Mobile Phone Ownership Research Articles

The AuTOMATIC trial: a study protocol for a multi-arm Bayesian adaptive randomised controlled trial of text messaging to improve childhood immunisation coverage

BackgroundWhile most Australian children are vaccinated, delays in vaccination can put them at risk from preventable infections. Widespread mobile phone ownership in Australia could allow automated short message service (SMS) reminders to be used as a low-cost strategy to effectively ‘nudge’ parents towards vaccinating their children on time.MethodsAuTOMATIC is an adaptive randomised trial which aims to both evaluate and optimise the use of SMS reminders for improving the timely vaccination of children at primary care clinics across Australia. The trial will utilise high levels of digital automation to effect, including eligibility assessment, randomisation, delivery of intervention, data extraction and analysis, thereby allowing healthcare-embedded trial delivery. Up to 10,000 parents attending participating primary care clinics will be randomised to one of 12 different active SMS vaccine reminder content and timing arms or usual practice only (no SMS reminder). The primary outcome is vaccine receipt within 28 days of the scheduled date for the index vaccine (the first scheduled vaccine after randomisation). Secondary analyses will assess receipt and timeliness for all vaccine occasions in all children. Regular scheduled analyses will be performed using Bayesian inference and pre-specified trial decision rules, enabling response adaptive randomisation, suspension of any poorly performing arms and early stopping if a single best message is identified.DiscussionThis study will aim to optimise SMS reminders for childhood vaccination in primary care clinics, directly comparing alternative message framing and message timing. We anticipate that the trial will be an exemplar in using Bayesian adaptive methodology to assess a readily implementable strategy in a wide population, capable of delivery due to the levels of digital automation. Methods and findings from this study will help to inform strategies for implementing reminders and embedding analytics in primary health care settings.Trial registrationANZCTR: ACTRN12618000789268.

Ethnic digital divide? Evidence on mobile phone adoption

ABSTRACT Between 2006 and 2014, Vietnam experienced a true information technology revolution. In rural areas, mobile phone ownership increased from 18% to 89%. I use a panel dataset from this period to study the ‘digital divide’ between the ethnic majority group and ethnic minorities. I find that underprivileged ethnic minorities are lag behind in phone adoption. These differences are fully explained by standard factors of demand and by education level, that is, I do not find unobservable barriers in adoption. Analysis using spatial data on digital mobile network coverage reveals that infrastructure is also not a barrier to adoption, even in remote regions of Vietnam. Results are robust to alternative model specifications.

Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study.

A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A1c (HbA1c) screening has not yet been studied. It is imperative to gauge perceptions of "cold texts" to ensure that information and language are optimized to promote engagement with text messages that affect follow-through with health behaviors. This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA1c screening and walk them through the steps required to perform the behavior based solely on an automated text exchange. In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages. Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA1c screening. Plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity, were important to participants' understanding of and receptiveness to messages. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step of the process. Participants needed further clarification to understand the steps involved in following through with HbA1c screening and receiving results. Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA1c in direct-to-patient alerts that use cold texting. Using plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. A patient's relationship with their provider and the financial costs associated with texts and screening may affect receptiveness and engagement in this process.

EFFECTS OF COVID-19 PANDEMIC ON LIVELIHOOD OF RURAL COMMUNITY DWELLERS IN NIGERIA

The study assessed the effects of covid-19 pandemic on the livelihood of the rural community dwellers in Edo State, Nigeria. A multistage sampling procedure was used to select 156 respondents. Structured interview schedule was used to collect data from the respondents which were subjected to descriptive and inferential analyses. The results revealed that the mean age of the respondents was 47.5 ± 16 years, about 61 percent of the respondents were males and majority (86.5%) had formal education with a mean annual income of N1233846.15. Majority engaged in multiple livelihood activities with arable farming (58.3%), agromarketing (34%) and petty trading (37.4%) taking the lead. Cash at hand (87.1%), access to land (76.9%), skill acquisition centre (86.7%), possession of mobile phones (90.1%), and access to markets (98.1%) were major livelihood assets of the respondents. Many (53.7%) of the respondents had indifferent perception towards Covid-19 pandemic while majority (64 %) indicated that the effects of Covid-19 pandemic on their livelihoods was low. Income, years of education and perception about covid-19 pandemic were significantly correlated with the effects of covid-19 pandemic on respondents’ livelihoods. The study concluded that Covid-19 pandemic did not seriously affect livelihoods of rural dwellers in the study area.

Influence of internet, mobile phone use, and sociodemographic factors on women's knowledge and attitude towards contraception in Indonesia.

Rapid population growth has been a problem in Indonesia for several decades. One of the reasons for this phenomenon is limited knowledge of reproductive health and proper contraception. . The use of mobile phones and the internet has made it easier to access health information. This study aimed to determine the influence of the internet, mobile phone use, and sociodemographic factors on Indonesian women's knowledge of and attitudes toward contraception. The present study used secondary data from the 2017 Indonesian Health and Demographics Survey. Altogether, 49,627 women participated in this study. Descriptive statistics were performed, and bivariate analysis using the chisquared test was performed to measure the association between variables. Knowledge about the ovulation cycle and contraception was positively associated with mobile phone ownership, frequent internet use, higher wealth index, reading printed media, listening to the radio, watching the television, higher educational level, and older age. The use and intention of contraception were positively associated with lower wealth index, watching television at least once a week, primary-secondary educational level, rural residence, and older age. Thus, acquisition of knowledge does not necessarily translate into implementation of contraceptive. , since there might be certain digital and social barriers. Access to the internet and mobile phones as well as certain sociodemographic factors have contributed to an increase in women's knowledge about contraception, but not necessarily in their knowledge regarding the use of contraception.

Digital marketing and customer satisfaction in the Garmentindustry during Post COVID 19 Pandemic in Zimbabwe

Consumer purchasing in Zimbabwe has always been dominated by Bricks and Mortar shops with few online stores. When COVID 19 set in the paths of consumers in March 2020with restrictions on movement but with needs and wants to be met, many firms were forced to re think their marketing strategies which saw a rise in digital marketing in Zimbabwe. Consumers are always seen as savvy animals with ever changing needs and wants, all to be met by the firms through the supply of goods and services. Therise in consumer needs, competition and declining income levels during and after COVID 19 made firms to blend their marketing strategies and encompass the recent digital marketing strategies. This was the optional marketing strategy firms were left toembrace as Zimbabwehas a 90% mobile phone ownership per household (Maphosa, 2021). The study was informed by Theory of planned behaviour. The target population for the study was low to medium income segment of the market mainly comprising of university students. Conveniencesampling technique was used and the interviewer used respondents that were easy to reach and the planned number of interviews was 25, however 18 interviews were conducted, data saturation (Kumar, 2011) was reached and no further data was gathered. The study results showed differed perceptions from consumers based on their technological knowledge towards ICT but mainly many consumers showed willingness to embrace digital purchasing in the 21Stcentury although many challenges included fear of cyber crimes, poor network, cost of data, age of the consumer and social networks influence. The results from the study will help many organisations in drafting their digital marketing strategies using consumer based perceptions

Impact of Climate Information Services on Crop Yield in Ebonyi State, Nigeria

This paper assessed crop farmers’ access and utilization of climate information services (CIS) and impact of CIS use on crop yields in Ebonyi State, Nigeria. The multi-stage sampling procedure was used to select 405 farmers from the State, and data were collected through a survey of the farmers using a questionnaire. We employed descriptive statistics, endogenous treatment effect, and Heckman probit selection model to analyze the data collected. The result indicates that a majority (89%) of the farmers accessed climate information and that the common sources of climate information include agricultural extension officers, fellow farmers, and radio. This study shows that 88% of the farmers used climate information services in making farming decisions. Farmers’ age, household size, marital status, farming experience, income extension contact, ownership of television, ownership of radio, ownership of mobile phone, proximity to the market, workshop/training participation, climate events experienced, and knowledge of appropriate application of fertilizer significantly influenced both access and utilization of CIS. The use of CIS in planning for farming activities significantly increased rice, maize, and cassava yields. The study demonstrates the important contribution of climate information services in crop production. We therefore recommend that access and use of climate information services in agricultural communities should be increased.

Implementing SMS reminders for routine immunization in Northern Nigeria: a qualitative evaluation using the RE-AIM framework

BackgroundShort Message Service (SMS) reminders have improved vaccine uptake in low- and middle-income countries (LMICs). However, the limited use of SMS reminders in LMICs requires evaluating the intervention’s internal and external validity to improve adoption and sustainability. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we qualitatively assessed the impact of a SMS reminder intervention implemented in Kebbi State, Northwest Nigeria between May 20, 2019 and May 31, 2020. This will guide and inform future SMS reminder interventions to improve childhood immunization uptake in LMICs.MethodsIn June 2020, we conducted 14 focus group discussions, 13 in-depth interviews, and 20 key informant interviews among 144 purposively selected participants from five local government areas of Kebbi State. For analysis, we used a deductive approach to develop preliminary codes based on the RE-AIM framework and the inductive approach to generate themes that emerged from the interviews.ResultsThe perceived importance and impact of the SMS reminder in improving demand and uptake for vaccinations were the consistent contributing factors that encouraged participants’ participation. Other facilitators included the involvement of health workers in supporting SMS reminder registration and community gatekeepers using existing structures to convey messages on scheduled immunization services. Policymakers adopted the intervention because it aligns with the state’s priority to improve immunization coverage. Similarly, the SMS reminder appealed to health workers and program managers because it reduced their workload and served as a performance monitoring tool to track immunization and intervention defaulters. Despite these, low mobile phone ownership and the inability to read text messages due to the low literacy level were the main barriers during implementation. Finally, data availability on cost-effectiveness and the intervention’s impact on improving coverage was critical for scalability.ConclusionsOur study demonstrated that SMS reminders in local languages could improve vaccination demand and uptake in resource-constrained settings due to their perceived importance and impact. Addressing the cited implementation barriers and promoting the facilitators is critical to its adoption and sustainability. Costing and impact data are needed to collaborate findings on the effectiveness of the SMS reminder to improve childhood vaccination uptake.

Agrifood system participation and production efficiency among smallholder vegetable farmers in Northern Ghana

AbstractFormalized marketing arrangements between smallholder farmers and produce buyers are gradually replacing spot market transactions in developing countries due to the rapid structural transformation of agrifood systems. This study examines the impact of agrifood system participation on the total value of vegetable production and technical efficiency (TE), using a sample of 423 vegetable farmers from Northern Ghana. We employ propensity score matching and W. Greene's selection bias‐corrected stochastic production frontier methods to correct for observable and unobservable selection bias issues, respectively. We further use a metafrontier model to derive technology gap ratios (TGRs) and meta‐TE for agrifood system participants and nonparticipants. The results reveal that agrifood system participants are about 50% more productive than nonparticipants. In addition, participants have higher meta‐TE (58% vs. 55%) and TGR (98% vs. 94%) than nonparticipants. Variables such as farmer group membership, extension visits, mobile phone ownership, irrigation and road access are the notable correlates of smallholder farmers' participation in agrifood systems. The total value of vegetable production is significantly influenced by fertilizer, agrochemicals, seeds, irrigation, soil fertility, and location‐fixed effects. [EconLit Citations: D24, Q12, Q18]

Determinants of uptake of biofortified crop varieties by smallholder farmers in Uganda

Hunger and malnutrition can be said to be one of the important global problems that have recently been exacerbated by climate change and environmental degradation. Meanwhile, an estimated two billion people suffer from micronutrient malnutrition, mostly due to low intake of vitamins and minerals such as iron and zinc. Biofortification, an agricultural technology that can increase the micronutrient content of staples, may confer large benefits to rural families and poor children with limited access to expensive high-quality foods. Possible pathways include own-consumption when directly consumed, the income pathway when they are sold and/or the food price pathway when they increase the availability of micronutrient-rich foods in the market place. This research aims to understand the factors associated with the uptake of biofortified crop varieties (BCV) among smallholder farmers in Uganda and derive policy information to support their accelerated uptake. The analysis used two waves of panel data consisting of 6,400 observations collected from 6 districts in Uganda as part of the Feed the Future (FtF) innovation laboratory for nutrition. Descriptive analysis was used to help discern the differences between adopters and non-adopters of BCV. Double hurdle regression analysis was used to understand the factors associated with adoption and the intensity of adoption of biofortified crop varieties. Descriptive results reveal significant differences between adopters and non-adopters of BCV. Double hurdle regression analysis results indicate that the primary determinants of uptake of biofortified crop varieties include geographical location, extension staff visits, household size, and mobile phone ownership. Other important factors associated with the adoption of BCV include the amount of land owned by the household. Results suggest that extension staff visits, and mobile phone ownership were important sources of information for rural households that appear to drive the decision to adopt biofortified crop varieties. Meanwhile, household size, regional location of the household and total land owned were important motivators in adopting BCV technology. From the present analysis, it was not possible to clearly discern the key drivers of the intensity of adoption of biofortified crop varieties among smallholder households in Uganda. Key words: Biofortification, smallholder farmers, quasi experimental design, double-hurdle regression, Uganda

COVID-19 and Food Security in Ethiopia: Do Social Protection Programs Protect?

We assess the ability of Ethiopia’s flagship social protection program, the Productive Safety Net Program (PSNP), to mitigate the adverse impacts of the COVID-19 pandemic on food and nutrition security of households, mothers, and children. We use both prepandemic in-person household survey data and a postpandemic phone survey. Employing a household fixed effects difference-in-differences approach, we find that household food insecurity increased by 11.7 percentage points and the size of the food gap increased by 0.47 months in the aftermath of the onset of the pandemic. Participation in the PSNP offsets virtually almost all of this adverse change; the likelihood of becoming food insecure increased by only 2.4 percentage points for PSNP households, and the food gap increased by only 0.13 months. The protective role of the PSNP was greater for poorer households and those living in remote areas. Results are robust to definitions of PSNP participation, different estimators, and how we account for the nonrandomness of mobile phone ownership. Furthermore, PSNP households were less likely to reduce expenditures on health and education by 7.7 percentage points and were less likely to reduce expenditures on agricultural inputs by 13 percentage points.

Correlates of Outdoor Time in Schoolchildren From Families Speaking Nonofficial Languages at Home: A Multisite Canadian Study.

Previous research shows that children from ethnic minority groups spend less time outdoors. Using data collected in 3 regions of Canada, we investigated the correlates of outdoor time among schoolchildren who spoke a nonofficial language at home. A total of 1699 children were recruited from 37 schools stratified by area-level socioeconomic status and type of urbanization. Among these, 478 spoke a nonofficial language at home. Children's outdoor time and data on potential correlates were collected via questionnaires. Gender-stratified linear multiple regression models examined the correlates of outdoor time while controlling for age and sampling variables. In boys, higher independent mobility, higher outdoor air temperature, mobile phone ownership, having older parents, and parents who biked to work were associated with more outdoor time. Boys living in suburban (vs urban) areas spent less time outdoors. The association between independent mobility and outdoor time became weaker with increasing age for boys. In girls, lower parental education and greater parental concerns about neighborhood safety and social cohesion were associated with less outdoor time. Correlates of outdoor time differ by gender and span the social ecological model underscoring the need for gender-sensitized interventions targeted at individual, family, social, and physical environmental correlates to increase outdoor time.

Effect of farmer socio-economic characteristics on extension services demand and its intensity of use in post-conflict Liberia

Farmers' demand for and use of agricultural extension services in post-conflict countries is key not only to agricultural productivity but for economic transformation and maintenance of peace. This paper examined the effect of socio-economic characteristics of smallholder rice farmers on demand for extension services and the intensity of their use in Gibi District of Liberia. Multistage sampling technique was used in select 296 smallholder rice farmers. Descriptive statistics were used to compare farmers' socio-economic characteristics and the heckpoisson model was used to simultaneously estimate the effect of socio-economic characteristics on demand for extension services and the intensity of their use. The results showed that farm income, sale of crops and mobile phone ownership had significant effect on farmers' demand for extension services, while gender, cash-crop ownership, use of improved seeds, and awareness of extension services had significant effects on the intensity of their use. The study suggests that government implements programs that promote increased provision of needed farm inputs for greater use of extension services and encourages commercialization among farmers. Also, service providers should tailor their services to the farmers' socio-economic characteristics.

Welfare implications of participating in agri‐value chains among vegetable farmers in Northern Ghana

AbstractThis study investigates the welfare implications of agri‐value chain participation utilizing data collected from 423 smallholder vegetable farmers in northern Ghana. The endogenous switching regression (ESR) model estimates the determinants of agri‐value chain participation and their associated impacts on farmers' welfare, measured by household income and consumption expenditure. The ESR model accounts for selectivity bias associated with observed and unobserved factors. We find that agri‐value chain participation improves vegetable farmers' welfare. Participation significantly increases household income and consumption expenditure by about 22% and 40%, respectively. Our results also reveal that agri‐value chain participation is significantly determined by education, household size, mobile phone ownership, irrigation, farm size, farmer group membership, and extension visits. Variables such as education, access to irrigation, farm size, access to credit, farmer group membership, and extension are the significant determinants of farmers' welfare [EconLit Citations: D24, Q12, Q18].

Patient Portal Perceptions in an Urban Community Health Center Setting: Insights for Telehealth

Introduction
 Patient portals are the “front door” to telehealth - online scheduling, video visit links, and digital after visit summaries are often conveyed via the patient portal. Patient portal tools often require similar patient skills and attitudes as telehealth adoption. Analyzing patients’ perceptions and beliefs around this digital patient engagement tool may lead to insights regarding telehealth, particularly in historically underrepresented patient populations.
 
 Methods
 Participants from a Federally Qualified Health Center (FQHC) in Chicago, IL were surveyed on general technology use, healthcare-specific technology use, and barriers and facilitators to patient portal use.
 
 Results
 The 149 respondents (81% response rate) represented a unique population base with 96% African American, 74% with educational attainment of some college or less, and 48% with at least one chronic medical condition. Technology access and use were high with 78% computer ownership, 98% mobile phone ownership (with 75% smartphone ownership). In terms of patient portal perception, 75% rated Perceived Usefulness (U) as high. Perceived Ease of Use (E) domains similarly had 70% or higher agreement from patients, and potential barriers and facilitators in the Attitudes Toward Use (A) section included a preference to calling their doctor, and minority of patients viewing the portal as unsafe way to communication, too complicated to use, or taking too much time. Additional stratification analysis by demographic variables (age, gender, educational attainment, and number of chronic conditions) revealed differences in portal perception across the Usefulness, Ease of Use, and Attitudes domains.
 
 Discussion
 Insights from barriers, attitudes, and capacity to use patient portal tools deliver important insight into overall adoption of other digital health modalities, including telehealth. In an urban historically underserved patient population, technology access and use is quite high, and mobile phones access was nearly ubiquitous with a large majority using the internet function on their mobile device. Different age groups, genders, levels of educational attainment, or degree of multi-morbidity have different values and needs. Therefore, each subpopulation needs targeted messaging of different portal benefits.
 
 Conclusion
 Our research provides initial insights into patient-level factors influencing patient portal attitudes, with implications toward telehealth adoption. Demographic differences have a significant impact on attitudes toward technology adoption. Equitable uptake of portal and telehealth services will require tailored messaging, training, and multiple modes of communication, including web-based and mobile.

Mobile phone access and preferences among medical inpatients at an urban Canadian hospital for post-discharge planning: A pre-COVID-19 cross-sectional survey.

Digital health interventions are increasingly used for patient care, yet little data is available on the phone access type and usage preferences amongst medical ward inpatients to inform the most appropriate digital interventions post-discharge. To identify mobile phone ownership, internet access, and cellular use preferences among medical inpatients, we conducted a researcher-administered survey of patients admitted to five internal medicine units at Vancouver General Hospital (VGH) in January 2020. The survey was administered over 2 days separated by a 2-week period. A total of 81 inpatients completed the questionnaire. Survey found that 85.2% of survey respondents had mobile phone access where 63.0% owned their own mobile phone, and 22.2% had access to a mobile phone via a proxy (or an authorized third-party) such as a family member. 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 access. Survey showed that 71.1% of males owned a mobile phone compared to only 52.8% of females. All participants at a "high" risk of readmission had access to a mobile phone, either as phone-owners or proxy-dependent users. Access to mobile phones among medical ward inpatients, 85.2%, was comparable to smartphone penetration rates amongst Canadians in 2019, 85.1%. 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.

Impact of mobile phones on HIV public stigma: a cross-sectional and pseudo-panel analysis from Ghana

ObjectiveHIV-related stigma still remains a major barrier to testing and a significant burden for people living with HIV (PLWH) in sub-Saharan Africa. This paper investigates how mobile phone ownership can...

Digital Technology Access and Health-Related Internet Use Among People Experiencing Homelessness in Hungary: Quantitative Survey.

In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care. However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system. Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons. The results demonstrated a considerable level of internet use in the homeless population; 52.9% (350/662) of the respondents used the internet frequently compared with 81.3% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6% (461/662) of the respondents reported mobile phone ownership, and 39.9% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2% (70/662) of the respondents had already used a health mobile app, and 34.6% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions. Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes.

Lack of ownership of mobile phones could hinder the rollout of mHealth interventions in Africa.

Mobile health (mHealth) interventions, which require ownership of mobile phones, are being investigated throughout Africa. We estimate the percentage of individuals who own mobile phones in 33 African countries, identify a relationship between ownership and proximity to a health clinic (HC), and quantify inequities in ownership. We investigate basic mobile phones (BPs) and smartphones (SPs): SPs can connect to the internet, BPs cannot. We use nationally representative data collected in 2017-2018 from 44,224 individuals in Round 7 of the Afrobarometer surveys. We use Bayesian multilevel logistic regression models for our analyses. We find 82% of individuals in 33 countries own mobile phones: 42% BPs and 40% SPs. Individuals who live close to an HC have higher odds of ownership than those who do not (aOR: 1.31, Bayesian 95% highest posterior density [HPD] region: 1.24-1.39). Men, compared with women, have over twice the odds of ownership (aOR: 2.37, 95% HPD region: 1.96-2.84). Urban residents, compared with rural residents, have almost three times the odds (aOR: 2.66, 95% HPD region: 2.22-3.18) and, amongst mobile phone owners, nearly three times the odds of owning an SP (aOR: 2.67, 95% HPD region: 2.33-3.10). Ownership increases with age, peaks in 26-40 year olds, then decreases. Individuals under 30 are more likely to own an SP than a BP, older individuals more likely to own a BP than an SP. Probability of ownership decreases with the Lived Poverty Index; however, some of the poorest individuals own SPs. If the digital devices needed for mHealth interventions are not equally available within the population (which we have found is the current situation), rolling out mHealth interventions in Africa is likely to propagate already existing inequities in access to healthcare.

Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service-Delivered Smoking Cessation Intervention for People With HIV in China: Qualitative Study.

BackgroundChina, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population.ObjectiveThis study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages.MethodsWe recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups.ResultsA total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level.ConclusionsWe identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China.