Broadening the concept of ‘engagement’ in mHealth interventions for equity of access

Victoria Loblay, Mahalakshmi Ekambareshwar, Ian Hickie, Aila Naderbagi, Iqthyer Zahed, Haley LaMonica

Background: Part of the appeal of digital health solutions and mHealth interventions (mobile/wireless technologies to support health) is their potential to overcome traditional barriers to health information including socio-economic status, region and gender.

Aims: Whilst the ‘digital divide’ has been recognised as a barrier to equity in mHealth interventions, this presentation explores how those without direct access to digital technology can engage with and benefit from mHealth interventions.

Methods: As part of an evaluation of a parenting app to promote socioemotional and cognitive development in early childhood in Indonesia, we conducted qualitative interviews and workshops with a variety of users and stakeholders [parents and caregivers (n=47), local experts on early childhood development (n=6) and funders (n=4)].

Results: ‘Engagement’ with the mHealth intervention did not necessarily involve interaction with the app itself. Many users were informally disseminating app content through non-digital networks in the community. We found engagement and enthusiasm for simple messages derived from the app content (e.g. advice on handwashing) was sometimes more pronounced and impactful through these non-digital dissemination channels. This was particularly evident in rural areas, where mobile phone usage and literacy were low.

Conclusions: Understanding non-digital modes of engagement in relation to mHealth interventions has implications for measuring reach, uptake and impact, particularly in disadvantaged communities and areas with limited access to digital technology. We argue that broadening the concept of ‘engagement’ in mHealth is crucial for realising goals of universal access.