Mobile Technology Engagement Among Caregivers and Its Implications for Childhood Antibiotic Stewardship in Northern Vietnam: Mixed Methods Community-Based Study
Journal of Medical Internet Research ·
Background: In Vietnam, antibiotic use without involvement of health care professionals is common in the community, despite the legal requirement for a prescription. In low- and middle-income countries, mobile health (mHealth) is perceived as having the potential to improve community health care at low cost. Objective: In this study, we aimed to explore the relationship between mobile phone ownership and health-seeking behaviors among caregivers of children aged 5 years or younger to inform the design of an mHealth intervention to improve antibiotic use practices in the community. Methods: A convergent mixed methods approach combined a cross-sectional household survey and in-depth interviews (IDIs). We surveyed 450 households with children aged 5 years or younger and interviewed caregivers about their health-seeking behaviors and how they engage with mobile technology to inform their health care decisions and antibiotic use. Qualitative data were collected through IDIs and focus group discussions (FGDs) with a purposive sample of household survey respondents. Data collection was conducted between June and September 2023 at 2 sites: 1 urban and 1 rural area in a northern province of Vietnam. Factors associated with using mobile phones to seek health care information were identified through multivariable logistic regression and thematic analysis. Quantitative and qualitative findings were then integrated to provide contextual insights. Results: For the quantitative household survey, 450 of 460 approached households completed the survey. For the qualitative component, 38 of 60 approached caregivers participated in 4 FGDs and 6 IDIs. Almost all households had an internet connection (444/450, 98.7%, 95% CI 97.1%-99.4%). While 80.2% (308/384, 95% CI 75.9%-83.9%) of caregivers used mobile devices to access child health care information, only 27.1% (29/107, 95% CI 19.6%-36.2%) reported using the internet to obtain antibiotic-related information. Older caregivers (adjusted odds ratio [aOR] 0.65, 95% CI 0.43-0.99) and caregivers living in the urban area (aOR 0.45, 95% CI 0.24-0.85) were less likely to seek health-related information online using mobile devices than younger or rural caregivers, respectively. In contrast, a higher level of caregiver education was significantly associated with more favorable engagement in online health information–seeking behavior (aOR 2.73, 95% CI 1.61-4.61). Caregivers demonstrated highly active and intentional online information-seeking behaviors, driven by a strong desire to enhance their knowledge and confidence in making childcare and treatment decisions. Qualitative findings highlighted a need for trustworthy, professionally supported digital health platforms tailored to child health and antibiotic use. Conclusions: This study highlights caregivers’ health care information–seeking behaviors and engagement with digital technologies for antibiotic-related information, demonstrating the potential of mobile phones to support antibiotic-related decision-making and improve antibiotic use practices. These findings provide insights to inform the design of context-appropriate mHealth interventions to support caregivers in making decisions about antibiotic use.