Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation

Background: Maternal and child health (MCH) is a global health concern, especially impacting low- and middle-income countries (LMIC). Digital health technologies are creating opportunities to address the social determinants of MCH by facilitating access to information and providing other forms of support throughout the maternity journey. Previous reviews in different disciplines have synthesized digital health intervention outcomes in LMIC. However, contributions in this space are scattered across publications in different disciplines and lack coherence in what digital MCH means across fields. Objective: This cross-disciplinary scoping review synthesized the existing published literature in 3 major disciplines on the use of digital health interventions for MCH in LMIC, with a particular focus on sub-Saharan Africa. Methods: We conducted a scoping review using the 6-stage framework by Arksey and O’Malley across 3 disciplines, including public health, social sciences applied to health, and human-computer interaction research in health care. We searched the following databases: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS. A stakeholder consultation was undertaken to inform and validate the review. Results: During the search, 284 peer-reviewed articles were identified. After removing 41 duplicates, 141 articles met our inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from human-computer interaction research in health care. These articles were then tagged (labeled) by 3 researchers using a custom data extraction framework to obtain the findings. First, the scope of digital MCH was found to target health education (eg, breastfeeding and child nutrition), care and follow-up of health service use (to support community health workers), maternal mental health, and nutritional and health outcomes. These interventions included mobile apps, SMS text messaging, voice messaging, web-based applications, social media, movies and videos, and wearable or sensor-based devices. Second, we highlight key challenges: little attention has been given to understanding the lived experiences of the communities; key role players (eg, fathers, grandparents, and other family members) are often excluded; and many studies are designed considering nuclear families that do not represent the family structures of the local cultures. Conclusions: Digital MCH has shown steady growth in Africa and other LMIC settings. Unfortunately, the role of the community was negligible, as these interventions often do not include communities early and inclusively enough in the design process. We highlight key opportunities and sociotechnical challenges for digital MCH in LMIC, such as more affordable mobile data; better access to smartphones and wearable technologies; and the rise of custom-developed, culturally appropriate apps that are more suited to low-literacy users. We also focus on barriers such as an overreliance on text-based communications and the difficulty of MCH research and design to inform and translate into policy

No More ‘Solutionism’ or ‘Saviourism’ in Futuring African HCI:A Manyfesto

Research in HCI4D has continuously advanced a narrative of ‘lacks’ and ‘gaps’ of the African perspective in technoscience. In response to such misguided assumptions, this paper attempts to reformulate the common and perhaps unfortunate thinking about African practices of design in HCI4D – i.e., largely as a function of African societal predicaments and Western technocratic resolutions. Through critical reflection on a range of issues associated with post-colonialism and post-development, I examine the possibilities that various historical tropes might offer to the reinvention of the African perspective on innovation. This leads to the consideration of how engaging in critical discussions about the future dimensions of African HCI can allow for grappling with the effect of the coloniality of being, power and knowledge. Developing on the ideas of futuring as a way of dealing with the complexities of the present – in this case the coloniality of the imagination - the paper ends by discussing three tactical propositions for ‘remembering’ future identities of African innovation where the values of autonomy are known and acted upon

“Be a Pattern for the World”: The Development of a Dark Patterns Detection Tool to Prevent Online User Loss

Dark Patterns are designed to trick users into sharing more information or spending more money than they had intended to do, by configuring online interactions to confuse or add pressure to the users. They are highly varied in their form, and are therefore difficult to classify and detect. Therefore, this research is designed to develop a framework for the automated detection of potential instances of web-based dark patterns, and from there to develop a software tool that will provide a highly useful defensive tool that helps detect and highlight these patterns

Minding the Gap: Computing Ethics and the Political Economy of Big Tech

In 1988 Michael Mahoney wrote that “[w]hat is truly revolutionary about the computer will become clear only when computing acquires a proper history, one that ties it to other technologies and thus uncovers the precedents that make its innovations significant” (Mahoney, 1988). Today, over thirty years after this quote was written, we are living right in the middle of the information age and computing technology is constantly transforming modern living in revolutionary ways and in such a high degree that is giving rise to many ethical considerations, dilemmas, and social disruption. To explore the myriad of issues associated with the ethical challenges of computers using the lens of political economy it is important to explore the history and development of computer technology

Technical Debt is an Ethical Issue

We introduce the problem of technical debt, with particular focus on critical infrastructure, and put forward our view that this is a digital ethics issue. We propose that the software engineering process must adapt its current notion of technical debt – focusing on technical costs – to include the potential cost to society if the technical debt is not addressed, and the cost of analysing, modelling and understanding this ethical debt. Finally, we provide an overview of the development of educational material – based on a collection of technical debt case studies - in order to teach about technical debt and its ethical implication

The Proceedings of the 23rd Annual International Conference on Digital Government Research (DGO2022) Intelligent Technologies, Governments and Citizens June 15-17, 2022

The 23rd Annual International Conference on Digital Government Research theme is “Intelligent Technologies, Governments and Citizens”. Data and computational algorithms make systems smarter, but should result in smarter government and citizens. Intelligence and smartness affect all kinds of public values - such as fairness, inclusion, equity, transparency, privacy, security, trust, etc., and is not well-understood. These technologies provide immense opportunities and should be used in the light of public values. Society and technology co-evolve and we are looking for new ways to balance between them. Specifically, the conference aims to advance research and practice in this field. The keynotes, presentations, posters and workshops show that the conference theme is very well-chosen and more actual than ever. The challenges posed by new technology have underscored the need to grasp the potential. Digital government brings into focus the realization of public values to improve our society at all levels of government. The conference again shows the importance of the digital government society, which brings together scholars in this field. Dg.o 2022 is fully online and enables to connect to scholars and practitioners around the globe and facilitate global conversations and exchanges via the use of digital technologies. This conference is primarily a live conference for full engagement, keynotes, presentations of research papers, workshops, panels and posters and provides engaging exchange throughout the entire duration of the conference

Évaluation de la fidélité des interventions en santé publique dans le cadre des essais randomisés en grappes dans les pays du Sud : revue systématique et étude de cas

La santé publique fondée sur des données probantes doit être basée sur les meilleures preuves disponibles pour prendre des décisions éclairées, afin de mettre en place des interventions dirigées vers le maintien et l’amélioration de la santé, ainsi que vers le bien-être de toute la population. Les essais contrôlés randomisés (ECR) sont souvent utilisés en recherche clinique pour tester les effets d’un médicament, d’une thérapie ou d’une intervention sur un groupe expérimental qui bénéficiera de l’intervention, en le comparant à un groupe contrôle qui recevra un placebo ou aucun traitement. Bien que le débat persiste, les essais randomisés constituent une source importante et, apparemment, de haute qualité pour évaluer l’efficacité des interventions en santé. Dû à de multiples facteurs, les essais randomisés en grappes (ERG) sont largement utilisés pour évaluer la prestation des services de santé et des interventions en santé publique. Dans ce type d’essai, ce ne sont plus des individus qui sont randomisés, mais des groupes d’individus tels que les familles, les médecins, les villages qui vont recevoir l’intervention. Ces interventions peuvent varier pendant la mise en œuvre en raison de divers facteurs liés à la conception de l’intervention, aux participants, aux intervenants ainsi qu’aux facteurs du contexte qui influencent les résultats. Ces facteurs doivent être pris en compte au moment de l’évaluation, et avant la réplication dans d’autres contextes. L’évaluation de la fidélité de la mise en œuvre, outil clé de l’évaluation du processus et élément essentiel du processus de mise à l’échelle, vise à mesurer le degré selon lequel une intervention a été implantée telle que conçue par les concepteurs. Cette thèse a comme objectif principal examiner la fidélité de la mise en œuvre des interventions en santé publique dans le cadre des essais randomisés en grappes, pour savoir si les interventions mises en place sous un modèle contrôlé doivent prendre en compte ce type d’évaluation pour renforcer ces résultats et faciliter leur réplication à grande échelle. Cette thèse comporte deux volets : une revue systématique et une étude de cas unique à trois unités d’analyse selon une approche mixte concomitante. Le premier article évalue la pratique de la fidélité de la mise en œuvre des interventions en santé publique dans le cadre des essais randomisés en grappes des études publiées qui ont été identifiées et incluses dans la révision systématique. La révision systématique met en lumière que les interventions mises en place sous ce modèle ne tiennent pas compte de cette évaluation de façon systématique, que la façon de la faire est très hétérogène, et que l’évaluation n’est pas bien documentée. Les deuxième et troisième articles sont les résultats de recherche de l’évaluation d’une intervention, à travers une étude de cas comme méthode de recherche, qui a été menée, dans un premier temps, pour examiner la plausibilité de la théorie de l’intervention, et, dans un deuxième temps, pour évaluer leur fidélité de la mise en œuvre et leur acceptabilité auprès des participants dans le but de l’améliorer, si nécessaire, avant sa mise en place à grande échelle. L’évaluation de l’intervention met en lumière plusieurs aspects. D’abord, la théorie sous-jacente et le modèle de l’intervention évaluée sont bien conçus pour parvenir aux résultats visés. L’évaluation fournit des points clés et des actions à prendre en considération, pendant le développement des interventions, pour servir les communautés difficiles à atteindre, et pour améliorer les résultats en matière de santé. Ensuite, les résultats ont démontré une fidélité de mise en œuvre élevée. La clarté de la théorie de l'intervention, la motivation et l'engagement des intervenants, ainsi que les réunions périodiques des superviseurs avec les intervenants-terrain expliquent largement le haut niveau de fidélité obtenu. Des facteurs contextuels tels que la distance géographique, l'accès à un téléphone portable, le niveau d'éducation et les normes de genre ont contribué à l'hétérogénéité de la participation du groupe cible de l’intervention. Finalement, cette évaluation souligne que la plateforme mobile combinée à la mobilisation communautaire, composantes clés de l’intervention, ont été bien accueillies par les participants, et pourraient être mis en place à grand échelle. Cette thèse contribue au développement des connaissances sur le plan méthodologique concernant l’évaluation de la fidélité de la mise en œuvre des interventions en santé publique en mettant en relief des lacunes dans ce domaine, et en suggérant un outil pour faire avancer cette pratique évaluative. Cette thèse participe également au renforcement de la recherche dans les sciences de l’implémentation, et apporte sur le plan empirique des éléments clés essentiels pour évaluer la fidélité de la mise en œuvre de ce type d’intervention à l’aide des essais randomisés en grappes, évaluation de cette fidélité qui est l’objet de cette recherche doctorale.Evidence-based public health should be based on the best available evidence to make informed decisions and to implement interventions aimed at maintaining and improving the health and well-being of all people. Randomized controlled trials (RCTs) are often used in clinical research to test the effects of a drug, therapy, or intervention on an experimental group that may benefit from the intervention, comparing it to a control group that received either a placebo or no intervention treatment. Although the debate persists, randomized controlled trials are an important and objectively high quality method for evaluating the effectiveness of health interventions. Due to multiple factors, cluster randomized trials (CRTs) are widely used to assess the delivery of health services and public health interventions. In this type of trial, it is no longer individuals who are randomized, but groups of individuals such as families, doctors, and village communities who receive the intervention. These interventions may differ during implementation as a result of various factors related to the complexity of the intervention design, context, participants, and stakeholders involved. These factors should be considered at the time of assessment and before replication in other contexts. Implementation fidelity assessment, a key tool in process evaluation, examines study processes to assess the extent to which the intervention was carried out as originally intended. The fidelity of implementation is an essential part of the scale-up process. This thesis aimed to examine the fidelity of implementation of public health interventions in the context of cluster randomized trials, to determine whether the interventions implemented under a controlled model should consider this type of evaluation to strengthen their results and facilitate their replication on a large scale. This thesis has two parts: a systematic review and a single case study with three units of analysis using a mixed triangulated approach. The first article assessed the implementation fidelity of public health interventions in the context of cluster randomized trials. The systematic review highlighted the finding that public health interventions implemented under this model did not systematically consider this type of evaluation, that the way of doing it was very heterogeneous, and that the evaluation was not adequately documented. The second and third articles were the research findings of the evaluation of an intervention, using a case study as the research method, that was conducted to first examine the plausibility of the intervention theory and to better understand the design and context of the intervention being evaluated, and second, to evaluate implementation fidelity and its acceptability among the participants with the aim of making improvements (if necessary) before large-scale replication. The evaluation of the case study highlighted several key findings. First, the results of the evaluation reflected that the underlying theory and model of the public health intervention were well designed to achieve the desired results. The evaluation provided key points and actions to consider during intervention development to serve hard-to-reach communities and improve health outcomes. Further, it was shown that the results demonstrated a high degree of implementation fidelity. The clarity of the theory of the intervention, the motivation and commitment of the stakeholders as well as the periodic meetings of supervisors with the field team largely explained the high level of fidelity obtained. Contextual factors such as geographical distance to the intervention, access to a mobile phone, level of education, and gender norms contributed to the heterogeneity of the participation of the intervention target group. Finally, this evaluation underlined the finding that the mobile platform coupled with community mobilization, both key components of the intervention, were well received by the participants and may be an effective means of improving health knowledge and changing health-related behaviors. This thesis contributes to the development of methodological knowledge concerning the evaluation of the fidelity of implementation of public health interventions by identifying gaps in this field, and by suggesting a tool that facilitates advancing this evaluation practice. This thesis also contributes to the strengthening of research in implementation sciences, and empirically provides key elements essential to assess the fidelity of the implementation of this type of intervention using CRT studies and evaluation of this fidelity, which is the subject of this doctoral research

Proceedings of the ETHICOMP 2022: Effectiveness of ICT ethics - How do we help solve ethical problems in the field of ICT?

This Ethicomp is again organized in exceptional times. Two previous ones were forced to turn to online conferences because of Covid-pandemic but it was decided that this one would be the physical one or cancelled as the need for real encounters and discussion between people are essential part of doing philosophy. We need possibility to meet people face to face and even part of the presentation were held distance–because of insurmountable problems of arriving by some authors– we manage to have real, physical conference, even the number of participants was smaller than previous conferences.The need of Ethicomp is underlined by the way world nowadays is portrayed for us. The truthfulness and argumentation seem to be replaced by lies, strategic games, hate and disrespect of humanity in personal, societal and even global communication. EThicomp is many times referred as community and therefore it is important that we as community do protect what Ethicomp stands for. We need to seek for goodness and be able to give argumentation what that goodness is. This lead us towards Habermass communicative action and Discourse ethics which encourages open and respectful discourse between people (see eg.Habermass 1984;1987;1996). However, this does not mean that we need to accept everything and everybody. We need to defend truthfulness, equality and demand those from others too. There are situations when some people should be removed from discussions if they neglect the demand for discourse. Because by giving voice for claims that have no respect for argumentation, lacks the respect of human dignity or are not ready for mutual understanding (or at least aiming to see possibility for it) we cannot have meaningful communication. This is visible in communication of all levels today and it should not be accepted, but resisted. It is duty of us all.</p