Implementation of mHealth to support cancer diagnosis in Sub-Saharan Africa: A systematic review

Background: A reduction in communicable diseases in sub-Saharan Africa (SSA) over recent decades has led to an increased life expectancy and non-communicable diseases such as cancer. However, cancer services in SSA remain inadequate. With increasing mobile use, mobile health (mHealth) has the potential to expand healthcare access. Aim: This systematic review aims to synthesise literature reporting on barriers and facilitators to the implementation and use of mHealth tools by patients or the public to support symptomatic cancer diagnosis in SSA. Method: A comprehensive literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two researchers independently conducted title and abstract screening, full-text review and data extraction. Extraction templates were compared and data were synthesised. Quality was assessed using the Mixed Methods Appraisal Tool. Results: Of 7695 records identified, three quantitative and two mixed-methods studies were included, published between 2016 and 2022. The studies focused on Kaposi's sarcoma, cervical cancer, breast cancer and any cancer. Three inter-related themes describe the barriers and facilitators: (1) user or population-related factors including access to mobile devices and connectivity, and language literacy; (2) mHealth tool-related factors such as tool accessibility and language translation; and (3) structural, societal or systemic factors such as sociocultural significance and stigma. Conclusion: Although SSA countries experienced similar challenges to mHealth tool use as high-income nations, some barriers such as limited mobile devices and connectivity were more severely evident. Contribution: The study findings can be used to guide future mHealth tool design and implementation strategies that are relevant to SSA.