How the healthcare-seeking socio-cultural context shapes maternal health clients' mHealth utilisation in a Kenyan context

Problem Statement: Many developing countries are still grappling with poor health as a result of strained healthcare systems. Top among health inequalities is maternal care with maternal mortality rates being almost 19 times higher in developing countries than in their developed counterparts. mHealth presents the potential for developing countries to overcome some of the traditional healthcare challenges. However, despite the compelling evidence for the potential of maternal mHealth from the plethora of effectiveness studies, why when and how interventions work/do not work in different contexts are not fully understood. Socio-cultural factors are one of the most cited reasons for variance in uptake and utilisation of such technologies. To date, research explaining how socio-cultural factors shape mHealth utilisation is sparse. Purpose of the study: The main objective of the study was to explain how mHealth utilisation behaviour emerges within the healthcare-seeking socio-cultural context. To achieve the objective, the study identified the socio-cultural characteristics of the maternal healthcareseeking context and analysed the user-technology interaction within this context. Research methodology: Building on the foundation that human experiences are best understood in situ, the study adopted explanatory methods guided by an interpretivist paradigm. The study drew upon Activity Theory as a lens to understand the maternal mHealth utilisation phenomenon. Hence, we theorised healthcare-seeking as an activity whose cultural aspects were further understood using Hofstede typology of culture. The study used a Kenyan maternal mHealth intervention to elucidate the phenomenon. We employed semi-structured interviews, focus group discussions, observations, informal discussions, and document review to gather data. The sample was purposively selected and comprised various maternal health stakeholders: maternal health clients, their partners, project implementers and healthcare professionals. Key findings: The results of the study show that the healthcare-seeking socio-cultural context which is characterised by socio-cultural attributes such as high-power distance, high uncertainty avoidance, gendered relations, and collectivism shapes mHealth utilisation behaviour in a dialectical process. This process takes place as maternal health clients shape and are shaped by mHealth within their healthcare-seeking socio-cultural context through a process of internalisation and externalisation. From an internalisation perspective, uncertainties and risks in the maternal healthcare-seeking context resulted in hesitated adoption. Contextual perceptions of usefulness of the intervention resulted in the use of mHealth to substitute other healthcare structures while having different perceptions of the role of mHealth created dissonance among the maternal health clients. With regards to externalisation, maternal health clients adopted legitimisation strategies to reduce uncertainties and to develop trust required for initial and continued use of the intervention. They legitimised both the intervention artifact, and the information. Since the mHealth intervention presented appropriate social cues, being accompanied by the expected health provider's persona, maternal health clients readily humanised the intervention. The contextual social norms around pregnancy also presented a need for the maternal health clients to make their mHealth use an ‘appropriate behaviour' by negotiating use with relevant stakeholders in the context. Finally, in response to mHealth technology paradoxes that challenged the very motive of healthcare-seeking, maternal health clients coped by abandoning mHealth, or otherwise accommodating it. Originality/contribution: This study contributed to knowledge, theory, and practice. First, the study suggests theoretical propositions that explain how mHealth utilisation behaviour emerges. These findings may be useful to similar developing-country contexts. A further contribution to theory emerges from the use of Activity Theory to understand the phenomenon. The study helps to operationalise Activity Theory concepts in Information Systems research. Second, the study provides recommendations to practise with regard to the design and implementation of mHealth interventions. These insights may be useful to mHealth designers and implementers in designing mHealth solutions that are contextually relevant. Here, we propose the consideration of mHealth intervention characteristics that will aid utilisation, involving healthcare professionals and other community stakeholders in mHealth implementation and integrating mHealth into existing healthcare structures

Providing home-based care using text messaging

2011 3rd International Conference on Information and Financial Engineering IPEDR vol.12 (2011), Singapore.The increasing miniaturization of mobile devices marks an important opportunity for the next generation health care delivery. Mobile health (mHealth), existing at the nexus of health and technology provides a singular opportunity to take health where it is needed the most. Having had nearly mainstream adoption, may explain why the developed world is in tandem with health-related Millennium Development Goals (MDGs). On the other hand, developing countries still lag behind in meeting the same health-related goals, yet they continue to report successful stories of mobile technology growth and adoption but no major usage of the same to deliver healthcare. This research sought to explore existing mHealth applications to establish their suitability for use in developing countries such as Kenya to provide home-based care. This was done by a survey of existing literature and mHealth models, and an architecture developed in light of local communication infrastructure and local mobile phone abilities. It was established that for developing countries to take advantage of this leapfrogging technology in health, they would have to take advantage of the Short Message Service (SMS) that is cheap and accessible to all. A relationship amongst mHealth stakeholders was considered as key to enhancing the adoption of mHealth in such countries.The increasing miniaturization of mobile devices marks an important opportunity for the next generation health care delivery. Mobile health (mHealth), existing at the nexus of health and technology provides a singular opportunity to take health where it is needed the most. Having had nearly mainstream adoption, may explain why the developed world is in tandem with health-related Millennium Development Goals (MDGs). On the other hand, developing countries still lag behind in meeting the same health-related goals, yet they continue to report successful stories of mobile technology growth and adoption but no major usage of the same to deliver healthcare. This research sought to explore existing mHealth applications to establish their suitability for use in developing countries such as Kenya to provide home-based care. This was done by a survey of existing literature and mHealth models, and an architecture developed in light of local communication infrastructure and local mobile phone abilities. It was established that for developing countries to take advantage of this leapfrogging technology in health, they would have to take advantage of the Short Message Service (SMS) that is cheap and accessible to all. A relationship amongst mHealth stakeholders was considered as key to enhancing the adoption of mHealth in such countries

The 3D gaming simulation for a real-world university experience

Article published in International Journal of Computer and Information TechnologyThis paper presents a gaming system which simulates the life of an ordinary University student. The University selected is Strathmore University. The simulation gives the player an idea of life experience in the University as it would be in the real world. In addition to simulating how various aspects affect student life, the simulation also acts as a good way of exploring the university without actually having to be there. Therefore one can learn a lot about the university at the comfort of their seats without suffering too much time expense whilst at the same time enjoying the experience of gameplay. To achieve the set goal Object Oriented Analysis and Design Methodology with Python scripting programming were used as to facilitate interactivity of the player. Blender 2.5 Beta software was used to model the virtual environment. This simulation would be great to both explorers, researchers, lecturers, parents, students and aspiring students alike among others. Many love the experience of gameplay whilst at the same time gaining other learning benefits, depending on the learning intentions of the individual player, for instance, knowing their way around the university.This paper presents a gaming system which simulates the life of an ordinary University student. The University selected is Strathmore University. The simulation gives the player an idea of life experience in the University as it would be in the real world. In addition to simulating how various aspects affect student life, the simulation also acts as a good way of exploring the university without actually having to be there. Therefore one can learn a lot about the university at the comfort of their seats without suffering too much time expense whilst at the same time enjoying the experience of gameplay. To achieve the set goal Object Oriented Analysis and Design Methodology with Python scripting programming were used as to facilitate interactivity of the player. Blender 2.5 Beta software was used to model the virtual environment. This simulation would be great to both explorers, researchers, lecturers, parents, students and aspiring students alike among others. Many love the experience of gameplay whilst at the same time gaining other learning benefits, depending on the learning intentions of the individual player, for instance, knowing their way around the university

The Role of User-Agent Interactions on Mobile Money Practices in Kenya and Tanzania

Digital financial services have catalyzed financial inclusion in Africa. Commonly implemented as a mobile wallet service referred to as mobile money (MoMo), the technology provides enormous benefits to its users, some of whom have long been unbanked. While the benefits of mobile money services have largely been documented, the challenges that arise -- especially in the interactions between human stakeholders -- remain relatively unexplored. In this study, we investigate the practices of mobile money users in their interactions with mobile money agents. We conduct 72 structured interviews in Kenya and Tanzania (n=36 per country). The results show that users and agents design workarounds in response to limitations and challenges that users face within the ecosystem. These include advances or loans from agents, relying on the user-agent relationships in place of legal identification requirements, and altering the intended transaction execution to improve convenience. Overall, the workarounds modify one or more of what we see as the core components of mobile money: the user, the agent, and the transaction itself. The workarounds pose new risks and challenges for users and the overall ecosystem. The results suggest a need for rethinking privacy and security of various components of the ecosystem, as well as policy and regulatory controls to safeguard interactions while ensuring the usability of mobile money.Comment: To be published in IEEE Symposium on Security and Privacy 202

A Mobile health architecture to provide home-based care using text messaging

Partial fulfillment for award of the degree of Master of Science in Information Technology.The increasing miniaturization of mobile devices marks an important opportunity for the next generation delivery of health care. Mobile health (mHealth), existing at the nexus health and technology provides a singular opportunity to take health where it is needed the most. Having had nearly mainstream adoption, this may explain the reason why the developing world is in tandem with the set Millennium Development Goals (MDGs). Developing countries like Kenya are still lagging behind in meeting the same health-related goals, yet they continue to report successful stories of mobile technology growth and adoption but no major usage of the same to deliver healthcare. This research explores the use of mobile phones in health and proposes an architecture for the use of Short Message Service (SMS) messaging in the provision of primary home-based care. The architecture is implemented by analysing, designing and testing a primary health-care mHealth application that can be used to support medication of HIV/AIDS patients to result in better and more efficient adherence to the treatment regimen. In conclusion some key design, business and technical requirements that need to be considered are suggested and we further propose a relationship of stakeholders that will ensure the successful adoption and implementation of mHealth applications in Kenya

Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review

BackgroundMany maternal clients from poorly resourced communities die from preventable pregnancy-related complications. The situation is especially grave in sub-Saharan Africa. Mobile health (mHealth) interventions have the potential to improve maternal health outcomes. mHealth interventions are used to encourage behavioral change for health care–seeking by maternal clients. However, the appropriation of such interventions among maternal health clients is not always guaranteed. ObjectiveThis study aims to understand how maternal clients appropriate mHealth interventions and the factors that affect this appropriation. MethodsThis study used a hermeneutic literature review informed by the model of technology appropriation. We used data from three mHealth case studies in sub-Saharan Africa: Mobile Technology for Community Health, MomConnect, and Chipatala Cha Pa Foni. We used the search and acquisition hermeneutic circle to identify and retrieve peer-reviewed and gray literature from the Web of Science, Google Scholar, Google, and PubMed. We selected 17 papers for analysis. We organized the findings using three levels of the appropriation process: adoption, adaptation, and integration. ResultsThis study found that several factors affected how maternal clients appropriated mHealth interventions. The study noted that it is paramount that mHealth designers and implementers should consider the context of mHealth interventions when designing and implementing interventions. However, the usefulness of an mHealth intervention may enhance how maternal health clients appropriate it. Furthermore, a community of purpose around the maternal client may be vital to the success of the mHealth intervention. ConclusionsThe design and implementation of interventions have the potential to exacerbate inequalities within communities. To mitigate against inequalities during appropriation, it is recommended that communities of purpose be included in the design and implementation of maternal mHealth interventions

User experiences with ID and SIM Card Registration in Kenya and Tanzania

The majority of adults in Sub Saharan Africa (SSA) use mobile money as their main financial account. Mobile money is the provision of financial services such as savings, credit, and insurance, through a person’s mobile phone. To open such an account, the mobile user first needs a SIM card, and across SSA, governments require SIM cards to be registered using an official ID. This is despite half of the population, around 490 million people, having no IDs. This dataset consists of 72 interviews, 36 from Kenya and 36 from Tanzania, on people’s experiences (user journeys) during ID and SIM card registration. We also explore the causes and consequences of using third-party SIM cards (SIM cards registered under a third party's ID)

Creative Multilingualism

Multilingualism is integral to the human condition. Hinging on the concept of Creative Multilingualism – the idea that language diversity and creativity are mutually enriching – this timely and thought provoking volume shows how the concept provides a matrix for experimentation with ideas, approaches and methods. The book presents four years of joint research on multilingualism across disciplines, from the humanities through to the social and natural sciences. It is structured as a manifesto, comprising ten major statements which are unpacked through various case studies across ten chapters. They encompass areas including the rich relationship between language diversity and diversity of identity, thought and expression; the interaction between language diversity and biodiversity; the ‘prismatic’ unfolding of meaning in translation; the benefits of linguistic creativity in a classroom-seting; and the ingenuity underpinning ‘conlangs’ (‘constructed languages’) designed to give imagined peoples a distinctive medium capable of expressing their cultural identity. This book is a welcome contribution to the field of modern languages, highlighting the intricate relationship between multilingualism and creativity, and, crucially, reaching beyond an Anglo-centric view of the world. Intended to spark further research and discussion, this book appeals to young people interested in languages, language learning and cultural exchange. It will be a valuable resource for academics, educators, policy makers and parents of bilingual or multilingual children. Its accessible style also speaks to general readers interested in the role of language diversity in our everyday lives, and the untapped creative potential of multilingualism. As with all Open Book publications, this entire book is available to read for free on the publisher’s website. Printed and digital editions, together with supplementary digital material, can also be found at www.openbookpublishers.co