JMIR Publications

ABSTRACT

Background:

Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health (mHealth) interventions, particularly for reaching and engaging with young people. However, there is a risk that use of such technologies may exclude those who lack access to them.

Objective:

We investigated the socio-demographic factors associated with mobile phone ownership, internet usage, and social media use among youth in Zimbabwe.

Methods:

A population-based prevalence survey was conducted in twenty-four urban and peri-urban communities across three provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youth aged 18-24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership, and current internet and social media use. Principal components analysis was used to develop a household wealth indicator, based on the ownership of six household assets. Multivariate logistic regression was used to investigate the factors associated with each primary outcome.

Results:

Of the 17636 participants assessed for the primary outcome, 16370 (92.8%) had access to a mobile phone, and 15454 (87.6%) owned a mobile phone. Among participants with access to a mobile phone, 58.9% (9594/16370) and 57.8% (9460/16370), respectively used internet and social media at least once a week. Older age (aOR 1.76, 95% CI 1.55 – 2.00), increasing wealth, and higher education level (secondary: aOR 1.96, 95% CI 1.60 – 2.39, tertiary: aOR 8.36, 95% CI 5.29 – 13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for two or more years, were associated with higher levels of both internet and social media use.

Conclusions:

While mobile phone ownership was near universal, over a third of young people in urban and peri-urban settings did not have access to the internet and/or social media. Access to the internet and social media usage were strongly associated with household wealth and education level. mHealth interventions must be careful to ensure that they do not inadvertently amplify existing inequalities in access to healthcare. Such interventions must be accompanied by alternative strategies to engage and enrol individuals without internet/social media access, to prevent exclusion of young people by sex and socioeconomic status.