title: Mobile phone use among female entertainment workers in Cambodia: an observation study.
abstract: BACKGROUND
  Text or voice messages containing health behavior change content may be an inexpensive, discreet, sustainable and scalable way to reach populations at high risk for HIV. In Cambodia, one of the important high-risk populations is female entertainment workers (FEWs). This ethnographic study aims to explore typical phone use, examining patterns and behaviors that may influence the design of future mHealth interventions.
  
  
  METHODS
  The study consisted of one 8-hour non-participant observation session for 15 randomly sampled FEWs. Observations focused on capturing normal daily use of mobile devices. Observation checklists were populated by observers during the observations and a post-observation survey was conducted. Findings were discussed with Cambodian HIV outreach workers and HIV research fellows and their interpretations are summarized below.
  
  
  RESULTS
  In this ethnographic study, all 15 participants made calls, checked the time and received research-related texts. More than half (n=8) of the participants engaged in texting to a non-research recipient. About half (n=7) went on Facebook (FB) and some (n=5) listened to music and looked at their FB newsfeed. Fewer played a mobile game, posted a photo to FB, went on YouTube, used FB chat/messenger, watched a video on FB, played a game on FB, used FB call/voice chat, looked at their phone's background or used the LINE app. Fewer still shared their phones, left them unattended, added airtime or changed their SIM cards. When participants received a research text message, most did not share the text message with anyone, did not ask for help deciphering the message and did not receive help composing a response. Notable themes from observer notes, HIV outreach workers and researchers include reasons why phone calls were the most frequent mode of communication, examples of how cell phone company text messages are used as a form of behavior change, literacy as a persistent barrier for some FEWs, and FEWs' high interest in receiving health-related messages and less concern about privacy and phone-sharing issues than expected.
  
  
  CONCLUSIONS
  This study suggests texting is a part of normal phone use although not as frequently used as voice calls or Facebook. Despite the less frequent use, FEWs were able to send and receive messages, were interested in health messages and were not overly concerned about privacy issues. Texting and voice messaging may be useful tools for health behavior change within the FEW population in Cambodia.
authors.affiliation: Center for Global Health Research, School of Public Health, Touro University California, Vallejo, CA, USA.
authors.forename: Carinne
authors.initials: C
authors.lastname: Brody
authors.affiliation: Center for Global Health Research, School of Public Health, Touro University California, Vallejo, CA, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Tatomir
authors.affiliation: Khmer HIV/AIDS NGO Alliance (KHANA), Center for Population Health Research, Phnom Penh, Cambodia.
authors.forename: Tuot
authors.initials: T
authors.lastname: Sovannary
authors.affiliation: Khmer HIV/AIDS NGO Alliance (KHANA), Center for Population Health Research, Phnom Penh, Cambodia.
authors.forename: Khuondyla
authors.initials: K
authors.lastname: Pal
authors.affiliation: Khmer HIV/AIDS NGO Alliance (KHANA), Center for Population Health Research, Phnom Penh, Cambodia.
authors.forename: Song
authors.initials: S
authors.lastname: Mengsrun
authors.affiliation: Center for Global Health Research, School of Public Health, Touro University California, Vallejo, CA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Dionosio
authors.affiliation: Center for Global Health Research, School of Public Health, Touro University California, Vallejo, CA, USA.
authors.forename: Minh-Anh
authors.initials: MA
authors.lastname: Luong
authors.affiliation: Khmer HIV/AIDS NGO Alliance (KHANA), Center for Population Health Research, Phnom Penh, Cambodia.
authors.forename: Siyan
authors.initials: S
authors.lastname: Yi
keywords: Cambodia; cell phone; ethnography; mHealth; observational study; sex workers; sexual health