Millions of Arabs are connected to the Internet and they are using mobile phones to go online several times a day. This represents a significant opportunity for the Arab world to confront its public-health concerns, which include rising rates of noncommunicable diseases such as diabetes.
With these numbers in mind, it makes perfect sense to use mobile phones and social media for communication strategies and campaigns, including public-health initiatives.
These platforms can be used to spread public-health messages far and wide. In this way they can disperse health care information more easily and more affordably to people who would otherwise not have had access to it.
Despite this potential, there are problems that come with these technologies. To reach as wide a population as possible, public-health campaigns should be careful not to over-rely on the Internet and smartphones or they risk missing groups like women, older people, and the poorest, most rural communities. These technologies are becoming increasingly affordable, but access to a decent Internet connection can vary drastically in low- and middle-income countries.
But the numbers of people that could be reached through the Internet are staggering.
The most recent Arab World Online report, produced by the Mohammed bin Rashid School of Government in Dubai, projects an optimistic picture of the adoption of digital technologies in the region. By 2020, the Internet population is expected to reach 208 million, and mobile subscriptions are expected to grow beyond 435 million. Also, Arab citizens have become avid social media users, especially of Facebook, Twitter and LinkedIn, according to a separate report on social media and the Internet of things.
Governments across the region are investing in infrastructure and technological innovations to further increase Internet access.
It is now the norm for a health drive, such as the Pan Arab breast-cancer awareness campaign, to feature a national website along with a presence on Facebook, Instagram, Twitter and YouTube. And of course, we would expect a plethora of hashtags such as #GoGetScreened, #HealthyYou, or #knowledgeIsPower.
“You need to be present where and when people hang out” is a motto commonly used by marketing professionals worldwide. And we, as public-health researchers and professionals, should follow the same principles when it comes to influencing health behavior.
However, mass media campaigns are by definition targeting large audiences and leaving out someone. They do not reach the entire population, but maybe a large majority. Marketers would say this is normal and that any campaign must carefully select a group of people with similar biological, psychological and media choice characteristics who are readier to change or to respond to a campaign message. In the case of the aforementioned breast-cancer awareness campaign, a potential target audience segment would be women 30 to 45 years old, who are at risk of developing the disease, and who are avid social media users, in particular of Facebook and Instagram.
This approach, while sensible and based on sound rationale, still explicitly leaves someone out. If we consider Internet and mobile penetration rates, any mass media campaign that relies heavily on digital technologies will leave out big chunks of the population, who are not covered by mobile or landline connections or who cannot afford to buy the devices to subscribe to the services.
A digital-only health promotion strategy might work for some Gulf states, such as Bahrain, Qatar and the United Arab Emirates, which have Internet penetration rates surpassing 90 percent, but it would be less effective for poorer, African countries such as Djibouti, Comoros and Somalia, where the penetration rates are below 50 percent. The digital divide in Internet connectivity seems to affect most remote rural communities, as broadband landline or fiber cables cannot be easily laid down. However, mobile phones can overcome technological barriers and soon we might just forget about wired connections.
Social media usage in the Arab region also varies by gender and across socioeconomic segments. Only one out of three users of mainstream social media platforms are female, and most users reside in the affluent Gulf region. That means the success of Internet campaigns that focus solely on women’s health issues is limited by these numbers.
Just 20 percent of those surveyed in the Arab social media report for 2017 said they use their mobile phones for health and wellness. Arabs use their smartphones chiefly for communication. Ninety percent of those surveyed use messaging apps and social media. More than 50 percent use their phones for entertainment and 39 percent use them for news. Health apps such as those that track fitness and sleep quality have yet to catch on in the region.
Social media and mobile technologies could therefore risk exacerbating health inequalities, as important segments of the population are left out, willingly or unwillingly. It might be because these technologies are too expensive or simply not available. It could also be because people do not know how to use the technologies or do not want to use them.
In searching for a solution, governments could increase their investments and develop policies to make the technologies cheaper and ubiquitous. If it is a problem of skills, educational institutions could conduct outreach programs to teach people, such as elderly populations, who are not ‘digital natives’ how to use social media or mobile phones and how to use these technologies for health-related information.
If it is a problem of motivation, researchers should carefully investigate people’s media choices. In other words, it might be better to learn whether traditional media channels such as radio and TV can be used to disseminate health messages.
If public-health professionals want to promote health for all, they should invest time and resources to understand how and why different segments of the population use certain media channels; focus on specific segments who do not have access to resources and health services; and find ways to involve those people and understand what could be done better to reach them and meet their needs and communication preferences.
Effective health promotion should be based on a strategic communication planning and systematic activity that should be conducted carefully, with the end user and beneficiary in mind. Only in this way can we avoid wasting money and human resources and promote health for all.
Marco Bardus is an assistant professor of health promotion and community health at the American University of Beirut. His research focuses on understanding how persuasive communication, delivered through mobile and web technologies, can be used to foster behavior change and address various public-health issues.