IM, Hempel S, Shanman R, Shekelle PG. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Syst Rev. 2016;528. https://doi.org/10.1186/s13643-016-0204-x
- 12.EPOC. Effective Practice and Organisation of Care (EPOC). EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services; 2015. Available at: http://epoc.cochrane.org/resources/epoc-resources-review-authors. Accessed 17 July 2018.
- 13.Simmons D, Devlieger R, van Assche A, et al. Effect of physical activity and/or healthy eating on GDM risk: The DALI Lifestyle Study. J Clin Endocrinol Metab. 2016jc20163455. https://doi.org/10.1210/jc.2016-3455
- 16.Freeman LW, White R, Ratcliff CG, et al. A randomized trial comparing live and telemedicine deliveries of an imagery-based behavioral intervention for breast cancer survivors: reducing symptoms and barriers to care. Psychooncology. 2015;24(8):910–8. https://doi.org/10.1002/pon.3656 CrossRefPubMedGoogle Scholar
- 18.Snaith VJ, Hewison J, Steen IN, Robson SC. Antenatal telephone support intervention with and without uterine artery Doppler screening for low risk nulliparous women: a randomised controlled trial. BMC Pregnancy Childbirth. 2014;14121. https://doi.org/10.1186/1471-2393-14-121
- 31.Nicolau AIO, Lima TM, Vasconcelos CTM, Carvalho FHC, Aquino PS, Pinheiro AKB. Telephone interventions in adherence to receiving the Pap test report: a randomized clinical trial. Rev Lat Am Enfermagem. 2017;25e2948. https://doi.org/10.1590/1518-8345.1845.2948
- 32.Rasouli M, AtashSokhan G, Keramat A, Khosravi A, Fooladi E, Mousavi SA. The impact of motivational interviewing on participation in childbirth preparation classes and having a natural delivery: a randomised trial. BJOG. 2017;124(4):631–639. https://doi.org/10.1111/1471-0528.14397 CrossRefPubMedGoogle Scholar
- 35.Sreedevi A, Unnikrishnan AG, Karimassery SR, Deepak KS. The Effect of Yoga and Peer Support Interventions on the Quality of Life of Women with Diabetes: Results of a Randomized Controlled Trial. Indian J Endocrinol Metab. 2017;21(4):524–530. https://doi.org/10.4103/ijem.IJEM_28_17 CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Steinberg DM, Levine EL, Lane I, et al. Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among Black women: randomized controlled trial. J Med Internet Res. 2014;16(4):e114. https://doi.org/10.2196/jmir.2996 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Parra-Medina D, Wilcox S, Salinas J, et al. Results of the Heart Healthy and Ethnically Relevant Lifestyle trial: a cardiovascular risk reduction intervention for African American women attending community health centers. Am J Public Health. 2011;101(10):1914–21. https://doi.org/10.2105/ajph.2011.300151 CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Schover LR, Rhodes MM, Baum G, et al. Sisters Peer Counseling in Reproductive Issues After Treatment (SPIRIT): a peer counseling program to improve reproductive health among African American breast cancer survivors. Cancer. 2011;117(21):4983–92. https://doi.org/10.1002/cncr.26139 CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Prinja S, Nimesh R, Gupta A, Bahuguna P, Gupta M, Thakur JS. Impact of m-health application used by community health volunteers on improving utilisation of maternal, new-born and child health care services in a rural area of Uttar Pradesh, India. Trop Med Int Health. 2017;22(7):895–907. https://doi.org/10.1111/tmi.12895 CrossRefPubMedGoogle Scholar
- 47.World Bank. How does the World Bank classify countries? Available at: https://datahelpdesk.worldbank.org/knowledgebase/articles/378834-how-does-the-world-bank-classify-countries. Accessed 17 July 2018.
- 48.Lee EW, Denison FC, Hor K, Reynolds RM. Web-based interventions for prevention and treatment of perinatal mood disorders: a systematic review. BMC Pregnancy Childbirth. 2016;1638. https://doi.org/10.1186/s12884-016-0831-1
- 49.Zhang Q, Zhang L, Yin R, Fu T, Chen H, Shen B. Effectiveness of telephone-based interventions on health-related quality of life and prognostic outcomes in breast cancer patients and survivors-A meta-analysis. Eur J Cancer Care (Engl). 2018;27(1). https://doi.org/10.1111/ecc.12632 CrossRefGoogle Scholar
- 54.Hameed W, Azmat SK, Ali M, et al. Comparing Effectiveness of Active and Passive Client Follow-Up Approaches in Sustaining the Continued Use of Long Acting Reversible Contraceptives (LARC) in Rural Punjab: A Multicentre, Non-Inferiority Trial. PLoS One. 2016;11(9):e0160683. https://doi.org/10.1371/journal.pone.0160683 CrossRefPubMedPubMedCentralGoogle Scholar
- 55.Berenson AB, Rahman M. A randomized controlled study of two educational interventions on adherence with oral contraceptives and condoms. Contraception. 2012;86(6):716–24. https://doi.org/10.1016/j.contraception.2012.06.007 CrossRefPubMedPubMedCentralGoogle Scholar
- 59.Paul M, Iyengar K, Essén B, et al. Acceptability of home-assessment post medical abortion and medical abortion in a low-resource setting in Rajasthan, India. Secondary outcome analysis of a non-inferiority randomized controlled trial. PLoS ONE. 2015;10:9 Article Number: e0133354.Google Scholar
- 60.Chang Y, Near AM, Butler KM, et al. Economic Evaluation Alongside a Clinical Trial of Telephone Versus In-Person Genetic Counseling for BRCA1/2 Mutations in Geographically Underserved Areas. J Oncol Pract. 2016;12(1):59, e1-13. https://doi.org/10.1200/jop.2015.004838 CrossRefPubMedPubMedCentralGoogle Scholar
- 76.van-Velthoven MH, Tudor Car L, Gentry S, Car J. Telephone delivered interventions for preventing HIV infection in HIV-negative persons. Cochrane Database Syst Rev. 2013(5):Cd009190. https://doi.org/10.1002/14651858.CD009190.pub2
- 77.ClinicalTrials.gov. NCT02667626. Reproductive Health Survivorship Care Plan. Available at: https://ClinicalTrials.gov/show/NCT02667626. Accessed 17 July 2018.
- 78.ClinicalTrials.gov. NCT03435380. Promoting Breast Cancer Screening in Women Who Survived Childhood Cancer. Available at: https://ClinicalTrials.gov/show/NCT03435380. Accessed 17 July 2018.
- 79.ClinicalTrials.gov. NCT03334149. Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension. Available at: https://ClinicalTrials.gov/show/NCT03334149. Accessed 17 July 2018.