Open research questions in Mobile Health and mHealth Applications

What the literature leaves open

• Age, sex, and disease severity were reported in all studies, but characteristics linked to health inequalities were underreported; for example, 8 (29.

  Engagement and Intersectionality in Digital Self-Management Interventions for Asthma and Chronic Obstructive Pulmonary Disease: Scoping Review · 2026 · DOI

• In conclusion, mobile health applications are regarded as innovative tools that enhance the quality of care in public health nursing, have the potential to reduce health inequities, and play a significant role in improving community health. These applications contribute to making health services more accessible, patient-centered, and sustainable; they also enhance the effectiveness of health systems. Mobile health applications are highly significant for promoting health and self-management of illness by offering convenience and accessibility, and this is an area that continues to evolve (6). To ensure the widespread and effective use of mobile health applications, it is necessary to increase digital health literacy, strengthen data security and ethical standards, and develop the competencies of healthcare professionals regarding these technologies. To promote the more widespread and effective use of mobile health applications: • Developing in-service training programs to digital health enhance competencies health technologies, nurses’ regarding mobile public • National policies and strategies should be established health integrate mobile applications into the healthcare system, to • Digital health literacy programs should be expanded to increase access to mobile health applications for disadvantaged groups, 84 Acta Medica Ruha - International Journal of Medicine and Health Sciences • Long-term, randomized controlled, and multicenter studies should be planned to evaluate the effectiveness of mobile health applications, • It is recommended that nurses one of the professional groups best equipped to identify individuals’ needs at the health promotion and prevention stages play an active role not only in the use but also in the development of mobile health applications. DESCRIPTIONS No financial support. No conflict of interest. REFERENCES 1. World Health Organization. Recommendations on digital interventions for health system strengthening. 2019. https://iris.who.int/server/api/core/bitstreams/c3c53f30- 23cc-48d0-a3b5-c05ddd7f5349/content 01.05.2026) (Accessed: 2. Free C, Phillips G, Watson L, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med. 2013;10(1):e1001363. 3. Gökçay G, Uğurlu A, Şen EE, Hudaykulyyeva A. Contribution of mobile health technologies to public health in rural areas: Accessibility and education methods. Health Sci Q. 2024;4(2):127-136. 4. Bakker CJ, Wyatt TH, Breth MC, et al. Nurses’ roles in mHealth app development: Scoping review. JMIR Nurs. 2023;6:e46058. 5. Nezamdoust S, Abdekhoda M, Ranjbaran F, Azami- Aghdash S. Adopting mobile health applications by nurses: a scoping review. J Res Nurs.

  Public Health Nursing In The Digital Health Era: Applications, Effectiveness, And Current Evidence Of Mobile Health Applications · 2026 · DOI

• Although this study provides valuable insights into older adults’ experiences with mHealth for chronic disease prevention and management in rural Korea, several limita- tions should be noted. Participants were current users with at least 6 months of engagement, which may overrepresent positive experiences and undercapture reasons for nonadop- tion or discontinuation. Former users were not included. Social desirability bias may have influenced self-reported technology use and perceived value. In addition, the study was conducted within a specific rural public health context, and findings should be interpreted in light of local health care structures. Finally, detailed usage patterns and clinical outcomes associated with the digital health devices were not examined and warrant further investigation.

  Experiences and Acceptance of Community-Based Mobile Health Services Among People in Underserved Rural Areas of Korea: Mixed Methods Study · 2026 · DOI

• Based on the findings, the study makes the following recommendations: 1. Families should establish clear digital-use boundaries, particularly during meals, conversations, worship, and shared activities. 2. Parents should model healthy communication behaviors by minimizing phone distractions during family interaction. 3. Faith-based organizations such as CITAM should develop awareness programs on healthy digital habits and family communication.

  Mobile-Phone-Driven Communication Patterns and Family Functionalities Among Selected Families in CITAM Ngong, Kajiado County · 2026 · DOI

• 1. More new ideas to implement in class and learn new things to implement everyday as ECD is an ongoing learning experience. 2. Showing how to do more activities on the app which I can use in the class and outdoor. 3. I would like to recommend more features for the app so that you would be able to get more answers and benefits from the app. 4. The app can improve with more motor skills added for us as teachers to get to the kids’ level and understanding without over- loading them with too many things. 5. Add more than one activity per week. 6. More activities and warm-ups. 7. Maybe to use more examples. Especially for teachers who do not have much access to computers, etc. 8. Create an offline mode. 9. To promote it all over. 10. To advise parents who can’t afford putting their children in a daycare/educare to download the app and help children to develop in their holistic skills before going to school. 11. Its great using it and it helps a lot. I highly recommend this app to all ECD centres to use and parents for more information for them to help their children at home and to understand what we as teachers are working on. 12. More pictures in the information by school readiness and activities. 13. Make tutorials as far as activities are concerned. 14. Measure user engagement and behaviour.

  A framework for the usability evaluation of a mobile health application for early childhood development teachers teaching in remote, rural and low-resourced settings in Africa · 2026 · DOI

• The co-creators of the contextual teacher training con- tent were comparable to the end-users testing the app, as they were all ECD teachers, similar in age, population group, marital status, place of residence, and language spoken at home. Although we had a comparative sample, we did not have a sample that was representative of all ECD teachers in low-resource areas in the Western Cape, as we had limited representation from the many ethnic and language groups predominant in South Africa.

  A framework for the usability evaluation of a mobile health application for early childhood development teachers teaching in remote, rural and low-resourced settings in Africa · 2026 · DOI

• The key limitation was that COVID-19 lockdowns and quarantines necessitated the consolidation of two planned follow-up surveys into one extended follow-up survey, creating challenges for evaluating some age-specific outcomes.

  Effect of a digitally-enabled, stage-based intervention on maternal and child health: a community-based, cluster-randomized controlled trial from rural China · 2026 · DOI

• There is limited research exploring the views and lived experiences of young people in Kenya, who are a strategic priority for NCD prevention because behavioral risk factors are established in this window, and for Community Health Providers (CHPs) who provide health services within the community.

  AI Adoption for NCDs in Kenya: A Qualitative Study · 2026 · DOI

• However, cross-therapeutic reviews examining sensor-based DHTs as outcome measurement tools rather than interventions in recent pharmaceutical and device trials are lacking, limiting understanding of practical implementation and utility in COA development for use in clinical trials.

  Sensor-based digital health technologies to capture endpoints in recent clinical trials: a scoping review · 2026 · DOI

• In addition to the strengths resulting from a large seafarer sample and the early to scientifically identifying the need for digital health promotion among seafarers, this study also has limitations. The study reflects the working standards of two shipping companies operating German seagoing vessels. Worldwide, there are many different shipping companies flying the flags of other nations, which in the majority have similar but also different working conditions. Documenting all these varying standards would go beyond the scope of this study; therefore, the findings of this investigation must also be evaluated within the context of the examined or similar shipping companies. The proportion of women in this study was very low at 0.8%, but this is due to the overall low rate in this occupational setting, meaning that no reliable influencing factors for the female gender could be investigated. The focus on quantitative analysis limits the range of possible answers, but this was expanded somewhat by a qualitative question with freely formulated answers. Although the restriction of the health topics covered in the questionnaire is a limitation in principle, it is based on findings from preliminary studies, which had already shown that nutrition, exercise, relaxation techniques for stress reduction, and sleep hygiene are relevant topics for health promotion among seafarers4,46. Possible limiting factors could include language barriers or responses influenced by social desirability; however, the last factor is likely to have a relatively minor impact in the context of the present anonymous online survey. As this is a cross-sectional study, there is no assessment of changes over time, meaning that changes caused by the COVID-19 pandemic in particular could not be recorded. Influences due to culturally related differences in previous experiences with health interventions, as well as social desirability bias in the responses, may have contributed to a distortion of the results. Finally, a potential limitation could be that this study focuses on behavioral measures and did not examine structural measures; however, doing so would exceed the scope of this study and should be the subject of further research.

  Health promotion and options for digital health interventions on board merchant vessels · 2026 · DOI

• Some limitations should be acknowledged: (1) Approxi- mately 50% of the included studies utilized pre-post control designs, which may limit causal inference. Additionally, Page 13 of 16 79 several studies were constrained by small sample sizes (n ≤ 20), potentially affecting statistical power. Moreover, the long-term effects of VR-based interventions remain largely unknown, as most studies included only short-term follow-up periods. Due to the limited number of studies included for each outcome (≤ 10), formal assessment of publication bias, such as funnel plots or statistical tests, was not performed; this limitation should be considered when interpreting the findings, as potential publication bias cannot be ruled out. Although the certainty of the evidence was systematically evaluated using the GRADE approach, all outcomes were rated as low quality, suggesting that the findings should be interpreted with caution. Collectively, these issues underscore the need for further well-designed, adequately powered RCTs to rigorously assess the effectiveness of VR-based interven- tions in diabetic populations. (2) Substantial heterogeneity was observed across studies, arising from multiple sources, including variability in assessment tools and differences in intervention duration and intensity. To enable meaningful cross-study comparisons and facilitate future meta-analytic synthesis, the adoption of standardized assessment tools and harmonized intervention protocols is strongly recommended. (3) While our systematic search targeted all XR technologies (VR, AR, and MR), only VR-based interventions were eli- gible for inclusion in the meta-analysis. Consequently, future studies should explore the broader potential of XR technolo- gies, beyond VR alone, to enhance behavioral adherence and determine their comparative effectiveness. Considering these methodological limitations, the findings of our meta-analy- sis require cautious interpretation and should be viewed as preliminary evidence. Moreover, it is noteworthy that while the existing studies in our meta-analysis on behavior change relied on non-immersive VR technology, future interventions should carefully consider whether immersive or non-immer- sive approaches are more effective in promoting self-man- agement behavior changes in T2DM.

  VR-Based Physical Activity and Self-Management Interventions for Glycemic Control and Behavioral Outcomes in Type 2 Diabetes: A Systematic Review and Meta-Analysis · 2026 · DOI

• Strengths of this study include that usability was assessed using the MAUQ, a validated and widely used instrument in mHealth research. The use of this tool increases both the reliability of our measurements and the comparability of findings with those from other studies in the field. The evaluation was conducted solely at a single postimplementation time point. The absence of preimplementation data precludes direct before-and-after comparisons of workflow efficiency, protocol adherence, or platform use, which would have provided stronger causal evidence. Furthermore, although voluntary participation in the questionnaire introduces the possibility of selection bias, this risk is mitigated by the exceptionally high response rate (142/160, 88.8%), which strengthens confidence in the representativeness of the data. This study did not collect objective operational or clinical outcome data (eg, protocol adherence rates, time-to-information retrieval, or patient-level outcomes). Consequently, the improvements in workflow efficiency and care quality discussed herein are based on user perception rather than measured performance indicators.

  C8 Health, a Platform for the Implementation of Best Practices: Survey-Based Usability Study. · 2026 · DOI

• In future research, quantifying improvements in patient care and institutional productivity following implementation of the app may assist in valuing the app in the context of outcomes and efficiency metrics. There is also a need for multicen- ter and longitudinal studies to assess sustained use. Future research should explore the integration of C8 Health with electronic health record systems to create a more compre- hensive clinical decision support ecosystem. This integration could enable automated protocol selection based on patient characteristics, streamlined documentation workflows, and enhanced tracking of clinical outcomes. Future studies should also incorporate prospective pre-post designs with baseline data collection before implementation to better isolate the platform’s effect on clinical workflow and protocol adher- ence. Overall, the strong usability and perceived value of the C8 Health app pave the way for it to become a transforma- tive tool in perioperative care, setting a new standard for technology-driven support in anesthesiology and beyond.

  C8 Health, a Platform for the Implementation of Best Practices: Survey-Based Usability Study. · 2026 · DOI

• Institutions should develop and implement a competency- based digital literacy framework that progressively builds students’ technological proficiency beyond basic tool usage towards meaningful educational engagement and addresses the prevalent technical barriers identified by students. They should promote social and collaborative learning tools to encourage the use of discussion forums and peer-collaborative platforms through curriculum design and educator facilitation. They should integrate immersive technologies to increase access to and training on virtual reality/Augmented reality (VR/AR) tools in clinical simulations, as these are underused despite their pedagogical benefits. They should provide targeted support based on demographic needs, address gender- and year-specific concerns through tailored workshop sessions to build digital confidence and reduce resistance. They should foster teacher presence in digital environments to strengthen the visibility and engagement of educators in online platforms to combat feelings of loss, particularly amongst senior students. They should conduct further research using qualitative studies to explore the reasons behind the constrains, gendered perceptions and year level differences in digital educational technology use would provide deeper insights for policy and practice.

  Utilisation of digital educational technology amongst undergraduate nursing students in the Western Cape · 2026 · DOI

• This study’s strength lies in recruiting multiple stakeholders and achieving data saturation for PLWH and doctors. The par- ticipation of two nurses reflects the limited direct involvement with patient care in our centre. Additionally, the overrepre- sentation of male PLWH may introduce bias, potentially impacting the perspectives and experiences of female individuals concerning the use of m-HA to improve HIV self-care. Future studies should adopt a more targeted recruitment strategy to ensure better representation of female PLWH.

  Views, barriers, and facilitators of people living with human immunodeficiency virus and healthcare professionals regarding the use of a mobile health application to improve HIV self-care in Malaysia · 2026 · DOI

• ■ The definition of diabetes used in the IDF Diabetes Atlas is based on an epidemiological definition which requires abnormal blood glucose levels to be detected on only one test compared to a clinical diagnosis of diabetes which requires abnormal blood glucose levels to be detected on two separate tests. ■ While we attempted to include only population- based representative studies, all studies have limitations and biases which require careful interpretation. In some countries/territories where territory-wide or population-based registers were included, the estimate of prevalence was adjusted, taking into consideration the proportion of people with undiagnosed diabetes in that country/territory. ■ When a country lacked any internal data, diabetes prevalence was extrapolated from a country with similar economy, language and demography. Such extrapolations may represent a source of error. ■ The urban and rural classifications are based on how the individual data sources defined urban and rural, rather than defined by the IDF analysis team.

  Experiences and Perceived Influence of the Artificial Intelligence–Based Health Education Accurately Linking System (AI-HEALS) on Health Behaviors Among Patients With Type 2 Diabetes: Qualitative Study · 2026 · DOI

• Next.js. This lets users enter their details easily, including age, weight, height, fitness goals, dietary preferences, and activity levels. The interface is clean and userfriendly, making it accessible for beginners. After users submit their data, the backend processes it using Node.js. This backend handles user requests, stores data, and performs necessary calculations. Based on the collected information, the system calculates important health metrics like Body Mass Index (BMI) and daily calorie needs. These calculations personalized serve for as recommendations. process combines rulebased logic with basic machine learning ideas drawn from existing research,. The system examines user data and matches it with appropriate workout plans and diet suggestions. For instance, users wanting to lose weight get caloriedeficit diet plans and suitable exercises, while those aiming to gain muscle receive highprotein diet suggestions and strength training routines. In addition to recommendations, the system supports progress tracking. Users can follow their fitness journey by monitoring changes in BMI, calorie intake, and completed activities. This feature helps keep users adjust allows motivated recommendations based on user progress. system and the to VIII. RESULTS AND DISCUSSION The system performed well in generating personalized diet and workout recommendations based on user profiles. We assessed the accuracy of the recommendations by comparing the systemgenerated plans with standard fitness guidelines and user feedback. The system achieved about 85% accuracy in providing relevant suggestions that matched user goals. 8.1. User Feedback and Engagement A survey among early users showed that almost 85% of participants found the system helpful for reaching their fitness goals. Personalized recommendations boosted user satisfaction and consistency. Features like progress tracking and goalbased suggestions helped keep users engaged with the platform. 8.2. Performance and Scalability The system maintained stable performance under multiple user requests and managed concurrent usage without major delays. Its modular backend design allowed for efficient data processing and quick response times. © Author(s). This work is peer-reviewed, openly published, and permanently archived This article is openly accessible and reusable with proper attribution.

  Nutrifitpro: AI-Based Personalized Fitness and Diet Recommendation System · 2026 · DOI

• SMS acceptability may be affected by limited knowledge of self-collection, accessibility for people with disabilities, differing English or digital literacy, and privacy concerns.

  Considerations in the development of an mHealth approach to increase cervical screening participation in primary care in Victoria, Australia · 2025 · DOI

• However, regardless of the positive developments in smart health applications and e-health research, there are two important gaps, (1) the role of gamification variables in the continued use of eHealth applications has not been adequately assessed, and (2) the extent to which people’s perception of the continued use of e-health applications is encouraged through habit.

  What are the impetuses Behind E-health applications’ self-management services’ ongoing adoption by health community participants? · 2023 · DOI

• INTRODUCTION: The COVID-19 pandemic has profoundly altered the ways in which health care professionals engage with continuing professional development (CPD), but the extent to which these changes are permanent remains unknown at present.

  Are We Ever Going Back? Exploring the Views of Health Professionals on Postpandemic Continuing Professional Development Modalities · 2023 · DOI

• BACKGROUND: Although several national organizations have declared the ability to work with electronic health records (EHRs) as a core competency of medical education, EHR education and use among medical students vary widely.

  Self-Perceptions of Readiness to Use Electronic Health Records Among Medical Students: Survey Study · 2020 · DOI

• Future research is needed to inform how to analyze large amounts of data passively collected as a native part of implementing mHealth and text messaging applications of MI interventions.

  Does the Use of Motivational Interviewing Skills Promote Change Talk Among Young People Living With HIV in a Digital HIV Care Navigation Text Messaging Intervention? · 2020 · DOI

• The challenges include issues related to equity, inclusion, and access; ethical concerns related to privacy and security; political and regulatory factors affecting interoperability and lack of standards; inclusive/human-centric design and issues; and inherent economic and distribution channel difficulties.

  Technology and Caregiving: Emerging Interventions and Directions for Research · 2020 · DOI

• The benefits of DHIs in managing ADHD, autism, psychosis and eating disorders are uncertain, and evidence is lacking regarding the cost-effectiveness of DHIs.

  Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta‐review · 2016 · DOI

• Internet-based communications including websites, weblogs and wikis, mobile devices and applications, social media, and wearable monitors) can be strategically leveraged to enhance self-care behaviors for CVD risk reduction and SP but further research is needed to evaluate their efficacy, cost-effectiveness, and long-term maintainability.

  Personal health technology: A new era in cardiovascular disease prevention · 2015 · DOI

Most-cited papers in Mobile Health and mHealth Applications

• Use of the Internet and E-mail for Health Care Information · JAMA · 2003 · 880 citations
• Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta‐review · Journal of Child Psychology and Psychiatry · 2016 · 770 citations
• Mobile Text Messaging for Health: A Systematic Review of Reviews · Annual Review of Public Health · 2015 · 753 citations
• Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review · Bulletin of the World Health Organization · 2012 · 408 citations
• Broadband Internet Access Is a Social Determinant of Health! · American Journal of Public Health · 2020 · 294 citations
• Mobile Health (mHealth) in Low- and Middle-Income Countries · Annual Review of Public Health · 2021 · 233 citations
• The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care · Management Science · 2018 · 208 citations
• Ethics of instantaneous contact tracing using mobile phone apps in the control of the COVID-19 pandemic · Journal of Medical Ethics · 2020 · 197 citations
• Exploring digital divides: An examination of eHealth technology use in health information seeking, communication and personal health information management in the USA · Health Informatics Journal · 2011 · 182 citations
• Technology and Caregiving: Emerging Interventions and Directions for Research · The Gerontologist · 2020 · 166 citations

Most recent work

• Health care access from the rural perspective: A narrative review · The Journal of Rural Health · 2026
• Responsible AI for Personalized Patient Education and Engagement Across Medical Conditions: Leveraging Multi-Agent LLMs, Ambient Technology, and NotebookLM—A Case Study in Diabetes Education and Limb Preservation · Journal of the American Podiatric Medical Association · 2026
• Effectiveness of telehealth low-carbohydrate intervention in preventing chronic kidney disease: a real-world, retrospective, matched cohort study · medRxiv · 2026
• Effect of digital health technologies on children's healthcare utilization: evidence from vaccination uptake in Kigoma region, Tanzania · Health Education · 2026
• Trust Analysis Canvas for Teaching in the Field of Digital Public Health and Medicine: Tutorial · JMIR Medical Education · 2026
• Effect of a digitally-enabled, stage-based intervention on maternal and child health: a community-based, cluster-randomized controlled trial from rural China · medRxiv · 2026
• Bridging the Socio-Technical Gap: A 2024–2025 Review of Integrated IoT Solutions for Geriatric Care · Zenodo (CERN European Organization for Nuclear Research) · 2026
• Sensor-based digital health technologies to capture endpoints in recent clinical trials: a scoping review · npj Digital Medicine · 2026
• Developing psychosocial phenotypes to understand engagement with digital health technologies for heart failure · npj Digital Medicine · 2026
• Effect of mobile applications in oral health promotion among elderly people: a systematic review and meta-analysis · BMC Oral Health · 2026

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