title: A study of mobile phone use among patients with noncommunicable diseases in La Paz, Bolivia: implications for mHealth research and development.
abstract: BACKGROUND
  While global momentum supporting mobile health (mHealth) research and development is increasing, it is imperative to assess the potential fit of mHealth programs in local settings. We describe the penetration of mobile technologies among Bolivian patients with noncommunicable diseases (NCDs) to inform research on mHealth interventions for the Andean region as well as low- and middle-income countries more generally.
  
  
  METHODS
  Five-hundred and fifty-nine NCD patients were identified from outpatient clinics affiliated with four hospitals in the cities of La Paz and El Alto. Respondents completed surveys about their use of standard mobile phones and smartphones. Respondents also provided information about their sociodemographic characteristics, health status, and access to care. We used descriptive statistics and logistic regression to understand the variation in mobile phone use across groups defined by patient characteristics associated with health service access and socioeconomic vulnerability.
  
  
  RESULTS
  Respondents were on average 52 years of age, 33% had at most a sixth grade education, and 30% spoke an indigenous language in their home. Eighty-six percent owned a mobile phone and 13% owned a smartphone. Fifty-eight percent of mobile phone users sent or received a text message at least once a week. Some mobile phone owners reported connectivity problems, such as lacking mobile signal (9%) or credit to make a call (17%). Younger age, male gender, high health literacy, more years of education, and having fewer previously diagnosed NCDs were positively related to mobile phone ownership. Among mobile phone users, respondents with lower education and other indicators of vulnerability were less likely than their counterparts to report frequent usage of texting services.
  
  
  CONCLUSIONS
  Mobile phones have high penetration among NCD patients in La Paz, Bolivia, including among those who are older, less educated, and who have other socioeconomic risk factors. Smartphone use is still relatively uncommon, even among patients who are younger and more educated. While certain patient characteristics such as age or education impact patients' use of text messaging, mobile phone-based mHealth interventions are feasible strategies for increasing NCD patients' access to self-management support between face-to-face clinical encounters.
authors.affiliation: University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48104, USA. kamisk@umich.edu.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kamis
authors.affiliation: University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48104, USA. mjanevic@umich.edu.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Janevic
authors.affiliation: University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48104, USA. stecn@med.umich.edu.
authors.forename: Nicolle
authors.initials: N
authors.lastname: Marinec
authors.affiliation: University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48104, USA. rachel.jantz@gmail.com.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jantz
authors.affiliation: El Servicio Departamental de Salud (SEDES) La Paz, Calle Capitán Ravelo #2180, La Paz, Bolivia. vh2r27@gmail.com.
authors.forename: Helen
authors.initials: H
authors.lastname: Valverde
authors.affiliation: University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48104, USA. jpiette@med.umich.edu.|Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA. jpiette@med.umich.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001838:Bolivia; D040421:Cell Phone / Q000706:statistics & numerical data*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012106:Research; D011795:Surveys and Questionnaires; D055815:Young Adult