What role do mHealth interventions play in changing gender relations? A systematic review of qualitative findings. (Preprint)

BACKGROUND The rapid, widespread growth of mobile technologies, in low-and-middle-income countries, can offer groundbreaking ways to disseminate public health interventions. However, gender-based inequalities present a challenge for women to access mobile technology. Research has shown that mHealth interventions can impact gender relations in positive and negative ways, yet few mHealth programs use a gender sensitive lens when designing, implementing, or analyzing programs. OBJECTIVE This systematic review aims to identify and summarize the findings of qualitative research studies which explore the impact of mobile health interventions on gender relations as a result of participating in such initiatives in low-and-middle income countries. METHODS We performed a systematic literature review to examines empirical evidence of changes in gender relations attributed to their participation in an mHealth intervention in a low-and-middle income country. Peer-reviewed articles included needed to evaluate an mHealth intervention and were published between 2013 and 2020. Articles were excluded that used mHealth that solely targeted health workers, did not assess a specific intervention or used mobile technology for data collection only or were formative or exploratory in nature. The search terms were entered into four key electronic databases, Medline, Excerpta Médica Database (EMBASE), PsycINFO, and Scopus generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report themes emerged from our data. RESULTS From the 578 full text articles retrieved, fourteen articles were eligible for inclusion. None of the articles appraised gender from the outset. Articles uncovered findings on gender relations through the course of the intervention or post program evaluation. Most studies took place in Sub-Saharan Africa with the remainder in South and South East Asia. Articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found mHealth programs could enhance spousal communication, foster emotional support between couples, improve women’s self-efficacy and autonomy in seeking health information and services, and increase involvement in health-related decision making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision makers and exacerbating relationship problems. CONCLUSIONS These results suggest given the rapid, persistent upscale of mobile health interventions in low-and-middle income settings, it is imperative to design interventions that consider the impact they may have on power dynamics and gender relations. Future research is needed to fill evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and need to actively participate and be empowered by mHealth interventions. CLINICALTRIAL The systematic review is registered with Prospero (CRD42021218001)