Mobile health interventions for African adults with hypertension: Evidence from a systematic review of implementation research outcomes.

Africa faces a disproportionate burden of hypertension, with a prevalence of 27% compared to 18% in the Americas. Despite cost-effective lifestyle and medical interventions, the region suffers from poor detection, treatment, and control rates. Mobile health (mHealth) interventions show promise for hypertension management, however, implementation outcomes in African countries remain underexplored. To fill this gap, this systematic review assessed the acceptability, feasibility, and adoption rates of mHealth interventions among adults diagnosed with hypertension in Africa and identified various facilitators and barriers to its implementation. The review was conducted across nine databases, adhering to the World Bank's classification of low and middle-income countries (LMICs) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The search was conducted in October 2023 and updated in January 2024 with no date restrictions. Studies evaluating mHealth interventions for hypertension management among African adults, using experimental, observational, or qualitative designs, and reporting Proctor's implementation outcomes were included. Studies involving individuals without diagnosed hypertension and pregnant women with preeclampsia, and African population living outside Africa were excluded. Risk of bias was evaluated using the ASSESS tool (A comprehenSive tool to Support rEporting and critical appraiSal of qualitative, quantitative, and mixed methods implementation reSearch Outcomes). Data was extracted independently in Covidence and conflicts were resolved by consensus. In the context of contemporary research practices, it is important to note that no large language models or other AI systems were utilized in the development of this paper. We found eighteen articles focusing on mHealth interventions for hypertension in Africa, exploring acceptability (n = 10), feasibility (n = 11), adoption (n = 4), and appropriateness (n = 2). Service outcomes including effectiveness (n = 3), efficacy (n = 1), patient-centeredness (n = 1), and scalability (n = 2) were also examined. Acceptability and effectiveness were the most frequently reported outcomes. However, feasibility challenges, mainly financial constraints, and cellular network issues, were prominent. Most studies were urban-centric, indicating a gap in understanding rural challenges. Risk of bias was low across all the included studies. Application-based mHealth interventions appears to have gained significant utilization in Africa, particularly in countries like Nigeria, Ghana, and South Africa, while SMS-based interventions show promise in reaching non-smartphone users. Despite successes, feasibility challenges persist, necessitating targeted interventions for financial constraints and network infrastructure. The limitations of this systematic review include exclusion of hypertension with comorbidities beyond diabetes and stroke. Moreover, most studies were confined to urban areas potentially limiting the scalability of these interventions in rural and non-urban regions in resource-constrained areas. Future research should aim to bridge the urban-rural gap and explore innovative solutions to enhance the feasibility, adoption, scalability, and sustainability of mHealth interventions for hypertension management across diverse African settings.