Stories From the Field: The Use of Information and Communication Technologies to Address the Health Needs of Underserved Populations in Latin America and the Caribbean

Background As their availability grew exponentially in the last 20 years, the use of information and communication technologies (ICT) in health has been widely espoused, with many emphasizing their potential to decrease health inequities. Nonetheless, there is scarce availability of information regarding ICT as tools to further equity in health, specifically in Latin American and Caribbean settings. Objective Our aim was to identify initiatives that used ICT to address the health needs of underserved populations in Latin America and Caribbean. Among these projects, explore the rationale behind the selection of ICT as a key component, probe perceptions regarding contributions to health equity, and describe the challenges faced during implementation. Methods We conducted an exploratory qualitative study. Interviews were completed via Skype or face-to-face meetings using a semistructured interview guide. Following participant consent, interviews were audio recorded and verbatim transcriptions were developed. All transcriptions were coded using ATLASti7 software. The text was analyzed for patterns, shared themes, and diverging opinions. Emerging findings were reviewed by all interviewers and shared with participants for feedback. Results We interviewed representatives from eight organizations in six Latin American and Caribbean countries that prominently employed ICT in health communication, advocacy, or surveillance projects. ICT expanded project's geographic coverage, increased their reach into marginalized or hard-to-reach groups, and allowed real-time data collection. Perceptions of contributions to health equity resided mainly in the provision of health information and linkage to health services to members of groups experiencing greater morbidity because of poverty, remote place of residence, lack of relevant public programs, and/or stigma and discrimination, and in more timely responses by authorities to the health needs of these groups as a result of the increased availability of strategic information on morbidity and its social determinants. Most projects faced initial resistance to implementation because of lack of precedents. Their financial and technical sustainability was threatened by reliance on external funding and weak transitional structures amidst key staff changes. Projects often experienced challenges in establishing meaningful communication with target audience members, mainly because of divergent motivations behind ICT use between projects and its target audience and the lack of access or familiarity with ICT among the most underserved members of such audiences. Conclusions ICT can benefit projects focusing on the health needs of underserved populations by expanding the breadth and depth of target audience coverage and improving data management. Most projects tended to be small, short-term pilot interventions with limited engagement with the formal health sector and did not include health equity as an explicit component. Collaborative projects with government institutions, particularly those with health surveillance objectives, seemed to be the most optimistic about long-term sustainability.

[1]  Clara B. Aranda-Jan,et al.  Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa , 2014, BMC Public Health.

[2]  Ronald H Gray,et al.  Responding to the human resource crisis: peer health workers, mobile phones, and HIV care in Rakai, Uganda. , 2008, AIDS patient care and STDs.

[3]  Ariel Pablos-Mendez,et al.  An agenda for action on global e-health. , 2010, Health affairs.

[4]  N. Lustig,et al.  The Rise and Fall of Income Inequality in Latin America , 2011 .

[5]  J. Blaya,et al.  E-health technologies show promise in developing countries. , 2010, Health affairs.

[6]  Erik Lebret,et al.  The use of expert elicitation in environmental health impact assessment: a seven step procedure , 2010, Environmental health : a global access science source.

[7]  N. Choi,et al.  The Digital Divide Among Low-Income Homebound Older Adults: Internet Use Patterns, eHealth Literacy, and Attitudes Toward Computer/Internet Use , 2013, Journal of medical Internet research.

[8]  Sharon Friel,et al.  Closing the gap in a generation: health equity through action on the social determinants of health , 2008, The Lancet.

[9]  A. Mukhopadhyay Equity, social determinants and public health programmes , 2011 .

[10]  Russell E. Glasgow,et al.  Implementation science approaches for integrating eHealth research into practice and policy , 2014, Int. J. Medical Informatics.

[11]  N. Mahmud,et al.  A text message-based intervention to bridge the healthcare communication gap in the rural developing world. , 2010, Technology and health care : official journal of the European Society for Engineering and Medicine.

[12]  Ronald E. Rice,et al.  The Internet and Health Communication: A Framework of Experiences , 2001 .

[13]  Jasmine Travers,et al.  eHealth Interventions for HIV Prevention in High-Risk Men Who Have Sex With Men: A Systematic Review , 2014, Journal of medical Internet research.

[14]  J. Hoffman,et al.  Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya. , 2010, American journal of preventive medicine.

[15]  Christina Synowiec,et al.  E-health in low- and middle-income countries: findings from the Center for Health Market Innovations. , 2012, Bulletin of the World Health Organization.

[16]  John Scott,et al.  E-health: potential benefits and challenges in providing and accessing sexual health services , 2013, BMC Public Health.

[17]  E. Blas,et al.  Equity, social determinants and public health programmes. , 2010 .

[18]  M. Metzler,et al.  Promoting health equity; a resource to help communities address social determinants of health , 2008 .

[19]  P. Braveman,et al.  Defining equity in health , 2003, Journal of epidemiology and community health.

[20]  A. Friede,et al.  Public health informatics: how information-age technology can strengthen public health. , 1995, Annual review of public health.

[21]  L. Swartz,et al.  Scaling Up mHealth: Where Is the Evidence? , 2013, PLoS medicine.