MHealth: Potentials and Risks for Addressing Mental Health and Well-Being Issues Among Nepali Adolescents.

Siobhan K Yilmaz,Alok K Bohara

doi:10.3389/fpubh.2021.563515

Abstract

Adolescents are slowly being recognized as a generation, worldwide, that may require different policy approaches to improve staggering statistics on their failing well-being, including mental health. By providing the support to allow the next generation to achieve better mental health outcomes, they are going to be more economically successful and the future economic growth of nations can be better assured. Adoption of mobile-based health interventions (e.g., mHealth) has garnered a lot of attention toward this end. While mHealth interventions are growing in popularity, many researchers/policy-makers appear to have neglected assessing potential (indirect) costs/negative consequences from their use. Evidence from the developed world shows strong associations between extensive cell phone use and negative mental health outcomes, but similar research is minimal in developing world contexts. Additionally, the bulk of work on the outcomes of mobile phone use is studied using a unidirectional approach with blinders to front-end motivations. Using primary data from a large-scale, school-based survey of older adolescents in southwestern Nepal (N = 539), this work investigates such a tension between mobile/smartphone usage as a true mobile health (mHealth) opportunity in Nepal or as a potential problem, introducing additional deleterious well-being effects from over-use. Founded in Basic Psychological Needs Theory (BPNT), robust results of analyses using full structural modeling approaches (and traditional regression-based sensitivity analyses) indicate support for the BPNT framework in explaining statistically significant positive associations between bullying and anxiety, as well as, negative associations between bullying and grit, including evidence to support the mediating role of problematic mobile phone use in these relationships. More than 56% of the sample showed indicators of mild to moderate anxiety and over 10% claim experiences of bullying, coupled with over 75% of the sample scoring above the midline of a problematic mobile phone use scale, all of which motivates the relevance of our findings. Potential policy implications of these findings, and mention of other intriguing avenues for future work are further discussed.

Highlights

AND BACKGROUNDOf the 1.2 billion people under age 18 across the globe, 90% of them live in the developing world [1]
While adolescent use of mobile technology is believed to be high, existing literature focusing on mHealth has primarily focused on the believed cost and reach benefits potentially offered
Though, there has been a noted lack of economic data to support the use of digital health interventions [9], and coupled with that is a recognition of the importance of acknowledging potential unintended downsides to its implementation

Summary

Introduction

AND BACKGROUNDOf the 1.2 billion people under age 18 across the globe, 90% of them live in the developing world [1]. Estimates indicate 20–50% of young people in the Southeast Asia (SEA) region report being bullied, 7.1% are using alcohol, 9.7% are smoking, 8.4% report being lonely most or all of the time, 6.9% report being so anxious they lose sleep, and 6.8% have admitted to seriously considering suicide within the prior year [4] Such behavioral and mental health/well-being concerns are exacerbated by governments and healthcare systems which either do not acknowledge the importance of mental health, fail to address adolescents differently than younger children or adults, or both. Most existing evidence of the acceptability and efficacy of mHealth approaches to change health-related behaviors has been well-received [7, 8], thorough assessment of true economic benefits is still lacking [9] Due to their existing high use of mobile-based technologies, the use of mHealth approaches in adolescent populations may be promising [10,11,12]. While use of mobile technology is prolific among adolescent populations, there is evidence of lack of sufficient research fully accounting for the effectiveness and potential consequences of pursuing mHealth initiatives [13, 14]

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