Improving digital health research methods with marginalised urban communities

Research with marginalised urban populations requires improved research design and careful consideration of inclusivity, safety, and ethics. This research focuses on remote digital survey design with urban populations affected by conflict and climate-related disasters, as well as residents of informal settlements. As opportunities for remote digital survey modalities expand, this research provides insights into design from the participant and researcher perspectives.

The performance of digital surveys is studied through a scoping review and three country studies in Nairobi, Lagos, and Port-au-Prince. In Kenya, a mobile phone survey researched the health and evacuation status of households after severe flooding in two large informal settlements. A web survey in Haiti researched the impact of violence on health workers and health care delivery. In Nigeria, a remote immunisation and nutrition survey in Lagos provided data on health-seeking behaviour and child health status. The studies analyse survey performance, operational efficiency, and aspects of equity and inclusion.

The scoping review and country studies provide evidence on the feasibility and performance of remote digital surveys among marginalised urban populations in LMICs. The survey response rates ranged from 14% in Nigeria to 69% in Kenya. The average cost of a completed survey across the three countries ranged from $2.2 to $21.5. The participation of women was 61% in Haiti, 65% in Kenya, and 87.1% in Nigeria. In Nigeria, respondents in both phone and in-person surveys preferred phone surveys to face-to-face research. The results culminate in a summary of best practices for digital health survey design and implementation with marginalised communities, which draws on participatory health research approaches.

The research aims to document the design of remote digital health surveys for urban, marginalised communities in low- and middle-income countries to inform the appropriate use of digital survey modalities in complex environments and the limitations of remote digital surveys. Opportunities include deployment in contexts with significant barriers to in-person research, such as conflict areas, areas of high population mobility, or where a hidden or marginalised population may benefit from added convenience or privacy. Improving research methods with marginalised communities helps promote health equity through evidence generation.