The Role of mHealth Interventions in Changing Gender Relations: Systematic Review of Qualitative Findings

Abstract

Background The rapid and widespread growth of mobile technologies in low- and middle-income countries can offer groundbreaking ways of disseminating public health interventions. However, gender-based inequalities present a challenge for women in accessing mobile technology. Research has shown that mobile health (mHealth) interventions can affect gender relations in both positive and negative ways; however, few mHealth programs use a gender-sensitive lens when designing, implementing, or analyzing programs. Objective This systematic review aims to identify and summarize the findings of qualitative research studies that explore the impact of mHealth interventions on gender relations as a result of participating in such initiatives in low- and middle-income countries. Methods We performed a systematic literature review to examine empirical evidence of changes in gender relations attributed to participation in an mHealth intervention in low- and middle-income countries. Peer-reviewed articles were included based on whether they evaluated an mHealth intervention and were published between 2013 and 2020. Articles using mHealth that solely targeted health workers, did not assess a specific intervention, used mobile technology for data collection only, or were formative or exploratory in nature were excluded. The search terms were entered into 4 key electronic databases—MEDLINE, EMBASE, PsycINFO, and Scopus—generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report the themes that emerged from our data. Results Of the 578 full-text articles retrieved, 14 (2.4%) were eligible for inclusion in the study. None of the articles appraised gender from the outset. The articles uncovered findings on gender relations through the course of the intervention or postprogram evaluation. Most studies took place in sub-Saharan Africa, with the remainder in South and Southeast Asia. The articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found that mHealth programs could enhance spousal communication, foster emotional support between couples, improve women’s self-efficacy and autonomy in seeking health information and services, and increase their involvement in health-related decision-making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision-makers, and exacerbating relationship problems. Conclusions These results suggest that given the rapid and persistent upscale of mHealth interventions in low- and middle-income settings, it is imperative to design interventions that consider their impact on power dynamics and gender relations. Future research is needed to fill the evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and that they need to actively participate and be empowered by mHealth interventions.

Digital rights and mobile health in Southeast Asia: A scoping review

“… 56 In a systematic review of the role of mHealth in changing gender relations, the authors remark that increased access to mHealth “enhanced women's empowerment to make informed decisions about health care”. 57 In a discussion about advancing women's self-efficacy with mHealth, one study reviewed by the authors centered on an SMS messaging-based maternal and child health program in Vietnam. The authors highlight that the Vietnam study led to women users reporting feeling “empowered by this newfound knowledge, made informed decisions about health care, and were more confident in their interaction with community health workers”.…”

“…The authors highlight that the Vietnam study led to women users reporting feeling “empowered by this newfound knowledge, made informed decisions about health care, and were more confident in their interaction with community health workers”. 57 …”

“…The digital gender divide and freedom of movement were cited in a systematic review, which included a Southeast Asian (Vietnam) study. 57 The authors did not directly link these topics to Southeast Asia, rather the topics were cited when reporting on other studies or as generalizations applying to all included articles. The digital gender divide was cited using several different terms and multiple contexts connected to mHealth.…”

“…This included the “gendered divide” related to mobile phone ownership affecting mHealth program enrolment, the reduction of the “gendered digital divide” due to gains in women's self-confidence and skills through mobile phone use and communication as a part of mHealth programs, the reinforcement of “existing gender-based inequities such as the digital divide” in mHealth initiatives that fail to overcome gender-based barriers, and the “gender-based digital divide” impacting mHealth generally. 57 In generalizing all the included articles in the review, freedom of movement was referenced. The authors state that mHealth can reduce gender-based barriers and cite the lack of freedom of movement as one of those barriers.…”

Ten Years of TeleHealth and Digital Healthcare: Where Are We?

“…COVID-19 has also lead to bottlenecks. The digital divide represents a major obstacle for the use of TH and DH [ 56 , 57 , 58 , 59 , 60 , 61 ]. Literacy with IT tools (essential for interacting with DH and TH) is often inadequate and opportunities are lost, even in wealthy countries.…”