Elaine Byrne

Contextuality of participation in IS design: a developing country perspective

Participatory approaches to information systems design have evolved over approximately the last three decades, mainly in Scandinavia, Europe, and lately in the US. However there has been limited and peripheral research and debates over participatory design approaches and techniques in developing country settings. This paper explores three case studies in developing countries where participatory approaches have been used in the design and implementation of health information systems. The investigation reveals the politics of design, the nature of participation, and the methods, tools and techniques for carrying out design projects are shaped with respect to the diversity of the socio-economic, cultural and political situations faced in each of these settings. Though common strategies, such as capacity development, could be found that cut across the three case studies it is the importance of the contextual nature of participatory design that emerges most strongly. There is no single algorithmic best practice regarding participatory design in information systems which is applicable to all situations.

Participatory design for social development: a South African case study on community-based health information systems

In this paper, the role of participation within the domains of information system (IS) research and social development is analyzed. Specifically, we examine how the process of IS development, and the IS itself, can reflect and shape the status of social development. Traditionally, participatory design (PD) research in IS has focused on business contexts in the Western world, with minimal application to developing country settings, especially in the context of social development. This paper seeks to contribute to developing these understandings and bases its analysis on a case study of a community-based health IS in South Africa. The case study involved the design and development of a community-based child health IS in a rural area of South Africa. Nationally, the formal district health IS in South Africa includes data only on those people who access health services through the health facilities. The premise behind developing a community-based child health IS was to include all the people living in that district in the district health IS. Analysis of the case study reveals three ways in which traditional PD needs reconceptualization. First, it is not only the users of the IS who should participate, but also those individuals who are affected by the IS, even when those individuals have no direct interaction with the system itself. Second, whereas there is some recognition in PD literature of the need for the participation of people at different levels vertically distributed within an organization, there has been little recognition of the value of involving actors outside the organization or sector. Third, the capacity of the users and those impacted by the system needs to be developed to ensure effective participation in the IS design and development processes. These three approaches to PD in IS, whose purpose is to contribute to social development, are essential components of a participatory strategy.

The role of identity in health information systems development: a case analysis from Mozambique

There is a need to look beyond the immediate process of implementation of computerized information systems to understand the broader social context in which the information and communication technology is being implemented. Using an interpretive approach to the implementation of a computerized health information system in a rural district in Mozambique we reconstruct an important aspect of this context from our interviews and observations—how the process of collective identity formation and information systems implementation are interconnected. Using this understanding of collective identity, we emphasize the importance of communication and shared meanings in developing and extending the primary health care network and in the successful implementation of a computerized health information system.

Information communication technologies and the millennium development goals

This special issue of the Journal of Information Technology for Development focuses on specific cases of how information and communication technologies (ICTs) can facilitate the attainment of the millennium development goals (MDGs). As a result, perhaps we are subject to the criticism of jumping on the MDG bandwagon – “the juggernaut of all bandwagons” (Saith, 2006). However, consideration of how ICT can serve developmental objectives and goals opens crucial debates. For instance, there is realistic skepticism on whether scarce resources should be used on ICT expenditure when there are so many competing priorities and the infrastructure for the effective and efficient utilization of ICT is often substandard (Thompson & Walsham, 2010). So why a special issue on the MDGs? We are nearly two-thirds of the way to the 2015 deadline of achieving the MDGs and the attainment of these goals remains elusive or “off-track.” ICTs have potential to contribute to meeting the MDGs as part of the MDGs themselves (Goal 8, Target 18) and/or impacting the achievement of other MDGs. ICTs can be used to more effectively tackle the MDGs through improved monitoring and surveillance systems on progress toward the MDGs, improving economic growth and reducing poverty, and more efficient and effective provision of basic social services (UNDP, 2008). However, the first full articulation of the MDGs (UN, 2000) was criticized for portraying a very narrow agenda for development. For example, MDG 1 can be critiqued for reducing poverty to those below the US

The small group subtlety of using ICT for participatory governance : a South African experience

1 a day income poverty line rather than inability to meet basic needs (Saith, 2006). Relative poverty positions and structural inequalities are not addressed. Additionally, it can be argued that like the precedents to the MDGs, they are subject to the same criticism – the MDGs remain hegemonic (“one-size-fit-all”). They were imposed by the north and are “denying developing countries the very paths to development that industrialised countries used” (Heeks, 2005, p. 9). Additionally, the measurement of progress, or lack thereof, toward the targets imposes huge data requirements on developing countries, in addition to requiring some form of baseline to start with. But, commitments to improving and assessing progress on human development are to be welcomed. The critiques above largely pertain to the reduction of the MDGs to these targets when assessing progress in development. To obtain a more accurate picture of the global developmental landscape necessitates an awareness of embedded structures, the influence of global and national economic, social and political powers and recognition that development is a global, not a developing country, issue. The papers in this issue illustrate that a contextualized, multi-disciplinary and multi-leveled approach to MDG attainment is required. Achieving the MDGs is not just a matter of measurement of the targets, but recognizing and integrating the social and cultural dimensions of development into an assessment of progress and embracing the opportunities ICTs can offer. The socio-technical focus of all the papers interrogates the goal-oriented vision of the MDGs and the complexity of assessing development through the measurement of the targets for each of these goals. Deeper understanding of the institutional logics embedded in ICT and information

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed

Abstract The greater number of government efforts to stimulate participative governance in communities using Information and Communication Technology (ICT) often fall short of expectations. In South Africa extending e-government to communities has been in the form of more and/or better equipped ICT-enabled community centres, called Thusong Service Centres. In this paper, based on action research experiences, we report outcomes of interpretive research into ICT-enabled approaches to participative governance in communities. Using the Diffusion of Innovations theory as an analytic lens, the findings reveal a subtlety that is not often mentioned in the call for participative e-governance; people from communities prefer to work in groups rather than individually. The collectiveness inclination is a common denominator of many developing countries where people choose to come together to leverage the few available resources. Individuals become apprehensive when made to work on their own using the ICT. The research reveals the necessity to re-design ICT to suit small groups as part of participative e-governance rather than the normative ICT design that suits individual work styles. Additionally, the research reveals that by working in groups, communities are more willing to accept the government initiatives that are being energised with the use of ICT. Methodologically, the research revealed the ethical issue that arises from action research in its raising of unrealistic expectations in a community.

A human environmentalist approach to diffusion in ICT policies: A case study of the FOSS policy of the South African Government

BackgroundUniversal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.DiscussionCommon demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented.SummaryWe suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

Peer interviewing in medical education research: experiences and perceptions of student interviewers and interviewees.

Purpose – Through an evaluation of the information technology (IT) adoption and diffusion models and the free and/or open source policy of the South African Government, the underlying assumption is that the developmental divide between those with and those without access to technology is purely technical. This paper aims to illustrate that if Free and/or Open Source Software is to be used as a building block to bridge the “digital divide” a more social and environmental perspective, which embraces the philosophy behind the software, needs to complement the technical perspective. The human environmental model is presented as a useful alternative which, if embraced, can inform more holistic information and communication technology (ICT) policies. Design/methodology/approach – Through a review of diffusion of innovations models an alternative diffusion framework is described and applied to an interpretive open source case study in South Africa. Findings – Contemporary diffusion and innovation models are narrowly focused on IT as a purely technological linear phenomenon. This perspective also underlies many ICT policies. A more socio‐technical adoption model can assist in providing a more holistic approach to ICT policy development. Originality/value – The application of a new innovation model, the human environmental model, to ICT policy provides a holistic framework in which the complexity of the innovation process can be reflected in policy. Such an approach to ICT policy formulation will assist with broadening the perspective of policy makers from IT as a technical solution to IT as part of a socio‐technical solution and recognise the duality of the innovation process.

Participatory Ethnographic Evaluation and Research Reflections on the Research Approach Used to Understand the Complexity of Maternal Health Issues in South Sudan

AbstractBackgroundInterviewing is one of the main methods used for data collection in qualitative research. This paper explores the use of semi-structured interviews that were conducted by students with other students in a research study looking at cultural diversity in an international medical school. Specifically this paper documents and gives ‘voice’ to the opinions and experiences of interviewees and interviewers (the peers and the communities) on the value of peer interviewing in the study and outlines (1) the preparation made to address some of the foreseen challenges, (2) the challenges still faced, and (3) the benefits of using peer interviews with respect to the research study, the individual and the institution.MethodsPeer interviewing was used as part of a two-year phased-study, 2012–2013, which explored and then measured the impact of cultural diversity on undergraduate students in a medical higher education institution in Ireland. In phase one 16 peer interviewers were recruited to conduct 29 semi-structured interviews with fellow students. In order to evaluate the peer interviewing process two focus group discussions were he ld and an online survey conducted.ResultsKey findings were that substantial preparations in relation to training, informed consent processes and addressing positionality are needed if peer-interviewing is to be used. Challenges still faced included were related to power, familiarity, trust and practical problems. However many benefits accrued to the research, the individual interviewer and to the university.ConclusionsA more nuanced approach to peer interviewing, that recognises commonalities and differences across a range of attributes, is needed. While peer interviewing has many benefits and can help reduce power differentials it does not eliminate all challenges. As part of a larger research project and as a way in which to get ‘buy-in’ from the student body and improve a collaborative research partnership peer interviewing was extremely useful.

The use of technology enhanced learning in health research capacity development: lessons from a cross country research partnership

Many methodological approaches have been used to understand cultural dimensions to maternal health issues. Although a well-designed quantitative survey with a representative sample can provide essential information on trends in behavior, it does not necessarily establish a contextualized understanding of the complexity in which different behaviors occur. This article addresses how contextualized data can be collected in a short time and under conditions in which participants in conflict-affected zones might not have established, or time to establish, trust with the researchers. The solution, the Participatory Ethnographic Evaluation and Research (PEER) approach, is illustrated through a study whereby South Sudanese marginalized women were trained to design research instruments, and collect and analyze qualitative data. PEER overcomes the problem that many ethnographic or participatory approaches face—the extensive time and resources required to develop trusting relationships with the community to understand the local context and the social networks they form.