Telemedicine and mHealth Applications for Health Monitoring in Rural Communities in Colombia: A Systematic Review

INTRODUCTION: Telemedicine and mHealth applications constitute a central pillar in the digital transformation of healthcare. OBJECTIVE: To describe the efficacy, applicability, and impact of telemedicine and mHealth applications on the monitoring and improvement of health in rural communities in Colombia. METHODS: This research was carried out as a systematic review, a type of study that allows for a thorough and replicable evaluation of the existing literature in the databases PubMed, Scopus, Embase, Web of Science, Cochrane Library, CINAHL, and ERIC. RESULTS: A total of 14 studies were included, which encompassed different types of research designs: two case-control studies, two randomized trials, four cross-sectional studies, two qualitative investigations, one consensus study, one retrospective cohort study, and two reviews. The sample size varied significantly among the studies, from 16 participants in the consensus study to 313,897 patients in one of the cross-sectional studies. CONCLUSIONS: Telemedicine and mHealth applications are transforming the way medical care is delivered to rural communities in Colombia. These tools have proven to be valuable in improving the detection and management of chronic diseases such as cognitive decline and cardiovascular diseases. At the same time, the implementation of these technologies has shown to be effective in improving the quality of medical care, providing greater access to specialized medical services, and reducing the sense of isolation among health professionals in rural areas.


Introduction
Telemedicine and mHealth applications represent a central pillar in the digital transformation of healthcare. However, their potential is particularly prominent in rural communities, poised to address these issues, providing remote medical care and reducing the need for physical travel. [9][10][11] Telemedicine allows medical professionals to provide remote care, using digital technology to communicate with patients, make diagnoses, and monitor treatment progress. This is particularly useful in rural communities, where patients may have difficulty accessing medical services due to remoteness or lack of transport. Likewise, mHealth applications, which allow patients to monitor their own health and receive medication and appointment reminders, can enhance health self-management and promote continuity of care. [12][13][14][15][16] Furthermore, telemedicine and mHealth applications can facilitate early disease detection and timely medical intervention in rural communities. [17][18][19] By enabling remote monitoring of vital signs and symptoms, these technologies can alert health professionals about potential issues before they become severe. In this way, they can help prevent complications and improve health outcomes. [20][21][22][23][24][25][26] But the path to successful implementation of telemedicine and mHealth applications in rural communities is not without challenges. Poor telecommunications infrastructure, lack of digital skills, and resistance to adopting new technologies are obstacles that must be overcome. [27][28][29][30][31] This paper also examines these challenges and proposes strategies for overcoming them. The objective of this paper is to describe the efficacy, applicability, and impact of telemedicine and mHealth applications on the monitoring and improvement of health in rural communities in Colombia.

Study Type
This research was conducted as a systematic review, a type of study that allows for a thorough and replicable evaluation of the existing literature on a specific topic.

Search Strategy
A structured search strategy was employed to identify all relevant studies on telemedicine and mHealth applications in rural communities in Colombia. The following terms were used: "ehealth", "telemedicine", "rural communities", "Colombia".

Consulted Databases
To ensure broad coverage of the literature, a search was conducted in several high-quality scientific databases. These included PubMed, Scopus, Embase, Web of Science, Cochrane Library, CINAHL, and ERIC.

Inclusion Criteria
The studies included in the review were those that: • Were written in English or Spanish.
• Were published in peer-reviewed academic journals.
• Explored the application of telemedicine and/or mHealth applications in rural communities in Colombia. • Provided empirical data on the outcomes of telemedicine and/or mHealth implementation.

Exclusion Criteria
Studies were excluded from the review if they: • Did not specifically focus on telemedicine or mHealth applications. • Did not focus on rural communities in Colombia.
• Did not provide empirical data, such as expert opinions, editorials, and letters to the editor.

Article Selection Process
The article selection process followed the guidelines of the PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). 32 Following the initial identification of potentially relevant studies through database searches, duplicates were removed. Subsequently, titles and abstracts were examined to determine their relevance based on the inclusion and exclusion criteria. Studies that appeared to meet the inclusion criteria underwent a full-text evaluation. Studies that met all inclusion criteria after full-text evaluation were included in the systematic review. The entire selection process was carried out by two independent reviewers to ensure reliability, and discrepancies were resolved through consensus or consultation with a third reviewer.

Results
The studies included in this systematic review presented a variety of methodological approaches and addressed various aspects of the application of telemedicine and mHealth applications in rural communities in Colombia. Figure 1 summarizes the systematic review process followed.  Table 1 shows the key findings of each study in more detail. A total of 14 studies were included, which comprised different types of research designs: two case-control studies, two randomized trials, four cross-sectional studies, two qualitative investigations, one consensus study, one retrospective cohort study, and two reviews.

subjects
The main result of the study is that telemedicine can be a useful tool to address the inequalities in cancer services access for patients with solid tumors living in rural areas. During the 9 months of the study, 2061 patients were attended to by the oncology specialty telemedicine service, out of which 1270 were diagnosed with solid tumors. Most of the patients received at least 1 telemedicine consultation, and the most frequent solid tumors were breast, prostate, and colon and rectum.
The practical implication of this paper is that telemedicine can be a useful tool to address the inequalities in cancer services access for patients with solid tumors living in rural areas. This means that patients in rural areas can receive similar follow-up care as those in urban areas, which can ultimately lead to better clinical outcomes. The study suggests that telemedicine should be promoted in lowand middle-income countries due to its ease of installation and use. This can help improve access to cancer care for patients in these areas. 13 Crosssectional The sample size varied significantly between studies, from 16 participants in the consensus study to 313,897 patients in one of the cross-sectional studies. Some studies focused on specific populations, such as rural elders and patients with cutaneous leishmaniasis, atrial fibrillation, STsegment elevation myocardial infarction, and solid tumors. Studies that examined the use of telemedicine by doctors and the implementation of telemedicine programs in the public health network were also included. Two of the studies did not involve patients or doctors but focused on the evaluation of the development of telemedicine in Colombia and the creation of a protocol for mental health care through telemedicine. Through Figure 2, we can corroborate that the studies reflect the diversity of the applications of telemedicine and mHealth applications in rural communities in Colombia, addressing a variety of health conditions, patient populations, and medical care contexts.
EAI Endorsed Transactions on Pervasive Health and Technology Volume 9

Discussion
The use of telemedicine in rural areas has shown positive results both for patients and health professionals. The studies indicate that telemedicine is accepted and appreciated by rural communities, and that it can be an efficient and convenient method to provide medical care. Notable benefits include the reduction of direct and indirect costs for patients and health service providers, improvement in the hiring and retention of doctors, increased patient and health professional education and training, and better accessibility to medical care. [46][47][48][49][50] The use of telemedicine skyrocketed during the COVID-19 pandemic, but 2022 marked a plateau in many respects. To continue moving forward, successful integration of remote patient monitoring with connected medical devices and sensors, and training of qualified personnel to handle this technology is required. [51][52][53][54][55][56][57][58][59] One of the main advantages of telemedicine and mHealth applications is improved access to medical care. In rural areas, physical distance and a scarcity of health care providers can be significant barriers to accessing health services. Telemedicine can help overcome these barriers by allowing patients to connect with health care providers remotely. [60][61][62][63] Experimentation with new methods is key, and artificial intelligence and other emerging technologies could play an important role. However, economic factors should also be considered, such as reimbursement codes for telemedicine services, which can influence the pace of progress. [64][65][66][67][68] In the pharmaceutical field, telemedicine can facilitate patient monitoring and reduce the need for face-to-face follow-up, which could lead to the decentralization of clinical trials and the inclusion of hybrid models with participation both in-person and at home. [69][70][71][72][73] mHealth applications can allow remote monitoring of chronic diseases. This type of monitoring can improve the management of these conditions and reduce the need for inperson doctor visits. Patients can use devices and applications to track their symptoms and share this information with their health care providers.
Telemedicine platforms can also be used to provide health education and promote healthy behaviors, which can be especially important in rural areas, where access to this information may be limited. [74][75][76][77] In a broader context, eHealth has the potential to improve health equity by making medical care more accessible to rural communities and other underserved populations. However, it is also important to take into account the challenges associated with these technologies, such as internet connectivity issues in rural areas and the need for training for health care providers and patients in the use of these technologies. Data privacy and security issues are also a relevant consideration for their analysis. [78][79][80] As for future trends, telemedicine is expected to continue its development and expansion. A key element in the success of telemedicine is remote patient monitoring, which relies on connected medical devices and sensors, mobile devices, and cloud platforms. As patients become more comfortable with these devices, sensors are expected to become smaller and more efficient. However, there are significant challenges to consider. One of these is the shortage of qualified personnel to implement telemedicine technology. While technology can help providers to be more efficient, qualified individuals are needed to make it work. Another challenge is the need for changes in reimbursement policies to promote broader use of telemedicine.

Conclusions
This review reveals an emerging landscape of technological integration in health care. The intersection of technology and medicine has shown significant improvements in cognitive impairment detection and treatment monitoring, as well as in the provision of medical services in general to rural communities. These advancements have been driven by a combination of technological innovation and regulatory changes that have allowed a deeper penetration of information and communication technologies in the medical sphere. Telemedicine and mHealth applications are transforming the way medical care is provided to rural communities in Colombia. These tools have proven valuable in improving the detection and monitoring of chronic diseases such as cognitive impairment and cardiovascular diseases. At the same time, the implementation of these technologies has shown effectiveness in improving the quality of medical care, providing greater access to specialized medical services, and reducing the sense of isolation among health professionals in rural areas. Telemedicine has proven to be a useful tool to address inequalities in access to health services, including oncological care. This suggests that telemedicine has the potential to overcome geographic and socioeconomic barriers to health care access. However, despite these advancements, there remain challenges, such as the lack of telecommunications infrastructure and familiarity with digital tools, that must be addressed to maximize the benefits of these technologies. The development of telemedicine in Colombia has largely been driven by regulatory changes and ICT infrastructure growth plans. Since the legalization of telemedicine in 2007, there has been significant growth in the number of telemedicine services implemented throughout the country. However, further development of the ICT infrastructure and greater familiarity with digital tools by health professionals is required to further expand the penetration of telemedicine. Ultimately, the review provides a comprehensive view of the growing integration of technology in health care in rural communities of Colombia. Telemedicine and mHealth applications are proving to be valuable tools in improving the quality and access to health care in these communities. However, to maximize the benefits of these technologies, the remaining challenges will need to be addressed and the development of the ICT infrastructure will need to continue to be driven forward.
Telemedicine is expected to continue to be an essential part of the healthcare ecosystem and is expected to become increasingly fundamental. As new technologies are developed and used, telemedicine is expected to continue to advance.