Determinants of mHealth Usability and Adoption in Maternal and Child Health and Nutrition Programs in Low and Middle-Income Countries

Abstract

Mobile health, or mHealth, interventions are increasingly used to support maternal, newborn, and child health and nutrition programs in low and middle-income countries. Mobile phones, short message service, voice calls, messaging platforms, and mobile applications may improve antenatal care attendance, immunization timeliness, breastfeeding practices, nutrition knowledge, and health-service utilization. However, many interventions remain limited to pilot implementation, experience declining use, or fail to become integrated into routine service delivery. This narrative review examines determinants influencing the usability, acceptability, adoption, implementation, and scale-up of mHealth interventions in maternal and child health and nutrition programs. A targeted literature search was conducted using PubMed, Google Scholar, reference-list screening, and selected institutional and government sources. Evidence was synthesized narratively and organized across individual, technological, organizational, and health-system levels. The reviewed evidence indicates that mHealth use is influenced by device access, digital literacy, perceived usefulness, trust, social influence, facilitating conditions, usability, privacy, connectivity, training, workflow integration, interoperability, governance, and financing. Findings concerning individual determinants vary across studies. For example, app quality was a strong predictor of intention to use in one developing-country study, but this finding should not be generalized across all settings. More recent evidence among health workers indicates that trust and facilitating conditions are also important determinants of behavioral intention and actual use. mHealth programs should therefore be designed as components of health-service delivery rather than as stand-alone applications. Human-centered design, equitable access, provider support, privacy safeguards, workflow integration, and alignment with national health-information architecture are necessary for sustained and scalable implementation.