Abstract
The seeming “ubiquity” of mobile phones has spawned a wave of interventions that use mobiles as platforms for health service delivery (mHealth). Operating in more than 100 countries, mHealth interventions commonly aspire to make healthcare more inclusive and efficient. Yet, mobile phone diffusion also stimulates locally emerging forms of health-related phone use that could create new digital inequalities among marginalised groups or compete with mHealth and other technology-based development interventions. We aim to inform this subject by asking, “How do mobile phone use and social support networks influence rural treatment-seeking behaviours among marginalised groups?” We hypothesise that (1) resource constraints drive marginalised groups towards informal healthcare access, and that (2) mobile phone use and social support networks facilitate access to formal healthcare with a bias towards private doctors. Analysing representative survey data from 2141 Thai and Lao villagers with descriptive statistics and multi-level regression models, we demonstrate that: (a) health-related phone use is concentrated among less marginalised groups, while social support networks are distributed more equitably; (b) marginalised villagers are more likely to utilise informal healthcare providers; and (c) mobile phones and social support networks are linked to increased yet delayed formal healthcare access that is directed towards public healthcare. We conclude that mobile phone diffusion has a mildly positive association with rural healthcare access, operating in a similar fashion but without (yet) appearing to crowd out social support. However encouraging, this is problematic news for mHealth and technology-based development interventions. The potential behavioural consequences of “informal mHealth” reinforce the notion that mobile phones are a non-neutral platform for mHealth and development interventions. The long-term implications require more research, but the literature suggests that increasing phone-aided healthcare facilitation could undermine local social support networks and leave already marginalised rural dwellers in yet more precarious circumstances.
Highlights
Through an analysis of rural contexts in northern Thailand (Chiang Rai province) and southern Lao PDR (Salavan province), we demonstrate that marginalisation was associated with lower rates of private and higher rates of informal healthcare access, especially in the more resource-constrained context of rural Salavan
Contrary to mainstream positions in mHealth research, our work demonstrates that health behaviours respond to situations of marginalisation, and that mobile phones in this context become part of a localised set of healthcare solutions in which they appear to fulfil similar functions as social support networks
We focus here on mobile phones as a type of information and communication technology (ICT) that is diffusing rapidly around the globe, and which has experienced the fastest growth within ICT and development (ICTD) research (Gomez, Baron, & Fiore-Silfvast, 2012)
Summary
Among recent contributions to this field are for example Samuel, Alkire, Zavaleta, Mills, and Hammock (2018), who discuss the role of social isolation as an often-neglected facet of multidimensional poverty, exemplifying their arguments with cases of South Africa and Mozambique. Another example is Graw and Husmann (2014). Datzberger (2018) provides an example of how the various dimensions of marginalisation interact in the context of Uganda, where structural factors spanning social, economic, and political dimensions (e.g. social aspirations, labour market conditions, corruption) prevented poor people from benefitting from educational reforms (similar to the notion of fractal poverty traps; Barrett & Swallow, 2006)
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