April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Experienced Stigma and Mobile Phone Harassment Predict Willingness to Adopt Mobile Health (mHealth) Interventions Among Female Sex Workers
Female sex workers (FSWs) are one of the most marginalized groups of people who experience social and structural barriers to accessing health information and services (Baral et al., 2012). They are stigmatized due to their involvement in sex work and as potential vectors of HIV. In Nepal, one of the poorest in the Global South, FSWs are disproportionately affected by HIV. Interventions on mobile phones have shown some promise to reach people directly and in a personal way. Literature shows that most women in the profession use mobile phones for personal communication and for managing their profession (You et al., 2020). However, there is limited research on the willingness to adopt such technological interventions among one of the most vulnerable and at-risk populations. Hence, this study aimed to understand the factors behind FSWs’ willingness to use mobile phone apps to receive health information.
Method
A survey method was used to collect data among 200 FSWs in Nepal from January to April 2023. Informed consent was administered using consent videos due to the low literacy levels. The research was conducted in collaboration with a non-governmental organization (NGO) based in Kathmandu, Nepal. An interviewer-administered survey was conducted by a trained research assistant using a survey app (CommCare).
Measures included Anticipated Stigma (7 items, α = .85), Experienced Stigma (5 items, α = .73), Experience of Harassment on Mobile Phones (5 items, α = .74), Perceived Stress Related to Mobile Phone Use (3 items, α = .90), and Willingness to Use Mobile Phone App for Health (7 items, α = .95).
Results
The mean age was M = 30.79 (SD = 8.2) (min = 18 and max = 54). The prevalence of HIV was high, with 7.4 % of participants reporting HIV infection. Almost 25% (n = 60) of the sample reported no schooling, 68.6% (n = 140) reported completing schooling of 5th to 10th grade. Results showed the model with four independent variables was statistically significant (F = 3.53, p <.01) accounting for 8% (R2 = .80) of the variance in the dependent variable. Only the experience of harassment on mobile phones significantly predicted the willingness to adopt mobile intervention (β = .26, p <.01).
Discussion
This is one of the first few studies to explore willingness to adopt mHealth intervention for sex workers in Nepal. The results showed a disturbing statistic of HIV prevalence of 7.4% when the official data is at 2%. There is, indeed, a high and immediate need for HIV prevention services. However, stigma and other structural problems pose barriers to accessing health information and services. Data show that experience of harassment from clients through mobile phones predicts willingness to adopt a health app that would allow them to access health information and connect them with services. A possible explanation is the FSWs perhaps expect that such health interventions would also equip them with tools to cope with and protect them from bullying and harassment from clients. Further research is warranted to explore and understand this relationship.
Method
A survey method was used to collect data among 200 FSWs in Nepal from January to April 2023. Informed consent was administered using consent videos due to the low literacy levels. The research was conducted in collaboration with a non-governmental organization (NGO) based in Kathmandu, Nepal. An interviewer-administered survey was conducted by a trained research assistant using a survey app (CommCare).
Measures included Anticipated Stigma (7 items, α = .85), Experienced Stigma (5 items, α = .73), Experience of Harassment on Mobile Phones (5 items, α = .74), Perceived Stress Related to Mobile Phone Use (3 items, α = .90), and Willingness to Use Mobile Phone App for Health (7 items, α = .95).
Results
The mean age was M = 30.79 (SD = 8.2) (min = 18 and max = 54). The prevalence of HIV was high, with 7.4 % of participants reporting HIV infection. Almost 25% (n = 60) of the sample reported no schooling, 68.6% (n = 140) reported completing schooling of 5th to 10th grade. Results showed the model with four independent variables was statistically significant (F = 3.53, p <.01) accounting for 8% (R2 = .80) of the variance in the dependent variable. Only the experience of harassment on mobile phones significantly predicted the willingness to adopt mobile intervention (β = .26, p <.01).
Discussion
This is one of the first few studies to explore willingness to adopt mHealth intervention for sex workers in Nepal. The results showed a disturbing statistic of HIV prevalence of 7.4% when the official data is at 2%. There is, indeed, a high and immediate need for HIV prevention services. However, stigma and other structural problems pose barriers to accessing health information and services. Data show that experience of harassment from clients through mobile phones predicts willingness to adopt a health app that would allow them to access health information and connect them with services. A possible explanation is the FSWs perhaps expect that such health interventions would also equip them with tools to cope with and protect them from bullying and harassment from clients. Further research is warranted to explore and understand this relationship.