title: Determinants of readiness to adopt mHealth in a rural community of Bangladesh.
abstract: BACKGROUND
  Evidence in favor of mHealth for healthcare delivery in settings where trained health workforce is limited or unavailable is accumulating. With rapid growth in access to mobile phones and an acute shortage of health workforce in Bangladesh, mHealth initiatives are increasing with more than 20 current initiatives in place. "Readiness" is a crucial prerequisite to the successful implementation of telehealth programs. However, systematic assessment of the community readiness for mHealth-based services in the country is lacking. We report on a recent study describing the influence of community readiness for mHealth of a rural Bangladesh community.
  
  
  METHODS
  A conceptual framework for mHealth readiness was developed, which included three categories: technological, motivational and resource readiness. This guided the questionnaire development for the survey conducted in the Chakaria sub-district of Bangladesh from November 2012 to April 2013. Multivariate logistic regression was used to examine ownership of mobile phones, use of the technology, and knowledge regarding awareness of mHealth services as predictors of the community readiness to adopt mHealth.
  
  
  RESULTS
  A total of 4915 randomly selected household members aged 18 years and over completed the survey. The data explained the sub-categories of the readiness dimensions. In terms of access, 45% of respondents owned a mobile phone with ownership higher among males, younger participants and those in the highest socioeconomic quintiles. Results related to technological readiness showed that among mobile phone owners, 50% were aware of SMS but only sending and receiving SMS. Only 37% generally read the received SMS. Only 5% of respondents used the internet capabilities on their phone and 25% used voice messages. The majority (73%) of the participants were interested in joining mHealth programs in the future. Multivariate analysis showed that ownership of a mobile phone (aOR 1.3, 95% CI 1.1-1.5), younger age (aOR 2.6, 95% CI 2.1-3.3), males (aOR 1.8, 95% CI 1.6-2.1), educated respondents (11 years or more education) (aOR 11.1, 95% CI 6.2-19.2) and those belonging to the highest socio-economic group (aOR 3.7, 95% CI 2.9-4.7) were significantly independently associated with knowledge regarding awareness of current mHealth services.
  
  
  CONCLUSIONS
  We developed a conceptual framework to assess community readiness for mHealth. We described three high level dimensions of readiness and have partially tested the conceptual framework in a rural sub-district in Bangladesh. We found that the community has some technological readiness but inequity was observed for human resource readiness and technological capabilities. The study population is motivated to use mHealth. Our conceptual framework is a promising tool to assist policy-makers in planning and implementing mHealth programs.
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW 2052, Australia; Asia-Pacific ubiquitous Healthcare Research Centre, School of Information Systems, Technology and Management, Australian School of Business, UNSW Australia, Sydney, NSW 2052, Australia; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Fatema
authors.initials: F
authors.lastname: Khatun
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW 2052, Australia.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Heywood
authors.affiliation: Asia-Pacific ubiquitous Healthcare Research Centre, School of Information Systems, Technology and Management, Australian School of Business, UNSW Australia, Sydney, NSW 2052, Australia.
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Ray
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: S M A
authors.initials: SM
authors.lastname: Hanifi
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Abbas
authors.initials: A
authors.lastname: Bhuiya
authors.affiliation: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW 2052, Australia; Asia-Pacific ubiquitous Healthcare Research Centre, School of Information Systems, Technology and Management, Australian School of Business, UNSW Australia, Sydney, NSW 2052, Australia. Electronic address: siaw@unsw.edu.au.
authors.forename: Siaw-Teng
authors.initials: ST
authors.lastname: Liaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001292:Attitude to Computers; D001459:Bangladesh / Q000453:epidemiology; D003197:Computer Literacy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D000068997:Smartphone / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult
keywords: Access; Bangladesh; Health services; Mobile phone; Readiness; Technology adoption; mHealth