Content uploaded by Siyan Yi
Author content
All content in this area was uploaded by Siyan Yi on Feb 05, 2022
Content may be subject to copyright.
Original Paper
Are Text Messages a Feasible and Acceptable Way to Reach
Female Entertainment Workers in Cambodia with Health
Messages? A Cross-Sectional Phone Survey
Carinne Brody1*, MPH, MA, Dr PH; Sukhmani Dhaliwal2*, MPH (current), DO (current); Sovannary Tuot3*, MA;
Michael Johnson2*, MPH (current), DO (current); Khuondyla Pal3*, MHS; Siyan Yi2,3*, PhD, MD
1Touro University California, Public Health Program, Center for Global Health Research, Vallejo, CA, United States
2Touro University California, Public Health Program, Vallejo, CA, United States
3KHANA, Center for Population Health Research, Phnom Penh, Cambodia
*all authors contributed equally
Corresponding Author:
Carinne Brody, MPH, MA, Dr PH
Touro University California
Public Health Program
Center for Global Health Research
1310 Club Drive
Vallejo, CA, 94592
United States
Phone: 1 7076388533
Fax: 1 7076388555
Email: carinne.brody@gmail.com
Abstract
Background: Despite great achievements in reducing the prevalence of HIV, eliminating new HIV infections remains a challenge
in Cambodia. Entertainment venues such as restaurants, karaoke bars, beer gardens, cafes, pubs, and massage parlors are now
considered important venues for HIV prevention efforts and other health outreach interventions.
Objective: The purpose of this study was to explore phone use and texting practices of female entertainment workers (FEWs)
in order to determine if text messaging is a feasible and acceptable way to link FEWs to health services.
Methods: This cross-sectional phone survey was conducted in May 2015 with 97 FEWs aged 18–35 years and currently working
at an entertainment venue in Phnom Penh.
Results: Of the 96 respondents, 51% reported sending text messages daily; of them, 47% used Khmer script and 45% used
Romanized Khmer. Younger FEWs were more likely to report daily texting (P<.001). Most FEWs (98%) in this study reported
feeling comfortable receiving private health messages despite the fact that 39% were sharing their phone with others. Younger
FEWs were less likely to share their phone with others (P=.02). Of all of the FEWs, 47% reported owning a smartphone, and
younger women were more likely to own a smartphone than were older women (P=.08).
Conclusions: The findings from this study support the development of mHealth interventions targeting high-risk groups in
urban areas of Cambodia. Our data suggest that mHealth interventions using texting may be a feasible way of reaching FEWs in
Phnom Penh.
(JMIR mHealth uHealth 2016;4(2):e52) doi:10.2196/mhealth.5297
KEYWORDS
mHealth; short message service; Cambodia; female sex workers; HIV
Introduction
Despite great achievements in reducing the prevalence of HIV,
eliminating new HIV infections remains a challenge in
Cambodia. Cambodia is one of the few countries in the world
that have reversed their HIV epidemic from generalized to
concentrated; it is now confined mainly to individuals who
engage in high-risk behaviors such as sex workers [1]. In 2013,
JMIR mHealth uHealth 2016 | vol. 4 | iss. 2 | e52 | p.1http://mhealth.jmir.org/2016/2/e52/ (page number not for citation purposes)
Brody et alJMIR MHEALTH AND UHEALTH
XSL
•
FO
RenderX
it was estimated that the HIV prevalence among the general
adult population was 0.6%, reflecting a significant decline from
the peak of 2.0% in 1998 [2]. This success was widely attributed
to the “100% condom use” program targeting brothel-based
commercial relationship, which led to a significant increase in
condom use [3-6]. The passage and implementation of the
“brothel ban” in 2008, an act that criminalized brothel-based
sex work, may be making the situation more complicated
because the sex trade has since gone underground, and more
women have moved into indirect sex work through the
entertainment industry, which is less stigmatized [7].
Entertainment venues include restaurants, karaoke bars, beer
gardens, cafes, pubs, and massage parlors [8,9].
In Cambodia, as in many parts of Asia, a common pathway for
young women from rural families is to migrate to urban areas
to earn a better wage and send money back to their families [9].
Many young women migrate to the capital city to work in
garment factories, which are the backbone of Cambodia's
economy and employ more than 650,000 females [10], who
typically begin working in the factories as teens [11]. These
women and girls receive low pay, work long hours, and often
struggle to navigate through the new social norms away from
family oversight [12,13]. Owing to the poor wages, many seek
to supplement or change jobs and move on to more lucrative
jobs at entertainment venues. In these roles, many women begin
engaging in one or more romantic relationships, which can
involve direct or indirect transactional sex [14,15]. Therefore,
entertainment venues are an important venue for HIV prevention
efforts and other health outreach interventions.
Text messages (short messaging service, SMS) containing health
service information and content advising health behavior change
have the potential to be an inexpensive, discreet, adaptable,
sustainable, and scalable way of reaching the vulnerable
populations. Information about service locations and availability,
live peer texting, and behavior change messages are some of
the ways in which text messages can be used to increase use of
critical services such as HIV testing.
Cambodia is the first country in the world in which the number
of mobile phone users has surpassed the number using fixed
line phones [16]. The number of mobile subscribers in Cambodia
reached 20 million at the end of 2013, surpassing the country's
population by about 5 million [17]. Mobile phone use by
entertainment workers has increased at a similar rate and is now
widespread among this population [18]. Worldwide, mobile
phones are being used in developing countries to increase
contraceptive use [19], improve pharmacovigilance [20],
encourage diabetes self-management [21], collect health data
[22], increase health knowledge [23], and increase adherence
to treatment [24,25]. However, few mobile health (mHealth)
interventions have been rigorously evaluated [23,26]. So far,
there is rigorous evidence that mobile phone messages can be
successfully used to support preventative health care [26-29].
Results from recent studies show that mHealth tools can also
be successfully implemented in Cambodia in an urban setting
[20], for HIV prevention [30] among young people, using
participatory approaches [31-37].
Mobile health is still an emerging field, and new projects,
particularly those in developing countries, face challenges. In
Cambodia, we have identified a number of challenges for testing
mHealth interventions. In terms of technical limitations, mobile
users often own multiple subscriber identity module (SIM) cards
in order to get cheaper in-network rates and better reception
from the competitive phone networks in Cambodia, who also
offer deals that entice users to use their SIM cards for a limited
period of time [38]. Sharing phones with family members or
neighbors, privacy concerns, and varying levels of literacy are
additional limiting factors [39]. Furthermore, there is the added
concern that most phones in Cambodia lack the ability to text
in Khmer script, although the younger generation of tech-savvy
Cambodians is more familiar with using a Romanized Khmer
language for texting and social media.
The purpose of this study was to explore phone use and SMS
practices in order to determine whether text messages are a
feasible and acceptable way of linking female entertainment
workers (FEWs) to health services in Cambodia.
Methods
The KHANA Center for Population Health Research reviewed
and approved this study on May 15, 2015. The Institutional
Review Board Committee of Touro University California
approved the study on May 19, 2015 (IRB Application #
PH-9015). All participants were informed of the study
procedures and purpose and gave their verbal informed consent
before participation.
This cross-sectional phone survey was conducted in May 2015.
To be eligible for the structured survey, participants needed to
be 18-35 years old, female, a mobile phone owner, and currently
working at an entertainment venue in Phnom Penh, Cambodia.
Three screening questions were used to determine eligibility:
“what is your age,” “do you currently work in the entertainment
industry in Phnom Penh,” and “do you currently own a mobile
phone?”
A list of all FEWs living in Phnom Penh associated with
KHANA, the largest national organization providing integrated
HIV prevention, care, and support services in Cambodia, was
generated by outreach workers working for KHANA’s
implementing partners. There were 135 women on the list. One
hundred participants were randomly selected from the complete
list of FEWs. If a participant did not meet the eligibility criteria
or a phone number was no longer in use, another participant
was randomly selected from the list. When the list was
exhausted, we had managed to recruit 96 participants who were
able to be interviewed.
Participants were recruited over the phone using a recruitment
script that included screening questions. If they agreed to
participate, they were given more information about the study,
and their verbal informed consent to participate was required.
Once they had given their consent, a structured interview was
conducted over the phone. A structured closed-ended
questionnaire was developed. The questionnaire covered
demographics, text messaging practices, mobile phone use, and
privacy concerns. The questionnaire was originally developed
JMIR mHealth uHealth 2016 | vol. 4 | iss. 2 | e52 | p.2http://mhealth.jmir.org/2016/2/e52/ (page number not for citation purposes)
Brody et alJMIR MHEALTH AND UHEALTH
XSL
•
FO
RenderX
in English and translated into Khmer, the national language of
Cambodia. The hard copy document was converted into a
Google Form to facilitate data input, which was done by multiple
research assistants.
Descriptive analyses were conducted to describe participants’
age, type of entertainment venue, and history of garment factory
work using n (%) for categorical variables and mean (SD) for
continuous variables. The chi-square test or Fisher exact test
(when sample sizes were smaller than 5 in 1 cell) was used for
categorical variables, and the Student t test was used for
continuous variables to compare demographic characteristics,
SMS use, phone use practices, and attitudes toward privacy and
SMS between age groups (≤27 years vs. >27 years). STATA
version 13 (StataCorp LP, Texas, USA) was used for all data
analyses.
Results
A total of 96 FEWs participated in this study. Table 1
summarizes the demographic data. The mean age of participants
was 27.3 years (SD 5.09). Half of the sample was over 27 years
of age. Women worked as beer promoters (39%), restaurant
hostesses (16%), karaoke girls (15%), sex entertainment workers
(ie, in strip clubs, 15%), and masseuses (9%), as well as in other
venues (7%). In total, 35% of participants had worked in a
garment factory at some point in the past.
Table 1. Demographic data of study participants by age group (n=96).
P
Oder FEWs
n (%) (>27 years)
(n=47)
Younger FEWs a
n (%) (≤27 years)
(n=48)
Total n (%)
(n=96)Demographic variables
31.7 (3)23.0 (3)27.33 (5)Age
48 (50)>27 Years
.04Type of entertainment work
24 (50)13 (27)37 (39)Beer promoter
5 (10)10 (21)15 (16)Restaurant hostess
6 (13)8 (17)14 (15)Karaoke girl
3 (6)11 (23)14 (15)Sex entertainment worker
7 (15)2 (4)9 (9)Masseuse
3 (6)4 (8)7 (7)Other
.9613 (36)10 (35)23 (35)Had worked in a garment
factory
aFEW: female entertainment worker.
Table 2 summarizes data on SMS use. When asked whether
they had ever sent a text message, 53% said that they had. Of
those, 69% reported sending more than 1 message per day, 22%
reported sending about 1 per day, and 10% sent less than 1 per
day. When asked what language they used most often when
sending text messages, 47% reported using Khmer script, 45%
reported using Romanized Khmer, and 8% reported using
English.
JMIR mHealth uHealth 2016 | vol. 4 | iss. 2 | e52 | p.3http://mhealth.jmir.org/2016/2/e52/ (page number not for citation purposes)
Brody et alJMIR MHEALTH AND UHEALTH
XSL
•
FO
RenderX
Table 2. Use of short message service by study participants by age group (n=96).
P
Older FEWs
n (%) (>27 years)
(n=47)
Younger FEWsa
n (%) (≤27 years)
(n=48)
Total n (%)
(n=96)Short message service variables
<.00114 (29)37 (77)51 (53)Have you ever sent a text
message on a mobile phone?
.32How often do you currently send text messages?
5 (36)6 (16)11 (21)About 1 per day
8 (57)27 (73)35 (69)More than 1 per day
1 (7)4 (11)5 (10)Less than 1 per day
.21What language do you use
most often to send text mes-
sages using a mobile phone?
0 (0)4 (11)4 (8)English
9 (64)15 (41)24 (47)Khmer
5 (36)18 (49)23 (45)Romanized Khmer
aFEW: female entertainment worker.
Table 3 summarizes participants’ mobile phone use practices.
Of all respondents, 77% owned at least 1 mobile phone, 21%
owned 2 mobile phones, and 2% owned 3 mobile phones. When
asked about SIM card use, 62% reported currently using 1 SIM
card, 37% used 2, and 2% used 3. When asked about the phone
that they used most often, 53% of respondents reported using
a regular mobile phone and 47% reported using a smartphone.
Table 3. Mobile phone use of study participants by age group (n=96).
P
Older FEWs n (%)
(Over 27)
(n=47)
Younger FEWsa
n (%) (27 and under)
(n=48)
Total n (%)
(n=96)Mobile phone use variables
.32How many mobile phones do you own right now?
40 (83.3)34 (70.8)74 (77.1)1
7 (14.6)13 (27.1)20 (20.8)2
1 (2.1)1 (2.1)2 (2.1)3
.98How many SIM cards do you use right
now?
29 (60.4)30 (62.5)59 (61.5)1
18 (37.5)17 (35.4)35 (36.5)2
1 (2.1)1 (2.1)2 (2.1)3
.08When thinking of the mobile phone you use most often, what
type is it?
29 (61.7)21 (43.8)50 (52.6)Regular
18 (38.3)27 (56.3)45 (47.4)Smart
aFEW: female entertainment worker, SIM: subscriber identity module.
Table 4 presents data on privacy and mobile phone use. When
asked to think about the phone they used most often, 39%
reported that they often shared their phone; these FEWs most
often shared the phone with work colleagues (43%); family
(24%); husbands, boyfriends, or partners (22%); and friends
(11%). When asked how comfortable they felt receiving text
messages with private health information on their phones, 97%
said that they felt comfortable. When asked how likely they
were to respond to various types of private health questions,
79% were very likely to respond to a question about eating
vegetables, 76% were very likely to respond to a question about
smoking, 73% were very likely to respond to questions about
condom use, and 87% were very likely to respond to questions
about HIV.
JMIR mHealth uHealth 2016 | vol. 4 | iss. 2 | e52 | p.4http://mhealth.jmir.org/2016/2/e52/ (page number not for citation purposes)
Brody et alJMIR MHEALTH AND UHEALTH
XSL
•
FO
RenderX
Table 4. Privacy and short messaging service of study participants by age group (n=96)
P
Older FEWs
(Over 27)
(n=47)
Younger FEWsa
(27 and under)
(n=48)
Total
(n=96)Privacy and short messaging service variables
.0224 (50)13 (27)37 (39)Thinking about the phone you use
most often, do you share the phone
with anyone else?
.78Who do you share the phone with most often?
10 (42)6 (46)16 (43)Work colleague
7 (29)2 (15)9 (24)Family
5 (21)3 (23)8 (22)Husband,
boyfriend, or
partner
2 (8)2 (15)4 (11)Friends
.56How comfortable do you feel receiving text messages with private
health messages on the phone you most often use?
47 (98)46 (96)93 (97)Comfortable
1 (2)2 (4)3 (3)Not comfortable
.16How likely are you to respond to health questions about vegetables?
30 (63)38 (79)68 (71)Very likely
6 (13)6 (13)12 (13)Somewhat likely
4 (8)2 (4)6 (6)Not at all likely
8 (17)2 (4)10 (10)Do not know
.49How likely are you to respond to health questions about smoking?
35 (73)38 (79)73 (76)Very likely
5 (10)2 (4)7 (7)Somewhat likely
8 (17)8 (17)16 (17)Not at all likely
.14How likely are you to respond to health questions about condom
use?
39 (81)31 (65)70 (73)Very likely
3 (6)2 (4)5 (5)Somewhat likely
5 (10)10 (21)15 (16)Not at all likely
1 (2)5 (10)6 (6)Do not know
.10How likely are you to respond to health questions about HIV?
45 (94)38 (79)83 (87)Very likely
0 (0)3 (6)3 (3)Somewhat likely
1 (2)5 (10)6 (6)Not at all likely
2 (4)2 (4)4 (4)Do not know
aFEW: female entertainment worker.
Younger FEWs were significantly more likely to work at sex
entertainment venues and karaoke bars (P=.035) and to have
ever sent a text message (P<.001); however, they were
significantly less likely to share their phones with others
(P=.021). Although not statistically significant at the P<.05
level, a greater number of younger FEWs owned smartphones
than did older FEWs (P=.08).
Discussion
Our data suggest that mHealth interventions relying on texting
may be a feasible way of reaching FEWs in Phnom Penh with
health communication programming that aims to improve sexual
and reproductive health literacy and access to prevention and
care. Half of our respondents sent text messages on a daily basis,
and younger FEWs were more likely to report daily texting
JMIR mHealth uHealth 2016 | vol. 4 | iss. 2 | e52 | p.5http://mhealth.jmir.org/2016/2/e52/ (page number not for citation purposes)
Brody et alJMIR MHEALTH AND UHEALTH
XSL
•
FO
RenderX
(P<.001). Of those who sent text messages, 47% used Khmer
script and 45% used Romanized Khmer. Most FEWs in this
study reported feeling comfortable receiving private health
messages, despite the fact that around half reported sharing their
phone with work colleagues. Younger FEWs were less likely
to share their phone with others. Smartphone use was
surprisingly high, at 47%, and younger FEWs were more likely
to own a smartphone as compared with older women.
The FEWs in our study had higher rates of smartphone
ownership and texting in both Khmer script and Romanized
Khmer than did those in a nationally representative study. These
findings are supported by national data from a recent study on
the use of mobile phones. Specifically, in this past study,
conducted in 2014, which included a nationally representative
sample of 2,066 Cambodians, 93% of respondents reported
owning a mobile phone and 28% owned a smartphone, which
was a 30% increase from 2013. Additionally, 68% of users
knew how to send messages in Khmer script, which represents
a 21% increase from 2013, while a quarter (26%) of the sample
were able to send messages in Romanized Khmer [40].
These findings may inform future mHealth program designs.
Given that more than half of the FEWs in this study did not
have smartphones and that this proportion among older women
was even less, app-based interventions may not reach an
important and influential portion of the population. The delivery
of information about where to find services, encouragement on
how to protect oneself against HIV, and information on how to
make contact with a peer counselor or call for a
community-based finger-prick HIV test can all be done using
simple text messages. However, an important limiting factor
regarding the use of text messages is the low literacy levels in
Cambodia, in both Romanized Khmer and Khmer script.
Smartphone use is predicted to increase further over the next
decade. In a recent report by Ericsson, a mobile Internet
company, usage trends suggest that smartphone subscriptions
in Southeast Asia are set to grow approximately five-fold by
2019 [41]. Given the likely increase in smartphone use, the
findings from this study suggest that smartphone apps may also
be a powerful health tool in addition to text-based interventions.
The limitations of this study include the following. First, the
small sample size requires us to be cautious in interpreting our
results because of the limited ability to detect statistical
significance. Second, we only included FEWs in Phnom Penh
who have had some interaction with KHANA in our sample.
The levels of mobile phone use and texting frequency reported
in this study may therefore represent a more modern view than
in other areas of Cambodia. Future studies should include a
wider range of the national population, particularly those who
have not yet been reached by the KHANA intervention
programs.
Although this study had a small sample size, it provides
important evidence for the mobile phone use patterns of a
specific high-risk population within the context of rapidly
increasing rates of mobile phone use in Cambodia. The findings
from this study support the development of mHealth
interventions targeting high-risk groups in urban areas of
Cambodia.
Acknowledgments
The authors would like to thank the respondents for their time and trust, and the entire staff at the KHANA Center for Population
Health Research for their support in conducting this research.
Conflicts of Interest
None declared.
References
1. UNAIDS, Joint United Nations Programme on HIV/AIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic
2013. 2013. URL: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Global_Report_2013_en_1.pdf [accessed
2016-03-02] [WebCite Cache ID 6fiVDnNMT]
2. National Center for HIV/AIDS, Dermatology, and STDs (NCHADS). Annual report 2013. Phnom Penh, Cambodia:
NCHADS; 2013.
3. National Center for HIV/AIDS, Dermatology, and STDs (NCHADS). Behavioral Sentinel Surveillance 2010. Phnom Penh,
Cambodia: NCHADS; 2011.
4. Saphonn V, Sopheab H, Sun LP, Vun MC, Wantha SS, Gorbach PM, et al. Current HIV/AIDS/STI epidemic: Intervention
programs in Cambodia, 1993-2003. AIDS Educ Prev 2004 Jun;16(3 Suppl A):64-77. [doi: 10.1521/aeap.16.3.5.64.35522]
[Medline: 15262566]
5. Sopheab H, Saphonn V, Chhea C, Fylkesnes K. Distribution of HIV in Cambodia: Findings from the first national population
survey. AIDS 2009 Jul 17;23(11):1389-1395. [doi: 10.1097/QAD.0b013e32832cd95a] [Medline: 19487909]
6. UNAIDS, Joint United Nations Programme on HIV/AIDS. Cambodia takes MDG prize for excellence in its AIDS response.
Geneva, Switzerland: UNAIDS; 2010.
7. The National AIDS Authority. National AIDS Authority for United Nations General Assembly Special Session (UNGASS).:
The National AIDS Authority; 2011. Cambodia Country Progress Report: Monitoring the Progress towards the Implementation
of the Declaration of Commitment on HIV and AIDS URL: http://www.unaids.org/sites/default/files/country/documents/
/file,94651,fr..pdf [accessed 2016-03-17] [WebCite Cache ID 6g57wqv2w]
JMIR mHealth uHealth 2016 | vol. 4 | iss. 2 | e52 | p.6http://mhealth.jmir.org/2016/2/e52/ (page number not for citation purposes)
Brody et alJMIR MHEALTH AND UHEALTH
XSL
•
FO
RenderX
8. UNICEF. UNICEF Cambodia. Phnom Penh, Cambodia: UNICEF; 2012 Nov. Examining Life Experiences and HIV Risks
of Young Entertainment Workers in Four Cities URL: http://www.unicef.org/cambodia/
Young_entertainment_workers_report_Eng_Final.pdf [accessed 2016-03-01] [WebCite Cache ID 6fiW13sGG]
9. International Labor Organization. Union Aid Abroad – APHEDA.: International Labor Organization; 2011. Cambodia -
addressing HIV vulnerabilities of indirect sex workers during the financial crisis: Situation analysis, strategies and entry
points for HIV/AIDS workplace education URL: http://www.ilo.org/asia/info/WCMS_165487/lang--en/index.htm [accessed
2016-03-01] [WebCite Cache ID 6fiWH6YBz]
10. Garment Manufacturers Association in Cambodia. Statement: 23-08-2014. Cambodia: Garment Manufacturers Association;
2014. GMAC Statements URL: http://www.gmac-cambodia.org/default-31-12-14.php [WebCite Cache ID 6hZmQ1Yor]
11. United States Department of Labor. Findings on the Worst Forms of Child Labor - Cambodia, 10 September 2009. Cambodia:
United States Department of Labor; 2009 Sep 10. URL: http://www.refworld.org/docid/4aba3eebc.html [accessed 2016-03-02]
[WebCite Cache ID 6fiWvFHv4]
12. Webber G, Edwards N, Graham I, Amaratunga C, Keane V, Socheat R. Life in the big city: The multiple vulnerabilities
of migrant Cambodian garment factory workers to HIV. Women's Studies International Forum 2010 May;33(3):159-169.
[doi: 10.1016/j.wsif.2009.12.008]
13. Gorbach PM, Sopheab H, Detels R, Harwell H, Pugatch D. The Cambodian Young Women’s Cohort: Factory Workers.
2005. Sexual Risk HIV/STD in Vulnerable Cambodian Females URL: http://www.aidsdatahub.org/sites/default/files/
documents/Sexual_Risk_and_HIVSTD_in_Cambodian_Young_Women_Factory_Workers_2005.pdf.pdf [accessed
2016-03-02] [WebCite Cache ID 6fiXHgUMy]
14. Nishigaya K. Female garment factory workers in Cambodia: Migration, sex work and HIV/AIDS. Women Health
2002;35(4):27-42. [doi: 10.1300/J013v35n04_03] [Medline: 12216990]
15. Sopheab H, Saphonn V, Chhea C, Fylkesnes K. Distribution of HIV in Cambodia: Findings from the first national population
survey. AIDS 2009 Jul 17;23(11):1389-1395. [doi: 10.1097/QAD.0b013e32832cd95a] [Medline: 19487909]
16. Digital Review of Asia Pacific 2007/2008. Ottawa, Canada: International Development Research Center URL: http://www.
digital-review.org/uploads/files/pdf/2007-2008/intro.pdf [accessed 2016-03-02] [WebCite Cache ID 6fiXdebAQ]
17. Sokhean B. “Mobile Users Top 20 Million, Internet Usage Still Rising” The Cambodian Daily, March. 2014. URL: https:/
/www.cambodiadaily.com/archives/mobile-users-top-20-million-internet-usage-still-rising-55024/ [accessed 2016-03-02]
[WebCite Cache ID 6fiXjKTAE]
18. Crothers L. Proposal Aims to Bring Workers’Voices to Negotiating Table.: The Cambodia Daily; 2014 Sep. URL: https:/
/www.cambodiadaily.com/archives/proposal-aims-to-bring-workers-voices-to-negotiating-table-67629/ [accessed 2016-03-02]
[WebCite Cache ID 6fiXpjvxp]
19. Smith C, Vannak U, Sokhey L, Ngo TD, Gold J, Khut K, et al. MObile Technology for Improved Family Planning Services
(MOTIF): Study protocol for a randomised controlled trial. Trials 2013 Dec 12;14:427. [doi: 10.1186/1745-6215-14-427]
[Medline: 24330763]
20. Baron S, Goutard F, Nguon K, Tarantola A. Use of a text message-based pharmacovigilance tool in Cambodia: Pilot study.
J Med Internet Res 2013;15(4):e68. [doi: 10.2196/jmir.2477] [Medline: 23591700]
21. van Olmen J, Ku GM, van Pelt M, Kalobu JC, Hen H, Darras C, et al. The effectiveness of text messages support for
diabetes self-management: Protocol of the TEXT4DSM study in the democratic Republic of Congo, Cambodia and the
Philippines. BMC Public Health 2013 May 1;13:423. [doi: 10.1186/1471-2458-13-423] [Medline: 23635331]
22. Curran K, Mugo NR, Kurth A, Ngure K, Heffron R, Donnell D, et al. Daily short message service surveys to measure
sexual behavior and pre-exposure prophylaxis use among Kenyan men and women. AIDS Behav 2013 Nov;17(9):2977-2985.
[doi: 10.1007/s10461-013-0510-4] [Medline: 23695519]
23. Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, et al. The effectiveness of mobile-health technology-based health
behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Med
2013;10(1):e1001362. [doi: 10.1371/journal.pmed.1001362] [Medline: 23349621]
24. Déglise C, Suggs LS, Odermatt P. Short message service (SMS) applications for disease prevention in developing countries.
J Med Internet Res 2012 Jan 12;14(1):e3. [doi: 10.2196/jmir.1823] [Medline: 22262730]
25. Islam S, Lechner A, Ferrari U, Froeschl G, Alam D, Holle R, et al. Mobile phone intervention for increasing adherence to
treatment for type 2 diabetes in an urban area of Bangladesh: protocol for a randomized controlled trial. BMC Health Serv
Res 2014 Nov 26;14:586. [doi: 10.1186/s12913-014-0586-1] [Medline: 25424425]
26. Vodopivec-Jamsek V, de Jongh J, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care.
Cochrane Database Syst Rev 2012 Dec 12;12:CD007457. [doi: 10.1002/14651858.CD007457.pub2] [Medline: 23235643]
27. Odeny TA, Bukusi EA, Cohen CR, Yuhas K, Camlin CS, McClelland RS. Texting improves testing: A randomized trial
of two-way SMS to increase postpartum prevention of mother-to-child transmission retention and infant HIV testing. AIDS
2014 Sep 24;28(15):2307-2312. [doi: 10.1097/QAD.0000000000000409] [Medline: 25313586]
28. Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and validity of daily self-monitoring by
smartphone application for health-related quality-of-life, antiretroviral adherence, substance use, and sexual behaviors
among people living with HIV. AIDS Behav 2015 Feb;19(2):330-340. [doi: 10.1007/s10461-014-0923-8] [Medline:
25331266]
JMIR mHealth uHealth 2016 | vol. 4 | iss. 2 | e52 | p.7http://mhealth.jmir.org/2016/2/e52/ (page number not for citation purposes)
Brody et alJMIR MHEALTH AND UHEALTH
XSL
•
FO
RenderX
29. Swendeman D. Are mobile phones the key to HIV prevention for mobile populations in India? Indian J Med Res 2013
Jun;137(6):1024-1026. [Medline: 23852282]
30. Kelly A. Technology can empower children in developing countries – if it’s done right.: The Guardian; 2013 Jun 17. URL:
http://www.theguardian.com/sustainable-business/technology-empower-children-developing-countries [accessed 2016-03-02]
[WebCite Cache ID 6fiYnhyCs]
31. Odeny TA, Newman M, Bukusi EA, McClelland RS, Cohen CR, Camlin CS. Developing content for a mHealth intervention
to promote postpartum retention in prevention of mother-to-child HIV transmission programs and early infant diagnosis
of HIV: A qualitative study. PLoS One 2014;9(9):e106383. [doi: 10.1371/journal.pone.0106383] [Medline: 25181408]
32. Hingle M, Nichter M, Medeiros M, Grace S. Texting for health: The use of participatory methods to develop healthy lifestyle
messages for teens. J Nutr Educ Behav 2013;45(1):12-19. [doi: 10.1016/j.jneb.2012.05.001] [Medline: 23103255]
33. Planned Parenthood Global. Youth peer provider program replication manual. New York, NY; 2012. URL: https://www.
plannedparenthood.org/files/8313/9611/6485/PP_Global_YPP_Manual.pdf [accessed 2016-03-02] [WebCite Cache ID
6fiZ2LNO7]
34. Medley A, Kennedy C, O'Reilly K, Sweat M. Effectiveness of peer education interventions for HIV prevention in developing
countries: A systematic review and meta-analysis. AIDS Educ Prev 2009 Jun;21(3):181-206. [doi:
10.1521/aeap.2009.21.3.181] [Medline: 19519235]
35. Siyan Y, Sovannary T, Kunthearith Y, Sanh K, Chhorvann C, Vonthanak S. Factors associated with risky sexual behavior
among unmarried most-at-risk young people in Cambodia. American Journal of Public Health Research 2014;2:211-220.
[doi: 10.12691/ajphr-2-5-5]
36. Siyan Y, Sovannary T, Pheak C, Brody C, Tith K, Oum S. The impact of a community-based HIV and sexual reproductive
health program on sexual and healthcare-seeking behaviors of female entertainment workers in Cambodia. BMC Infect
Dis 2015;15:221.
37. Ministry of Education, Youth and Sports. Kingdom of Cambodia. Kingdom of Cambodia: “Cambodia’s Most At Risk
Young People Survey 2010” , Youth and Sports, , 2010; 2010. "Cambodia’s Most At Risk Young People Survey" URL:
http://hivhealthclearinghouse.unesco.org/library/documents/most-risk-young-people-survey-cambodia-2010 [accessed
2016-03-17] [WebCite Cache ID 6g5Hafad6]
38. Bullen PB. Operational challenges in the Cambodian mHealth revolution. Journal of Mobile Technology in Medicine
2013;2(2):20-23.
39. Smith C. Overcoming mHealth operational challenges in Cambodia. Journal of Mobile Technology in Medicine
2013;2(2):27-28.
40. Phong K, Sola J. Mobile Phones in Cambodia 2014.: The Open Institute and The Asia Foundation; 2014 Oct. URL: https:/
/asiafoundation.org/resources/pdfs/MobilephonesinCB.pdf [accessed 2016-03-23] [WebCite Cache ID 6gDdClr6R]
41. South East Asia And Oceania: Ericsson Mobility Report Appendix. Stockholm, Sweden: Ericsson; 2014. URL: http://www.
ericsson.com/res/docs/2015/mobility-report/emr-nov-2015-regional-report-south-east-asia-and-oceania.pdf [accessed
2016-03-02] [WebCite Cache ID 6fiaiLPhO]
Edited by G Eysenbach; submitted 28.10.15; peer-reviewed by L Kelly-Hope, D Swendeman; comments to author 23.12.15; revised
version received 04.01.16; accepted 04.01.16; published 20.05.16
Please cite as:
Brody C, Dhaliwal S, Tuot S, Johnson M, Pal K, Yi S
Are Text Messages a Feasible and Acceptable Way to Reach Female Entertainment Workers in Cambodia with Health Messages? A
Cross-Sectional Phone Survey
JMIR mHealth uHealth 2016;4(2):e52
URL: http://mhealth.jmir.org/2016/2/e52/
doi:10.2196/mhealth.5297
PMID:27207374
©Carinne Brody, Sukhmani Dhaliwal, Sovannary Tuot, Michael Johnson, Khuondyla Pal, Siyan Yi. Originally published in
JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.05.2016. This is an open-access article distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly
cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright
and license information must be included.
JMIR mHealth uHealth 2016 | vol. 4 | iss. 2 | e52 | p.8http://mhealth.jmir.org/2016/2/e52/ (page number not for citation purposes)
Brody et alJMIR MHEALTH AND UHEALTH
XSL
•
FO
RenderX
