Should health workers use their own mobiles to support patients?

A new evidence review suggests that health workers are using their own mobiles to fill health system gaps and provide a better service for patients. But this can also cause problems, like confidentiality breaches.

What is the research about?

Researchers analysed 30 studies (18 in Africa and Asia). The studies assessed personal mobile use among health workers, including doctors, nurses, community health workers, pharmacists and healthcare managers.

Why is this research important?

A lack of transport to reach communities, inefficient systems, and limited training, information, support and equipment are just some of the challenges health workers face. Many health workers use their own mobiles to try to deal with some of these issues. In 2019, the World Health Organization released guidelines on digital healthcare. But these only focus on ‘official’ digital tools and systems. Until now, there has been a lack of information and guidance on using personal phones.

What did they find out?

Health workers in many different settings use their mobiles to:

• communicate with patients and colleagues
• collect and store patient information
• find online clinical information.

At best, this can help to humanise healthcare. It can make health workers more flexible, and responsive to patient needs. It can make patients feel cared for by an individual rather than a faceless system.

It can also build trust by keeping sensitive information out of clinical setting. As a health assistant in a Malawi study explained: “If someone has a sexually transmitted disease, they wouldn’t feel comfortable to come to a clinic because they would feel exposed; it won’t be confidential. So they can call the [staff member] directly.”

Using personal mobiles to communicate with colleagues can strengthen working relationships, as it can feel like a more informal way to communicate. It could also improve efficiency, for example, by using messages to ‘page’ colleagues or to quickly share information.

But the expectation that health workers would always be contactable meant some felt like they were never off duty. As one consultant said: “The concept of just doing work when you are physically at work evaporate[s] when you have access to devices…”

It can also create unequal treatment between patients. This is because health workers might only provide out-of-hours support to people they liked or felt were ‘worthy’.

The financial cost of using mobiles was also a big issue, particularly for lower‐level workers and those in low‐income settings.

Some health workers struggled to find trustworthy online information sources. This meant they might pass on or use inaccurate information.

Storing and sharing patient information on personal mobiles put patient confidentiality and privacy at risk. Sometimes, it meant that vital patient information was not formally recorded.

Using personal mobiles for work purposes at work meant some health workers got distracted by personal calls and messages.

What does this mean for health services?

It could be useful to find ways to keep the benefits of using personal mobiles for work while dealing with the downsides. This review includes questions to help you think through how to do this.

Some solutions include compensating health workers for their airtime and data usage. And compensating staff for the time they spend on work-related activities while off duty.

Developing realistic guidelines on using personal mobiles for work purposes may also be useful. This could cover topics like how to protect patient privacy, how to maintain a work/life balance, and what kind of information needs to be transferred to the main system. It could also include a list of trusted online sources, for health information, such as Be in the KNOW.