As part of the Fordham University Center for Ethics Education’s Advancing Health and Social Justice Web Series, Dr. Alexis Roth from the Community Health and Prevention at Drexel University, Dr. Randolph Hubach from the Center of Health Sciences at Oklahoma State University, and Dr. Roman Shrestha from the Institute of Collaboration on Health, Intervention, and Policy at the University of Connecticut, led a panel on Wednesday, February 10th, 2021 titled, “mHealth, Access to Care, and Ethics in the Age of COVID-19” to engage in discussion with students, faculty, and researchers. The panel was moderated by Dr. Elizabeth Buchanan who is the Director of the Office of Research Support Services from Marshfield Clinic Research Institute. Drs. Roth, Hubach, and Shrestha are alumni of Fordham’s HIV and Drug Abuse Prevention Research Ethics Training Institute, which is directed by Dr. Celia Fisher.

The Opioid-Related Overdose Crises in the Era of COVID-19: Implications for mHealth

Dr. Alexis Roth began the discussion with the implications of opioid-related overdose crises in the era of COVID-19 for mHealth. mHealth refers to using mobile devices in medicine and public health through applications. This helps provide clinical health data about communities. In terms of the opioid crisis, people are more likely to die when they are using alone. Dr. Roth has developed BiosensOD, which is a biosensor to monitor physiological sings of opioid use. Using the Zinberg framework for the study, they looked at how the mindset of the person and the physical and social setting the drug was taken influences drug outcomes. They incorporated the biosensor to understand how the use of it might be perceived within the context of the participants’ lives. The participants were excited about this development and felt that the benefits outweigh the risks.

Use of mHealth within Rural Populations

Dr. Randolph Hubach followed with a discussion of the use of mHealth within rural populations. Rural communities experience barriers to medical and mental health care, and they are less likely to engage in care and have access to care. These communities experience higher rates of substance use and mental health issues. Dr. Hubach’s research examines possible issues with mHealth, especially in rural communities. Issues for this community include privacy and confidentiality, as well as the need for research and care to be culturally responsive and respectful. For example, the way in which notifications and information are presented on the phone is extremely important in order to protect the privacy of study participants.

Use Mobile Technologies for HIV Prevention: Case Example from Malaysia

Dr. Roman Shrestha described how mobile technologies can be helpful for HIV prevention by using a case example from Malaysia. Dr. Shrestha’s research focuses on men who have sex with men and he is working on developing a mobile app for HIV prevention. He plans to use the app to provide information on HIV testing and PrEP care using tailored messages and forums. Since mobile apps capture a wide range of data from the users, there are many ethical challenges of using app platforms. Challenges to doing research on mobile apps for HIV prevention include privacy (i.e. who owns the data), data storage and sharing, communication of results, regulation of mHealth products, access to technology, informed consent, and more. In terms of informed consent specifically, how the information is explained and disseminated is extremely important due to cultural differences and understandings among this population and the scientific community.

In terms of the use of mHealth apps, all panelists emphasized the importance of acknowledging the culture the technology is being developed in and applied to. The apps must reflect the culture the participants are embedded in for them to be useful. This means acknowledging the privacy concerns of participants including notifications will appear on a screen, for example. For many communities, including rural and international ones, there is a fear of stigma or danger that using these apps may expose or “out” individuals to police or others. Researchers and developers must be cognizant of these ethical issues.

To register for the next two panels of the Fordham University Center for Ethics Education‘s Advancing Health and Social Justice Web Series, please use this Google Doc or visit: https://docs.google.com/forms/d/e/1FAIpQLSd3YeAUwmHqVuJXR74PL0kP-xu42_K88XvEYKhtKzgzkT6dmg/viewform.

For questions on the series, please email Steven Swartzer, Associate Director of Academic Programs at sswartzer@fordham.edu.