BACKGROUND Mobile health (mHealth) interventions have the potential to improve health through patient education and provider engagement while increasing efficiency and lowering costs. This raises the question of whether disparities in access to mobile technology could accentuate disparities in mHealth mediated care. This study addresses whether programs planning to implement mHealth interventions risk creating or perpetuating health disparities based on inequalities in smartphone ownership. METHODS Video Directly Observed Therapy (VDOT) is an mHealth intervention for monitoring tuberculosis (TB) treatment adherence through videos sent by patients to their healthcare provider using smartphones. We conducted secondary analyses of data from a single-arm trial of VDOT for TB treatment monitoring by San Diego, San Francisco, and New York City health departments. Baseline and follow-up treatment interviews were used to assess participant smartphone ownership, sociodemographics and TB treatment perceptions. Univariate and multivariable logistic regression analyses were used to identify correlates of smartphone ownership. RESULTS Of the 151 participants enrolled, mean age was 41 years (range: 18-87 years) and 41.1% were female. Participants mostly identified as Asian (45.0%) or Hispanic/Latino (29.8%); 57.8% had at most a high school education. At baseline, 30.4% did not own a smartphone, which was similar across sites. Older participants (adjusted odds ratio [AOR] = 1.09 per year, 95% confidence interval [CI]: 1.05-1.12), males (AOR = 2.86, 95% CI: 1.04-7.86), participants having at most a high school education (AOR = 4.48, 95% CI: 1.57-12.80), and those with an annual income below $10,000 (AOR = 3.06, 95% CI: 1.19, 7.89) had higher odds of not owning a smartphone. CONCLUSIONS Approximately one-third of TB patients in three large United States of America (USA) cities lacked smartphones prior to the study. Patients who were older, male, less educated, or had lower annual income were less likely to own smartphones and could be denied access to mHealth interventions if personal smartphone ownership is required.

中文翻译：

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移动医疗干预措施要求拥有智能手机：谁会被排除在外？


背景技术移动医疗（mHealth）干预措施有可能通过患者教育和提供者参与来改善健康，同时提高效率和降低成本。这就提出了一个问题：移动技术获取方面的差异是否会加剧移动医疗介导的护理方面的差异。这项研究探讨了计划实施移动医疗干预措施是否存在因智能手机拥有不平等而造成或延续健康差异的风险。方法 视频直接观察治疗 (VDOT) 是一种移动医疗干预措施，通过患者使用智能手机向医疗保健提供者发送的视频来监测结核病 (TB) 治疗的依从性。我们对圣地亚哥、旧金山和纽约市卫生部门进行的用于结核病治疗监测的 VDOT 单臂试验的数据进行了二次分析。基线和后续治疗访谈用于评估参与者的智能手机拥有情况、社会人口统计学和结核病治疗认知。使用单变量和多变量逻辑回归分析来确定智能手机拥有量的相关性。结果 151 名参与者中，平均年龄为 41 岁（范围：18-87 岁），其中 41.1% 为女性。参与者大多为亚洲人 (45.0%) 或西班牙裔/拉丁裔 (29.8%)； 57.8%的人最多受过高中教育。基线时，30.4% 的人没有智能手机，各个网站的情况相似。老年参与者（调整后比值比 [AOR] = 1.09 每年，95% 置信区间 [CI]：1.05-1.12）、男性（AOR = 2.86，95% CI：1.04-7.86）、参与者至多受过高中教育（AOR = 4.48，95% CI：1.57-12.80），年收入低于 10,000 美元（AOR = 3.06，95% CI：1.19，7.89）的人不拥有智能手机的可能性更高。 结论 在美国三个大城市中，大约三分之一的结核病患者在研究之前没有智能手机。年龄较大、男性、受教育程度较低或年收入较低的患者拥有智能手机的可能性较小，如果需要个人拥有智能手机，则可能无法获得移动医疗干预措施。