Mobilizing Health and Work: Investigating the Role of Mobile Instant Messaging (MIM) as a Community Medium for Health Information Acquisition Among Thai Low-Income Workers

In recent years, the number of Thai low-income workers has kept growing, especially workers who work abroad, however, improving their life by connecting them with the government via the MIM (Mobile Instant Messaging) community platform has still not yet been studied. Previously studies were limited to the aspect of the worker’s life in healthcare services. This study had two aims. First, could anonymity help engage Thai low-income workers to seek health information or work-related information from the government through the MIM community platform? Second, how the MIM community platform helps improve their quality of life in perceiving information. We conducted the survey through questionnaires and interviews focusing on health information and work-related information perceptiveness of workers after being introduced to the MIM community platform (also known as LINE Open Chat). The preliminary results showed that the MIM community, on the user’s side, gives a sense of security due to its anonymity feature and sense of trust for real-time responses along with the sense of belonging from the MIM community model. On managerial contribution, the MIM is cheaper and more convenient for the government to manage. We also included group size suggestion, which is limited based on the purpose of information perceptiveness, to reduce information overload and confusion.


INTRODUCTION
In Thailand, the number of mobile user's numbers keeps increasing each year and now we are one of the most online user countries in Asia [22,36].With the huge number of users, it leads to the power of having social media with them in their daily life.Many surveys and studies found that online users in Thailand keep increasing each year and the trend of using a mobile phone is enormous [22,25,36].
One of the affordances of social media frequently used, which we assume that maybe tight with the increasing number of online users, is "anonymity" [2,35].Anonymity, is used to help people keep their privacy and then at the same time can encourage users to seek out help and speak with each other even though they are strangers [38].In this case, anonymity can help encourage Low-Income Thai workers, to seek out help via instant message social media without feeling intimidated.
Along with the communicative affordances, these affordances can help promote "Line Open Chat", the most popular Mobile Instant Message application in Thailand, to be the online community that might benefit Thai workers, who want to obtain information regarding government policy and work-related.
For the methods, we will start with the pre-observation among Thai workers in Thailand, as they are our sample to find what they think and what they are looking for from a Mobile Instant Message (MIM) in terms of helping them with perceiving information.By doing so, we used "Line Open Chat" to form the Thai worker community in the position of helping them to get important information in terms of work-related or government policy whether working as a domestic or alien worker.
The purpose of this research, the objective is to find how to improve the quality of life of Thai workers who live abroad.The result of this study, which we think would be very useful, is not only for the Thai workers who live in Taiwan but also be useful for Thai workers, who decide to work or settle their lives in other countries.
Moreover, the findings of this study can also be useful for the governments of both sides, Thailand's and other country's governments (i.e.Taiwan), to use as a piece of information on how to manage, help or deal with migrant Thai workers in their countries.
The rest of this paper is organized as follows.Section 2 provides a review of prior research and related theory.Tools and methods used in our system are introduced in Section 3 The findings of this study are shown in Section 4. The conclusion of this research is given in Section 5. Finally, Section 5 formally details the disclosure and conflicts of interest.

RELATED WORK 2.1 Migrant low-income worker
Migrant workers are referring to individuals, who work outside their home country or country of origin whether in required-skill or unrequired-skill jobs.However, being outsiders in the destination country, migrant workers can be considered a disadvantaged group of people with lower status along with socio-status and economic inequality and it is quite a struggle for migrants to maintain their health or well-being over time.Exiting research discovered that immigrant workers, especially Low-income, often possess and associate with the characteristic package that sets them apart from the local population, which can range from ethnicity, language, income, culture, occupation, education, legal and social status.When it comes to information seeking, immigrants often face the feeling of left out and struggling due to the source of information needed is being too localized [10].Migrant workers, usually, get criticized for how well they would take care of themselves during their time working regarding their vulnerability to health-related problems due to their low economic status, education level, health insurance status, immigration status, and cultural differences.Recently studies in the past on immigration status from migrant workers' self-report health outcomes, found four factors associated with poor self-care regarding healthcare services access including limited employment rights, restricted access to healthcare and social welfare in destination countries, undocumented migrants (legal status) and national health insurance status [4], [32].International migrant workers are often faced with barriers to healthcare services in the country to which they migrate due to their immigration status.Moreover, obtaining legal status can be to hassle for migrant workers with many documents preparation that often force them to enter the host country illegally and end up in jobs known as 3D for "Dirty, Difficult, and Dangerous".Additionally, for those reasons, migrant workers usually being unaware of laws and their rights regarding healthcare benefits, which leads to poor access to healthcare services [1], [6].

Contextual Factors on
2.2.2 Language and Cultural differences.Studies relating to immigrant workers indicated that language difference is the contributing factor that makes migrants face with many problems including lack of health seeking and illness, poor adaptation to stress, and lower socioeconomic status.Language barriers were also associated with all health-influencing factors regarding immigrant women [41], [15].Non-native language speakers often reported struggling and are unable to understand oral or written instructions or communicate to ask questions in a request for assistance regarding their health or wellbeing-related issues.For example, the language used appears to be a significant contributor to online health information seeking among Hispanic adults living in the US [31].The language barrier often leads migrant workers to avoid searching from one source to another source that they are familiar with or feel related to instead, even if that source is sometimes considered less trustfulness than the former one [24].When migrants to the destination country, the workers do require medical check-ups or follow-ups with health reports however, their lack of experience in using resources in the health care system is a considerable severe problem due to their economic situation and language barriers [40].
Despite the advantages of being an international labor migration, migrant workers are still faced with many challenges in their daily life, including modern slavery, discrimination, contract violations, abuse and exploitation, unsafe working conditions, and difficulties in acculturation and adapting to destination countries.The difficulties that most migrant workers face, especially those in unrequired skilled jobs, can be able to critically affect both their physical and mental health [18], [5].A study about breast cancer detection in South Asian women discovered that stress coming from language barriers, socioeconomic status, and difficulties in adapting to a new life with the new environment are all affecting factors related to health both psychologically and physiologically for women migrant labor.The study also found that Thai migrant women who immigrated to the US did not think of themselves as a sensible group to disease and basically did not consider engaging in any health-related activities including health-promoting and disease-preventative behaviors [9].

Economic and Social status.
Inequalities are widespread and persistent; they exist across virtually all contexts, measures of health, and socio-economic status.Therefore, those with higher incomes enjoy longer and healthier lives than those with lower incomes.When some crises arise, such as the Great Recession or pandemic, the government or society would express concerns that socioeconomic disparities in health would be exacerbated, i.e. that the health and socioeconomic status of the most vulnerable members of society might be disproportionally hit [41].
Teo M.'s [37] study found that people in the low-income occupation with low socio-economic status have limited resources for taking preparedness and response actions in needed events and their economic background can influence their information-seeking behavior, unmistakably that income is counted as a significant playing role in information seeking.

Anonymity in the MIM
Anonymity is the degree to evaluate a communication to which a communicator perceives the message source as being unknown and unspecified [3].Being anonymous in the MIM can be counted as one way of encouraging people to reach out to initiate communication.Especially, minority people, who are often faced with the threat of being discriminated against while being online.In our case, being a low-income worker can be a drawback for them to expose themselves online even for doing information seeking.Therefore, it is quite challenging to go out of their comfort zone to ask for information freely regarding their status [16].
For Mobile instant message communicative affordance of availability, anonymity can be thought of as a way to increase frequency and engagement.In terms of keeping the user's identity secret which can help create security feelings within low-income workers to act on searching for information with more comfortable feeling and ease [14].

Health Information seeking
Health information seeking has been described as an action or effort of an individual in searching for information to fulfill an instructive need or objective goal.Regularly, this behavior is started considering vulnerability related to one's well-being or health.Studies of online health information seeking until now, have been conducted to investigate information seeking related to many problems including cancer, eating disorders, or health care information required [21].
Online health information seeking requires the skills necessary to locate and assess the credibility of information sources.Factors correlated with negative health information seeking and information overload are health literacy, education level, cognitive effort, anxiety and lower confidence in seeking health information, poor searching skills, greater concern about the quality of information, low socioeconomic status, and race [19], [42].
Health Literacy is the level or degree to which users or individuals can process, understand, obtain, and communicate to be informed about health-related information in making health decisions, and limited health literacy level can be associated with many healthcare services access problems [23].According to Kugbey [20] found that access to healthcare information is linked to health literacy.Poor health literacy is associated with poor use of health care and health information overload.The greater your literacy skills the better online health information seeking.
Minority people with low health literacy or poor access to health information sources like migrant low-income workers do not recognize their needs and can be limited by the use of online health information [28].People with low health literacy, even if represented with high eHealth literacy degrees, happened to be less in choosing on well-established, instead, they are relying more on non-established ones compared with the high health literacy group [13].

Online information platform
In the past, the most popular platforms, and channels for Thai people to seek online health information included national healthcare hotline numbers, newspapers, television, local community or local medical centers, and hospitals.For low-income workers, who had limited sources of income and resources, the local community or local medical center and hospital would be their best choice for health information seeking.However, as the internet became more and more important and considered very popular among Thai people, low-income workers also changed their behavior and choice of platforms over time.
From our preliminary results in the survey, even if low-income workers did own smartphones or devices, they still struggle with trusting or searching for important information through the internet including health-related information.The preliminary result of our study has consisted of the key point finding from Powe [29] which suggested that "Traditional sources of information such printed materials, television, and radio should be incorporated with Internet sources to provide a multiplatform approach for health information sharing".

Health Information seeking categories
Health information-seeking categories are the types of content for the way it presents health information for individuals to seek to follow their own needs.The difference between each category can be defined by the information-writing or content-generating styles, which fall into four categories.
Storytelling and General health information: The study, examines Social Media users' attention to simulated Facebook and Twitter posts, and finds that health information in general writing style is much preferred for health-promoting in terms of sharing rates while health information including serious symptoms would be preferred by users when it is in personal storytelling or narrative form [8].
Question-and-answer (Q&A) information: Health information is generated by starting from question posting to answers written by members of the same community.A study on the Yahoo!Answers platform found that the answers that were written by a health professional are likely to be chosen as the best answer while the identity of both the respondent and the stance can affect the trustworthiness of the answers [34].
Patient-center with evidence health information: A study about Knowledge gaps and information seeking by parents about hypospadias [7] discovered that parents, who have children in need of surgery, prefer reliable information with high-quality and clear evidence about hypospadias.Parents viewed this type of information as the source that would help them to do the health decision-making regarding surgery for it should be with high quality and detailed images of hypospadias cases.
Expert-generated and Peer-generated information: These two information categories, in some ways, can be considered information platforms.Different platforms for different patients' studies [33] found that emotional support and sharing related to health information appeared more on peer-generated information platforms than it is on expert-generated information, however, informational support profoundly appeared on expert-generated information platforms instead of appearing on the former platform.

Health information and Information seeking behaviors
The study about information-seeking behaviors of a health disparities population served by a community center in North Philadelphia comes to term that users' information-seeking behaviors can be described into three general categories: "Caregiver, " "Sufferer, " and for information services to be successful, it needs to be created with the preferences of users when performing information-seeking and habits in mind [12].Factors that have an effect on health information-seeking behaviors range from age, race, education, socioeconomic status, region, perceived health, self-esteem, and cultural adaptation [17,39], these factors are also related and consistent with the contextual factors on migrant health informationseeking behavior.
All the reviews on the above led us to have a clear picture that because of their life situation and environment, anything regarding health might not be in their mind or concern for migrant workers unless it already happened.However, for the example situation like COVID-19 that requires information perceived to be able to prevent and protect yourself, it requests us to reach first for the information.Even though, there are studies about low-income workers looking for healthcare services or information.However, there is no talking or insight explanation of how low-income workers would prefer to do in seeking health information and work-related information regarding their being a migrant in the host country and how digital community technology like Mobile Instant Messaging (MIM) helps them to receive information.
Therefore, it is worth investigating on: (1) What do migrant low-income workers think and do in searching for health information?(2) If there are any contextual effects from their living life on how they are doing health-related information seeking.(3) How would they react and feel when they have to do healthinformation searching?(4) What kind of health information-seeking migrant low-income workers would prefer?(5) How do low-income workers do while searching for workrelated information?(6) How does digital community technology like LINE Open chat help them in searching for information?(7) Would anonymity affordance in LINE open chat help them in reaching out first for information?Especially, when migrant low-income workers are surrounded by not-so-motivated surroundings and face too limited resources to encourage them to do the health and work-related information seeking.

DESIGN
Personal interview on how migrant Thai low-income workers do health and work-related information seeking.Explanatory design interview questions for health information seeking, health information literacy, and work-related information were developed based on Powe's [26] and Rao's [30] research.While explanatory design interview questions for motivated emotion on health information seeking and work-related information seeking were developed from the results of Myrick's study [26].Explanatory design interview questions for provided categories were using developed sequential explanatory personal interview questions from Nokes's [27] and Creswell's [11] work.In terms of providing, an understanding of what health information-seeking category will the migrant low-income worker preferred that might affect their choice about whether to use the internet for health information seeking.

Sampling
Participants were six Thai low-income workers and four migrant Thai low-income workers, who met the following criteria including low wages, long hours, a lack of health insurance, and individual characteristics (immigration status, duration of presence in Taiwan, economic status, language ability, and level of experience in performing health information seeking).
• Thai citizen • Obtain an ARC and the duration of staying in Taiwan.
• Living with minimum income or lower than average wage (For workers, who reside in Thailand, would use these criteria: giving around 300 baht per day or 9,000 baht per month and working longer than 8 hours a day.For a worker, who is working in Taiwan, NTD 23,800 NTD 49,000 per month and working long hours then 8 hours will be an indicator of low-income status.) • Able to speak, read, and understand Thai.
• Have experience in online health information and workrelated information seeking.• Non-higher education (Lower than bachelor's degree) • Enrolled in any public assistance health insurance program, need assistance with health insurance or no insurance.• Have experience in seeking help with work-related document preparation.

Data Collection
Conducted an in-depth personal interview with each participant using a voice recorder and field notes.The data will be analyzed by thematic analysis and the interviewing transcripts will be transcribed from an audio recorder for analysis.The transcripts of the interviews were coded for the purpose of finding the answers to research questions following the code and scope from the literature and relevant paper review.

Analysis
We used thematic analysis to determine a theme that could emerge for the interview transcript including: (1) Repetition of a concept in all health and work-related information categories.(2) Extensive discussion by the participants on the explanatory question.(3) Emotional and body expression while performing a task.(4) Associations that arose through the comparison of similarities and differences between the participants [27].
Health information seeking, health information literacy, and workrelated information seeking will determine a concept following Rao's [30] summary of online searching for health information and work-related information.

FINDINGS
From the interview, we found that Thai low-income workers did struggle with a way to find information.They felt that seeking health or work-related information can be a hassle and sometimes consume too much time which can cost them money from taking a day off to contact government officials.As mentioned, there is an uneasy feeling about being a low-income worker which comes with negative stereotype traits.This is the key reason why online information seeking can be helpful in undergoing this research.
The MIM community platform like Open Chat, after getting introduced to how to use this platform, the worker, who is our participant found this platform is acceptable.Their opinions align in terms of how useful it is to come with anonymity affordance to which they feel more secure and at ease to ask for information.Especially, being an instant message-based communication, it gives a sense of reliability and trust to workers while using it.At the same time, there is a sense of belonging when met with a chat room made specifically for people like them.Therefore, their decision to use this platform is positive.
In conclusion, the implication of this study can be helpful for low-income workers, the low-income worker community, health information providers, and employers to work together in creating the appropriate health information platform and work-related information sources that are suitable for the minority, like low-income workers to reach out and get what information that they need on their own without limitation.

CONCLUSIONS
This study highlights the importance of developing appropriate health information platforms and work-related information sources for low-income workers.By understanding their unique needs and challenges, collaboration between low-income workers, worker communities, health information providers, and employers can lead to the creation of inclusive platforms that empower low-income workers to access the information they require independently.This research has implications for improving the overall well-being and empowerment of low-income workers and addressing the limitations they face in seeking relevant information.

DISCLOSURE AND CONFLICTS OF INTEREST
This research has been applied for the IRB from the National Tsing Hua University Research Ethics Office.The reference number of the IRB in this research is REC 10907HS074.The authors have no conflicts of interest to declare.We certify that the submission is original work and is not under review at any other publication.