Six mechanisms determine whether mobile health improves home-based palliative care, realist review finds

A realist review examined 126 studies, drawn from 4,134 screened, to establish how and under what conditions mobile health (mHealth) interventions improve home-based palliative care outcomes Synthesis. It identified six mechanisms: alleviating concerns and perceived-threat about the technology through proper orientation for patients and carers; minimising infrastructural and technological barriers through user-friendly design; engaging diverse stakeholders in how the intervention is designed; interoperable information systems that connect across care levels; reliable access to and communication with care teams; and adequate information access to empower patients and families.

The review’s central caution is that mHealth interventions must be tailored to local infrastructure and technology competence to work as intended — a mobile health tool is not a substitute for the underlying nursing and coordination workforce needed to deliver home-based palliative care, particularly where digital exclusion is high.

For services weighing mHealth-supported home palliative care, particularly in areas where travel time limits in-person visiting capacity, this review offers a concrete framework — the six mechanisms above — against which to assess a proposed tool, rather than treating mobile health adoption itself as the intervention.