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An Anthropological Approach to mHealth: Health & Care in the Smartphone Age

alex.clegg3 March 2022

Open access image by Mohamed Hassan

Author: Charlotte Hawkins

As part of the ASSA project, we are currently working to publish a volume called: ‘An Anthropological Approach to mHealth: Health & Care in the Smartphone Age’. This volume consolidates insights from the team’s various anthropological initiatives in mobile health or ‘m-health’ – health-related uses of the phone – in diverse settings around the world. Drawing from an ethnographic perspective, we seek to contribute an anthropological understanding of mHealth, a growing industry often otherwise dictated by top-down priorities such as bespoke app creation. Instead, building from our own ethnographic insights about older people’s everyday uses of phones, and other studies stressing the evident importance of ‘informal mHealth’ (Hampshire et al., 2021), we illustrate a ‘smart-from-below’ approach which prioritises the everyday appropriation of phones and existing communicative apps for health purposes. We analyse the failures of conventional mHealth initiatives and the emergence of our alternative perspective, and how that led to several initiatives in which team members were themselves involved.

In this book, we offer a grounded ethnographic picture of mHealth in our various research contexts, with a view to broader global trends in population ageing, health and economic crises, the Covid-19 pandemic, declining public investment, increasing phone access, and global migration. This shows the potential of prioritising the everyday appropriation of mobile technologies in line with both social change and longer-standing care norms.. This is intended topromote an anthropological approach to support the relevance and effectiveness of mHealth going forward. We have already created a free online course (available here) for those interested in the topic but hope that the book will benefit other medical anthropologists and ethnographers interested in digital health, as well as digital health practitioners interested in social research around the design, implementation and evaluation of their work.

We have organised the book into three parts, reflecting what anthropology can offer for contextualizing, analysing and informing mHealth. Part one consists of three chapters concerned with contextualizing mHealth;

  • Xinyuan Wang on mHealth practice in mainland China;
  • Shireen Walton on visual digital communications about health during covid in Italy, and
  • Laura Haapio-Kirk on social self-tracking in Japan.

This is followed by contributions analysing mHealth:

  • Daniel Miller on googling for health in Ireland, and the ways it exacerbates existing disparities;
  • Patrick Awondo on the failures of various mHealth initiatives in Yaoundé, Cameroon; and
  • Pauline Garvey outlining the uses of phones to seek information and support around the menopause in Dublin, Ireland.

The volume concludes with three chapters informing specific mHealth initiatives:

  • Alfonso Otaegui’s recommendations for scaling the ‘nurse navigator’ model in public oncological clinics in Chile;
  • Marília Duque’s protocol for meal-logging and WhatsApp communications in Brazil; and
  • Charlotte Hawkin’s and John Mark Bwanika’s work on a digital mental health programme in Uganda.

Taken together, the volume seeks to provide a grounded ethnographic discussion on the challenges and opportunities of anthropology for mHealth, and of seeking health and care in the smartphone age. We aim for publication in 2022 with UCL Press, follow ASSA on Twitter, Instagram and Facebook to keep updated.

References

Hampshire et al. (2021). Informal mhealth at scale in Africa: Opportunities and challenges. World Development, 139:105257, 1-23

Illustrating ASSA’s Findings With Comics: Part 2

Georgiana Murariu22 June 2021

By Georgiana Murariu & Laura Haapio-Kirk

In this blog post, we present the second comic in our series illustrating key findings from the ASSA project. ‘The Next Step’, based on research by Alfonso Otaegui, drawn by John Cei Douglas, and scripted by ourselves, can be seen below in both English and Spanish.

Alfonso Otaegui did his fieldwork in Santiago, the capital of Chile, where he spent a year volunteering at a cultural centre in the city, teaching older adults how to use smartphones. Alfonso has recently written about Chile’s increasing digitalisation of services and the government’s aim to become ‘paperless’ soon. Many of his research participants expressed the anxiety that soon they might be left with no choice but to use a smartphone to access specific services, even if they do not feel confident using one.

Alfonso has also written about how the COVID-19 pandemic has further accelerated the imposition of digital services upon people in Chile. Older people are not only strongly encouraged to become digitally savvy by their government, but also by their own family and other acquaintances in order to stay connected during the pandemic.

Alfonso’s experience teaching smartphones at the cultural centre has given him a wealth of insight into the sorts of things older people struggle with when they first learn how to use the device. One of the common struggles older adults encounter when learning to use the device is the experience of anxiety facing too many options, for example on a menu that offers several calls to action illustrated through icons. While doing an exercise on sharing an image, several students would be distracted by the vast array of other possibilities/icons.

It’s not all negative, however – far from it: Alfonso found that once older people had mastered the smartphone, their developing digital skills opened up all sorts of possibilities for them. As Alfonso put it in the short video below, at any given time, they are two taps away from frustration, and two taps away from empowerment.

It is this journey towards digital literacy that we wanted to illustrate in the comic below.

To script the comic, we used material from Alfonso’s photos, research, anecdotes and the short film above, deciding to create a character that combined many of the experiences of his participants. Using the direct quote “pa,pa,pa, it’s done!”, which came from an individual in Alfonso’s research, we shaped a character and narrative around this particular moment of frustration, which you can see below in both English and Spanish:

‘The Next Step’

‘¿Y ahora, cómo sigo?’