JMIR Publications

Background:

While mobile technologies have addressed health care access and affordability gaps, billions of emerging mobile users have yet to benefit from the health information available on their mobile phones.

Objective:

• To understand data-enabled mobile phone ownership and behaviors among low-income young urban Indian families, who represent the next billion mobile users. • To identify the barriers to usage and how these barriers can be overcome in the design of mHealth interventions.

Methods:

We used a two-step process, starting with research on mobile adoption behaviors and then testing several versions of a mobile health application. We interviewed 257 young people in diverse low-income communities in Mumbai and Delhi who were expecting a child or had an infant. We used the hypotheses generated by our research for iterative, rapid prototype development and qualitative and quantitative testing over two rounds with users in Mumbai. The mobile application included health information presented in audio, text, images and videos, and we studied users as they navigated the mobile journey. Prototype development was informed by learnings from commercial apps used by emerging mobile users that address patchy connectivity, low data speeds and cost-conscious consumers. Our design team included experts in IT, economic development, health, and behavioral science.

Results:

We found rapidly increasing and recent ownership of internet-enabled phones (83%). More than half (56%) of users had acquired their smartphone in the last year. Smartphone ownership rose from 47% in households earning less than INR 20,000 (US$308) per month to 81% in households earning INR 20,000–40,000 per month (US$308–US$615). Phone ownership across the same income segments increased dramatically in neighborhoods that had better infrastructure and connectivity. Internet users sought primarily entertainment (95%), social networking (82%), and online gaming (74%). The 18% of respondents who used the internet to seek health care information reported that, among all sources of health care information, they felt that digital information was the least reliable. The 20% of the sample who did not use the internet cited lack of knowledge (80%), high cost (57%), lack of local language content (39%), and lack of motivation (35%). In our prototype testing, our users were more likely to respond to the test mobile app when it was data light, transparent, and allowed for offline viewing and sharing. Limiting screen choices allowed users to make confident decisions. Visual and video content was preferred to written text.

Conclusions:

Serving the unique needs of emerging mobile users will require socioculturally appropriate health applications designed by multidisciplinary teams. The user journey should be linear and nudge users toward useful information with both reward and loss-aversion techniques. The app alone will not be successful in improving health unless it is part of a holistic, systemic approach that includes technology companies, local government officials, health clinics, community businesses, and other stakeholders.