TECNOSOCIALIDAD Y PROMOCIÓN DE LA SALUD EN LA VIDA DIARIA DE LOS USUARIOS DE ATENCIÓN PRIMARIA: <i>SCOPING REVIEW</i>

Nascimento, Leila Cristine do; Campos, Amanda Morais; Figueiredo, Stephanie Botelho; Nitschke, Rosane Gonçalves; Moncada, Maria Josefa Arcaya; Viegas, Selma Maria da Fonseca

Acessibilidade / Reportar erro

Brasil

Texto & Contexto - Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Literature Review • Texto contexto - enferm. 30 • 2021 • https://doi.org/10.1590/1980-265X-TCE-2020-0675 copiar

TECNOSOCIALIDAD Y PROMOCIÓN DE LA SALUD EN LA VIDA DIARIA DE LOS USUARIOS DE ATENCIÓN PRIMARIA: SCOPING REVIEW

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

mapear la evidencia disponible sobre el uso de tecnologías por los usuarios de la Atención Primária de Salud en el contexto de la promoción de la salud.

Método: esta es una revisión de alcance según el Instituto Joanna Briggs, y se siguieron las recomendaciones de la guía internacional Preferred Reporting Items for Systematic Reviews y la extensión de metaanálisis para Scoping Reviews (PRISMA-ScR). Se utilizó la estrategia PCC (participants, concept y context). La búsqueda en las bases de datos se realizó de enero a abril de 2020.

Resultados:

se recuperaron un total de 5.267 estudios y se seleccionaron 28 artículos para su revisión. El origen de los artículos fue diverso, con el mayor número de los Estados Unidos de América (7), el idioma predominante es el inglés, el año fue 2018 y el nivel de evidencia 2. Estudios muestran que los usuarios obtienen beneficios en la atención a la salud a través de el uso de tecnologías.

Conclusión:

las intervenciones en salud, utilizando tecnología, impactan positivamente en el comportamiento y estilos de vida de las personas, enfocándose en la prevención y control de enfermedades crónicas. Cabe señalar que las tecnologías utilizadas de forma aislada no pueden superar las barreras conductuales y su uso no reemplaza la atención y el seguimiento cara a cara.

DESCRIPTORES:
Tecnología; Atención primaria de la salud; Red social; Aplicaciones móviles; Promoción de la salud; Conductas relacionadas con la salud

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] CORRESPONDING AUTHOR
Selma Maria da Fonseca Viegas selmaviegas@ufsj.edu.br

Sample	Title /Level of evidence//Country/Study design/Number of participants (Sample)	Study objective	Main conclusions
Oliver-Mora; Iniguez-Rueda33. Oliver-Mora M, Iñiguez-Rueda L. O uso das tecnologias da informação e da comunicação (TIC) nos centros de saúde: a visão dos profissionais na Catalunha, Espanha. Interface [Internet]. 2017 [cited 2020 Mar 19];21(63):945-55. Available from: https://doi.org/10.1590/1807-57622016.0331 https://doi.org/10.1590/1807-57622016.03... (2017)	El uso de las tecnologías de la información y la comunicación (TIC) en los centros de salud: la visión de los profesionales en Cataluña, España. Level 3 Spain Qualitative research 11 participants.	Identify experiences using ICT that are able to improve the public management of health centers in Catalonia (Spain), in addition to being generated from the bottom up by primary health professionals.	When studying the experiences in the use of ICT capable of improving the public management of health centers, in Catalonia, it was argued that improving management does not mean reducing their budgets or the working conditions of their workers, but improving the experiences that contribute to improve its social, organizational and technical dynamics.
Carson-Chahhoud et al.66. Carson KV, Ameer F, Sayehmiri K, Hnin K, van Agteren JE, Sayehmiri F, et al. Mass media interventions for preventing smoking in young people. Cochrane Database Syst Ver [Internet]. 2017 [cited 2020 Mar 21];6:CD001006. Available from: https://doi.org/10.1002/14651858.CD001006.pub3 https://doi.org/10.1002/14651858.CD00100... (2017)	Mass media interventions for preventing smoking in young people Level 2 Australia Published review update.	Assess the effects of mass media interventions on youth smoking prevention.	Mass media interventions, such as campaigns to prevent or reduce tobacco use among young people, have the potential to reach and change the knowledge, attitudes and behaviors of a large proportion of the community.
Berman et al.77. Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, et al. Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care. BMC Fam Pract [Internet]. 2018 [cited 2020 Mar 23];19(1):139. Available from: https://doi.org/10.1186/s12875-018-0829-z https://doi.org/10.1186/s12875-018-0829-... (2018)	Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care Level 3 Sweden Qualitative study 10 PHC clinics participated in the study.	Explore PHC physicians’ perceptions of promoting a healthy lifestyle with or without digital screening and intervention.	Clarify clinicians’ perceptions about promoting healthier lifestyles, with or without digital intervention, in PHC. The introduction of digital tools to promote a healthier life is complementary to one-to-one meetings, in order to maintain significance in the patient-clinical meeting.
Subasinghe et al.1616. Subasinghe AK, Garland SM, Gorelik A, Tay I, Wark JD. Using mobile technology to improve bone-related lifestyle risk factors in young women with low bone mineral density: feasibility randomized controlled trial. JMIR Form Res [Internet]. 2019 [cited 2020 Mar 23];3(1):e9435. Available from: https://doi.org/10.2196/formative.9435 https://doi.org/10.2196/formative.9435... (2019)	Using mobile technology to improve bone-related lifestyle risk factors in young women with low bone mineral density: Feasibility randomized controlled trial Level 2 Australia Randomized trial with 35 participants.	Determine the acceptability and feasibility of an mHealth intervention called Tap4Bone in improving health behaviors associated with osteoporosis risk in young women.	Mobile health intervention is an acceptable and viable method of improving health behaviors. The far-reaching capabilities of mobile technologies can be used to enable low-cost interventions and support interactivity.
Stevenson et al.1717. Stevenson JK, Campbell ZC, Webster AC, Chow CK, Tong A, Craig JC, et al. eHealth interventions for people with chronic kidney disease. Cochrane Database Syst Ver [Internet]. 2019 [cited 2020 Mar 21];8:CD012379. Available from: https://doi.org/10.1002/14651858.CD012379.pub2 https://doi.org/10.1002/14651858.CD01237... (2019)	eHealth interventions for people with chronic kidney disease Level 2 Australia Literature review 43 studies with 6,617 participants.	Assess the benefits and harms of using eHealth interventions to change health behaviors in people with chronic kidney disease.	It is uncertain whether the use of eHealth interventions improves outcomes for people with chronic kidney disease, but it is known that eHealth interventions can improve dietary sodium intake management and fluid management.
Lee et al.1818. Lee JA, Choi M, Lee SA, Jiang N. Effective behavioral intervention strategies using mobile healthapplications for chronic disease management: a systematic review. BMC Med Inform Decis Mak [Internet]. 2018 [cited 2020 Mar 23];18(1):12. Available from: https://doi.org/10.1186/s12911-018-0591-0 https://doi.org/10.1186/s12911-018-0591-... (2018)	Effective behavioral intervention strategies using mobile health applications for chronic disease management: A systematic review Level 1 United States Systematic review 12 controlled randomizados trials.	Examine the effectiveness of mHealth interventions on process measures, as well as health outcomes in randomized controlled trials, to improve chronic disease management.	Most studies using mHealth interventions have shown some improvement in health outcomes in patients with chronic illnesses. Favorable factors in mHealth approaches (mHealth) are, among others, frequent and accurate monitoring of symptoms and improved communication between patients and healthcare professionals, resulting in improved self-management.
Glynn et al.1919. Glynn LG, Glynn F, Casey M, Wilkinson LG, Hayes PS, Heaney D et al. Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory. BMC Fam Pract [Internet]. 2018 [cited 2020 Mar 23];19(1):48. Available from: https://doi.org/10.1186/s12875-018-0737-2 https://doi.org/10.1186/s12875-018-0737-... (2018)	Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory Level 2 Ireland Qualitative research with 14 participants.	Conduct a theoretically informed analysis using the theory of the normalization process, barriers and potential levers for implementing an mHealth intervention to promote physical activity in PHC.	It is an application for smartphones, with the objective of promoting physical activity as part of a project of Transnational Solutions for International Telemedicine. Its use has successfully promoted physical activity among users of PHC services and service providers.
Jones et al.2020. Jones A, Mitchell LJ, O’Connor R, Rollo ME, Slater K, Williams LT, et al. Investigating the perceptions of primary care dietitians on the potential for information technology in the workplace: qualitative study. J Med Internet Res [Internet]. 2018 [cited 2020 Mar 23];20(10):e265. Available from: https://doi.org/10.2196/jmir.9568 https://doi.org/10.2196/jmir.9568... (2018)	Investigating the Perceptions of Primary Care Dietitians on the Potential for Information Technology in the Workplace: Qualitative study Level 4 Australia Qualitative study with 20 participants.	Explore the perceptions of PHC nutritionists about the use of information technology in their workplace.	The PHC scenario is an effective avenue for the management and prevention of chronic diseases. Nutritionists help manage modifiable risk factors. They realized that information technology brings benefits to PHC professionals and patients. But to achieve the optimal benefit, support is needed to overcome barriers and integrate information technology into practice.
Bennett et al.2121. Bennett GG, Steinberg D, Askew S, Levine E, Foley P, Batch BC, et al. Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care. Am J Prev Med [Internet]. 2018 [cited 2020 Mar 23];55(6):777-86. Available from: https://doi.org/10.1016/j.amepre.2018.07.005 https://doi.org/10.1016/j.amepre.2018.07... (2018)	Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care Level 2 USA Randomized controlled trial 351 participants.	Assess the effectiveness of an app and provider counseling for the treatment of obesity in PHC.	Digital healthcare approaches promise to extend the reach of highly personalized, low-cost, evidence-based obesity treatments to a variety of clinical care settings. They compare the effectiveness of usual care to a digital obesity treatment, combined with counseling from primary and auxiliary care providers, 12-month weight change, among patients with socioeconomic disadvantage and high risk of cardiovascular disease.
Bengtssona et ^al.2222. Bengtsson U, Kjellgren K, Hallberg I, Lundin M, Mäkitalo Å. Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system. Scand J Prim Health Care [Internet]. 2018 [cited 2020 Mar 19];36(1):70-9. Disponível em: Disponível em: https://doi.org/10.1080/02813432.2018.1426144 https://doi.org/10.1080/02813432.2018.14... (2018)	Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system Level 4 Sweden Qualitative exploratory study 27 participants.	Describe the structure and contributions of patients to follow-up consultations after eight weeks of self-report through a support system for self-management of hypertension by cell phone.	The cell phone self-management support system and its concrete visual resources can support patients’ active involvement in health consultations for the management of hypertension in PHC.
Taki et al.2323. Taki S, Russell CG, Wen LM, Laws RA, Campbell K, Xu H, et al. Consumer engagement in mobile application (app) interventions focused on supporting infant feeding practices for early prevention of childhood obesity. Front Public Health [Internet]. 2019 [cited 2020 Mar 19];7:60. Available from: https://doi.org/10.3389/fpubh.2019.00060 https://doi.org/10.3389/fpubh.2019.00060... (2019)	Consumer engagement in mobile application (app) interventions focused on supporting infant feeding practices for early prevention of childhood obesity Level 3 Australia 1st Study: cross-sectional research, 107 pregnant women participated. 2nd Study: qualitative study with 29 mothers of babies <1 year old.	Describe two independent studies that investigated the perceptions, interest and experiences of mothers or pregnant women with technological devices, apps and websites on infant feeding practices.	Applications contribute as one of the many sources of information in health and to promote health, when professionals are involved for proper use. The use of apps is acceptable, from the perspective of mothers, to promote healthy infant feeding practices.
Mascarenhas et al.2424. Mascarenhas MN, Chan JM, Vittinghoff E, Van Blarigan EL, Hecht F. Increasing physical activity in mothers using video exercise groups and exercise mobile Apps: randomized controlled trial. J Med Internet Res [Internet]. 2018 [cited 2020 Mar 23];20(5):e179. Available from: https://doi.org/10.2196/jmir.9310 https://doi.org/10.2196/jmir.9310... (2018)	Increasing physical activity in mothers using video exercise groups and exercise mobile apps: randomized controlled trial Level 2 United States Randomized trial with 64 participants.	Test the feasibility, acceptability, and effectiveness of an individually adaptive and socially supportive physical activity intervention, incorporating video conferencing and mobile apps for mothers.	Digital technology interventions represent a convenient, cost-effective, and scalable delivery mechanism for delivering interventions. However, new technologies alone cannot overcome barriers to behavior change.
Pinto; Rocha2525. Pinto LF, Rocha CMF. Innovations in Primary Health care: the use of communications technology and information tools to support local management. Cien Saude Coletiva [Internet]. 2016 [cited 2020 Mar 19];21(5):1433-48. Available from: https://doi.org/10.1590/1413-81232015215.26662015 https://doi.org/10.1590/1413-81232015215... (2016)	Innovations in Primary Health Care: the use of communications technology and information tools to support local management Level 5 Brazil Descriptive case study carried out in 16 Technology Observatories.	Describe the results of research carried out in 16 Information Technology and Communication in Health Observatories.	Social media have been used in various contexts in order to streamline the flow of information and data for decision making, contributing to the production of knowledge in networks and expanding access to health services through communication channels. As perspectives, the possibility of using Distance Learning tools can provide evidence for information and decision-making in the health area.
Milward et al.2626. Milward J, Deluca P, Drummond C, Kimergård A. Developing typologies of user engagement with the BRANCH Alcohol-Harm reduction smartphone app: qualitative study. JMIR Mhealth Uhealth [Internet]. 2018 [cited 2020 Mar 23];6(12):e11692. Available from: https://doi.org/10.2196/11692 https://doi.org/10.2196/11692... (2018)	Developing typologies of user engagement with the BRANCH alcohol-harm reduction smartphone app: Qualitative study Level 3 United Kingdom Qualitative study 20 participants.	- Understand why and how participants engaged with the BRANCH app; - Explore enablers and barriers with the app’s features; - Explore how the BRANCH app impacted drinking behavior; - Use data to identify application user typologies in terms of engagement behaviors; - Identify future design implications of the eSBI application.	Electronic screening and brief intervention (eSBI) applications with people using alcohol can serve as a tool that prevents individuals from developing more serious conditions related to alcohol use.
Kaner et al.2727. Kaner EF, Beyer FR, Garnett C, Crane D, Brown J, Muirhead C, et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Ver [Internet]. 2017 [cited 2020 Mar 21];25(9):CD011479. Available from: https://doi.org/10.1002/14651858.CD011479.pub2 https://doi.org/10.1002/14651858.CD01147... (2017)	Personalized digital interventions for reducing hazardous and harmful alcohol consumption in community‐dwelling populations Level 1 United Kingdom Literature review 57 studies that randomized a total of 34,390 participants.	Assess the effectiveness and cost-effectiveness of digital interventions to reduce hazardous and harmful alcohol consumption, alcohol-related problems, or both in people who live in and are recruited from the community.	Technological innovations allow people to interact via computer, mobile device or smartphone with digital interventions designed to solve alcohol consumption problems. There is medium-quality evidence that digital interventions can decrease alcohol consumption by an average of up to three standard drinks per week compared to control participants.
Tait; Kirkman; Schaub2828. Tait RJ, Kirkman JJL, Schaub MP. A participatory health promotion mobile app addressing alcohol use problems (The Daybreak Program): protocol for a randomized controlled trial. JMIR Res Protoc [Internet]. 2018 [cited 2020 Mar 23];7(5):e148. Available from: https://doi.org/10.2196/resprot.9982 https://doi.org/10.2196/resprot.9982... (2018)	The Participatory Health Promotion Mobile App Addressing Alcohol Use Problems (The Daybreak Program): Protocol for a Randomized Controlled Trial Level 1 Australia Randomized clinical trial 467 participants.	Systematically evaluate different versions of the Hello Sunday Morning Daybreak program (with and without coaching support) in reducing risky alcohol use.	The Hello Sunday Morning blog program asks participants to publicly set a personal goal to stop drinking or reduce their drinking for a specified period, recording their reflections and progress on blogs and social media. Daybreak is Hello Sunday Morning’s evidence-based behavior change program designed to support people who want to change their relationship with alcohol.
Gomes et al.2929. Gomes MLS, Rodrigues IR, Moura NS, Bezerra KC, Lopes BB, Teixeira JJD, et al. Evaluation of mobile Apps for health promotion of pregnant women with preeclampsia. Acta Paul Enferm [Internet]. 2019 [cited 2020 Mar 23];32(3):275-81. Available from: https://doi.org/10.1590/1982-0194201900038 https://doi.org/10.1590/1982-01942019000... (2019)	Evaluation of mobile Apps for health promotion of pregnant women with preeclampsia Level 5 Brazil Evaluative study of mobile applications available on platforms (iOS and Android).	“Evaluate the mobile Apps available about PE in the main operating systems for the health promotion of pregnant women” ^28:276	The use of health applications is due to their low cost, increasing access to health information about healthy lifestyle and habits, diseases and their respective treatments.
Silva et al.3030. Silva RMD, Brasil CCP, Bezerra IC, Queiroz FFSN. Mobile health technology for gestational care: evaluation of the GestAção’s app. Rev Bras Enferm [Internet]. 2019 [cited 2020 Mar 19];72(3):266-73. Available from: https://doi.org/10.1590/0034-7167-2018-0641 https://doi.org/10.1590/0034-7167-2018-0... (2019)	Mobile health technology for gestational care: evaluation of the GestAção’s app Level 3 Brazil Evaluative, applied, methodological, quantitative-qualitative study 13 pregnant women.	“Evaluate theGestAçãoapplication, based on the experience of pregnant women use^{” 29:280}	The use of technology by mobile devices is a reality that has transformed people’s daily lives through differentiated learning and entertainment experiences. GestAção is a technological tool aimed at empowering pregnant women about gestational health care. It contains information about the stages of pregnancy associated with easy-to-understand content, as well as resources to monitor maternal health and fetal evolution.
Halili et al.3131. Halili L, Liu R, Hutchinson KA, Semeniuk K, Redman LM, Adamo KB. Development and pilot evaluation of a pregnancy-specific mobile health tool: a qualitative investigation of SmartMoms Canada. BMC Med Inform Decis Mak [Internet]. 2018 [cited 2020 Mar 23];18(1):95. Available from: https://doi.org/10.1186/s12911-018-0705-8 https://doi.org/10.1186/s12911-018-0705-... (2018)	Development and pilot evaluation of a pregnancy-specific mobile health tool: a qualitative investigation of SmartMoms Canada Level 3 Canada Qualitative research 17 participants.	Implement a qualitative and descriptive research design to assess the responsiveness, functionality of the SmartMoms Canada app.	Women of childbearing age have adopted health information technology for counseling related to pregnancy, as communication in prenatal consultations is scarce and brief. Pregnant women and mothers highly value using online sources to support their pregnancy information needs. MHealth tools (mHealth) have the potential to reduce excessive gestational weight gain, providing reliable guidance to expectant mothers, ultimately improving the health outcomes of mothers and babies.
Badawy et al.3232. Badawy SM, Morrone K, Thompson A, Palermo TM. Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia. Cochrane Database Syst Ver [Internet]. 2019 [cited 2020 Mar 21];6:CD012900. Available from: https://doi.org/10.1002/14651858.CD012900.pub2 https://doi.org/10.1002/14651858.CD01290... (2019)	Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia Level 1 United States Literature review with 25 studies.	Identify and evaluate the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia.	It was based on the identification and assessment of the effects of interventions on computers and mobile technologies designed to facilitate medication adherence and disease management in individuals with thalassemia. Due to the lack of evidence, it is recommended to carry out randomized clinical trials on the effect of technological interventions on adherence to iron chelation therapy in people with thalassemia.
Blease et al.3333. Blease C, Bernstein MH, Gaab J, Kaptchuk TJ, Kossowsky J, Mandl KD, et al. Computerization and the future of primary care: a survey of general practitioners in the UK. PLoS One [Internet]. 2018 [cited 2020 Mar 23];13(12):e0207418. Available from: https://doi.org/10.1371/journal.pone.0207418 https://doi.org/10.1371/journal.pone.020... (2018)	Computerization and the future of primary care: A survey of general practitioners in the UK. Level 2 United Kingdom Cross-sectional online survey with 1,474 participants.	Describe the views of British general practitioners on the potential of future technology to replace key tasks performed in PHC.	Most UK general practitioners are skeptical about the potential of future technology to perform primary care tasks as well as or better than humans. However, respondents were optimistic that, in the near future, the technology would have the ability to completely replace the fulfillment of administrative tasks related to patient documentation in PHC.
Maniatopoulos et al.3434. Maniatopoulos G, Haining S, Allen J, Wilkes S. Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care. BMC Health Serv Res [Internet]. 2019 [cited 2020 Mar 23];19(1):648. Available from: https://doi.org/10.1186/s12913-019-4477-3 https://doi.org/10.1186/s12913-019-4477-... (2019)	Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care Level 3 United Kingdom Empirical case study 24 participants.	Explore the process by which commissioning organizations make their decisions to commission innovative health technologies.	Commissioning is a decision-making process whereby public services are planned, contracted and monitored to meet the needs of users/population. It involves activities that range from assessing health needs to specifying the service and negotiating or purchasing contracts, with continuous quality assessment. It is necessary to explore the processes by which commissioners make their decisions to commission a path to new diagnostic technology in PHC practice.
Vann et al.3535. Jacobson Vann JC, Jacobson RM, Coyne-Beasley T, Asafu-Adjei JK, Szilagyi PG. Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev [Internet]. 2018 [cited 2020 Mar 21];18(1):CD003941. Available from: https://doi.org/10.1002/14651858.CD003941.pub3 https://doi.org/10.1002/14651858.CD00394... (2018)	Patient reminder and recall interventions to improve immunization rates Level 2 United States Literature review with 75 studies	Evaluate and compare the effectiveness of various types of patient reminders and recall interventions to improve immunization receipts.	To increase vaccine coverage levels, the intervention strategy is used ‘reminder systems’ or patient recall, including telephone calls and automatic dialing, letters, postcards, text messages.
Gray et al.3636. Gray SC, Barnsley J, Gagnon D, Belzile L, Kenealy T, Shaw J, et al. Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies. Implement Sci [Internet]. 2018 [cited 2020 Mar 19];13(1):87. Available from: https://doi.org/10.1186/s13012-018-0780-3 https://doi.org/10.1186/s13012-018-0780-... (2018)	Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies Level 2 Canada Comparative multiple case study 137 participants.	Explore how ICT are used to support integrated care activities and organizational and environmental barriers and enablers to their adoption.	ICT is a critical enabler of integrated community-based PHC models, but little is known about how existing technologies were used to support new integrated service models. Technological limitations prevent more innovative uses of technology that could withstand the disruption needed to improve care delivery.
Wu et al.3737. Wu Q, Huang Y, van Velthoven MH, Wang W, Chang S, Zhang Y. The effectiveness of using a WeChat account to improve exclusive breastfeeding in Huzhu County Qinghai Province, China: protocol for a randomized control trial. BMC Public Health [Internet]. 2019 [cited 2020 Mar 19];19:1603. Available from: https://doi.org/10.1186/s12889-019-7676-2 https://doi.org/10.1186/s12889-019-7676-... (2019)	The effectiveness of using a WeChat account to improve exclusive breastfeeding in Huzhu County Qinghai Province, China: protocol for a randomized control trial Level 2 China Case -control study with 200 pregnant women.	Describe the study protocol of a WeChat intervention aimed at promoting breastfeeding in rural areas in China.	WeChat is considered one of the biggest social media platforms in China. It is a free, all-in-one communication app, widely used to send text and voice messages, video calls, share photos and ‘moments’ (updates on someone’s everyday life) and play games.
Sin et al.3838. Sin J, Henderson C, Spain D, Cornelius V, Chen T, Gillard S. eHealth interventions for family carers of people with long term illness: A promising approach? Clin Psychol Ver [Internet]. 2018 [cited 2020 Mar 19];60:109-25. Available from: https://doi.org/10.1016/j.cpr.2018.01.008 https://doi.org/10.1016/j.cpr.2018.01.00... (2018)	eHealth interventions for family carers of people with long term illness: A promising approach? Level 1 United Kingdom Systematic review with 78 studies.	Conduct a comprehensive systematic review of eHealth and mHealth interventions for family caregivers of people with long-term illness.	eHealth interventions for caregivers of people with long-term illnesses have high satisfaction and acceptability rates. The understanding of technologies should improve interventions, improving the outcome of caregivers. The approach comprises psychoeducational interventions carried out online with complementary modes of communication such as network support with professionals and colleagues.
Garg et al.3939. Garg SK, Lyles CR, Ackerman S, Handley MA, Schillinger D, Gourley G, et al. Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems. BMC Med Inform Decis Mak [Internet]. 2016 [cited 2020 Mar 23];16:16. Available from: https://doi.org/10.1186/s12911-016-0258-7 https://doi.org/10.1186/s12911-016-0258-... (2016)	Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems Level 5 United States Qualitative analysis 75 participants.	Understand why text messages are not widely used to improve medical services; Identify enablers and barriers to implementation in real-world safety-net configurations.	Text messaging is an affordable, ubiquitous and emerging technology that can help healthcare systems improve the quality of healthcare services. Improve the robustness of clinical text messaging applications in the long run will require more infrastructure investment.
Naples et al.4040. Nápoles AM, Appelle N, Kalkhoran S, Vijayaraghavan M, Alvarado N, Satterfield J. Perceptions of clinicians and staff about the use of digital technology in primary care: qualitative interviews prior to implementation of a computer-facilitated 5As intervention. BMC Med Inform Decis Mak [Internet]. 2016 [cited 2020 Mar 23];16:44. Available from: https://doi.org/10.1186/s12911-016-0284-5 https://doi.org/10.1186/s12911-016-0284-... (2016)	Perceptions of clinicians and staff about the use of digital technology in primary care: qualitative interviews prior to implementation of a computer-facilitated 5As intervention Level 4 United States Qualitative research 35 participants.	Identify factors from the perspectives of primary care providers and clinical staff that were likely to influence the introduction of digital technology and a CF5As smoking cessation counseling intervention.	Using a 5As model (ask, advise, assess, help, organize eg CF5As), the aim was to identify factors from the perspectives of primary care providers that likely influenced the introduction of digital technology and a counseling intervention for smoking cessation. The identification of factors that promote and hinder the adoption of CF5As could inform the implementation of other behavioral health interventions in PHC.