This paper attempts to reveal the heterogeneity of Internet users in rural areas. Who is really using the Internet? Is it the farmer or other members of the rural family? Can rural areas be seen as a homogenous space or do different types of Internet users exist? Research is based on both the descriptive statistics and multivariate analysis techniques on a sample of 920 individuals in three administrative regions of rural Greece. Basic findings suggest that less than one out of three rural residents go online. A set of perceived potentials and pitfalls of Internet use are analyzed. Social networking and e-mail are the principal uses of the Internet, classifying users into three distinct types. For “basic users”, Internet access is influenced by income and gender while the “socially interactive users” are influenced by the existence of a young member in the family. For “farm oriented users”, Internet access is influenced by the digital divide between rural and urban location and by farmers' competency. The typology of users along with their perceptions regarding Internet use can provide useful policy insights on the ways that Internet access can contribute to diffusion of innovation and rural development.
There is over 20 years of accumulated cross-country evidence on the link between telecommunications provision and economic growth. Looking at micro-studies from a range of countries including Bangladesh, Botswana and Zimbabwe, there is also some evidence that provision of telephony has a dramatic effect on the income and quality of life of the rural poor. This paper examines cross-country evidence to discover if teledensity (the number of telephones per capita) has a pro-poor growth impact—fostering increased average incomes while reducing inequality. It also examines the impact of telecommunications rollout on quality of life variables including infant mortality and literacy. It finds that, historically, telecommunications rollout has had a positive and significant impact on increasing inequality and little impact on quality of life variables. A reason for this is tested and preliminarily confirmed that rollout has (historically) only benefited the wealthy. The paper will then turn to emerging evidence on the role of the Internet in poverty relief and statistics on the access gap in provision between rich and poor, suggesting that this new ICT will also be a force for income divergence. Using the results of the cross-country analysis on telecommunications, the paper will conclude with a discussion of potential policy responses (such as sector reform and universal access programs) to turn telecommunications from a source of growth that also increases inequality to a source of growth that diminishes it.
In the 21st century, access to information technologies will be necessary for rural communities to attract and retain businesses and, therefore, remain economically viable. However, low population density makes it difficult for rural areas to support expensive technology investments such as are required for broadband. In addition, history shows rural adoption timelines significantly lag those in urban areas, which slows development of the demand economically necessary to support infrastructure construction. This study examined variables that influenced rural residents’ comparatively early adoption of information technologies at a time when the rural-urban digital divide in the use of basic online services was still growing. The study found employment by a company that was using specific information technologies was the strongest predictor of individual adoption. The effect was particularly strong among those with less formal education. The findings suggest rural development specialists should focus on encouraging locally owned rural businesses to adopt information technologies as a means of maximizing local diffusion and increasing demand levels.
This article examines forms of shared access to technology where some privileges of ownership are retained. Sharing is defined as informal, non-remunerative resource distributing activities where multiple individuals have a relationship to a single device as purchaser, owner, possessor, operator and/or user. In the specific case of mobile phones in rural Uganda, dynamics of social policing and social obligation were mediated and concretized by these devices. Patterns of sharing mobile phones in rural Uganda led to preferential access for needy groups (such as those in ill health) while systematically and disproportionately excluding others (women in particular). The framework for sharing proposed in this article will be useful for structuring comparisons of technology adoption and access across cultural contexts.
Increasingly, information and communication technology (ICT) is being used as a development tool. For example, a recent innovative experiment by the FIDAMERICA development cybernetwork (sponsored by IFAD, the International Fund for Agricultural Development) in Latin America used an electronic network to collect, post and discuss rural women's life histories, intending to support gender mainstreaming in IFAD projects. However, cybernetworking processes can also reflect contradictory agendas and power relations that ultimately make them a site of contestation. In the FIDAMERICA case, the authors did not participate in the electronic conference, nor were there any subsequent efforts to connect them or to develop this process further. In this paper, I argue that the analysis of increasingly complex cybernetworked development efforts must incorporate a correspondingly sophisticated technique that can uncover the nuanced relations of transnational cyber communication; and I propose that an actor-network approach should be investigated as an analytical framework in these cases. I then apply this approach to the case study, using field research conducted with the participants of the FIDAMERICA electronic life history project in Central America. I conclude that an actor-network approach is a fruitful means by which these processes can be both understood and improved.
UNLABELLED: Background To evaluate the feasibility and acceptability of a text message intervention to improve young people's knowledge of sexual reproductive health (SRH) and harms related to smoking in Indonesia.
METHODS: A quasi-experimental short message service (SMS) trial of young people aged 16-24 years receiving twice weekly SMS over a 10-week intervention period. Pre- and post-online demographic and risk behaviour surveys were used to assess changes in knowledge. Among respondents who completed both surveys, we assessed changes in knowledge before and after SMS intervention using paired McNemar's test and differences in mean knowledge score using a paired t-test.
RESULTS: In total, 555 eligible young people were enrolled into the SMS intervention; 235 (42%) completed a follow-up survey, of which 198 (84%) were matched to a baseline survey. Median age of participants was 19 years and the majority were female (63%). The mean knowledge score significantly increased between baseline and follow-up surveys for SRH questions [2.7, (95% CI 2.47, 2.94) vs 3.4 (95% CI 2.99, 3.81) (P = <0.01)] and smoking-related questions [3.8 (95% CI 3.66, 3.99) vs 4.1 (95% CI 3.99, 4.28) (P = 0.03)]. A majority of participants reported that the SMS intervention increased their knowledge (95%) and were a useful reminder (95%).
CONCLUSIONS: An SMS intervention was feasible, acceptable and improved adolescents' SRH knowledge and smoking knowledge in a low- to middle-income setting. SMS interventions targeting young people need to be scaled up, with the potential to explore additional topics around healthy lifestyle, nutrition and physical activity.
BACKGROUND: Sexually Transmitted Infections (STIs) are a major public health challenge globally especially among adolescents and young adults in lower-middle-income countries (LMICs) in Africa including Ghana. In light of this, mobile phone innovations are advocated to enhance public health education and prevention of STIs in developing health systems.
OBJECTIVE: This study assessed mobile phone usage among adolescents and young adult populations pursuing tertiary education and their use of these technologies in the education and prevention of STIs.
METHOD: This was a cross-sectional analytical study among 250 adolescents and young adults aged 18-24 at Ghana's premier and biggest public University. The study was however conducted in only one public university in the Greater Accra region which potentially poses generalizability challenges due to socio-cultural and economic differences in other regions of the country. Data was collected using structured questionnaire and data analysis done with STATA (version 12.0). Univariate probit regression (VCE, Robust) analysis was used to determine factors associated with adolescents and young adult population's usage of mobile phones in the education and prevention of STIs.
RESULTS: Out of the 250 adolescents and young adults interviewed, 99% owned mobile phones. Out of this number, 58% them were smartphone users. Also, it was found that male young adults (Coef. = 1.11, p = 0.000) and young adults who owned a smartphone (Coef. = 0.46, p = 0.013) were more likely to use mobile phones for education and prevention of STIs.
CONCLUSION: Mobile phone penetration among young adults is nearly 100% in line with the national trend. Additionally, these young adults largely believe in the use of mobile phone programmes for STIs education and prevention. Moreover, respondents were found to be more comfortable using mobile applications than traditional text messaging or phone calls in STIs education and prevention. Future mobile phone programmes for STIs education and prevention should consider innovating customized mobile applications to promote acceptability by the youth and enhance sustainability of such interventions on STIs in Ghana. Even though this study was conducted in only one public university in Ghana, the findings are nonetheless informative and future researchers could consider using a larger sample size across private and public universities in other regions of the country.
BACKGROUND: Young people aged 15 to 24 years account for one-third of new adult HIV infections. Controlling the HIV epidemic requires effective interventions targeted toward young people and their needs. Smartphone games offer a promising avenue for reaching this population with evidence-based HIV prevention interventions. It is crucial to the effectiveness of these interventions that they be acceptable and intrinsically motivating to adolescents as well as acceptable to their parents.
OBJECTIVE: Tumaini is a narrative-based smartphone game designed to help prevent HIV among young Africans aged 11 to 14 years by delaying first sex and increasing condom use at first sex. Following a 16-day feasibility study of Tumaini, we assessed the acceptability (1) of the intervention, where acceptability was operationalized as appeal, relevance, value, usability, and understandability, and (2) of this study and a planned future randomized controlled efficacy trial.
METHODS: During the randomized feasibility study (n=60) of Tumaini in western Kenya in spring 2017, 30 participants used the intervention on a study-provided smartphone. The app automatically logged participant interaction with the game in time-stamped log files. All 30 participants completed an Audio Computer-Assisted Self-Interview-based game experience survey, and 27 took part in 4 focus group discussions (FGDs) about the game's appeal, relevance, value, usability, and understandability. Their parents (n=22) also participated in 4 FGDs about the acceptability of the intervention, of this study, and of a planned efficacy trial. Survey data were analyzed using SAS software (SAS Institute Inc); FGD transcripts were coded and analyzed in MAXQDA 12 (Verbi GmbH); and gameplay log files were analyzed using Microsoft Excel.
RESULTS: Adolescent participants' survey responses indicated that Tumaini scored well with players on all indicators of acceptability (appeal, relevance, value, usability, and understandability). Focus group analyses aligned with these findings and emphasized a high degree of player engagement with the game, which was supported by log file analysis. Adolescent participants were eager for additional content, and parents were receptive to a longer study involving biomarkers, based on their positive experiences with this study. There is scope to improve communication with parents about their role in the intervention. As the game was tested in beta version, there is also scope to fine-tune some of the game mechanics to increase usability.
CONCLUSIONS: This study shows the strong acceptability of an interactive smartphone-based game both to adolescents and their parents in western Kenya and that of the study methods used to pilot-test the intervention. It also suggests that longitudinal efficacy studies of this type of intervention, including those using biomarkers, have the potential to be acceptable among parents.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW).
BACKGROUND: The control of HIV/AIDS has been a contemporary public health success story however, whilst infection rates are falling and people are living longer due to antiretroviral therapy, adolescents and young people remain disproportionally affected. Infection rates and AIDS-related deaths continue to increase in these age groups in some areas globally. This has been primarily attributed to structural barriers including HIV-services not being youth friendly with opening hours conflicting with school time, fears around unintended disclosure and confidentiality, and the attitudes of healthcare professionals-but research targeting these specific age groups remains limited. Early mHealth (i.e., the use of mobile and wireless devices to assist in achieving health objectives) projects have been shown to improve health outcomes in other disease areas and health settings however, amongst people living with HIV, current research is limited. The aim of this study was to explore barriers to HIV care and the acceptability and feasibility of using mHealth to improve retention into care and ART adherence for young people living with HIV (16-24 years old) in Lusaka, Zambia.
METHODS: Qualitative in-depth interviews and focus group discussions were carried out in four CIDRZ-supported health facilities in Lusaka, Zambia. Six interviews were carried out with nurses and peer-support workers working with young people living with HIV and three focus groups with a total of 24 young people. Recruitment was via purposive sampling. Interviews and focus groups were recorded, translated and transcribed and entered into NVivo for thematic analysis.
RESULTS: Twenty-four of the young persons interviewed had access to mobile phones and reported using them for social networking, information gathering and regular communication. Barriers to HIV care and adherence were largely underpinned by stigma. Participants described healthcare facilities as not being conducive for confidentiality and therefore were reluctant to be seen attending or collecting medication from the pharmacy due to possible unintended disclosure and consequential HIV-related stigma. Clinic opening and waiting times and experiences with healthcare professionals also served as barriers. It was felt unanimously by participants that mHealth would be beneficial in improving retention into care and ART adherence in young people living with HIV.
CONCLUSIONS: HIV-related stigma remains a barrier to care. With growing access to mobile phones and internet, and a growing population of adolescents who are already using their phones to support each other and seek information, mHealth appears to be both a feasible and acceptable tool to support retention, provide young people with information, and potentially reduce time spent at health facilities via appointment reminders and electronic drug refill requests.
OBJECTIVES: To evaluate whether text-messaging programs can improve reproductive health among adolescent girls in low- and middle-income countries.
METHODS: We conducted a cluster-randomized controlled trial among 756 female students aged 14 to 24 years in Accra, Ghana, in 2014. We randomized 38 schools to unidirectional intervention (n = 12), interactive intervention (n = 12), and control (n = 14). The unidirectional intervention sent participants text messages with reproductive health information. The interactive intervention engaged adolescents in text-messaging reproductive health quizzes. The primary study outcome was reproductive health knowledge at 3 and 15 months. Additional outcomes included self-reported pregnancy and sexual behavior. Analysis was by intent-to-treat.
RESULTS: From baseline to 3 months, the unidirectional intervention increased knowledge by 11 percentage points (95% confidence interval [CI] = 7, 15) and the interactive intervention by 24 percentage points (95% CI = 19, 28), from a control baseline of 26%. Although we found no changes in reproductive health outcomes overall, both unidirectional (odds ratio [OR] = 0.14; 95% CI = 0.03, 0.71) and interactive interventions (OR = 0.15; 95% CI = 0.03, 0.86) lowered odds of self-reported pregnancy for sexually active participants.
CONCLUSIONS: Text-messaging programs can lead to large improvements in reproductive health knowledge and have the potential to lower pregnancy risk for sexually active adolescent girls.
This paper attempts to reveal the heterogeneity of Internet users in rural areas. Who is really using the Internet? Is it the farmer or other members of the rural family? Can rural areas be seen as a homogenous space or do different types of Internet users exist? Research is based on both the descriptive statistics and multivariate analysis techniques on a sample of 920 individuals in three administrative regions of rural Greece. Basic findings suggest that less than one out of three rural residents go online. A set of perceived potentials and pitfalls of Internet use are analyzed. Social networking and e-mail are the principal uses of the Internet, classifying users into three distinct types. For “basic users”, Internet access is influenced by income and gender while the “socially interactive users” are influenced by the existence of a young member in the family. For “farm oriented users”, Internet access is influenced by the digital divide between rural and urban location and by farmers' competency. The typology of users along with their perceptions regarding Internet use can provide useful policy insights on the ways that Internet access can contribute to diffusion of innovation and rural development.
