What does it mean for a woman to have access to a phone in India? Implications for the development of mHealth interventions for maternal health (Preprint)

BACKGROUND As mobile phone uptake in India continues to grow, there is continued interest in mobile platform-based interventions for health education among other topics. Existing studies demonstrate a significant gender gap in mobile phone access, and suggest women’s access to mobile phones is constrained by economic and diverse social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions which particularly rely on women’s access to and facility with mobile phone use. OBJECTIVE This paper describes dynamics and patterns of women’s mobile phone access and use among both phone owners and non-owners, including potential barriers to mHealth participation. METHODS Mixed-methods data were obtained from two different surveys (n=102 and n=29), two sets of in-depth interviews (n=20 and 29), and weekly data collection obtained in preparation for or within the pilot of an mHealth postpartum care intervention in rural Punjab in July 2020-February 2021. RESULTS A majority of women owned their own phone, though about half (52%) of phone owners still reported sharing their phone with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households have strict preferences against daughters-in-law having phones, or otherwise significantly restrict or control women’s phone access. Others reported concerns about phone use-related health hazards during pregnancy or postpartum for mother and infant. CONCLUSIONS These findings suggest significant variability and nuance to what is meant by women’s phone ownership and access given the numerous additional constraints on their use of phones, particularly during pregnancy and postpartum. Future research and mHealth interventions should probe these domains to better understand these dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions. mHealth, mobile health, digital health, India, pregnancy, pregnant women, postpartum, postpartum care INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.34087

Associations between sustainable development goals accelerators and well-being, by household heads' disability status among adolescents in Zambia

We examined associations between accelerators (interventions impacting two or more SDG targets) and well-being indicators among adolescents in Zambia. Methods: We randomly sampled 1,800 households receiving social cash transfers (SCT) in four districts, surveyed adults 16 years and older. Using multivariable logistic regressions, stratified by household heads disability status, we examined associations between accelerators (SCT, life-long learning (LLL), mobile phone access (MPA)) and seven well-being indicators among adolescents 16 to 24 years old. We predicted adolescents' probabilities of reporting indicators with marginal effects models. Results: We included 1,725 adolescents, 881(51.1%) girls. MPA was associated with no poverty (adjusted Odds Ratio [aOR] 2.08, p<0.001), informal cash transfers (aOR 1.82 p=0.004), seeking mental support (aOR 1.61, p=0.020); SCT with no health access restrictions related to disability (aOR 2.56, p=0.004), lesser odds seeking mental support (aOR 0.53, p=0.029); LLL with informal cash transfers (aOR 3.49, p<0.001), lower school enrolment (aOR 0.70, p=0.004). Adolescents living with disabled household heads reported worse poverty, good health, less suicidal ideation. Conclusions: Accelerators - SCT, LLL, MPA - were associated with well-being indicators. Adolescents living with disabled household heads benefited less.

Freedom within a cage: how patriarchal gender norms limit women’s use of mobile phones in rural central India

IntroductionIndia has one of the highest gender gaps in mobile phone access in the world. As employment opportunities, health messaging (mHealth), access to government entitlements, banking, civic participation and social engagement increasingly take place in the digital sphere, this gender gap risks further exacerbating women’s disadvantage in Indian society. This study identifies the factors driving women’s unequal use of phones in rural Madhya Pradesh, India.MethodsWe interviewed mothers of 1-year-old children (n=29) who reported that they had at least some access to a mobile phone. Whenever possible, we also spoke to their husbands (n=23) and extended family members (n=34) through interviews or family group discussions about the use of phones in their households, as well as their perspectives on gender and phone use more broadly. Our analysis involved comparing wife–husband pairs to assess differences in phone access and use, and thematic coding on the determinants of women’s phone use using an iteratively developed conceptual framework.ResultsWhile respondents reported that women could use the phone without needing permission, this apparent ‘freedom’ existed in a context that severely constrained women’s actual use, most directly through: (1) narrow expectations and desires around how women would use phones, (2) women’s dependence on men for phone ownership and lower proximity to phones, (3) the poorer functionality of women’s phones; (4) women’s limited digital skills, and (5) time allocation constraints, wherein women had less leisure time and were subject to social norms that discouraged using a phone for leisure.ConclusionOur framework, presenting the distal and proximate determinants of women’s phone use, enables more nuanced understanding of India’s digital divide. Addressing these determinants is vital to shift from re-entrenching unequal gender relations to transforming them through digital technology.

Mobile Phone Access and Preferences Among Medical Inpatients at an Urban Canadian Hospital: A Cross-Sectional Survey

Background: Digital health interventions are increasingly used for patient care, yet little data is available on the phone access type and usage preferences of medical ward patients to inform the most appropriate digital interventions.Methods: To learn about mobile phone ownership, internet access, and cellular use preferences among medical patients, we conducted a researcher-administered survey of patients admitted to five internal medicine units at Vancouver General Hospital (VGH) in January 2020.Results: A total of 81 ward patients completed the questionnaire from the two survey dates. Of those, 63.0% owned their own mobile phone, an additional 22.2% had access to a mobile phone via a proxy (or an authorized third-party) such as a family member, and 14.8% did not own or have access to a mobile phone. All participants with mobile phone access had cellular plans (i.e., phone and text) ; however, a quarter of respondents did not have data plans with internet. 71.1% of men owned a mobile phone compared to only 52.8% of women. All participants at a ‘high’ risk of readmission had access to a mobile phone, either as phone-owners or proxy-dependent users.Conclusion: Access to mobile phones among medical ward patients was high, but incomplete. More patients had cellular than data plans (i.e., internet and applications). Understanding patient-specific access is key to informing potential uptake of digital health interventions aimed at using patients’ mobile phones (mHealth) from an effectiveness and equity lens.

Lifebook Excerpt: Assessing Health From Home

Objectives To consolidate and simplify the plethora of available information regarding health and nutrition. The Lifebook aims to serve as an accessible community resource that can help improve one's health, regardless of any health equity barriers one may experience. As the internet is filled with seemingly endless pages of information surrounding these topics, presenting a summary for those who may not have the access, time, or knowledge to conduct such a search is greatly needed. Methods By examining book and online resources, while keeping in mind the reliability of the utilized sources, several fundamental questions were answered and adapted into chapter content for the Lifebook. These questions allowed exploration of topics such as determinants of health and nutritional analysis. Results Identified that can provide users with ways to identify their personal health risks, as well as provide them with an actionable plan to move towards a healthier lifestyle. For those without internet access, it was determined that there are ten key areas of health that are commonly identified as being vital to living a healthy life. Moreover, a method to grade one's health on a traditional A-F scale, known as the “Health Report Card,” was also discussed. Although it in no way can fully replace a doctor's assessment one's health, it can be used as a good first step when examining one's health with their physician and in identifying target areas for improvement. Lastly, diet was explored. This included both specific recipes, as well as different ways to determine the nutritional value of food. With mobile phone access, some apps that allow the tracking of daily calories consumed, exercise, weight, and water intake were identified. Conclusions The Lifebook will provide consolidated and simplified information regarding health and nutrition. It may not cover every possible aspect of of these topics, however it will surely be a useful start to those wanting to take control of their health from the comfort of their own home. Funding Sources There are no funding sources associated with this research at this time.

Limited Technology Access Among Residents of Affordable Senior Housing During the COVID-19 Pandemic

While U.S. adults living in affordable senior housing represent a vulnerable population during the COVID-19 pandemic, affordable housing may provide a foundation for interventions designed to improve technology access to support health. To better understand technology access among residents of affordable senior housing, we surveyed members of a national association of resident service coordinators to assess their experiences working with residents during the pandemic ( n = 1,440). While nearly all service coordinators report that most or all residents have reliable phone access, under a quarter report that most or all have reliable internet access; they also report limited access to technology for video calls. Lack of internet access and technology literacy are perceived as barriers to medical visits and food procurement for low-income older adult residents of affordable housing. Policies to expand internet access as well as training and support to enable use of online services are required to overcome these barriers.

Cell Phone Access and Election Fraud: Evidence from a Spatial Regression Discontinuity Design in Afghanistan

This paper examines the impact of cell phone access on election fraud. I combine cell phone coverage maps with the location of polling centers during the 2009 Afghan presidential election to pinpoint which centers were exposed to coverage. Results from a spatial regression discontinuity design along the two-dimensional coverage boundary suggest that coverage deters corrupt behavior. Polling centers just inside coverage report a drop in the share of fraudulent votes of 4 percentage points, while the likelihood of a fraudulent station decreases by 8 percentage points. Analyses of the effect of coverage on citizen participation in election monitoring, election-related insurgent violence, and the tribal composition of villages suggest that the observed declines in fraud are likely attributed to cell phone access strengthening social monitoring capacity. (JEL D72, K16, K42, O17, Z13)

The potential and barriers in the expansion and utilization of a text message-based tobacco cessation service among tobacco users in India

BackgroundThere is growing recognition of the role of the mCessation service (MCS) in promoting tobacco cessation in India.ObjectiveTo examine the potential for expanding the utilization of the MCS for tobacco cessation in India after assessing the dimensions related to literacy, mobile phone access, intention to quit, and advice to quit from the second round of the Global Adult Tobacco Survey.MethodsA cross-sectional analysis of the data collected during the second round of the nationally-representative Global Adult Tobacco Survey (GATS) (2016–17) was conducted.ResultsCurrent tobacco smokers, smokeless tobacco, and dual users compromised 10.7%, 21.4%, and 3.4% of the survey participants, respectively. Quit attempts were reported by 36.3% of the existing tobacco smokers, of whom nearly 72% tried to quit without any assistance, while only 0.3% used the MCS. However, the potential expansion of the MCS was likely among 11.2% tobacco users with an existing intention to quit, being literate, Hindi-speakers and having cell-phone access.ConclusionsThe utilization of the MCS can be considerably expanded among tobacco users in India by enabling multilingual usage and incorporation as standard care practice to allow the opportunistic promotion of tobacco cessation by healthcare providers at their health clinics.

Establishing content for a digital educational support group for new adolescent mothers in the Dominican Republic: a user-centered design approach

BackgroundAs digital interventions to improve health become widespread globally, it is critical to include target end-users in their design. This can help ensure interventions are maximally beneficial among intended populations.ObjectivesTo generate the content of a digital educational support group, administered through WhatsApp, for new adolescent mothers and establish participants’ cellular access and WhatsApp use.ParticipantsAdolescent mothers with new babies.MethodsWe completed a two-phase user-centered design process. In phase I design sessions, participants discussed their postpartum experiences and completed an activity to elucidate their health and wellbeing information needs. In phase II sessions, participants individually identified which health information topics were important to them, then all topics were prioritized as a group. Phase II participants also completed a brief survey on cell phone access and WhatsApp use.ResultsPhase I included 24 participants, 21 of whom completed phase II. Priority health and wellbeing information topics in the postpartum period were identified as: child growth and development, understanding your baby, common childhood illnesses, breastfeeding, childhood nutrition, family planning, and self-care. Of phase II participants, 45% had cellular phone access and none had a data plan. Cellular service was inconsistently obtained with data packages or Wi-Fi. 30% of participants had no experience using WhatsApp.ConclusionsParticipants identified numerous health information needs, which will serve as the content for our planned digital support group and provides valuable insight for health care providers globally. Less than half of participants had consistent cellular phone access, and none had reliable access to cellular service.