Designing with community health workers: feedback-integrated multimedia learning for rural community health

Community Health Workers (CHWs) are an integral part of the rural health system, and it is imperative that their voices are accommodated in digital health projects. In the mobile health education project discussed in this thesis (The Bophelo Haeso project), we sought to find ways to amplify CHWs' voices, enabling them to directly influence design and research processes as well as technological outcomes. The Bophelo Haeso (BH) project equips CHWs with health videos on their mobile phones to use for educating and counselling the rural public. We investigated how to best co-design, with CHWs, a feedback mechanism atop the basic BH health education model, thus enabling their voices in the design process and in the process of community education. This thesis chronicles this inclusive design and research process - a 30-month process that spanned three sub-studies: an 18-month process to co-design the feedback mechanism with CHWs, a 12-month deployment study of the feedback mechanism and, overlapping with the feedback deployment study, a 17-month study looking at the consumption patterns of the BH educational videos. This work contributes to the field of Human Computer Interaction (HCI) in three distinct ways. First, it contributes to the growing knowledge of co-design practice with participants of limited digital experience by introducing a concept we termed co-design readiness. We designed and deployed explorative artefacts and found that by giving CHWs increased technical, contextual, and linguistic capacity to contribute to the design process, they were empowered to unleash their innate creativity, which in turn led to more appropriate and highly-adopted solutions. Secondly, we demonstrate the efficacy of incorporating an effective village-to-clinic feedback mechanism in digital health education programs. We employed two approaches to feedback - asynchronous voice and roleplaying techniques. Both approaches illustrate the combined benefits of implementing creative methods for effective human-to-technology and human-tohuman communication in ways that enable new forms of expression. Finally, based on our longitudinal study of video consumption, we provide empirical evidence of offline video consumption trends in health education settings. We present qualitative and quantitative analyses of video-use patterns as influenced by the CHWs' ways of being and working. Through these analyses, we describe CHWs and their work practices in depth. In addition to the three main contributions, this thesis concludes with critical reflections from the lessons and experiences of the 30-month study. We discuss the introduction of smartphones in rural villages, especially among elderly, low-literate, and non-English-speaking users, and present guidelines for designing relevant and usable smartphones for these populations. The author also reflects on her position as an African-born qualitative researcher in Africa, and how her positionality affected the outcomes of this research

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

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

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

From Research to Practice: The Operationalisation of Human-Computer Interaction and Service Design in an African Context

To increase the reception, adoption and implementation of human computer interaction and service design within Africa, this panel hopes to unpack the obstacles to its achievement as well help charter a way forward. This panel was the initiative of the South African Protea SIGCHI chapter, to increase the robustness and operationalisation of both areas as well as their reception with the region