Changes in Perceptions and Use of Mobile Technology and Health Communication in South Africa During the COVID-19 Lockdown: Cross-sectional Survey Study

Abstract

Background In late March 2020, South Africa implemented a 5-stage COVID-19 Risk Adjusted Strategy, which included a lockdown that required all residents to remain home to prevent the spread of COVID-19. Due to this lockdown, individuals have been forced to find and use alternatives for accomplishing tasks including shopping, socializing, working, and finding information, and many have turned to the internet and their mobile devices. Objective This study aimed to describe how South Africans consume and internalize information surrounding the COVID-19 outbreak in order to determine whether the COVID-19 lockdown and social isolation have influenced technology behavior, particularly in terms of health communication and information. Methods From June 24 to August 24, 2020, people in South Africa were invited to complete a survey through the Upinion mobile app, an online data collection resource. The survey collected information on demographics, and technology use during the lockdown, and COVID-19 knowledge. Results There were 405 participants, of which 296 (73.06%) were female. A total of 320 (79.01%) participants had a tertiary school education, 242 (59.75%) were single, and 173 (42.72%) had full-time employment. The lockdown forced 363 (89.63%) participants to use more technology, especially for work (n=140, 24.05%) and social media/communication (n=133, 22.85%). Security or privacy issues (n=46, 38.98%) and unfamiliarity with technology (n=32, 27.12%) were identified as the most common issues faced by the 127 (31.36%) participants who were unsure about using technology prior to the lockdown. Almost all participants (n=392, 96.79%) stated that they would continue using technology after the lockdown. Multimedia (n=215, 53.09%), mobile phone content (n=99, 24.44%), and health organizations and professionals (n=91, 22.47%) were the main sources of COVID-19 information. Most participants (n=282, 69.63%) felt that they had enough information. Two-thirds (n=275, 67.90%) of participants stated that they had used their mobile phones for health information before the lockdown, with web searches (n=109, 26.91%), social media (n=58, 14.32%), and government and institutional websites (n=52; 12.84%) serving as their main sources of information. Overall, the mean COVID-19 knowledge score was 8.8 (out of 10), and 335 (82.72%) had adequate knowledge (scored ≥8). Males were less likely to identify the correct transmission routes, and single participants were less likely to identify the signs and symptoms of the coronavirus. Tertiary school graduates were 4 times more likely to correctly identify the routes and 2 times more likely to identify how to stop the spread of the virus. People aged 43-56 years were 4 times more likely to identify how the coronavirus can be prevented, and participants ≥57 years were 2.6 times more likely to obtain a knowledge score of 10 when compared to those under 29 years of age. Conclusions This study has shown that the COVID-19 lockdown has forced people to increase technology use, and people plan to continue using technology after the lockdown is lifted. Increased technology use was seen across a variety of fields; however, barriers including privacy, unfamiliarity, and data costs were identified. This population showed high COVID-19 knowledge, although the use of web searches and social media, instead of government and institutional websites, increases the potential for health misinformation to be spread.

Virtual healthcare services and digital health technologies deployed during coronavirus disease 2019 (COVID-19) pandemic in South Africa: a systematic review

“…Complaints regarding the platforms by health workers, specifically nurses dealing with pregnant and postpartum women 32 7 Appointment reminders, adherence to maternal and infant health care and bridging existing gaps in access to quality health education 33 MAMA SMS text messages Teleconsultation and communications Gauteng Language barriers, access to mobile phones understaffed facilities and poor services 34 8 Exposure notification and social distancing 35 COVID-19 Alert SA application COVID-19 exposure notification Western Cape Concerns over the infringement of users’ rights to security and privacy 9 Tracks individuals who have come into contact with others who have tested positive 36 COVi-ID smartphone contact tracing application Contact tracing Not specified, generalised to SA Lack of access, contributing to low penetration rates and limited application with deepening socio-economic divides especially in rural areas. Ethical and human rights dilemmas 10 Communicate COVID-19 daily cases (new and recovered) and deaths as well as preventive measures 37 Social media platforms Health communication Not specified, generalised to SA Misinformation, conspiracy theories surrounding the virus creation, ineffective home remedies for treatment, and downplaying of the need for prevention control, such as social distancing and mask use 11 Home delivery of medication system linked an e-pharmacy was established to reduce the risk of COVID-19 in this vulnerable group of patients 38 E-prescribing and e-delivery Electronic delivery of prescriptions and home delivery of medication. Western Cape Unanswered follow-up phone calls, redirecting of a parcel due to change of physical address which was not easily accommodated by the system, home delivery could lead to inadvertent disclosure of HIV status to family members.…”

“…One of the challenges of social media is misinformation, such as conspiracies surrounding the COVID-19, vaccines, sharing of ineffective home remedies for COVID-19 treatment, and downplaying the need for prevention and control measures such as social distancing and the wearing of masks. 37 …”

COVID-19 Daily Realities for Families: A South African Sample

“…In support of these findings, a study in South Africa studied the changes in perceptions and the utilization of mobile technology and communication during COVID-19 restrictions. The study argues that lockdowns have constrained people to rely on digital technology for communication usage [ 58 ]. Although participants were knowledgeable on COVID-19, their use of web searches and social media outlets- as opposed to searching official government websites- can lead to misinformation of COVID-19 and related topics, being shared.…”

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

“…Currently there are multiple mHealth interventions that are being investigated or being used at a small-scale in almost every African country; the number of mHealth interventions is continuing to increase. Throughout the continent, mHealth interventions are being used for multiple reasons: for disease diagnosis and treatment support by health workers (Anstey Watkins et al, 2018), to increase adolescent’s use of sexual and reproductive health services (Onukwugha et al, 2022), for HIV prevention and management (Manby et al, 2022), to improve maternal and child health (Ag Ahmed et al, 2017), to support the COVID-19 response (Fischer et al, 2021), and to improve surveillance coverage for new outbreaks of infectious diseases (e.g., Ebola) (Tom-Aba et al, 2018).…”

“…for disease diagnosis and treatment support by health workers (Anstey Watkins et al, 2018), to increase adolescent's use of sexual and reproductive health services (Onukwugha et al, 2022), for HIV prevention and management (Manby et al, 2022), to improve maternal and child health (Ag Ahmed et al, 2017), to support the COVID-19 response (Fischer et al, 2021), and to improve surveillance coverage for new outbreaks of infectious diseases (e.g., Ebola) (Tom-Aba et al, 2018).…”