title: Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration.
abstract: There are increasing numbers of mHealth initiatives in middle and low income countries aimed at improving health outcomes. Bangladesh is no exception with more than 20 mobile health (mHealth) initiatives in place. A recent study in Bangladesh examined community readiness for mHealth using a framework based on quantitative data. Given the importance of a framework and the complementary role of qualitative exploration, this paper presents data from a qualitative study which complements findings from the quantitative study.
  
  
  
  The study was conducted in the Chakaria sub-district of Bangladesh. In total, 37 in-depth interviews were conducted between December 2012 and March 2013. Participants included the general public, students, community leaders, school teachers, and formal and informal healthcare providers. Thematic analysis was used to develop a logical and relevant framework to examine community readiness. As in the quantitative exploration, this study approached the investigation with four types of readiness in mind: core readiness, technological readiness, human resource readiness and motivational readiness.
  
  
  
  Community members, community leaders and healthcare providers expressed their interest in the use of mHealth in rural Bangladesh. Awareness of mHealth and its advantages was low among uneducated people. Participants who have used mHealth were attracted to the speed of access to qualified healthcare providers, time savings and low cost. Some participants did not see the value of using mobile phones for healthcare compared to a face-to-face consultation. Illiteracy, lack of English language proficiency, lack of trust and technological incapability were identified as barriers to mHealth use. However, a sense of ownership, evidence of utility, a positive attitude to the use of mHealth, and intentions towards future use of mHealth were driving forces in the adoption of mHealth services.
  
  
  
  This study re-affirmed the mHealth readiness conceptual framework with different dimensions of readiness and identified potential barriers and possible solutions for mHealth. Moving forward, emphasis should be placed on training users, providing low-cost services and improving trust of users.
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; Health Systems and Population Studies Division. 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: Health Systems and Population Studies Division. 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; General Practice Unit, South West Sydney Local Health District and Ingham Institute of Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170, Australia. Electronic address: siaw@unsw.edu.au.
authors.forename: Siaw-Teng
authors.initials: ST
authors.lastname: Liaw
mesh_terms: D000293:Adolescent; D000328:Adult; D001292:Attitude to Computers; D001459:Bangladesh; D040421:Cell Phone / Q000706:statistics & numerical data*; D003197:Computer Literacy / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012424:Rural Population; D017216:Telemedicine / Q000379:methods*; D035502:Trust; D055815:Young Adult
keywords: Access; Bangladesh; Health services; Mobile phone; Readiness; mHealth