Mobile technology access and use among youth in Nairobi, Kenya: implications for mobile health intervention design

Kharono, Brenda; Kaggiah, Anne; Mugo, Cyrus; Seeh, David; Guthrie, Brandon L.; Moreno, Megan A.; John‐Stewart, Grace; Inwani, Irene; Ronen, Keshet

doi:10.21037/mhealth-21-23

Cited by 17 publications

(10 citation statements)

References 24 publications

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“…Mobile phone ownership was high with 77.2% of participants reporting mobile phone ownership of which 46.1% were smartphones. This is similar to findings of the study among youth whereby 48% had smartphones ( 37 ) and high mobile phone penetration in the general population ( 21 , 23 ). This is also consistent with other studies where phone ownership among individuals with OUD ranges between 77%–89% ( 28 , 33 , 34 ).…”

Section: Discussionsupporting

confidence: 90%

“…This may be due to low access to internet as reported by 30% of participants in our study compared to up to 96.2% daily internet use in studies in high income countries ( 32 ). This is more consistent with the average social media use in our setting as shown by findings from a study among youth attending general outpatient in Kenya where 55% reported access to social media and 22.3% had weekly access to internet ( 37 ).…”

Section: Discussionsupporting

confidence: 89%

“…Access to mobile phone ownership varies among the different settings in Kenya. For example a study among youth aged 14–24 years found 64% had access to phones ( 37 ); one study among young adults in informal settlements reported prevalence of mobile phones at 79% individual phone ownership and 93% household access whereby 69% were willing to receive HIV counselling via phone ( 38 ); and a nationwide study in public hospitals reported overall 61.2% phone ownership ( 39 ). Two studies report on use and acceptability of telepsychiatry at a private facility.…”

Section: Introductionmentioning

confidence: 99%

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Mobile phone ownership, digital technology use and acceptability of digital interventions among individuals on opioid use disorder treatment in Kenya

Kiburi

Paruk

Chiliza

2022

Front. Digit. Health

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BackgroundThere is limited research on the use of digital interventions among individuals with opioid use disorders (OUD) in low-and-middle income countries. This study aimed to assess mobile phone ownership, digital technology use and acceptability of digital interventions for treatment among individuals on treatment for OUD in Nairobi, Kenya.MethodsA cross-sectional study was conducted among individuals with OUD. Structured questionnaires were used to collect data on socio-demographic and clinical characteristics, use of mobile phones and other digital technology and acceptability of digital interventions for treatment.ResultsOne hundred and eighty participants were enrolled comprising 83.3% males with mean age of 31.5 years (SD 8.6). Mobile phone ownership was reported by 77.2% of participants of which 59.7% used smartphones. One hundred and sixty-six (92.2%) used phones to call, 82.8 and 77.2% used phones to send and receive text messages respectively; 30% used the internet; 57.2% had replaced the phone in past year and 51.1% of participants reported use of at least one social media platform, of these 44.4% had searched social media for information on drug use. Acceptability to receive treatment by phone was 95% and computer 49.4% with majority (88.1%) preferring a text message-based intervention. The preferred approach of delivery of a text message-based intervention were: one text message per day once a week, message to be personalized and individuals allowed to choose time and day to receive the message. Factors associated with acceptability of digital interventions were education level, being single, smartphone ownership and employment.ConclusionMajority of individuals on treatment for OUD had access to mobile phones but with high device turnover and limited access to computers and internet. There was high acceptability of digital interventions to provide treatment for OUDs, mostly through phones. These findings highlight factors to consider in the design of a digital intervention for this population.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mobile phone ownership, digital technology use and acceptability of digital interventions among individuals on opioid use disorder treatment in Kenya

Kiburi

Paruk

Chiliza

2022

Front. Digit. Health

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“…The discrepancy in perceived usability and actual use highlights the need to continually assess the acceptability of mHealth tools in real-world settings and to use an iterative design process that incorporates and focuses on system improvements based on direct feedback from users to the extent possible. Opportunities remain for the development of technologies that are responsive to the needs of AYA living with HIV, both in the United States and globally [ 57 - 59 ].…”

Section: Discussionmentioning

confidence: 99%

A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study

Fee¹,

Fuller²,

Guss³

et al. 2022

JMIR Form Res

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Background Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. Objective The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). Methods We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. Results The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. Conclusions Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. Trial Registration ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066

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“…SMS is a method of communication that transmits text messages up to 160 characters in length, between mobile devices or from a computer to a mobile device. Kenya is reported to have 98% mobile penetration amongst adults(9).…”

Section: Introductionmentioning

confidence: 99%

Pilot implementation of short message service for randomisation in a multisite pragmatic factorial clinical trial in Kenya

Chepkirui,

Kimego,

Nzioki

et al. 2023

Preprint

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The traditional use of sealed envelopes for randomisation is susceptible to manipulation and the risk of damage to envelopes during shipping and at storage. Additionally, the filling and sealing envelopes is, tedious, time-consuming, and error prone. Other randomisation alternatives such as web-based methods are preferred. However, they are expensive and unsuitable in settings with poor internet infrastructure. Mobile phone-based randomisation using Short Message Service (SMS) potentially offers a low-cost and reliable alternative.We developed an SMS-based method for random allocation of treatments. Plain text messaging or an Android app were used to formulate text messages using a fixed syntax consisting of participant unique identifier, trial site, stratum, and the trial name as input parameters. The system verified the input parameters and obtained an allocation from the database before returning a response to the sender. The text response contained the details of the treatment allocation. The study was done in two sites of a multi-site 3×2 factorial clinical trial in Kenya involving two interventions with up to nine possible allocations. We evaluated the accuracy of treatment allocations against the master randomisation list for each randomisation SMS processed, and SMS latency in seconds. A post-implementation survey was conducted to evaluate user feedback.A total of 218 participants were randomised between 7th February 2022 and 11th April 2022, out of which 179 were randomised to only one arm while 39 were randomised to both treatment arms. Allocation accuracy was 100%. Median latency was 22 seconds with the fastest message processed in 10 seconds and the slowest (non-network delayed) message processed in 2129 seconds. Four users completed a post-implementation survey. The pilot study demonstrated that SMS randomisation to be easy, user-friendly, fast, and accurate and a feasible alternative randomisation technique.Author SummaryWhile conducting a randomized clinical trial with a sample size of more than 4000 participants, in routine care settings in Kenya, we encountered a challenge with the approach to randomisation. In our study protocol we settled on the use of sealed opaque envelopes for allocation concealment. This approach, given our large sample size and nine possible treatment allocations, necessitated the preparation of an overwhelming (4000×9) envelope stratified across 12study sites. This manual process was tedious, time consuming and error prone, with issues arising such as mislabelling, empty envelopes, and some being damaged in storage or transit.Recognizing these challenges, our team was prompted to innovate an alternative digital solution, with the ultimate aim of establishing a proof of concept that could support future clinical trials in routine care settings. Given the high mobile penetration in Kenya, we sought to leverage SMS-based mobile communication as a means of determining treatment allocation for study participants. We developed a platform capable of accommodating both Android and feature phones using open-source tools. Our findings indicate that SMS is a fast, user-friendly, and low-cost method, presenting a viable solution that could potentially revolutionize randomisation in clinical studies. However, it is important to note that our testing of this method was limited to only two study sites. Despite this, our study lays the groundwork for digital randomisation and hopefully inspire future advancements in health research.

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Mobile technology access and use among youth in Nairobi, Kenya: implications for mobile health intervention design

Cited by 17 publications

References 24 publications

Mobile phone ownership, digital technology use and acceptability of digital interventions among individuals on opioid use disorder treatment in Kenya

Mobile phone ownership, digital technology use and acceptability of digital interventions among individuals on opioid use disorder treatment in Kenya

A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study

Pilot implementation of short message service for randomisation in a multisite pragmatic factorial clinical trial in Kenya

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