Mobile Phone Access Research Articles

Digital access, choice and agency in remote Sarawak

Internet use and access to digital devices continues to increase even in remote regions around the world, but users do not participate equally or engage in the same practices online. This leads to inequalities in the outcomes different groups of users can generate as a result of their online practices. Drawing from recent literature on digital divides and using a theoretical framework focused on user choice and agency, we present data from a study of internet and device use in remote villages in Sarawak, a state of Malaysia on the island of Borneo. These villages lack most basic infrastructure such as paved roads or grid electricity, but some have mobile phone and mobile internet access installed under Malaysia’s Universal Service Provision. We discuss qualitative and quantitative data collected between 2015 and 2017 to point to the opportunities as well as obstacles users in remote communities encounter in their engagements with digital devices and the internet. We argue that while remote areas seem to lag behind urban areas in terms of users’ internet skills and practices, people choose to engage with these technologies in ways that are appropriate to their needs and to the local low-bandwidth environment. To enable these communities to tap into additional potential benefits of internet use, however, faster and more reliable access is a prerequisite.

Design and implementation of an m-health data model for improving health information access for reproductive and child health services in low resource settings using a participatory action research approach

BackgroundInformation and Communication Technologies (ICTs) have been utilised globally for advancing social and economic development. As information becomes key to enlightening development initiatives, the role of mobile technology-based ICT services is becoming more significant. The aim of this study was to design and implement a mHealth data model with an intention of improving mothers’ knowledge of Reproductive and Child Health (RCH) services in rural environments and to remind mothers who do not have access to mobile phones to attend antenatal care.MethodsThe methodology adopted in this research was participatory action research. A phased approach was utilised to answer the research question. The phases were: diagnosis of the problem, action planning, action taking, evaluation and reflection. The study was conducted in Chamwino district of Dodoma region, Tanzania. Reproductive and Child Health sections of Buigiri dispensary and Chamwino health centre were purposively selected. Data were collected through key informant interviews, document review, focus group discussion and observation. Content analysis methods were utilised during analysis. Consequently, the data model was designed, implemented and evaluated.ResultsChallenges of information dissemination in low resource settings noted in this study are: mobile phone ownership and access of mothers, vertical coordination of health services and low staffing levels of health workers. Mothers who do not own mobile phones can leverage phone ownership of community leaders, TBAs, CHWs and relatives. This in turn facilitates communication of health messages to mothers.ConclusionsAlthough this study was conducted in a low resource setting, mobile network coverage was good and thus SMS technology could be used. Research should be conducted on how to disseminate similar information in remote areas without mobile coverage.

Mobile phone interventions for tuberculosis should ensure access to mobile phones to enhance equity - a prospective, observational cohort study in Peruvian shantytowns.

ObjectivesMobile phone interventions have been advocated for tuberculosis care, but little is known about access of target populations to mobile phones. We studied mobile phone access among patients with tuberculosis, focusing on vulnerable patients and patients who later had adverse treatment outcomes.MethodsIn a prospective cohort study in Callao, Peru, we recruited and interviewed 2584 patients with tuberculosis between 2007 and 2013 and followed them until 2016 for adverse treatment outcomes using national treatment registers. Subsequently, we recruited a further 622 patients between 2016 and 2017. Data were analysed using logistic regression and by calculating relative risks (RR).ResultsBetween 2007 and 2013, the proportion of the general population of Peru without mobile phone access averaged 7.8% but for patients with tuberculosis was 18% (P < 0.001). Patients without access were more likely to hold a lower socioeconomic position, suffer from food insecurity and be older than 50 years (all P < 0.01). Compared to patients with mobile phone access, patients without access at recruitment were more likely to subsequently have incomplete treatment (20% vs. 13%, RR = 1.5; P = 0.001) or an adverse treatment outcome (29% vs. 23% RR = 1.3; P = 0.006). Between 2016 and 2017, the proportion of patients without access dropped to 8.9% overall, but remained the same (18%) as in 2012 among the poorest third.ConclusionAccess to mobile phones among patients with tuberculosis is insufficient, and rarest in patients who are poorer and later have adverse treatment outcomes. Thus, mobile phone interventions to improve tuberculosis care may be least accessed by the priority populations for whom they are intended. Such interventions should ensure access to mobile phones to enhance equity.

Preliminary Evaluation of a Web-Based Psychological Screening Tool in Adolescents Undergoing Minimally Invasive Pectus Surgery: Single-Center Observational Cohort Study.

BackgroundPreoperative anxiety and depression are predominant risk factors for increased postoperative pain. Thoracic wall deformities in adolescents often cause low self-esteem, which contributes to psychological concerns. Several studies have suggested a relationship between preoperative mental health support and enhanced recovery after surgery.ObjectiveThis study investigated the validity of screening questionnaires concerning psychological trait and state characteristics via a patient-specific online platform.MethodsPatients scheduled for elective pectus surgery between June 2017 and August 2017 were invited to participate in clinical interviews and online self-report questionnaires. All patients were recruited in the Anesthesiology Department, Antwerp University Hospital, Belgium. This single-center observational cohort study was performed in accordance with the ethical standards of the International Council for Harmonisation–Good Clinical Practice guidelines and the Declaration of Helsinki after obtaining study approval by the Institutional Review Board and Ethics Committee of the Antwerp University Hospital, Belgium (study identifier: 17/08/082). An online preoperative psychological inventory was performed using the Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, and State-Trait Anxiety Inventory. Postoperatively, pain intensity and interference were assessed using the Multidisciplinary Pain Inventory, Coping With Pain Questionnaire, and numeric pain rating scale assessment. Patient satisfaction of the Web-based platform was evaluated.ResultsA total of 21 adolescent patients used our Web-based psychological perioperative screening platform. Patients rated the mobile phone app, usability, and accessibility of the digital platform as good or excellent in 85% (17/20), 89% (17/19), and 95% (20/21) of the cases, respectively. A total of 89% (17/19) of the patients rated the effort of generating answers to the online questionnaires as low. The results from the completed questionnaires indicated a strong negative correlation between self-esteem and the anxiety trait (R=–0.72, P<.001) and overall anxiety characteristics (R=–0.49, P=.04). There was a positive correlation between depressive and anxiety characteristics and the anxiety trait (R=0.52, P=.03 and R=0.6, P=.02, respectively) measured by the online self-report questionnaires. Moreover, preoperative anxiety was positively correlated with postoperative pain interference (R=0.58, P=.02). Finally, there was a negative correlation between self-esteem and pain interference (R=–0.62, P=.01).Conclusions: Perioperative screening of psychological symptoms and trait characteristics with specific treatment, if necessary, could further improve postoperative pain and overall health status. Research on eHealth technology, even for psychological patient care, is rapidly increasing.Trial RegistrationClinicalTrials.gov NCT03100669; https://clinicaltrials.gov/ct2/show/NCT03100669 (Archived by WebCite at http://www.webcitation.org/6zPvHDhU5)

Patterns of usage and preferences of users for tuberculosis-related text messages and voice calls in Uganda.

Little information exists about mobile phone usage or preferences for tuberculosis (TB) related health communications in Uganda. We surveyed household contacts of TB patients in urban Kampala, Uganda, and clinic patients in rural central Uganda. Questions addressed mobile phone access, usage, and preferences for TB-related communications. We collected qualitative data about messaging preferences. We enrolled 145 contacts and 203 clinic attendees. Most contacts (58%) and clinic attendees (75%) owned a mobile phone, while 42% of contacts and 10% of clinic attendees shared one; 94% of contacts and clinic attendees knew how to receive a short messaging service (SMS) message, but only 59% of contacts aged 45 years (vs. 96% of contacts aged <45 years, P = 0.0001) did so. All contacts and 99% of clinic attendees were willing and capable of receiving personal-health communications by SMS. Among contacts, 55% preferred detailed messages disclosing test results, while 45% preferred simple messages requesting a clinic visit to disclose results. Most urban household TB contacts and rural clinic attendees reported having access to a mobile phone and willingness to receive TB-related personal-health communications by voice call or SMS. However, frequent phone sharing and variable messaging abilities and preferences suggest a need to tailor the design and monitoring of mHealth interventions to target recipients.

Characteristics of mobile phone access and usage in rural and urban Guatemala: assessing feasibility of text message reminders to increase childhood immunizations.

Despite efforts to promote vaccination in low- and middle-income countries (LMICs), over 20 million infants remain under-immunized and at risk for unnecessary morbidity and mortality. Mobile health technologies, such as Short Message Service (SMS) texts, have tremendous and untapped potential for disease management. Patient reminder systems are an important mechanism for improving childhood vaccination coverage and can be easily adapted to SMS platforms. However, current research lacks an understanding of the barriers and facilitators to mHealth program design, implementation, and scale in LMICs. We analyzed survey data collected March-November 2016 at the enrollment visit from a randomized controlled trial conducted at public health clinics in urban and rural Guatemala. Participants included eligible infants 6 weeks to 6 months of age receiving the first dose of the primary immunization series. At least one parent needed to own a mobile phone and be capable of deciphering SMS. Chi-square or Fisher's exact and Student's t-test were used to assess significance levels in demographic differences to describe factors that contribute to the feasibility of using an SMS-based vaccination reminder system. Of 1,088 families approached for enrollment, 871 were eligible and 720 (82.7%) participated with equal numbers of urban and rural children enrolled; 54 parents did not own a mobile phone with SMS capability and three parents could not use SMS. There was no significant difference between urban and rural maternal mobile phone ownership (94.4% vs. 93.3%, P=0.53), but more urban fathers owned mobile phones (72.8% vs. 47.1%, P<0.0001) and, overall, more mothers compared to fathers owned mobile phones (93.9% vs. 61.1%, P<0.0001). Most families (90.4%) chose to have reminders sent to the mother. Urban participants reported more mobile phones present in the home (P<0.0001), but rural participants reported more telephone landlines (34.7% vs. 15.6%, P<0.0001). Most participants reported a daily average of ≤5 telephone calls made (87.4%), ≤10 texts sent (91.0%), and ≤10 texts received (89.9%), with urban families reporting greater telephone usage (P=0.006, P<0.001, and P<0.001 respectively). Parents preferred to make calls over sending texts (74.7% vs. 25.3%, P<0.0001), with more urban families preferring text messaging (31.9% vs. 18.6%, P<0.0001). Our study results provide important insight into mobile phone access, usage, and preferences for voice and text communication across rural and urban populations of an LMIC that can be used to inform future mHealth interventions. Our findings suggest that offering a combination of more traditional communication methods with newer, modern technologies may be more effective at reminding families about vaccination visits, particularly for our rural population, and that targeting mothers for mobile phone interventions may provide the greatest benefits. Overall, our study suggests that using SMS reminders in LMICs can be a feasible tool for public health interventions.

Reliability of Self-Reported Mobile Phone Ownership in Rural North-Central Nigeria: Cross-Sectional Study.

BackgroundmHealth practitioners seek to leverage the ubiquity of the mobile phone to increase the impact and robustness of their interventions, particularly in resource-limited settings. However, data on the reliability of self-reported mobile phone access is minimal.ObjectiveWe sought to ascertain the reliability of self-reported ownership of and access to mobile phones among a population of rural dwellers in north-central Nigeria.MethodsWe contacted participants in a community-based HIV testing program by phone to determine actual as opposed to self-reported mobile phone access. A phone script was designed to conduct these calls and descriptive analyses conducted on the findings.ResultsWe dialed 349 numbers: 110 (31.5%) were answered by participants who self-reported ownership of the mobile phone; 123 (35.2%) of the phone numbers did not ring at all; 28 (8.0%) rang but were not answered; and 88 (25.2%) were answered by someone other than the participant. We reached a higher proportion of male participants (68/133, 51.1%) than female participants (42/216, 19.4%; P<.001).ConclusionsSelf-reported access to mobile phones in rural and low-income areas in north-central Nigeria is higher than actual access. This has implications for mHealth programming, particularly for women’s health. mHealth program implementers and researchers need to be cognizant of the low reliability of self-reported mobile phone access. These observations should therefore affect sample-size calculations and, where possible, alternative means of reaching research participants and program beneficiaries should be established.

High mobile phone ownership but low internet access and use among young adults attending an urban HIV clinic in Uganda

ABSTRACTWhilst there is increasing interest in the use of mobile phones and other technologies for improving health outcomes (mHealth), limited data exists on how young people living with HIV use these technologies to gather information and support their health. We sought to assess access and use of mobile phones and the internet among young adults living with HIV attending the Infectious Diseases Institute (IDI) clinic, Kampala. Data collection took place between March 2014 and January 2016 among young adults aged 18–24 years attending the IDI transition clinic in a cross-sectional survey using a semi-structured questionnaire. Of the 272 young adults interviewed, 75% were female and median age was 22.3 years (IQR: 20.6–23.5). Whilst there was a trend to females being more likely to use mobile phones compared to the males, this was not statistically significant (93.7% female versus 85.9%, p = 0.057). Fifty percent of mobile phone users used their phones for HIV-related activities such as medication reminders. General access and use of the internet was low at 34% and users were more likely to be males than females (45.5% versus 30.6%, p = 0.027). A third (32.3%) of the internet users used it to search for HIV-related information. Owning a mobile phone was associated with ease of access to HIV information and preference to receive messages via text messages (p < 0.05). Having internet access was associated with very easy access to HIV information and preference to receive information via email. Despite the rise in smartphones and internet access in Uganda, in this group both access to and use of standard mobile phones are higher than internet-based methods such as email. Using newer technologies to engage with patients especially young people is a great opportunity, but the innovations need to be tailored to the needs and technology access for different patient populations.

Mobile Health Technology (mDiab) for the Prevention of Type 2 Diabetes: Protocol for a Randomized Controlled Trial.

BackgroundThe prevalence of type 2 diabetes is increasing in epidemic proportions in low- and middle-income countries. There is an urgent need for novel methods to tackle the increasing incidence of diabetes. The ubiquity of mobile phone use and access to Internet makes mobile health (mHealth) technology a viable tool to prevent and manage diabetes.ObjectiveThe objective of this randomized controlled trial is to implement and evaluate the feasibility, cost-effectiveness, and sustainability of a reality television–based lifestyle intervention program. This intervention program is delivered via a mobile phone app (mDiab) to approximately 1500 Android smartphone users who are adults at a high risk for type 2 diabetes from three cities in India, namely, Chennai, Bengaluru, and New Delhi.MethodsThe mDiab intervention would be delivered via a mobile phone app along with weekly coach calls for 12 weeks. Each participant will go through a maintenance phase of 6 to 8 months post intervention. Overall, there would be 3 testing time points in the study: baseline, post intervention, and the end of follow-up. The app will enable individuals to track their weight, physical activity, and diet alongside weekly video lessons on type 2 diabetes prevention.ResultsThe study outcomes are weight loss (primary measure of effectiveness); improvement in cardiometabolic risk factors (ie, waist circumference, blood pressure, glucose, insulin, and lipids); and improvement in physical activity, quality of life, and dietary habits. Sustainability will be assessed through focus group discussions.ConclusionsIf successful, mDiab can be used as a model for translational and implementation research in the use of mHealth technology for diabetes prevention and may be further expanded for the prevention of other noncommunicable diseases such as hypertension and cardiovascular diseases.Trial RegistrationClinical Trials Registry of India CTRI/2015/07/006011 http://ctri.nic.in/Clinicaltrials/pdf_generate.php? trialid=11841 (Archived by WebCite at http://www.webcitation.org/6urCS5kMB)

Assessing Mobile Phone Access and Willingness for Text-Based mHealth Intervention to Improve Prenatal Care at Primary Care Centers in North West Ethiopia: a Cross-sectional Study (Preprint)

Assessing Mobile Phone Access and Willingness for Text-Based mHealth Intervention to Improve Prenatal Care at Primary Care Centers in North West Ethiopia: a Cross-sectional Study (Preprint)

Smart phone accessibility and mHealth use in a limited resource setting.

To determine smartphone access and use including future opportunities for mHealth and potential ethical implications among health care professionals practicing at a health care facility in Bengaluru, India. The evolution of smart phones can provide convenient, portable, and rapid access to resources for health care professionals. While mobile phone accessibility has improved in recent years in many low and middle-income countries, the use of smart phones to address health priorities remains limited in some limited resource settings. A quantitative descriptive design was used. A survey was administered in November of 2016 to nurses and physicians at a tertiary care hospital in India. All respondents had a mobile phone, and the majority owned a smart phone that was used for text messaging, email, accessing internet, and downloading apps. Participants recommended smart phone use to improve health care provider access to continuing education and to improve patient knowledge about health. Physicians had better access to mHealth resources compared with nurses. Credible, evidence-based, affordable mobile applications are needed to provide a platform for continuing health education to health professionals and patients in India and limited resource settings. Nurses need equitable access to mHealth resources to build successful mHealth initiatives.

Gatekeepers of our lives [Internet censorship

WHAT'S WRONG WITH women's nipples? Or rather, why do some social-media platforms allow men post topless pictures of themselves, but ban women from doing the same thing? The answer this question neatly encapsulates the key issue of online censorship today. We may think of the online world as a global commons, a public space for free expression, but it is increasingly a series of private spaces within which we are given limited permission act. Our access each other and the resources available within these spaces is increasingly being controlled not just by law, but by gatekeepers whose motivations may include political advantage, social control, or simple profit. For example, the Free The Nipple movement was launched in 2012 highlight the differing ways in which society expects the bodies of women and men be portrayed, as part of a campaign focused on equality, empowerment and the freedom of all human beings. When women started posting topless images of themselves using the #freethenipple hashtag on Instagram, their posts were banned for breaching the service's Community Guidelines. In a 2015 interview with Business Insider, Kevin Systrom, CEO of Instagram, explained that one reason for this was meet the content guidelines of Apple's App Store. One gatekeeper (Instagram) bowed another (Apple) control how a campaign for equality was expressed online. In a sense, this should be no surprise. When Steve Jobs launched the iPhone App Store in 2008, he said that apps would not be allowed distribute pornography, hog bandwidth, breach user privacy, act maliciously, or otherwise violate rules set by the company. The motivation, Jobs said, was to get a ton of apps out there. This is fair enough in the context of furthering a business' interests. However, as the web, Facebook, YouTube, Instagram, Twitter, WhatsApp, Sina Weibo, Snapchat and more gather billions of users and become prime conduits for our communications, the way they are governed and controlled becomes increasingly important the functioning of society. How big an issue is online censorship? According estimates by Freedom House, a US watchdog backed by sponsors ranging from the US State Department and the Dutch Ministry of Foreign Affairs BAE Systems and Google: . 3.2 billion people have access the internet . 67 per cent live in countries where criticism of the government, military, or ruling family has been subject censorship . 60 per cent live in countries where ICT users were arrested or imprisoned for posting content on political, social and religious issues . 49 per cent live in countries where individuals have been attacked or killed for their online activities since June 2015 . 47 per cent live in countries where insulting religion online can result in censorship or jail time . 33 per cent live in countries where online discussion of LGBT+ issues can be repressed or punished . 38 per cent live in countries where social media or messaging apps were blocked over the past year . 27 per cent live in countries THIS IIIS MRCI'IIME FIGHTS IMTERλeET SHUTDOWMS #Keej On The pressure group Access Now monitors and campaigns against internet shutdowns Eπgiπaartnthetas 8 Tichnology November 2017 www.EandTmagazine ceπwhere users have been arrested for writing, sharing or even liking Facebook posts . 38 per cent live under governments that disconnected internet or mobile phone access, often for political reasons. In other words, the global commons is increasingly strictly policed, and offending its gatekeepers can lead harsh punishments.

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OBJECTIVES/SPECIFIC AIMS: This study sought to determine the accessibility, utilization, and preference for mobile phone use among a marginalized population of teens enrolled in an adolescent substance abuse treatment program and their parents. Specific study aims were to: (1) characterize mobile phone use, (2) assess the accessibility and reliability of mobile phone usage, (3) determine specific barriers to mobile phone use, and (4) examine parent and teen perceptions of the utility of integrating communication technology in substance use treatment. METHODS/STUDY POPULATION: In total, 103 (78.6% female; 75.7% Hispanic) parents of teens participating in an outpatient substance abuse treatment program with an average age of 42.60 (SD=9.28) participated in our study. Upon enrollment in a substance abuse treatment program between October 2014 and July 2016, parents completed a technology use survey as part of program development and a chart review of clinic outbound calls to parent mobile phones was completed to evaluate reliability of parent mobile phone access throughout treatment. Survey collection among teens is ongoing. Study population information for teens will be presented at the conference. RESULTS/ANTICIPATED RESULTS: The vast majority of parents owned a cell phone and used it as their primary phone (97.1%); 83% of parents owned smart phones in particular, with the majority being Android phones (68.7%). Parents were more likely to have pay-as-you-go (41.4%) and yearly (32.3%) contracts, and only 15% of the sample endorsed changing their phone number more than once in the past year (64%=never; 21%=once). Parents reported using several of the phone features: text (97%), email (76%), pictures (93%), and accessing the internet (92%); 92% reported they did not have a texting limit; and the most popular use of the mobile phone was to send and receive text messages (58.6%), followed by accessing the internet (19.2%). During the course of a 10-week treatment program, the clinic made 2776 confirmation phone calls to parents who completed surveys. Report of accessibility matched the clinic’s ability to reach parents. Of the 2776 calls, 97.2% were made to the original number provided, which was in service. Only 2.7% were determined to be disconnected, with the median number of days for disconnected service being 2 days with no voice and no texting capabilities (range=14) and 2 days with no voice, but with texting capabilities (range=28). In terms of parent perceptions of the utility of integrating communication technology in substance use treatment, 91% of parents reported they would be receptive to receiving text messages with parenting tips as aftercare support. Preferred content areas included: strategies for monitoring teen substance use (56%), strategies for using consequences (62%), suggestions for encouraging positive activities (62%), and ways to improve parent-child communication (63%). Accessibility, utilization, and preference for mobile phone use in a treatment program among teen respondents will be presented at the conference. DISCUSSION/SIGNIFICANCE OF IMPACT: This study characterized both subjective and objective mobile phone accessibility and usability among teens participating in an adolescent substance abuse treatment program and their parents. This study also provides information on teen and parent perceptions of using mobile phones during the aftercare period and ratings of acceptable messages following treatment. This data will help researchers design mobile-based interventions both during and after treatment, which is the future direction of our research group.

Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh

BackgroundTraditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh.MethodsWe interviewed 4915 randomly selected respondents aged 18 years and above. Associations between gender and knowledge of available mHealth services, use of existing mHealth services and intentions to use mHealth services in the future were examined by multivariate logistic regression analysis, controlling for the effect of categorised covariates.ResultsOf the 4915 respondents to the survey, 61.8% of men (1213/1964) and 34.4% of women (1015/2951) owned a mobile phone. For men, mobile phone ownership was highest among those aged 18–29 years (n = 663, 76.3%), and for women among those aged 30–39 years (n = 825, 44.7%). A higher proportion of men owned phones compared to women, irrespective of socioeconomic status (SES) as indicated by asset index (p < 0.001). Although mobile phone ownership on average was lower among women, they were more likely to share their mobile phone with their family members (19.7%) compared to men (11.6%, p < 0.001). Greater number of men were more likely to be aware of the use of mobile phones for healthcare compared to women (38.5% vs 26.5%, p < 0.001). Knowledge about available mHealth services was lower among women than men; however, intention to use mHealth services in the future was high for both genders, irrespective of age, education and socioeconomic status.ConclusionsCompared to men, women are less likely to own a mobile phone and less aware of available mHealth services, despite high intention to use mHealth among both genders. To optimise the use of mHealth services and to achieve equity of use, uptake strategies should target women, with a focus on the poorer and less educated groups.

Text messaging to decrease tuberculosis treatment attrition in TB-HIV coinfection in Uganda.

BackgroundLow tuberculosis (TB) treatment completion rates in sub-Saharan Africa are an important driver of multidrug resistance. Mobile technology-based interventions have been shown to improve adherence to antiretroviral therapy in sub-Saharan Africa. We aimed to test the effect of a short-message service (SMS) intervention on loss to follow-up (LFU).Materials and methodsIn this quasi-experimental study, all adult, literate, HIV-infected patients with mobile phone access diagnosed with TB between November 2010 and October 2011 in an urban clinic in Uganda were eligible to receive adherence and appointment reminders and educational quizzes during the first 8 weeks of TB treatment. Their risk of LFU in the first 8 weeks of treatment was compared with that of patients starting treatment between March 2009 and August 2010 using logistic regression.ResultsOne of 183 (0.5%) enrolled patients was lost to FU during the intervention compared to six of 302 (2.0%) in the preintervention control group (RR 0.27, 95% CI 0.03–2.07; P=0.22). The SMS intervention was rated as very helpful by 96%. Barriers identified included interrupted phone access (26%, median 14 days) and difficulties responding by SMS. The response rate to educational quizzes was below 10%. There were no unintentional disclosures of TB or HIV status due to the intervention.ConclusionAn SMS reminder service did not show a clear effect on short-term risk of LFU in this study, which was underpowered due to a lower baseline risk in the control group than expected. The SMS-reminder service was rated highly, and there were no breaches of confidentiality. Important technological barriers have implications for larger-scale implementation, not only for TB but also other disease modalities.

Traditional Resources, Internet Resources, and Youth Online Political Participation: The Resource Theory Revisited in the Chinese Context

This study tests whether resource theory can be used to examine the effects of traditional resources and Internet-specific resources on youth online political participation using a representative sample of Chinese college students studying in Shanghai in 2012. The authors find that traditional resources in the form of civic skills and family income are negatively associated with online participation while a distinct set of Internet-specific resources are significantly and positively associated with different modes of youth online political participation depending on their unique cost structures. Mobile phone Internet access and advanced Internet skills are crucial for youth online expressive political participation, advanced Internet skills, mobile phone and home Internet access, and perceived Internet freedom are required for youth online collective action participation. We contribute to the literature by demonstrating that the Chinese political system moderates the cost structures for various types of political behaviors.

Mobile telephony and democracy in Ghana: Interrogating the changing ecology of citizen engagement and political communication

This paper explores how far mobile telephony, in concert with other media platforms, has borne out the optimism of the mobile phonedemocracy nexus in the context of Ghana's politics and democratic practice. It examines the relationship between mobile phone access, citizen engagement, and appropriation of the technology by the governing elite for political communication and electoral campaigns. It concludes that Ghana has witnessed a rich convergence of mobile telephony and broadcast media which, in tandem with an open political environment, has significantly transformed the ecology of political communication. This development has helped to deepen democratic engagement among citizens, and between citizens and the political class, by fostering civic vigilance and accountability and facilitating multivocal expression of views from a more diverse constituency of political participants. However, while mobile phones and related platforms have allowed contra- and counter-hegemonic voices in Ghanaian politics to find expression across the electromagnetic spectrum, this access should not be construed to necessarily mean that political discourse has shifted in significant ways as to alter the fundamental structures of political power. Overall, the fundamental structures of political power and the levers of control remain unassailed by ordinary citizens, despite some of the progress made possible by mobile telephony.

Changing communication ecologies in rural, peri-urban and urban Kenya

Abstract This article aims to discuss changing media ecologies in rural, peri-urban and urban Kenya. The article is based on a comprehensive baseline survey of 799 individuals carried out in October 2014 in Uasin Gishu County, Kenya. The survey recorded media access and media use in relation to demographic data. The findings suggest that media ecologies in rural, peri-urban as well as urban Kenya have undergone dramatic changes. The much hyped and unprecedented spread of mobile telephony has taken place simultaneously with the introduction of or increased access to radio and television, including satellite television. Different emerging communication ecologies can be identified, often with radio providing a solid foundation and combining in different ways with television and mobile phones. Even though mobile ownership, for example, has increased in all segments and areas, gender inequalities are reproduced in relation to mobile phone access especially in the rural areas, while in urban areas the inequalities are less significant. This pattern is also visible in connection with television and social media use, thereby highlighting the fact that the urban–rural and gender divides often intersect.

Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review.

BackgroundNational and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys.ObjectiveThe objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs).MethodsPrimary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsA total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times.ConclusionsVery few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey.

Noncommunicable Disease Risk Factors and Mobile Phones: A Proposed Research Agenda.

Noncommunicable diseases (NCDs) account for two-thirds of all deaths globally, with 75% of these occurring in low- and middle-income countries (LMICs). Many LMICs seek cost-effective methods to obtain timely and quality NCD risk factor data that could inform resource allocation, policy development, and assist evaluation of NCD trends over time. Over the last decade, there has been a proliferation of mobile phone ownership and access in LMICs, which, if properly harnessed, has great potential to support risk factor data collection. As a supplement to traditional face-to-face surveys, the ubiquity of phone ownership has made large proportions of most populations reachable through cellular networks. However, critical gaps remain in understanding the ways by which mobile phone surveys (MPS) could aid in collection of NCD data in LMICs. Specifically, limited information exists on the optimization of these surveys with regard to incentives and structure, comparative effectiveness of different MPS modalities, and key ethical, legal, and societal issues (ELSI) in the development, conduct, and analysis of these surveys in LMIC settings. We propose a research agenda that could address important knowledge gaps in optimizing MPS for the collection of NCD risk factor data in LMICs and provide an example of a multicountry project where elements of that agenda aim to be integrated over the next two years.