Sixty male and female college students were asked a set of eight questions regarding knowledge and skill relating to electronic platforms and health information. The responses were recorded as a Likert scale and scored as: ‘strongly agree’ (five), ‘agree’ (four), neutral (three), ‘disagree’ (two) and ‘strongly disagree’ (one). The mean eHEALS score was 25, which was the same for both male and female students.
The lowest eHEALS score can be 8 and the highest can be 40. If divided into quintiles, the score 25 falls into the fourth quintile and so does the median score (27). This means that the Mirzapur college students (overall and also male and female, separately) viewed themselves as having high levels of eHealth literacy and can use electronic devices to seek health services and/or information. However, the female students had higher eHealth literacy as a group. The median eHEALS score for female students was higher (29) than the score for male students (26). Range-wise, the maximum score reported by the female students was 38 while it was 36 for male students (Table 7.2).
Table 7.2: Distribution of eHEALS scores for college students in Mirzapur by all (n=60), Male (n=35) and Female (n=25).
Distribution
Participants
Mean Median
Range
Maximum Minimum
All (N=60) 25 27 38 8
Male (n=35) 25 26 36 8
Female (n=25) 25 29 38 8
When the score was looked at question-by-question, the mean score for all of the eight questions was 3 (Figure 7.1). This means for each question, the perception of the college students regarding their own eHealth literacy was neither high nor low (neutral). The median score for each question suggested that for all the questions, half of all the respondents claimed to have a high score (not highest) which was 4 (agree), except for question 7 (‘I can tell high quality from low quality health resources on the internet’).
For question 7, half of the respondents settled for 3(neither agree nor disagree). But there was a slight difference between male and female students in terms of their perceptions of their own eHealth literacy.
Male students were more confident in making health decisions based on information from the internet (Q8, mean 4) while the female students scored 4 for Q1. The question-by-question median score was 4 for the male college students; half of them perceived themselves to have high eHealth literacy (neutral) except for when it came to questions 4 and 7; the mean score for these was 3 (neither high nor low). For
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Figure 7.1: Distribution (#) of self-perceived eHEALS scores of the young college students of Mirzapur question by question by All (n=60), Male (n=35) and Female (n=25)
All (N=60) Mean All (N=60) Median All (N=60) Mode
Male (n=35) Mean Male (n=35) Median Male (n=35) Mode
Female (n=25) Mean Female (n=25) Median Female (n=25) Mode
female students, the perception was high for half of the students except for questions 3 and 5, which were 3 (neither high nor low). The most of common mode of response for each question was 4 (‘agree’) except for the male students for question 4. Half of the male students strongly disagreed that they knew where to find helpful health resources on the internet.
Quantitatively, the distribution of eHEALS scores does not appears to be normal; the distribution is not bell shaped as the results of univariate analysis varies. The main reason for this is probably the sample size and related power. However, it is also important to note that this study was not done from a quantitative point of view. The aim was to document the eHealth literacy of the participants for further exploration and understanding. The findings of the eHEALS suggest that:
a. College students of Mirzapur perceive their eHealth literacy skills to be high. According to the eHEALS range, which is divided into five categories, 1 being lowest and 5 being highest, they perceived that their skill fell into category 4. This supports the general notion that younger generations have a better than average understanding of technology and related skill (Centeno et al., 2012) and hence a high eHealth literacy. This is also consistent with the self-reported skill-related findings in Chapter Six.
b. The analysis also indicates that there is gender differential of eHealth literacy; female students have higher skill compared to male students. However, a growing base of literature mentions that technical skill to access electronic information is still skewed toward male users given the number of socio-cultural barriers, and this results in fewer opportunities for the women. This literature also suggests that in case of school students, boys are more into leisure-related uses of ICT while girls are more into doing homework and sharing ICT access in groups (Dixon et al., 2014; ITU, 2016a; Kaarakainen et al., 2017). eHEALS relates to people’s knowledge of eHealth and health is a very important aspect of human life. This may have been the reason for the higher levels of eHealth literacy claimed by the female students.
More on the gender divide in terms of eHEALS was revealed when the scores were looked at question-by-question. For female students, knowledge of health-related resources on the internet and
how to use those resources for better health was reported to be neither low nor high. For male students, knowledge of where to find health resources over internet and of how to assess the quality of those resources was reported to be neither low not high.
Chapter Six, and this section on eHEALS, both present evidence on self-perceived abilities to access technology and electronic health information. There is evidence that self-perception of one’s ability to use internet can be different than actual ability. A study conducted in January and February 2014 reported that 66% of Australians have access to multiple electronic devices and perceive that they have high digital skill while only 7% scored as ‘very well’ when observed performing these skills. Another study of a Swiss population, conducted during spring 2015, reported that 67% participants thought they have good/very good skills whereas only 31% of them could achieve corresponding scores when observed (ECDL Foundation, 2016; Robinson et al., 2015). A study among 100 internet users in New Jersey reported that women tend to report lower skill compared to men whereas both genders had similar web-use skill (Hargittai & Shafer, 2006). If self-perception of skill is different than actual (for this thesis higher), it may mean that people may have less skill to be able to access eHealth but think otherwise. This explains why despite high ownership and considerable skill, access to eHealth has been low among young educated adults (and probably the other population groups as well) in Mirzapur.
7.2.2 Observed Technical Skill of the College Students to Operate Electronic Devices
Participants who took the eHEALS questions were asked to demonstrate the use of a laptop and a mobile phone to browse the internet and social media sites (in this case Facebook), send text messages and talk to a health call centre to seek health information and/or services. This was observed by me and a female research assistant (for female participants) and performance was recorded as completed, half completed or not completed. However, everyone needed some form of help from me to complete these tasks.
The half-completed tasks mean the participants failed to complete the tasks even with help.
Figure 7.2 shows that most of the participants were best at finishing the SMS and call-centre tasks, and were next most successful at using Facebook, or accessing the internet on their phone and
were least successful at accessing the internet on their laptop/computer. 21 participants could use the internet to look for health information and/or services using a phone and only 4 could do the same using a laptop. Proportionally slightly more female students (36%) could use the internet for health using a phone compared to male students (34%). Thirty-four participants could complete the social media (Facebook) task, 54 could use SMS messaging and 50 could use a call centre to look for health information and/or services. Throughout the task performance exercises, there were not many pronounced differences between male and female students. For all students, most of the half-completed task involved using social media, followed by SMS messaging and call centre tasks. The pattern was same for male and female students.
Time taken to perform the internet task(s) ranged from 5 to 15 minutes. Most of the participants did not have their own laptop and were diffident about using the laptop provided during the interview to participate in the task. However, participants were aware of the use of mobile phones for accessing the internet. But as mentioned earlier, almost all of them experienced problems seeking health information and/or services through mobile internet. Typing in English was not easy for them either and
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Figure 7.2: Distribution (#) of observed technical skill of the young college students of Mirzapur by All (n=60), Male (n=35) and Female (n=25)
Skill to use health call centre Skill to use SMS
Skill to use social media (FaceBook) Skill to use internet (Mobile) Skill to use internet (Laptop)
almost everyone typed Bangla in English alphabets and needed help to decide what to type in the search box. In most cases they needed help to enter key words in a search engine and with choosing from the search results. Participants were also confused regarding what to choose from the search list. It seemed that they had little or no understanding of the authenticity of websites. It was difficult for the participants to differentiate between independent and authentic sites or those backed by Google advertisements.
Hence, the site that came first or second in the ranking was chosen by most of the participants.
Altogether, although about one-third of the participants could complete the task, everyone appeared to be very uncomfortable, hesitant and unsure. For most the main concern about using the internet related to financial constraints.
Most of the participants were familiar with social media, in this case Facebook. But still, many found the task challenging. The participants were not familiar with looking for information through Facebook, therefore finding the desired HIV Facebook page was challenging. Almost everyone could write a comment under a status text or give a like. However, most of the participants did not know how to share a page or suggest a page to their peers (in this case, Facebook friends). During observation, it seemed that HIV was not a comfortable subject for them to share. Nonetheless, social media skills were somewhat satisfactory for most of the participants and female students were slightly more comfortable compared to male students. The overall impression regarding this task was satisfactory if not high.
Figure 7.2 shows that using SMS messaging and making voice calls is the most comfortable use of technology (in this case, using a mobile phone) for the college students of Mirzapur. For everyone, retrieving texts from the inbox, reading and understanding the texts were an easy and familiar task. This was also consistent with the findings presented in Chapters Four and Five, where SMS and voice calls were the two most preferred methods for seeking information. For most of the participants, it was easy to forward a SMS message to their peers, however, only a few knew how to send a group message. Other than this, their SMS skill was high. While making phone calls are easy for the participants, almost all of them were hesitant about to talk about HIV to the call centre agent, who they did not know. Also, almost everyone needed help with the hotline number of the health call centres. This raises a critical question
about the awareness of the eHealth and mHealth services in Bangladesh. Although it seems like everyone knows about the provision (and based on the eHEALS score, claims accordingly), whilst performing the tasks, only a few knew which number to call. Everyone was prompted to use the internet to find the number, but only eight participants attempted and of those three were successful. The overall impression of this task was not satisfactory since they did not know which number to call to.
7.2.3 Access to Technology and Technical Skill of the College Students in Mirzapur to Use Mobile