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Globalization and Health

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Open Access 01-12-2018 | Research

‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information

Authors: Linda Waldman, Tanvir Ahmed, Nigel Scott, Shahinoor Akter, Hilary Standing, Sabrina Rasheed

Published in: Globalization and Health | Issue 1/2018

Abstract

Background

Information and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers’ control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students’ usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this.

Methods

This study relies on two surveys: a 2013–2014 General Survey that randomly sampled 854 households drawn from the general population and a 2015 Student Survey that randomly sampled 436 students from two Mirzapur colleges. Select focus group discussions and in-depth interviews were undertaken with students. Icddr,b’s Ethical Review Board granted ethical clearance.

Results

The data show that Mirzapur’s college students are economically relatively well positioned, more likely to own mobile and smart phones, and more aware of the internet than the general population. They are interested in health information and use phones and computers to access information. Moreover, they use digital technology to share previously-discreet information, adding value to that information and bypassing former gatekeepers. But access to health information is not entirely unfettered, affecting male and female students differently, and powerful gatekeepers, both old and new, can still control sources of information.

Conclusion

Personal searches for SRH and the resultant online information shared through discrete, personal face-to-face discussions has some potential to challenge social norms. This is particularly so for women students, as sharing information may enable them to bypass gatekeepers and make decisions about reproduction. This suggests that digital health information seeking may be exercising a disruptive effect within the health sector. However, the extent of this disruption may depend, not on students’ mobile phone usage, but on the degree to which powerful new gatekeepers are able to retain control over and market SRH information through students’ peer-to-peer sharing.

Young, educated and better-off males tend to be most active on the internet or most experienced with mobile phone usage [10, 30] with evidence from both high income countries [10, 15, 35, 39, 44] and low- and middle-income countries [14, 45]. For example, Nisbett shows that young men in Asia enthusiastically embraced careers in IT enterprises and adopted ‘highly visible consumption habits’, exemplified in mobile phone use ([43]: 175).

In February/March 2016, Grameen phone offered 20 min talk time, 5 MB internet usage, 5 SMS and 5MMS over a two-day time period to Grameen subscribers for 5 Taka. Banglalink advertised ‘Facebook, Whatsapp & Twitter All-Day Long’ for one Taka.

Airtel offered users 2400 min, 10,000 SMS messages and 10GB internet access for 2000 BDT per month in March 2016.

Community health workers or Shasthya Sebikas are trained workers who support Upazila health complexes by undertaking home visits to promote health and provide family planning services. Health workers can be Non-Government Organisations’ employees, voluntary community workers or government employees.

These informal healers were introduced in the 1970s and modelled on the Chinese concept of barefoot doctors. These village doctors have received limited training, in the form of short courses run either by the government or pharmaceutical companies.

In the absence of prior variance estimates of the outcome variables, a value of 0.5 (the maximum for dichotomous variables) was used to calculate the required sample size to obtain 95% confidence limits with a precision of ±10%, assuming a design effect of 2. This implied a sample size of 840 households.

The target sample size for the college students was 420 because in the absence of clustering, a design effect of 1 was assumed.

After formal introductions with the college head, researchers were directed to possible participants and thereafter used personal introductions to peers and opportunistic meetings. There is no reason to believe that selected students were atypical in respect of their ICT use and sample size was large enough to minimise bias.

A small plastic card with an embedded microchip storing information: user identification, phone number, credit, network authorisation, and contact numbers.

For the purposes of comparison data from the General Mirzapur Population survey has been presented along with a sub-sample representing youth. The age bracket of 18–24 years has been selected on the basis that 97% of the college student sample fall within this range.

Other sources included internet cafés (2% (n = 6); fixed modems (9% (n = 26); places of work (3% (n = 9) and other (% (n = 10).

Launched in 2011, MAMA (Mobile alliance for Maternal Action) or Aponjon as it is known locally in Bangladesh is a public-private partnership involving the Bangladeshi Ministry of Health and Family Welfare and the Prime Minister’s Office, Johnson and Johnson, USAID, the UN Foundation, and BabyCenter. It is delivered by D-Net, DNet, a social enterprise that employs ICTs to encourage knowledge and access to information. MAMA it uses mobile phone technology and SMS messaging to provide free, stage-appropriate, expert health information to pregnant women and new mothers. http://www.aponjon.com.bd/mama_inner and http://www.unfoundation.org/what-we-do/issues/global-health/mobile-health-for-development/mama.html, accessed 2 December 2017.

Founded in 2011, this Bangladeshi technology company connects women and young people to a wide range of health information and provides answers for health questions seldom publically voiced through its website, its app and internet.org. http://www.maya.com.bd/#/about accessed 9 March 2016

Billed as ‘Asia’s first total health care solution Portal and Health Care Management Centre’, this health portal allows patients to read health advice, request consultations with doctors and purchase products. http://www.healthprior21.com/about-us accessed 9 March 2016

The United Nations Children’s Fund (UNICEF) was established 70 years ago and now operates in 190 different countries and territories. It protects children’s rights, helps to ensure basic needs and seeks to expand children’s opportunities to achieve their full potential. The UNICEF Facebook page operates as an ‘engaging and learning environment for our fans to share ideas and to discuss UNICEF, UNICEF’s work and the rights of children worldwide’. https://www.facebook.com/pg/unicef.bd/about/?ref=page_internal accessed 2 December 2017.

This is does not include students who may have had ‘serious’ health concerns.

The call was answered and he was presented with different options, to narrow down the type of problem that he was calling about. After selecting the relevant option, ‘at one point it got disconnected. So I didn’t call again’

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Title: ‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information
Authors: Linda Waldman
Tanvir Ahmed
Nigel Scott
Shahinoor Akter
Hilary Standing
Sabrina Rasheed
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Globalization and Health / Issue 1/2018
Electronic ISSN: 1744-8603
DOI: https://doi.org/10.1186/s12992-018-0349-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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