Author ORCID Identifier

Date of Award

Spring 5-13-2021

Degree Type

Capstone Project

Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Xiangming Fang

Second Advisor

Cedric Truss

Third Advisor

Claire Spears


The increase of disease incidence and prevalence in developing countries urges governments and health care leaders to invoke a more efficient response to protect populations' health. Mobile health (mHealth) is changing the face of health care and strengthening health care systems. However, its slow growth in developing countries is an actual discussion topic among the scientific community. There is an urgent need to find solutions for the sustainability and scalability of mHealth programs in low- and middle-income regions. We are the first to conduct a case study on an African country's health system, demonstrating that mHealth provides promising opportunities for healthcare system strengthening. We used the technology-organization-environment (TOE) framework to conduct our scoping review. The theory explains how technology adoption is influenced by an organization's technological, organizational, and environmental context. Our study found a total of 87 studies. One-third (30) of studies covered Denmark's landscape, while two-thirds (57) covered Kenya's landscape. We included in our analysis studies that focused on evaluating an organizational, technological, or environmental determinant for nationwide eHealth adoption. We selected eight studies that analyzed the Danish eHealth landscape and nine studies that analyzed the Kenyan eHealth landscape. We found an association of government and hospital organizational determinants in the sustainable implementation of mHealth solutions. Kenya and Denmark's healthcare reforms were pivotal in the growth of their eHealth market and structure. Both countries have decentralized governance, fiscal and administrative systems. Technological ICT capacity and human resources were also found as a predictor for their sustainable deployment in both countries. Environmental factors such as competitivity in the ICT market, hospital market, government support, and trialability mechanisms were also found as critical elements for mHealth technology adoption in both countries.


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