Melissa Densmore

Leveraging Intermediated Interactions to Support Utilization of Persuasive Personal Health Informatics

Behavior change support systems (BCSS) and persuasive technologies for healthcare often entail users interacting with mobile devices. However, especially in developing countries, the target community is unfamiliar with and often intimidated by new technologies. In this paper we propose the use of intermediaries to facilitate interaction with a mobile phone-based application and to motivate ongoing use by the target beneficiaries. The application incentivizes utilization through gamification techniques, using badges, scoreboards, and other rewards. For example, a young girl might help her father keep track of his walking and diet, maintaining participation as much for her fathers health as for the social awards given by the app. We explain how intermediaries can be leveraged to improve utilization and engagement of the beneficiaries, and describe factors affecting interaction between the participating pairs and interaction with the application. This study highlights the importance of social rapport - typically through a familial relationship - as a key component of the intervention. Finally, we discuss the implications of designing for the motivation of two different users: gamification, personalization and utility play different roles for the intermediary and the beneficiary but ultimately combine to make a more effective application for the beneficiary than one targeting the beneficiary alone.

Apps and Skits: Enabling New Forms of Village-To-Clinic Feedback for Rural Health Education

We present the results of deploying a feedback mechanism in a community health education project, which enables rural-based nurses to elicit feedback from rural villages in order to improve their efforts in health education and service delivery in these areas. We implemented a mobile asynchronous-voice platform, through which Community Health Workers (CHWs) in rural Lesotho report previously unknown health challenges and knowledge gaps to the nurses, who then create new digital content and redesign service delivery to address these challenges. Beyond this, we also used role-play both as an additional feedback channel and a design tool. Our results demonstrate the combined benefits of implementing creative methods for effective human-to-technology and human-to-human communication in ways that enable new forms of expression; and highlight the importance of using role play in HCI4D contexts. We also present the benefits of incorporating an effective village-to-clinic feedback mechanism in health education programs.

The evolving braid: how an organization in Uganda achieved reliable communications

When engaged in ICTD research, it is often simpler to focus efforts on a single specific technology, whether that entails computers for telecenters, mobile phones for data collection, or text messages for public health education. In practice, however, people and organizations use a variety of technologies together, smoothly interweaving them as they navigate their lives. In this paper we analyze the ways in which a health financing organization in Uganda integrates a variety of communications technologies together to achieve reliable communications with their partnering health facilities distributed throughout Southwest Uganda. Based on four years of participant observation, we describe two communication scenarios in this organization to illustrate braided communications at work. We find that stakeholders work together to develop and maintain effective relationships using many different communications channels together in parallel, a combined channel we describe as braided communications. Braided communications have three primary characteristics. Firstly, they use co-existing channels, employing each as best suits a given set of goals. Secondly, they are co-dependent, or co-reinforcing, with strengths of individual channels reinforcing weaknesses of other channels. Finally, they are co-evolving; as available technologies and the ways in which they are used change, the nature of the braided use changes as well.

Designing with Community Health Workers: Enabling Productive Participation Through Exploration

In this paper, we present the results of an 18-month engagement with community health workers (CHWs) in Lesotho, through which we designed a feedback-integrated platform for community health education using mobile multimedia. We initiated a co-design process using participatory action research to empower CHWs to use their own knowledge and experiences to define our shared design and research agenda. We present our process and its outcomes, noting the importance of engaging with CHWs using techniques considerate of their literacy and experience, and the necessity of separating the concept from the artefact in the process of co-design. Further, we demonstrate how deep engagement and multiple participatory action research cycles give CHWs time to develop confidence and experience around the use of technology in their work. We argue that when CHWs are empowered to contribute their creativity and local experiences in this manner, the outcome is technology that is best suited for their unique context of work, in ways that would not be achieved using conventional approaches to co-design. Finally, we present early outcomes of the co-design efforts, articulating design requirements for a feedback mechanism for CHWs.

How to choose a mobile phone for an ICT4D project

At the beginning of an ICT4D project where mobile phones will be used, the question that researchers and practitioners ponder is: what mobile device will be best for the project? In this paper, we present guidelines for making this choice, based on lessons drawn from a review of 30 ICT4D projects, and the reflection of our own work with Community Health Workers in Lesotho in the last four years, during which we used three types of devices in the field. We discuss the considerations that can guide the process of selecting the best device or mobile platform for each project and context, and discuss the recent upsurge of smartphone preference over feature phones in ICT4D projects, and the factors to consider when selecting smartphones for fieldwork.

Video Consumption Patterns for First Time Smartphone Users: Community Health Workers in Lesotho

There is already strong evidence that mobile videos are a good vehicle for public health information dissemination, but there remain open questions around sustainability, appropriate target users, consumption patterns, content, and usage models. We analyse log and interview data of 42 community health workers (who were first time smartphone users) from a longitudinal 17-month deployment to better understand how the utility of mobile videos played out over time in rural Lesotho. During the study period, videos were viewed at an average of 170 times per month, for a total of 2898 views. Through this data we draw these primary findings: a) pausing is not contextually necessary, b) age is not a barrier to usage, c) the primary predictor of popularity of a given video is topical relevance and national campaigns, d) there is no apparent relationship between video length, popularity and completion rates, and e) new videos have only a short-lived novelty effect. Furthermore, we affirm that regular engagement with CHWs has an impact on continued usage, in addition to being important for reducing attrition due to technical issues.

Research Ethics in HCI: A Town Hall Meeting

As interactive technologies evolve and reach into every aspect of modern life, research practices in human-computer interaction (HCI) have changed. The methodological and epistemological foundations of the field are shifting to reflect the diversity of contexts in which rapidly changing digital technology is being used. Alongside these changes, new ethical challenges emerge for the HCI community, both in terms of research ethics and responsible research and innovation. Open dilemmas include issues such as the shifting meaning of informed consent, anonymisation or privacy in an always-online world. The SIGCHI Ethics Committee has been established to look into the processes, practices and structures at SIGCHI venues to deal with such ethical dilemmas and how they can be addressed in a transparent, consistent and open way. This town hall style panel will be an opportunity to prompt community discussion and collect input into how we can further address these challenges.

A First Look at Mobile Internet Use in Township Communities in South Africa

This paper presents a study of mobile data usage in South African townships. In contrast to previous studies, which have studied mobile data usage in developing regions (including South Africa), we focus our study on two townships in South Africa; the extremely resource-constrained nature of townships sheds light, for the first time, on how people in these communities use mobile data. We perform a mixed-methods study, combining quantitative network measurements of mobile app usage with qualitative survey data to gain insights about mobile data usage patterns and the underlying reasons for user behavior concerning mobile data usage. Due to the limited availability of public free Wi-Fi and despite the relatively high cost of mobile data, we find that a typical township users median mobile data usage is significantly more than Wi-Fi usage. As expected, and consistent with observations of mobile data usage in parts of South Africa with better resources, users tend to favor using Wi-Fi for streaming video applications, such as YouTube. Interestingly, however, unlike users in less resource-constrained settings, township users also consume significant mobile data to update mobile applications, as opposed to relying on Wi-Fi networks for application updates. These behaviors suggest that network and mobile application designers must pay more attention to data usage patterns on cellular networks to provide mobile network architectures that provide more cost-effective mechanisms for tasks such as application update.

A Family Health App: Engaging Children to Manage Wellness of Adults

The pandemic of lifestyle-related chronic diseases has led to an advent of personal health informatics, often using mobiles and gamification to persuade individuals to adopt healthful lifestyles. However, this approach can constrain benefits to younger, more technically literate beneficiaries, despite the higher need for PHI in older populations. In prior work, we proposed that children in the household aid in reaching beneficiaries, targeting intermediated use. This study compares the use of two versions of a nutrition and exercise monitoring app in 14 households. One supported logging and occasional SMS reminders while the other added gamification elements. We measure self-determination with respect to each version using pre- and post-tests, also drawing on observation and interview data. Our findings suggest that virtual rewards can enhance use of such systems through intermediaries, via benefits such as increased perceived competence. We highlight the challenges and design implications involved in fostering engagement in our system.

Using Co-Design to Discern and Overcome Barriers to Employment in Cape Town

In this paper we describe the co-design process to uncover the unemployment problem, in Cape Town South Africa. We engage with unemployed or underemployed individuals at two different NGO sites in Cape Town. We engage, primarily with current and former students of two job readiness programmes and supplement our work with input from intermediary trainers. We outline our use of co-design under the umbrella of Participatory Design (PD) and discuss our findings, in line with the different documentations of benefits of intermediaries. Our findings highlight the benefits of working with intermediaries from the NGOs and the benefit of working with NGOs as embedded community partners. Additionally, we show that co-design can be used to successfully uncover issues around a problem such as unemployment.