Towards women's digital health equity: A qualitative inquiry into attitude and adoption of reproductive mHealth services in Bangladesh.

Abstract

Health equity in Bangladesh faces a large chasm over the economic conditions, socio-cultural factors and geographic location despite the push for digitalization of the health sector. While some research has been conducted assessing the viability of digital health solutions in Bangladesh, gender dynamics of digital healthcare have been absent. This study dived into healthcare equity for women with a focus on reproductive health services delivered through mobile devices. This paper reported the findings of a qualitative study employing in-depth interviews conducted among 26 women about their behavioral intention to use mHealth services for reproductive health and the underlying factors influencing this intention with the help of the Integrative Model of Planned Behavior (IMPB). A snowball sampling technique were used to interview those university educated women, aged 21-31, based on their familiarity and exposure of mHealth services from seven universities in Bangladesh. The findings suggested that users of mHealth services find it more convenient and secure compared to visiting healthcare facilities, especially for trivial issues and inquiries regarding their reproductive health. Although promoting such services is lagging behind traditional healthcare, the attitude toward reproductive health services in Bangladesh is generally favorable resulting increasing adoption and use. Because such information-related mobile services (apps, websites, and social media) served as a first base of knowledge on reproductive health among many young girls and women in Bangladesh, who are generally shy to share or talk about their menstruation or personal health problems with family members, peers, or even health professionals due to socio-cultural factors and stigmatization. Conversely, urban centric services, availability of experts, quality management, security of privacy, authenticity of the information, digital divide, lack of campaign initiatives, lack of equipment and technology, lack of sex education, and outdated apps and websites were identified as obstacles that constrain the widespread use of reproductive mHealth services in Bangladesh. This study also concluded that promotion will be crucial in reforming conservative norms, taboos, and misconceptions about women's health and recommended such endeavors to be initiated by the policy makers as there is a substantive need for a specific policy regulating emerging digital health market in Bangladesh. Notwithstanding, women-only sample, low sample size, narrow focus on mHealth users and absence of perspectives from healthcare providers were among shortcomings of this study which could be addressed in future research. Further quantitative explorations are must to determine the usage patterns of reproductive mHealth services and their effectiveness that would identify implementation challenges in terms of customization and personalization in reproductive healthcare in a developing country like Bangladesh.