Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
International Development Research Centre, Nairobi, Kenya.
PLoS One. 2019 Sep 11;14(9):e0220834. doi: 10.1371/journal.pone.0220834. eCollection 2019.
Non-Communicable Diseases (NCDs) constitute 40 million deaths annually. Eighty-percent of these deaths occur in Low- and Middle-Income Countries. MHealth provides a potentially highly effective modality for global public health, however access is poorly understood. The objective of our study was to assess equity in access to mHealth in an NCD intervention in Kenya.
This is a secondary analysis of a complex NCD intervention targeting slum residents in Kenya. The primary outcomes were: willingness to receive SMS, whether SMS was received, and access to SMS compared to alternative health information modalities. Age, sex, level of education, level of income, type of work, number of hours worked, and home environment were explanatory variables considered. Multivariable regression analyses were used to test for association using likelihood ratio testing.
7,618 individual participants were included in the analysis. The median age was 44 years old. Majority (75%, n = 3,691/ 4,927) had only attended up to primary (elementary) school. Majority reported earning "KShs 7,500 or greater" (27%, n = 1,276/ 4,736). Age and level of income had evidence of association with willingness to receive SMS, and age, sex and number of hours work with whether SMS was received. SMS was the health information modality with highest odds of being accessed in older age groups (OR 4.70, 8.72 and 28.89, for age brackets 60-69, 70-79 and 80 years or older, respectively), among women (OR = 1.86, 95% CI 1.19-2.89), and second only to Baraazas (community gatherings) among those with lowest income.
Women had the greatest likelihood of receiving SMS. SMS performed equitably well amongst marginalized populations (elderly, women, and low-income) as compared to alternative health information modalities, though sensitization prior to implementation of mHealth interventions may be needed. These findings provide guidance for developing mHealth interventions targeting marginalized populations in these settings.
非传染性疾病（NCDs）每年导致 4000 万人死亡。其中 80%的死亡发生在中低收入国家。移动医疗为全球公共卫生提供了一种潜在的高效手段，但获取途径仍不清楚。我们的研究目的是评估肯尼亚一项非传染性疾病干预措施中移动医疗获取的公平性。
这是一项针对肯尼亚贫民窟居民的复杂非传染性疾病干预措施的二次分析。主要结局是：愿意接收短信、是否接收短信以及与其他健康信息方式相比获取短信的情况。年龄、性别、教育程度、收入水平、工作类型、工作时间和家庭环境是考虑的解释变量。使用似然比检验进行多变量回归分析以检验关联。
共有 7618 名个体参与者纳入分析。中位数年龄为 44 岁。大多数人（75%，n=3691/4927）仅接受过小学（初等）教育。大多数人报告收入为“KShs 7500 或以上”（27%，n=1276/4736）。年龄和收入水平与接收短信的意愿有证据表明存在关联，年龄、性别和工作时间与是否接收短信有关。在年龄较大的人群中（60-69 岁、70-79 岁和 80 岁或以上年龄组）、女性（OR=1.86，95%CI 1.19-2.89）和收入最低的人群中（仅次于 Baraazas[社区聚会]），短信是最有可能被获取的健康信息方式。
女性最有可能收到短信。与其他健康信息方式相比，短信在边缘化人群（老年人、女性和低收入者）中表现出公平性，尽管在实施移动医疗干预措施之前可能需要进行宣传。这些发现为在这些环境中针对边缘化人群制定移动医疗干预措施提供了指导。
