title: Stories From the Field: The Use of Information and Communication Technologies to Address the Health Needs of Underserved Populations in Latin America and the Caribbean.
abstract: BACKGROUND
  As their availability grew exponentially in the last 20 years, the use of information and communication technologies (ICT) in health has been widely espoused, with many emphasizing their potential to decrease health inequities. Nonetheless, there is scarce availability of information regarding ICT as tools to further equity in health, specifically in Latin American and Caribbean settings.
  
  
  OBJECTIVE
  Our aim was to identify initiatives that used ICT to address the health needs of underserved populations in Latin America and Caribbean. Among these projects, explore the rationale behind the selection of ICT as a key component, probe perceptions regarding contributions to health equity, and describe the challenges faced during implementation.
  
  
  METHODS
  We conducted an exploratory qualitative study. Interviews were completed via Skype or face-to-face meetings using a semistructured interview guide. Following participant consent, interviews were audio recorded and verbatim transcriptions were developed. All transcriptions were coded using ATLASti7 software. The text was analyzed for patterns, shared themes, and diverging opinions. Emerging findings were reviewed by all interviewers and shared with participants for feedback.
  
  
  RESULTS
  We interviewed representatives from eight organizations in six Latin American and Caribbean countries that prominently employed ICT in health communication, advocacy, or surveillance projects. ICT expanded project's geographic coverage, increased their reach into marginalized or hard-to-reach groups, and allowed real-time data collection. Perceptions of contributions to health equity resided mainly in the provision of health information and linkage to health services to members of groups experiencing greater morbidity because of poverty, remote place of residence, lack of relevant public programs, and/or stigma and discrimination, and in more timely responses by authorities to the health needs of these groups as a result of the increased availability of strategic information on morbidity and its social determinants. Most projects faced initial resistance to implementation because of lack of precedents. Their financial and technical sustainability was threatened by reliance on external funding and weak transitional structures amidst key staff changes. Projects often experienced challenges in establishing meaningful communication with target audience members, mainly because of divergent motivations behind ICT use between projects and its target audience and the lack of access or familiarity with ICT among the most underserved members of such audiences.
  
  
  CONCLUSIONS
  ICT can benefit projects focusing on the health needs of underserved populations by expanding the breadth and depth of target audience coverage and improving data management. Most projects tended to be small, short-term pilot interventions with limited engagement with the formal health sector and did not include health equity as an explicit component. Collaborative projects with government institutions, particularly those with health surveillance objectives, seemed to be the most optimistic about long-term sustainability.
authors.affiliation: Public eHealth, Innovation & Equity in Latin America & the Caribbean (eSAC) project Tegucigalpa Honduras.
authors.forename: Nasim
authors.identifier: 0000-0001-6821-9613
authors.initials: N
authors.lastname: Farach
authors.affiliation: Public eHealth, Innovation & Equity in Latin America & the Caribbean (eSAC) project Tlayacapan Mexico.
authors.forename: Gladys
authors.identifier: 0000-0001-5715-798X
authors.initials: G
authors.lastname: Faba
authors.affiliation: Public eHealth, Innovation & Equity in Latin America & the Caribbean (eSAC) project Kingston Jamaica.
authors.forename: Soroya
authors.identifier: 0000-0002-2826-0926
authors.initials: S
authors.lastname: Julian
authors.affiliation: Public eHealth, Innovation & Equity in Latin America & the Caribbean (eSAC) project Bogotá Colombia.
authors.forename: Felipe
authors.identifier: 0000-0002-4078-9646
authors.initials: F
authors.lastname: Mejía
authors.affiliation: Clínica Alemana Faculty of Medicine Universidad del Desarrollo Santiago Chile.
authors.forename: Báltica
authors.identifier: 0000-0003-0756-1954
authors.initials: B
authors.lastname: Cabieses
authors.affiliation: Pan American Health Organization (PAHO) Washington, DC United States.
authors.forename: Marcelo
authors.identifier: 0000-0002-6083-7713
authors.initials: M
authors.lastname: D'Agostino
authors.affiliation: Dalla Lana School of Public Health University of Toronto Toronto, ON Canada.
authors.forename: Andrea A
authors.identifier: 0000-0003-3779-5719
authors.initials: AA
authors.lastname: Cortinois
keywords: Latin America; eHealth; qualitative research; vulnerable populations