Mobile phone use among female entertainment workers in Cambodia: an observation study

Abstract

Background: Text or voice messages containing health behavior change content may be an inexpensive, discreet, sustainable and scalable way to reach populations at high risk for HIV. In Cambodia, one of the important high-risk populations is female entertainment workers (FEWs). This ethnographic study aims to explore typical phone use, examining patterns and behaviors that may influence the design of future mHealth interventions. Methods:The study consisted of one 8-hour non-participant observation session for 15 randomly sampled Results: In this ethnographic study, all 15 participants made calls, checked the time and received researchrelated texts. More than half (n=8) of the participants engaged in texting to a non-research recipient. About half (n=7) went on Facebook (FB) and some (n=5) listened to music and looked at their FB newsfeed. Fewer played a mobile game, posted a photo to FB, went on YouTube, used FB chat/messenger, watched a video on FB, played a game on FB, used FB call/voice chat, looked at their phone's background or used the LINE app. Fewer still shared their phones, left them unattended, added airtime or changed their SIM cards.When participants received a research text message, most did not share the text message with anyone, did not ask for help deciphering the message and did not receive help composing a response. Notable themes from observer notes, HIV outreach workers and researchers include reasons why phone calls were the most frequent mode of communication, examples of how cell phone company text messages are used as a form of behavior change, literacy as a persistent barrier for some FEWs, and FEWs' high interest in receiving health-related messages and less concern about privacy and phone-sharing issues than expected.Conclusions: This study suggests texting is a part of normal phone use although not as frequently used as voice calls or Facebook. Despite the less frequent use, FEWs were able to send and receive messages, were interested in health messages and were not overly concerned about privacy issues. Texting and voice messaging may be useful tools for health behavior change within the FEW population in Cambodia.

Mobile Link – a theory-based messaging intervention for improving sexual and reproductive health of female entertainment workers in Cambodia: study protocol of a randomized controlled trial

“…In the Asian-Pacific countries, the number of mobile social media users was set to reach one billion by the fourth quarter of 2015; and in Cambodia, increasing 108% from the previous year [ 45 ]. According to our recent observation study, FEWs have both smart and basic mobile phones, use them daily to text and engage in social media, and have expressed interest in receiving health information through their phones [ 46 ].…”

Developments in Privacy and Data Ownership in Mobile Health Technologies, 2016-2019

“…Still other authors noted this dichotomy within their reported results with some participants expressing significant privacy concerns and others stating it to not be an issue [146,147]. While some users expressed such concerns related to collection of highly sensitive-data, such as that related to behavioral health, reproductive health, or HIV status [135,[148][149][150][151], other users who provided such data still reported little unease related to their privacy [139,142,[152][153][154]].…”

“…User concern with privacy of personal data collected by mobile health apps is widely variable. In some studies, data privacy and security was cited as of primary concern or importance [74,134,138], while in others, users expressed very little concern [125,[139][140][141][142][143][144][145]. Still other authors noted this dichotomy within their reported results with some participants expressing significant privacy concerns and others stating it to not be an issue [146,147].…”

Online-to-offline models in HIV service delivery

“…Given, FSW’s increasing use of technologies for health information seeking [90, 91], refining and tailoring O2O models is of urgent priority to address substantial gaps in optimal HIV prevention uptake [92, 93]. …”