Shearer, Kate

South Africa

Analysis of characteristics associate with mobile phone usage among patient populations in South Africa

With a growing number of mobile phone subscriptions and access to smart-phone technology in low- and middle-income countries (LMIC), mHealth strategies are increasingly being proposed as useful tools for integration into health service delivery. The potential for integrating mHealth technologies into health service systems in South Africa is promising, as a large proportion of South Africans use mobile phones. While pilot studies in LMICs provide evidence for potential positive impact of mHealth programs, few have gone to scale not only due to lack of funding, but also due to a lack of information to effectively guide the design and implementation of interventions. Context-specific implementation studies and behavioral research are required to ensure these potentially beneficial services are best suited for the population in need. Needs assessments are also necessary to make sure programs reach all populations equitably. Further, each health care setting and program may vary in important ways regarding successful implementation of mHealth strategies. Population dynamics, sensitivity or stigma of health condition, and clinic setting may play important roles in implementation and scale-up. Understanding the landscape of access to mobile technology, which may vary based on income, literacy, sex, or other socio-demographic indicators, is important to understand prior to implementation of mHealth interventions. The objective of this study is to describe the characteristics associated with mobile phone access and use among individuals attending diabetes, maternal and child health, TB, and HIV clinics in South Africa. The results of this study will provide important baseline information for development of future mHealth intitiatives in these clinics.   

Global Health Mentor: Jonathan E. Golub, PhD

I had lived in Johannesburg for 3 years prior to moving to Baltimore to attend JHSPH so arriving at the airport felt much like coming home. I jumped on the Gautrain at OR Tambo airport, one of the most efficient forms of public transportation in South Africa, and headed out to Rosebank station from where I battled through Joburg’s always heavy traffic to my apartment. Joburg is a city of contradictions. While home to some of the wealthiest neighborhoods on the African continent, poverty is abundant and many still live in informal housing without access to basic services.

My initial plan for the summer was to work on a project to assess mobile phone usage among South Africans accessing public-sector primary health care clinics to inform future mHealth initiatives. However, as is often the case in fieldwork, things do not always go as planned. With ethics approval still pending locally at the University of the Witwatersrand and back in Baltimore, I instead took on the task of putting together a NIH grant application with the Perinatal HIV Research Unit at the Chris Hani Baragwanath Hospital.

Despite having lived in Joburg for a few years, I had never been to ‘Bara’ prior to this trip. Bara is the largest hospital on the African continent and is thought to be the third largest in the world, with more than 3,000 beds and over 6,000 staff members (and yes, I did get lost trying to find where to buy a coffee). Located in Soweto, one of the largest townships in South Africa and the former home of Nelson Mandela, Bara provides a range of services to the community and has strong research collaborations that have helped shape health policy over the years.

The grant writing process was an exciting one. It was my first grant writing experience so each day was an opportunity to learn – about how to put together compelling aims, to determine the sample size for cluster randomized trials (a study design that was also new to me), how to craft the research strategy, and, perhaps most importantly, how to write collaboratively with a large team of co-investigators, making sure that everyone was on the same page and was confident in the research question, approach, and objectives. After many meetings, Skype calls, and more emails than I could count, we finalized our aims, had a draft of the research strategy, and put finishing touches on the other remaining pieces to ready the application for submission.

I would say that my summer in South Africa was fairly typical of fieldwork. Even the most well laid plans face obstacles and working internationally has taught me how to adapt quickly and make the most of every opportunity. Even though my initial project didn’t work out, I was able to have an incredibly educational and rewarding summer experience and look forward to continuing the collaborations I began with new colleagues into the future.

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October 2020

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