Abstract
BackgroundMobile health (mHealth) interventions have the potential to improve health through patient education and provider engagement while increasing efficiency and lowering costs. This raises the question of whether disparities in access to mobile technology could accentuate disparities in mHealth mediated care. This study addresses whether programs planning to implement mHealth interventions risk creating or perpetuating health disparities based on inequalities in smartphone ownership.MethodsVideo Directly Observed Therapy (VDOT) is an mHealth intervention for monitoring tuberculosis (TB) treatment adherence through videos sent by patients to their healthcare provider using smartphones. We conducted secondary analyses of data from a single-arm trial of VDOT for TB treatment monitoring by San Diego, San Francisco, and New York City health departments. Baseline and follow-up treatment interviews were used to assess participant smartphone ownership, sociodemographics and TB treatment perceptions. Univariate and multivariable logistic regression analyses were used to identify correlates of smartphone ownership.ResultsOf the 151 participants enrolled, mean age was 41 years (range: 18–87 years) and 41.1% were female. Participants mostly identified as Asian (45.0%) or Hispanic/Latino (29.8%); 57.8% had at most a high school education. At baseline, 30.4% did not own a smartphone, which was similar across sites. Older participants (adjusted odds ratio [AOR] = 1.09 per year, 95% confidence interval [CI]: 1.05–1.12), males (AOR = 2.86, 95% CI: 1.04–7.86), participants having at most a high school education (AOR = 4.48, 95% CI: 1.57–12.80), and those with an annual income below $10,000 (AOR = 3.06, 95% CI: 1.19, 7.89) had higher odds of not owning a smartphone.ConclusionsApproximately one-third of TB patients in three large United States of America (USA) cities lacked smartphones prior to the study. Patients who were older, male, less educated, or had lower annual income were less likely to own smartphones and could be denied access to mHealth interventions if personal smartphone ownership is required.
Highlights
Mobile health interventions have the potential to improve health through patient education and provider engagement while increasing efficiency and lowering costs
Participants had low socioeconomic status as 49.6% earned less than $10,000 United States Dollars (USD) annually, 57.6% had a high school education or less, and only 62.3% lived in their own home or apartment; no participant reported being homeless and 79.3% had health insurance at baseline
This study addressed the question of who would be denied access to Mobile health (mHealth) interventions if they were only available to patients who possessed their own smartphone
Summary
Mobile health (mHealth) interventions have the potential to improve health through patient education and provider engagement while increasing efficiency and lowering costs. Nonadherence to complicated medication regimens is a major cause of poor patient outcomes globally [1] This is evident in the treatment of infectious diseases, such as tuberculosis (TB). As the leading cause of death due to infectious diseases worldwide, TB affects nearly 2 billion people with 8.8 million new cases diagnosed each year [2, 3] This has prompted the World Health Organization (WHO) and other agencies to prioritize the timely and effective treatment of TB via directly observed therapy (DOT) [2]. VDOT was found to be an acceptable alternative to DOT in Bangalore, South India, and Vietnam [8, 9]
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