Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
J Med Internet Res. 2024 Sep 23;26:e52670. doi: 10.2196/52670.
BACKGROUND: Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. OBJECTIVE: In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. METHODS: A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. RESULTS: Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82%) had access to a mobile phone, and 15,454 (87.63%) owned a mobile phone. Among participants with access to a mobile phone, 58.61% (9594/16,370) and 57.79% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95% CI 1.60-2.39; tertiary: aOR 8.36, 95% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ≥2 years were associated with higher levels of internet and social media use. CONCLUSIONS: While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status.
背景:在全球范围内,移动电话和互联网等数字技术的日益普及使得创新型移动医疗干预措施得以发展,特别是在接触和吸引青年群体方面。然而,使用这些技术可能会使那些无法获得这些技术的人被排除在外。
目的:本研究旨在调查津巴布韦青年群体中与拥有移动电话、使用互联网和社交媒体相关的社会人口学因素。
方法:在津巴布韦的 3 个省(哈拉雷、东马绍纳兰和布拉瓦约)的 24 个城市和城郊社区中进行了一项基于人群的患病率调查。居住在研究社区中随机选择的家庭中的 18 至 24 岁的青年完成了一份由访谈者管理的问卷调查。主要结局是拥有移动电话以及当前使用互联网和社交媒体的情况。根据家庭资产拥有情况,使用主成分分析制定了家庭财富指标。使用多变量逻辑回归来调查与每个主要结局相关的因素。年龄、性别和省份被认为是先验混杂因素。如果在单变量分析中,年龄、性别和省份调整后的主要结局与家庭财富、婚姻状况、教育程度、就业状况、在当前地址居住的时间和 HIV 状况存在关联,且关联的显著性水平为 P<.10,则将这些因素纳入最终的多变量模型中。
结果:在评估主要结局的 17636 名参与者中,16370 名(92.82%)拥有移动电话,15454 名(87.63%)拥有移动电话。在拥有移动电话的参与者中,分别有 58.61%(9594/16370)和 57.79%(9460/16370)至少每周使用互联网和社交媒体。年龄较大(调整后的优势比[OR] 1.76,95%置信区间[CI] 1.55-2.00)、财富增加(范围从财富五分位 2 的调整后 OR 1.85,95%CI 1.58-2.16 到财富五分位 5 的调整后 OR 3.80,95%CI 3.00-4.80,五分位 1 为参考)和较高的教育程度(中学:调整后 OR 1.96,95%CI 1.60-2.39;高等教育:调整后 OR 8.36,95%CI 5.29-13.20)与拥有移动电话相关。年龄较大、男性、财富增加、未婚、较高的教育程度、处于教育或正规就业状态以及在同一地址居住≥2 年与更高水平的互联网和社交媒体使用相关。
结论:尽管拥有移动电话的比例接近普及,但城市和城郊地区仍有超过三分之一的青年无法使用互联网和社交媒体。互联网的使用和社交媒体的使用与家庭财富和教育程度密切相关。移动医疗干预措施必须确保它们不会加剧在获得医疗保健方面的现有不平等。这些干预措施必须辅以其他策略,以吸引和招募那些无法使用互联网或社交媒体的个人,以防止青年群体因性别和社会经济地位而被排斥。
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