Will mhealth Be Accepted in India? Results of a Pan-India Survey Dr. Arun Rai Regents Professor & Harkins Chair Center for Process Innovation & CIS Department Robinson College of Business Georgia State University, Atlanta, U.S.A. arunrai@gsu.edu Web site: arunrai.us Dr. K. Ganapathy President, Apollo Telemedicine Networking Foundation Chennai, India drganapathy@apollohospitals.com Web site: www.kganapathy.com Liwei Chen & Jessica Pye Doctoral Students Center for Process Innovation Robinson College of Business Georgia State University, Atlanta, U.S.A. liwei.chen@eci.gsu.edu & jessica.pye@eci.gsu.edu 4 th International Conference on Transforming Healthcare with IT 6 th 7 th Sep. 2013 Hyderabad, India
Study Motivation Amritya Sen Nobel Laureate, Economics, 1998 Bharat Ratna, 1999 Quality of life is linked to citizens capability to use resources to function effectively Marc Zuckerberg CEO, Facebook Basic (mobile) internet access needs to be a human right given its pivotal role to effective living Realizing the transformative potential of mhealth in India hinges on acceptance & use
Study Objectives 1. Willingness? 2. Awareness? 3. Use? 5. IMPLICATIONS? Designing Solutions Building Awareness Promoting Use 4. Disparities?
Procedures Questionnaire developed by ATNF and GSU Pilot testing and refinement Trained volunteers from Apollo Nursing Colleges for multilingual field survey administration Stratified sampling across demographics & location Pan-India Survey (Oct 2012 - April 2013) 1886 valid responses
Sample Characteristics (I) Age 18-22 31% 23-30 30% 31-40 18% 41-50 11% 51-60 6% over 61 4% Location Urban 69% Rural 31% Education Below secondary school 10% Secondary School (6-12 std) 28% College Graduate 31% Master s degree and higher 31% Gender Female 52% Male 48% Income/month RS 5,000 20% > RS 5,001 & RS 15,000 26% > RS 15,001 & RS 30,000 17% > RS 30,001 14%
Sample Characteristics (II) Health perceptions Healthy: 65% Moderate/Unhealthy: 35% Healthcare checkup No health checkup in last year: 54% No health checkup in last 5 years: 30% BASIC Share mobile: 57% SMART URBAN 54% 46% RURAL 78% 22%
LOW NEUTRAL LOW NEUTRAL Behavioral Intention to Use mhealth: Equal Enthusiasm Among Urbanites and Ruralites 60% 55% 55% 50% 40% 30% 20% 14% 27% 25% 18% 10% 0% Urban Rural N=1271 N=573
UNAWARE AWARE USERS UNAWARE AWARE USERS mhealth Awareness & Use: The Urban-Rural Divide 60% 50% 40% 30% 20% 10% 0% 51% 44% 28% 31% 28% 17% Urban Rural N=1271 N=573
Awareness and Use: The (Three) SMS Urban-Rural Divides #2. CONVERSION 100% #1. USE 80% 52% 60% 40% 94% 94% 84% 24% 20% 0% 7% 22% 5% Urban Rural Urban Rural Phone calls Text messages Missing Data Not Aware Aware Non-User User #3. AWARENESS
#4. AWARENESS Awareness and Use: The (Four) Urban-Rural Internet Mobility Divides 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% #1. USE 42% 28% 53% 24% #2. AWARENESS #3. USE 17% 19% 25% 51% 21% 21% 24% 53% Urban Rural Urban Rural Emails Internet Missing Data Not Aware Aware Non-User User
Leading Disparities of URBAN Relative to RURAL Socioeconomic Mobile Access & Utilization Healthcare Access & Utilization Education (>= College) 2 : 1 Individual income (> 15 K) 3 : 1 SMS use 1.6 : 1 Smart device ownership 2.1 : 1 Mobile internet use 2.7 : 1 Health checkup at least in last 5 years 1.07 : 1 Proximity to primary care (<3km) 1.02 : 1 Proximity to specialized care (<10km) 1.13 : 1
Leading Disparities of AWARE Relative to UNAWARE Socioeconomic Mobile Access & Utilization Healthcare Access & Utilization Education (>=College) 1.5 : 1 Individual income (>15K) 1.85 : 1 SMS Use 1.45 : 1 Smart device ownership 1.98 : 1 Mobile internet use 1.41 : 1 Health checkup in last one year 1.07 : 1 Proximity primary care (<3km) 1.1 : 1 Proximity-specialized care (<10 km) 1.19 : 1
Leading Disparities of USERS Relative to AWARE Socioeconomic Mobile Access & Utilization Healthcare Access & Utilization Education (>= College) 1.25 : 1 Individual income 1:13 : 1 SMS use 1.04 : 1 Smart device ownership 1.25 : 1 Mobile internet use 1.52 : 1 Health checkup in last one year 1.14 : 1 Proximity primary care (< 3km)* 0.95 : 1 Proximity-specialized care (<10 km)* 0.93 : 1
IMPLICATIONS? Designing Solutions Building Awareness Promoting Use
Designing Solutions & Building Awareness: Key Segmentation Criteria 1. Advantaged OR Disadvantaged? 2. 3. Preventive Disposition to Health?
Promoting mhealth Use: Key Levers Across Segments 1. SELF-EFFICACY 2. 3. IN ELECTRONIC MEDIUM FOR HEALTHCARE SERVICES
Willingness: Uniformly high across urbanites & ruralites Build Awareness: Tailor strategies to segments advantaged vs. disadvantaged; male vs. female; prevention Disparities: Socio-economic Basic/Internet Mobility Healthcare access/utilization Develop Use: Promote Trust, Self-efficacy & Empowerment
Acknowledgements Apollo Hospitals Educational & Research Foundation, India Principal, Apollo Institute of Nursing, Gandhi Nagar, Gujarat, India Principal, Apollo College of Nursing, Hyderabad, Andhra Pradesh, India Principal, Apollo College of Nursing, Chennai, Tamil Nadu, India Principal, Apollo College of Nursing, Aragonda, Andhra Pradesh, India Principal, Apollo College of Nursing, Bilaspur, Chattisgarh, India Principal, Madurai Apollo College of Nursing, Madurai, Tamil Nadu, India Principal, Apollo School of Nursing, New Delhi, India Principal, Apollo Gleneagles Nursing College, Kolkata, West Bengal, India Ms. Geethanjali, Project Coordinator, ATNF, Chennai, Tamil Nadu, India Staff of Apollo Telemedicine Networking Foundation, Chennai, India 4 th International Conference on Transforming Healthcare with IT 6 th 7 th Sept. 2013 Hyderabad, India
Will m-health Be Accepted in India? Results of a Pan-India Health Survey Comments and reactions welcome! Dr. Arun Rai arunrai@gsu.edu Web site: arunrai.us Dr. K. Ganapathy drganapathy@apollohospitals.com Web site: kganapathy.com 4 th International Conference on Transforming Healthcare with IT 6 th 7 th Sept. 2013 Hyderabad, India