Mobile Phone Ownership, Internet Access, and Frequency of Use as Predictors of Healthcare Facility Contact Across Africa: A Sequential Regression Analysis and Test of Effect Modification by Lived Poverty

Background: Mobile technologies are increasingly viewed as tools for connecting African populations with healthcare systems, yet whether phone ownership, internet access, and frequency of use are independently related to healthcare contact, after accounting for socioeconomic, demographic, and regional differences, remains unclear. Methods: We analysed pooled cross-sectional data of 44,761 respondents in Round 8 of the Afrobarometer survey across five regions in Africa. The outcome variable was self-reported contact with a public clinic or hospital in the previous 12months. Primary exposures were phone ownership, phone-based internet access, and frequency of phone use. Sequential multivariable logistic regression models assessed their independent relationships before and after adjustment for age, sex, education, religion, rural residence, and African region. A separate model examined whether lived poverty modified the relationship between internet access and healthcare contact using poverty-by-internet-access interaction terms. Results: Overall, 61.1% of respondents reported contact with a public clinic or hospital in the last 12months. Phone ownership was not independently related to contact after full adjustment (AOR=1.054, 95% CI 0.950-1.170; p=.268). Internet access was positively linked with contact after full adjustment (AOR=1.081, 95% CI 1.033-1.131; p< 0.001), despite an inverse relationship before adjustment (AOR=0.850, 95% CI 0.818-0.883). Frequency of use showed the most consistent relationship, with daily users having higher odds of contact than never-users (AOR=1.217, 95% CI 1.091-1.357). Lived poverty was independently related to contact with healthcare facility, with the highest odds among those reporting moderate poverty (AOR=1.709, 95% CI 1.528-1.911), but did not modify the internet access-contact relationship (all interaction p≥.553). Regional disparities were substantial, with lower odds of contact found in Northern Africa than in West Africa (AOR=0.411-0.437 across models). Conclusion: Mobile-phone engagement dimensions showed distinct links with healthcare contact. Frequency of use was most consistently related, while internet access showed a positive connection after covariate and factor adjustment; phone ownership alone was not independently related. The absence of effect modification by lived poverty suggests no detectable heterogeneity in the internet access-contact link across poverty levels. Persistent regional disparities highlight the importance of contextual determinants beyond mobile access.