CATIE News

1 October 2020 

Mobile phones found important for accessing healthcare and services for Indigenous people in B.C.

  • Owning a mobile phone may have health benefits for Indigenous people who use drugs
  • A B.C. study found that phone ownership facilitates access to healthcare services and support
  • Researchers say addressing “phonelessness” may be helpful for HIV prevention and treatment

A team of researchers in British Columbia explained the idea of mobile phone-based health programs (mHealth) in this way:

“Mobile phone-based interventions that aim to improve health outcomes among clients experiencing a variety of health conditions. These mHealth interventions utilize mobile phone functions such as calling, texting, and/or smartphone apps, and may be used to provide reminders, information or support.”

The team conducts research with Indigenous people with or at high risk of HIV and made the following statement:

“Indigenous scholars and leaders continue to be concerned about high rates of HIV and other harm among Indigenous young people who use drugs resulting from the ongoing impacts of colonialization. Substance use, poverty, barriers to health care access and limited mobile phone ownership may be mutually reinforcing, leading to further marginalization from care and services.”

As part of ongoing research, the team surveyed some Indigenous people who use drugs “in the inner-city settings of two cities in B.C.: Vancouver and Prince George.” The larger study is called the Cedar project. The present sub-study focused on 131 participants—40% of whom had HIV—who answered questions about mHealth.

Key findings

The researchers found the following:

  • Less than half of the participants owned a mobile phone.
  • Many participants thought that having a mobile phone for mHealth would be very important.
  • Many HIV-positive participants felt that having a mobile phone would be good for their health and well-being.

The researchers stated that their findings may be useful “for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.”

Study details

A brief profile of participants upon their entry into the study was as follows:

  • age – 33 years
  • 62% women, 38% men
  • 40% were HIV positive
  • 60% were positive for hepatitis C virus
  • 12% were recently hospitalized
  • 82% did not graduate from high school
  • 26% experienced recent homelessness
  • 44% experienced recent housing instability
  • 15% were recently imprisoned
  • nearly 50% had a parent that had been in a residential school
  • 76% had been apprehended from their biological parents
  • 34% had attempted suicide in the past
  • 17% had engaged in recent sex work
  • 44% had recently injected street drugs
  • 40% had overdosed in the past
  • 58% were currently on prescribed methadone
  • 85% had tried to quit alcohol and/or drugs
  • Less than half of the 131 participants (45%) owned a mobile phone.

Benefits of a phone for health

Participants were asked an open-ended question about why smartphones may be useful for their health. As readers can see, participants gave answers that encompassed a holistic view of health. Researchers divided the answers into the following themes:

  • connection for emotional, mental and spiritual support
  • connection to family
  • staying in touch and/or being reachable
  • overcoming current barriers to phone use
  • convenience, privacy and safety
  • access to healthcare and emergency services

Connection for support

A large proportion of participants anticipated that a mobile phone would help them keep connected to sources of support, such as doctors, nurses, staff from social service agencies, friends, spouses and other family members.

One participant noted: “I’m a social person…I constantly stay in contact with people so I don’t get depressed.”

The researchers stated that some participants said that a mobile phone would be helpful to “call their 12-step/recovery sponsor, remember to take their methadone, access [withdrawal management services], and/or avoid a relapse.”

One participant made the following statement underscoring the importance of a mobile phone: “My mental health has not been all that good lately but having someone to talk/text with will be better than turning to the bottle or needle. I won’t be so alone.”

Connection to family and parenting

Participants said that having a phone would help maintain connections to their parents and extended family members.

The researchers stated that participants “anticipated benefits related to pregnancy and parenting, including being able to stay in touch with social workers, receiving health care leading up to and during labour, and calling for help in case of an emergency.”

Staying in touch

According to the researchers, participants underscored “the importance of staying in touch” by making statements such as the following:

  • “I don’t have to stress—people can reach me. The phone is my lifeline.”
  • “If I don’t have a phone I feel cut off. I get anxiety.”

Overcoming current barriers to phone use

Participants who did not have a phone tried to find ways around this issue by doing the following:

  • borrowing a phone from a friend
  • using the phone sometimes found in the lobby of a building
  • using the phone available at an agency or service provider

However, these strategies to overcome what the researchers referred to as “phonelessness” had drawbacks, including the following that the researchers identified: “time and energy it took to find a phone, time limits on phone calls, inability to receive messages or a callback, lack of privacy, and potential for stigma or [unwanted disclosure].”

Here are some statements made by participants to highlight the drawbacks of some of these strategies:

Time limits

“You have to get people right away or it doesn’t work out.”

Calling from an agency or service provider

“If you call from [a supervised injection facility], it has call display…then people know that you are a drug user.”

Convenience, privacy and safety

The researchers stated that participants felt that having a mobile phone would “make communication more convenient, including reducing the need to seek support on foot.” As one participant explained, having a mobile phone would save “the mileage on your shoes.”

Participants expressed the desire for relative privacy that could come with having a mobile phone. One participant stated that such a device would give her more control, which she explained as follows: “I can talk to my doctor one-on-one without having [partner] follow me or know everything.”

The researchers stated that some participants suggested that mobile phone ownership “would afford some degree of safety, including from violence in relationships and street life.”

Access to healthcare and emergency services

According to the researchers, “more than 20% of participants expected [to or] currently used their own mobile phones to connect directly to health care, including calling doctors, nurses, counsellors, arranging out-of-town medical care, making appointments, organizing rides, and receiving messages from health services.”

The researchers stated that “owning a mobile phone was seen as a potentially important resource in the case of physical or mental health emergencies faced by the participants themselves or those around them.”

The context for phonelessness

The researchers noted that among this population “phone ownership was considerably lower than rates in Canada and North America in general, and similar or lower compared with other marginalized groups” reported in other studies. To explain this, the researchers made the following statement:

“Many young Indigenous people have been acutely affected by colonization, including having parents and family members who were forced into residential schools, removal from family into the child welfare system, and experiences of childhood sexual abuse. Some have turned to substance use as a way to cope with the effects of these historical and lifetime traumas. Intersections of substance use and poverty can create barriers to connectedness, for example, by contributing to incarceration and housing transitions. Lack of phone ownership must be understood within the context of colonization, which continues to impact the well-being of Indigenous people across Canada and is a key consideration for future mHealth programs.”

Phonelessness and HIV care and treatment

The researchers made the following statement: “The impact of phonelessness on overall health may be especially pronounced in the context of HIV care. Findings from our recent systematic review highlighted profound gaps in access to the HIV cascade of care among Indigenous peoples. Emerging evidence also indicates that barriers to phone access may be associated with poorer health outcomes among people with HIV. However, our study indicates that young Indigenous people living with HIV are especially interested in receiving mHealth support to enhance engagement with health care. Others have shown that mHealth programs may improve relationships between health care providers and patients over time, and that strong patient-provider relationships that are engaging, validating, and emphasize partnership are more likely to facilitate engagement and retention in HIV care. For young Indigenous people who use drugs, mHealth programs that take a culturally safe approach, including avoiding judgment of drug use and honoring Indigenous identities, may help to strengthen relationships with health care providers and engagement in care.”

For the future

As part of the conclusions reached in their study, the researchers stated: “While interest in using mobile phones for health is high among young Indigenous people who have used drugs in British Columbia, low rates of phone ownership present a barrier to engagement in mHealth. Future mHealth programs will need to take this into account, either by providing mobile phone handsets and cellular plans, by supporting texting through Web-based platforms currently utilized by their client base or innovating to reduce periods of phonelessness and/or loss of connectivity.”

—Sean R. Hosein

REFERENCE:

Jongbloed K, Pearce ME, Thomas V, et al. The Cedar Project – Mobile phone use and acceptability of mobile health among young Indigenous people who have used drugs in British Columbia, Canada: mixed methods exploratory study. JMIR mHealth and uHealth. 2020;8(7):e16783.