Concerns and questions associated with GPS use from focus groups.
Men and women alike responded positively and affirmatively about their willingness to use a GPS unit for a period of a month. The list of concerns was long in all groups, but the level of concern overall was low. The two main concerns (issues brought up most frequently and discussed most extensively in all groups) were 1) whether the GPS unit could tape their conversations or in some way record what they were doing, and 2) how to charge, properly handle, and use the unit. Other concerns raised in most groups, but not all, included health/safety, confidentiality/privacy, responsibility for the unit, and compensation or personal benefit for using the GPS unit ().
Questions and concerns regarding use of a global positioning system device reported as number of groups in which the issue was discussed at least once, Iquitos, Peru
Although each focus group discussion started with a brief description of what the GPS units were and how they were used, as we handed out a unit for participants to hold, we had to clearly emphasize numerous times in each group that the GPS unit could not audio- or videotape them in any way. Despite this assurance, in most groups, people repeatedly asked whether we would be able to hear conversations they had or see with whom or where they had been. Also, in the three focus groups with young men (18–30 years old), they asked about us being able to hear or see them in real time and possibly spy on them or track them.
The other main concern was whether the participants would receive adequate instructions for caring for and using the units correctly. Some questions related to charging the unit: how and how often and how would they know to charge it? Most participants indicated they would be willing to charge the units themselves with proper instruction, with the exception of older women, most of whom preferred that it be charged for them because they might forget, but also because of a concern that they would charge it incorrectly. There was also extensive concern about accidentally turning the units off, especially by those with small, curious children around. They wanted to know if they would be taught how to recognize when it was off and how to turn it back on. There was also discussion, among men and women of all ages, as well as mothers of 3–8-year-old children, about the durability of the GPS unit. They were concerned that the unit would not withstand being exposed to heavy rains, water (for those who work on the river and sometimes get wet), heat, or sweat. Finally, there were numerous questions about whether they had to use the unit constantly, or if they could take it off periodically, such as when at home. In a few groups, people asked about unit use when outside of city limits, concerned that the unit might not pick up a signal outside of Iquitos or that they would not be around when the unit needed to be charged.
Health questions were broad, such as whether using the GPS units could be harmful in any way to one's health, as well as specific, such as whether prolonged use could cause fertility problems, cancer, heart problems, skin irritation, affect one's organs, or even attract lightning. Mothers of young children, who did not have any specific concerns about having their children use the GPS units, instead expressed concern about what their child might do to the unit. Despite the numerous health-related questions, the level of concern was low.
Participants also expressed concern that the research team, family members, bosses, or friends might find out personal things about them, including the possibility that a family member or friend might download information from the unit. We explained that only the research team would be able to download the data from the GPS units, and that this information would not be shared with anyone. Moreover, the data would show us where they were at (location), but we would not be able to know who they were with, what they were doing, or what relationship they had with that person, nor would this information be shared with anyone else. We also clarified that although the research team would be able to reconstruct where the user had gone while wearing the GPS unit, we would not be able to track them in real time. The reverse was the case in one of the mother's groups (3–8 year-old children): they were not concerned about the confidentiality of the data for their children, but rather were interested in seeing the data. We explained that all data would be confidential, including the children's data.
There were a few other issues discussed in some focus groups that warrant mentioning. In most of the men's groups, at least one man asked what they would personally get from using a unit. Other men in the group would often respond to those men about the benefit to the community to reduce dengue. However, there seemed to be agreement that it would be nice for them to get something for our role in this study that benefits their community. This issue of personal benefit or compensation did not come up in any of the women's groups. Related to this point, we did provide a gift basket with toiletries or food items to all participants in the pilot study as an incentive to improve compliance.
Another observed difference in the responses seemed to be related to age and sex. All men in the younger age group (18–30 years old) responded that they would be willing to use the GPS, but further probing revealed that some of them might initially accept the GPS, but not actually use it properly. Several mentioned that it was likely that some young men might initially act serious and consent to the use in front of the researchers, but subsequently might not actually take the GPS seriously.
Possibly related to responsible use of the GPS unit based on the flow of the discussions, in all of the young men's groups (18–30 years old), there were questions about who was responsible for the unit if it got lost, and whether participants would have to pay for a lost or stolen unit. In various groups, we were asked if the people receiving the GPS unit would be asked to sign a contract committing to wearing it and returning it when it was requested back. Young men, in particular, felt that issues of responsibility for the unit and whether one would still get a gift for participating in the study if the GPS was lost or stolen should be clearly stated in this contract.
In some women's groups, women commented that jealousy from their partners/spouses might be a problem: some men might not trust that their wives had been asked to participate in a study and might not believe this was a GPS unit to reconstruct where they had been. They suggested that the research team either invite the woman to participate in the presence of her partner, or that the research team give out some type of document that provided evidence that this GPS unit was part of a research study, which was done in the pilot study. In a few groups, men and women discussed the fact that those selected to use GPS units might actually gain status in the community and that others might also want to use a GPS and might be concerned that they were not selected to use this novel technological device.
Several women's and men's groups talked about ways to protect the unit from being stolen, focusing on ways in which they could wear the unit in inconspicuous ways. However, the issue of the user's safety only came up in one of the men's groups and the mothers of 8–18-year-old children. The men's group participants discussed their concern about being harmed by others who might want to steal the GPS unit.
In most of the men's focus groups, there were typically one or two men who had already heard of or even used GPS technology. Among the younger men (18–30 years old), they might have heard about it or seen one used in a movie. Among the older men (31–45 and 46–59 years old), some men had seen them used or used them themselves in their jobs, such as to reference locations (logging industry or road construction), and a few had seen them used in movies.
Other issues discussed with less frequency and intensity included whether the GPS unit might interfere with other electronic devices in their homes or vice versa, that the operation of an electronic device near the GPS unit might interfere with its functioning, and what the effect of overheating might be on the unit.
Although mothers of children 3–8 years of age asked whether GPS units could have negative health effects on their child, they seemed much more concerned about what their child might do to the unit or not use it. In general, mothers felt that they would have to remind their children to wear it on a daily basis.
Suggestions regarding how to wear the GPS unit for an extended period of time.
During the focus groups, we explored ideas regarding the most comfortable and convenient way to use a GPS unit for 14–30 days. Responses varied by age and sex, and the discussions about options centered around carrying the GPS unit in a way that was convenient (i.e., keeping one's hands free, not forgetting it), safe from possible theft, and that did not draw attention to it. The top choices included wearing it on a strap around one's neck (lanyard) or on a waist belt-clip. There were few disadvantages discussed about the lanyard, and among the younger persons (18–30 years old), we were told this is actually a fashionable way to carry one's cell phone. The waist belt-clip was a popular choice for men because many carry their cell phones this way. Another suggestion was to carry it in one's secret pocket (most women and many men have a pocket sewn into their clothes to carry their money, usually located near the waist band) or in a woman's bra.
When we asked about how children 8–18 years of age might carry it, mothers felt that having their young daughters carry it in a small purse (12–18 years old) or small, bright backpack (8–12 year old) would work, but also noted that there were many times of day when their daughters may go somewhere without their purse. Mothers of girls 8–18 years of age also felt that their daughters could be convinced to use and care for it properly. However, mothers of 8–18 year-old boys coincided with mothers of children 3–8 years of age that the only way to ensure their children wore it was to sew it into the clothes, but felt that it might work to have the boys wear it on a lanyard under their clothes. The suggestion of sewing it on or into the clothes was strongly supported by most women, who also did not think it would be much of an inconvenience to sew in the GPS to their child's clothes on a daily basis.
Based on insights provided by participants in focus groups, we identified a commercially available GPS device that met most of our key criteria (I-GotU 100; Mobile Action Technologies, Taipei, Taiwan) (). These units had the longest battery life for their size in the market (approximately 3 days at a 2.5-minute collection interval), had memory for capturing 16,000 tracks, were small and lightweight (< 5 cm and 21 grams), were water-resistant, and enabled password protection for safeguard of personal GPS data.19
Based on consensus across focus groups, we distributed GPS units with lanyards for persons to carry around their necks.
Only 2 persons (1.6%) considered for participation declined; a 23-year-old man who was interested in using the GPS unit but did not want to be interviewed, and a 35-year-old man who was going to be traveling and not be home for unit exchange. Questions asked by participants when GPS units were distributed and exchanged were similar to those voiced in the focus group discussions and covered in the pamphlet. During GPS unit exchange, questions similar to those asked in focus groups were repeated, although one new question focused on a flickering of light that the GPS emitted regularly: whether this light could cause cancer or whether this light was dangerous for pregnant women.
All participants reported using the GPS device when they had them and some admitted they did not use the devices occasionally (e.g., for an afternoon) either because they thought it was no longer working, it was due for exchange, or they simply forgot. Overall, 9.6% of the times GPS units were issued (i.e., new units were issued every three days), participants reported forgetting or not using the unit at least once in the 14–30-day period. Forty-four percent of participants reported forgetting or not using the GPS on at least one occasion, and 16% on more than one occasion. There was a significant positive relationship between the length of the observation period and the frequency devices were forgotten (P <
0.01), with 35% of participants forgetting the device at least once when required to carry it for two weeks versus 52% when using it for one month. Only those carrying devices for one month forgot to use them on more than three occasions (5% of participants). Men reported forgetting to use the GPS less often than women (P
= 0.03) and middle-aged (31–45 years of age) participants tended to be less likely to report forgetting than other age groups, although this was not significant (P
= 0.08). Examination of the GPS tracking records () indicated that all participants did carry units with them because multiple locations in their tracking records are identifiable (defined as > 5 points recorded by the GPS occurring within 100 meters of each other, when points were recorded every 2.5 minutes). Based on our preliminary analysis, most instances in which devices did not record points or indicate movement were caused by the devices not tracking as opposed to participants not using them on a continuous basis.19
Daily individual mobility pattern for a randomly selected resident of Iquitos, Peru, tracked with a global positioning system for a 15-day period during September–October 2008.
To explore GPS non-use more thoroughly, we asked research assistants who recruited and exchanged GPS units for input on non-use based on their observations and interactions with participants. They reported that the pilot study participants openly admitted to not using GPS units at times. The two most common reasons were 1) forgetfulness when rushing out for a specific activity, and 2) specifically among young men, embarrassment about some of the places where they went. One young man specifically admitted that despite being assured that the GPS did not tape, he did not use it to visit his lover because of this concern. Another reason given by a few persons was that in the comfort of a relative's home, they took off the GPS unit and then forgot it was there. There were two mentions of security. One man who liked to drink admitted he was concerned that his drinking friends would want to steal the GPS unit, and another man stated that someone had tried to rob him and he felt it was because the GPS emitted a light that made the thief think he had a digital camera around his neck.
A serious concern was shown by participants about making sure that the GPS unit was working properly. One person stopped wearing his unit because he thought, correctly, that the GPS unit had been accidentally turned off when it stopped emitting the light. During the first days of the pilot trial, before we deactivated the button that could accidentally turn off the GPS, a few GPS units were accidentally turned off, and in a few occasions, participants asked about or sent back their GPS units when they thought it was not working properly because the units had a flashing red light.