Where there is no phone: The benefits and limitations of using intermediaries to extend the reach of mHealth to individuals without personal phones in Malawi

Abstract

The purpose of this study is to identify the benefits and limitations associated with intermediaries to provide access to and increase utilization of an mHealth intervention amongst people without personal phones in Balaka District, Malawi. A mixed-methods approach was utilized including quantitative data on usage and focus groups and interviews with users and volunteers. Community volunteers equipped with mobile phones served as intermediaries and were critical access points to the service for users without personal phones. However, there were challenges maintaining phones and solar panels, sustaining volunteer motivation and understanding how to use the service. While these strategies had a number of limitations, the majority of users (more than 65%) were individuals without a personal phone, who may not have been able to access the service otherwise. Further research is needed to better understand the resources, strategies and effort needed to sustain access through intermediaries in the long-term.