Towards a Framework on the Use of Infomediaries in Maternal mHealth in Rural Malawi

Abstract

Aim/Purpose: The aim of the study is to explore factors that affect how healthcare clients in rural areas use infomediaries in maternal mHealth interventions. The study focuses on maternal healthcare clients who do not own mobile phones but use the mHealth intervention. Background: Maternal mHealth interventions in poor-resource settings are bedevilled by inequalities in mobile phone ownership. Clients who do not own mobile phones risk being excluded from benefiting from the interventions. Some maternal mHealth providers facilitate the access of mobile phones for those who do not own them using “infomediaries”. Infomediaries, in this case, refer to individuals who have custody of mobile phones that other potential beneficiaries may use. However, the use of infomediaries to offer access to the “have nots” may be influenced by a number of factors. Methodology: The study uses a case of a maternal mHealth intervention project in Malawi, as well as a qualitative research method and interpretive paradigm. Data was collected using secondary data from the implementing agency, semi-structured interviews, and focus group discussions. Empirical data was collected from maternal healthcare clients who do not own mobile phones and infomediaries. Data were analysed inductively using thematic analysis. Contribution: The study proposed a theoretical framework for studying infomediaries in ICT4D. The study may inform mHealth designers, implementers, and policymakers on how infomediaries could be implemented in a rural setting. Consequently, understanding the factors that affect the use of infomediaries may inform mHealth intervention implementers on how they could overcome the challenges by implementing mHealth interventions that reduce the challenges on the mHealth infomediaries side, and the maternal healthcare clients’ side. Findings: Characteristics of the maternal healthcare client, characteristics of the mHealth infomediary, perceived value of mHealth intervention, and socio-environmental factors affect maternal healthcare clients’ use of mHealth infomediaries. Recommendations for Practitioners: Implementers of interventions ought to manage the use of infomediaries to avoid volunteer fatigue and infomediaries who may not be compatible with the potential users of the intervention. Implementers could leverage traditional systems of identifying and using infomediaries instead of reinventing the wheel. Recommendation for Researchers: This research adopted a single case study to develop the theoretical framework for mHealth infomediary use. We recommend future studies are conducted in order to test and develop this framework further, not only in ICT4D, but also in other areas of application. Impact on Society: People still lack access. The lack of ownership of technology may still exclude them from participating in an information society. The use of infomediaries may help to provide access to technologies to those who do not have them thereby bridging the digital divide gap. Future Research: We propose herein that traditional systems may offer a good starting point for designing a system that would work for communities. We, therefore, recommend that future research may explore these possibilities.