Background:
Digital health communication is increasingly used to support cancer prevention and early detection. In low- and middle-income countries, however, unequal access to mobile phones, smartphones, and internet connectivity may limit reach and risk exacerbating existing health inequities. Ethiopia is undergoing rapid digitalization, yet comparative evidence on readiness for phone-based and messenger-based health communication across urban and peripheral settings remains limited. Such evidence is essential for designing equitable digital strategies for cancer awareness, including breast and cervical cancer.

Objectives:
To compare access to mobile phones and smartphones, messenger application use, and perceived usefulness and interest in receiving digital health information via SMS and messenger applications between urban Addis Ababa and peripheral Ethiopian settings, and to derive implications for equitable digital cancer communication and implementation research.

Methods:
We analysed data from two community-based cross-sectional surveys. Urban data were drawn in 11/12 2024 from the COMBAT cohort in Addis Ababa (n=4007 household heads). Peripheral data were collected between 03/04 2025 among women aged ≥18 years residing in the catchment areas of six primary health centres in Oromia and the Central Ethiopia Regional State (n=431). Multi-stage cluster sampling was applied using health posts and household family registers as sampling frames. Participants reported mobile phone and smartphone ownership or access, use of common messenger applications, perceived usefulness of digital health information, and interest in receiving health information via SMS and messenger apps. Analyses are descriptive and comparative, focusing on structural and attitudinal indicators relevant for equitable intervention design.

Results:
Household mobile phone ownership was high in both settings but lower in peripheral areas (Addis Ababa: 96.9% vs peripheral: 83.5%). Smartphone access showed pronounced inequities, with substantially higher availability in Addis Ababa (56.8%) than in peripheral settings (22.4%). Interest in receiving health information via SMS was high in both settings (69.8% in Addis Ababa; 60.9% in peripheral areas), but uncertainty differed markedly: 6.7% of participants in Addis Ababa were undecided compared with 18.6% in peripheral settings. Interest in messenger-based health information was similar overall (45.3% in Addis Ababa; 44.1% in peripheral areas); however, uncertainty was substantially higher in peripheral populations (24.8% vs 16.1%). Telegram was the most frequently used messenger in both settings, followed by Facebook Messenger and WhatsApp, with consistently lower usage in peripheral areas. Previous urban analyses indicate strong age-related gradients in access and interest; age-stratified analyses for peripheral settings are ongoing.

Conclusions / Implications:
Urban–peripheral inequities in smartphone access and digital familiarity represent a key constraint for equitable digital cancer communication in Ethiopia. High interest in SMS across settings supports SMS as an inclusive backbone channel, while higher uncertainty and lower access in peripheral areas suggest that messenger-based approaches should be implemented selectively and alongside supportive measures such as digital health literacy and gradual exposure. Hybrid strategies combining SMS with optional messenger-based content may maximize reach while remaining adaptable to evolving user habits. Explicit attention to equity, context, and readiness is essential to ensure that digital cancer communication strengthens prevention and early detection without widening disparities.

Access and Interest in Digital Health Information in Ethiopia