Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Mobile phones feature widely in the delivery of health care, and they are also used informally by people delivering this care. This is explored in an August 2024 Cochrane qualitative evidence synthesis of healthcare workers’ use of their own phones at work. In this podcast, two of the authors, Nelson Sewankambo from Makerere University in Uganda and Claire Glenton from the Western Norway University of Applied Sciences talk about why they did the review and its findings.

Claire: Hello Nelson, first of all, let’s explain why we were interested in healthcare workers’ informal use of their personal mobile phones.

Nelson: Hello Claire. Yes, let’s start there. We know that most healthcare systems are using formal digital systems. But we also know that healthcare workers are using their own mobile phones for work purposes, even when this isn’t formally organised, and we wanted to look into why healthcare workers do this and the implications. We wanted to find out how future policies could help protect the positive implications while getting rid of the negative implications, and that brings us to what we found.

Claire: Thanks. We were able to include 30 qualitative studies, which were published between 2013 and 2022. These looked at different types of healthcare workers, some working in hospitals, and others in clinics or in the community, with the studies coming from both high-income countries and low- and middle-income countries.  Therefore, when grading our confidence in the findings, we looked particularly closely to see whether the data were different across these different settings.

Nelson: Yes, that’s right. And we actually didn’t find much difference. Data were similar across different parts of the world and different types of healthcare workers. Focusing on the findings for which we had high or moderate confidence, let’s begin with what were they using their own mobile phones informally for.

Claire: What we found was that healthcare workers use their personal mobile phones to do a range of work activities. For instance, to talk to patients and to contact their families, to ask for advice from colleagues, to coordinate work, to store information, to take photos, or to search for information online. And, when they were using their own phones, they were also using their own data and airtime, their personal time by taking calls outside of working hours, and their personal networks by contacting people they knew when they needed advice. Nelson, do you want to explain why they were doing this?

Nelson: Mainly, it was to plug gaps in the healthcare system. Either because formal systems weren’t there or because those that were there weren’t fit for purpose.  We also found that this type of unregulated phone use had become a normal part of work in many places, which meant that some healthcare workers felt pressure from colleagues or managers to do this. But they were also doing it out of feelings of obligation to their patients and to their colleagues. They knew they could help them by using their own phones when formal systems weren’t working. Let’s move on to talk about positive implications of this informal use.

Claire: Healthcare workers saw a lot of advantages, such as allowing them to be more efficient when formal systems weren’t working and helping them be more responsive to their patients. For instance, they’d sometimes share their personal phone numbers with patients so they could contact them directly. Healthcare workers and patients could also share sensitive information on the phone rather than putting it in a formal journal.  But we also found quite a few problems tied to this informal use. 

Nelson: Yes, first of all, it costs healthcare workers money and this was obviously particularly serious for healthcare workers with low incomes. Being available outside of work was also a problem and, although, a lot of healthcare workers used their personal networks to get advice, this wasn’t possible for healthcare workers with weak networks, which has implications for equity.

Claire: Yes, there were also negative implications for patients, mainly tied to confidentiality issues when their information is stored on other people’s phones. Another concern was that healthcare workers might choose to use their personal resources for some patients but not others.

Nelson: It could also be a problem that healthcare workers were more distracted at work because they were getting calls from family or from colleagues or because they were on social media. And finally, we saw that information about things like patient flow or logistics was often stored on healthcare workers’ personal phones, without being recorded in the formal system.

Claire: So, Nelson, what are our conclusions and our next steps?

Nelson: Well, realistically speaking, the use of healthcare worker’s own phones may be the best option in many settings, with a lot of advantages. But we need to find ways to limit the disadvantages. To help with this, we’re planning a series of dialogue meetings with policy makers and others in different countries to discuss using this evidence to come up with some good solutions.

Claire: To finish. If listeners want to learn more, our review is available online. If they go to CochraneLibrary.com and type “healthcare workers’ informal mobile device use” in the search box, the review will be near the top of the list.