JMIR Publications

ABSTRACT

Background:

The rapid growth of technology and its use as development solutions have generated much interest in eHealth, globally. In line with global trends, Bangladesh too is integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper examines the equity implications of eHealth and mHealth considering who use electronic devices to access health information and services and why, in Bangladesh.

Objective:

To understand how access to healthcare through electronic means (eHealth and/or mHealth) is affected by socio-demographic determinants (age, gender, education, socioeconomic status, personal and household ownership of mobile phone) in a semi-urban community in Bangladesh.

Methods:

A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February to March 2017) were conducted to understand i. who owns electronic devices, ii. among the owners, who use these to access health information and services, and why, iii. awareness of electronic sources of health information and iii. the role of intermediaries (family members or peers who helped to look for health information using electronic devices).

Results:

Ninety percent of households (55% of respondents) owned electronic devices; mostly mobile phones. Among these, 7% have used them to access health information and/or services. Middle-aged (35-54 years), female, less (and no) educated and poorer people used them the least (p = <0.5). Lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills and proximity to health facilities were the main reasons for not using devices to access eHealth.

Conclusions:

Although influenced by socio-demographic traits, access to eHealth is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill, as well as social recognition of health needs and of inequity. This should serve as a basis for integrating eHealth into any health system and ensure equitable access to healthcare.