You've got a friend in me: How social networks and mobile phones facilitate healthcare access among marginalised groups in rural Thailand and Lao PDR
You've got a friend in me: How social networks and mobile phones facilitate healthcare access among marginalised groups in rural Thailand and Lao PDR
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DOI：
10.1016/j.worlddev.2020.105156
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发表时间：
2021-01-01
影响因子：
6.9
通讯作者：
Zanello, Giacomo
中科院分区：
文献类型：
--
作者：
Haenssgen, Marco J.;Charoenboon, Nutcha;Zanello, Giacomo
看似“无处不在”的移动电话催生了一波使用移动电话作为医疗服务提供平台（移动医疗）的干预浪潮。移动医疗干预措施在100多个国家开展，其目标通常是使医疗保健更具包容性和效率。然而，移动电话的普及也刺激了当地出现的与健康有关的电话使用形式，这可能在边缘化群体中造成新的数字不平等，或与移动医疗和其他基于技术的发展干预措施形成竞争。我们的目标是通过发问“手机的使用和社会支持网络如何影响农村边缘群体寻求治疗的行为”来告知这一主题。我们假设：(1)资源限制促使边缘群体获得非正式医疗服务；(2)移动电话的使用和社会支持网络有助于获得正规医疗服务，但倾向于私人医生。通过描述性统计和多层次回归模型分析来自2141名泰国和老挝村民的代表性调查数据，我们证明：(a)与健康相关的电话使用集中在不太边缘化的群体中，而社会支持网络的分布更为公平；(b)边缘化村民更有可能利用非正规保健提供者；(c)移动电话和社会支持网络与面向公共医疗保健的正式医疗保健机会增加但延迟有关。我们得出的结论是，移动电话的普及与农村医疗保健的获取有轻微的正相关，以类似的方式运作，但没有（尚未）出现排挤社会支持。尽管令人鼓舞，但对于移动医疗和基于技术的发展干预措施来说，这是一个有问题的消息。“非正式移动医疗”的潜在行为后果强化了这样一种观念，即手机是移动医疗和发展干预的非中立平台。长期影响需要更多的研究，但文献表明，增加电话辅助医疗便利可能会破坏当地的社会支持网络，使已经被边缘化的农村居民处于更加不稳定的环境中。(C) 2020作者。Elsevier Ltd.出版。这是一篇基于CC BY许可（http://creativecommons.org/licenses/by/4.0/）的开放获取文章。
The seeming "ubiquity" of mobile phones has spawned a wave of interventions that use mobiles as plat-forms for health service delivery (mHealth). Operating in more than 100 countries, mHealth interventions commonly aspire to make healthcare more inclusive and efficient. Yet, mobile phone diffusion also stimulates locally emerging forms of health-related phone use that could create new digital inequalities among marginalised groups or compete with mHealth and other technology-based development interventions.We aim to inform this subject by asking, "How do mobile phone use and social support networks influence rural treatment-seeking behaviours among marginalised groups?" We hypothesise that (1) resource constraints drive marginalised groups towards informal healthcare access, and that (2) mobile phone use and social support networks facilitate access to formal healthcare with a bias towards private doctors. Analysing representative survey data from 2141 Thai and Lao villagers with descriptive statistics and multi-level regression models, we demonstrate that: (a) health-related phone use is concentrated among less marginalised groups, while social support networks are distributed more equitably; (b) marginalised villagers are more likely to utilise informal healthcare providers; and (c) mobile phones and social support networks are linked to increased yet delayed formal healthcare access that is directed towards public healthcare.We conclude that mobile phone diffusion has a mildly positive association with rural healthcare access, operating in a similar fashion but without (yet) appearing to crowd out social support. However encouraging, this is problematic news for mHealth and technology-based development interventions. The potential behavioural consequences of "informal mHealth" reinforce the notion that mobile phones are a non-neutral platform for mHealth and development interventions. The long-term implications require more research, but the literature suggests that increasing phone-aided healthcare facilitation could undermine local social support networks and leave already marginalised rural dwellers in yet more precarious circumstances. (C) 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).