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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

Smartphones as Constant Companions

Shireen Walton17 May 2021

Ageing with Smartphones in Urban Italy considers the experiences of a range of people of different ages and backgrounds, and how their lives play out in different contexts: within an inner-city neighbourhood in Milan, the broader urban environment of the city, across Italy, or transnationally and digitally, online. Throughout my urban digital ethnographic research, I came to learn about how different older adults experience and shape their social worlds and activities between levels and conceptualisations of autonomy, privacy and freedom. The smartphone features prominently in this everyday modulating of sociality, helping people decide when to make themselves available to whom and giving them a way to keep in touch with what is going on locally and further afield.

To consider some examples: Pietro and his wife Maria in their seventies had recently been added to a new WhatsApp group representing the apartment building they have lived in for more than 30 years. The two had different reactions to this; while Maria welcomed the digital sociality and its usefulness for communicating on practical matters, such as the use of communal spaces and corridors, or issues to be shared and discussed, Pietro was more ambivalent at first about this unfamiliar mode of communication, especially as the WhatsApp group quickly morphed from the supposed function of information exchange to the wider postings of emojis, memes and even poems. At the same time the notifications he receives on his phone, including wider notifications such as news alerts, bring Pietro pleasure throughout the day, making both him, and Maria, who is active in a number of WhatsApp community groups, feel connected to a certain social buzz of ‘distant closeness’ (Van House 2007) and ‘intimacy at a distance’ (Elliott and Urry 2010) they enjoy in retirement.

Fig 1 – Casa di ringhiera apartment buildings in Milan – Photo by Shireen Walton

Fig 2 – Meme shared in a local women’s WhatsApp group.

For Rosalba, a participant in her sixties, the smartphone was a kind of familiar presence informing her about the weather or recipes found online. Rosalba drew comfort from the multiple presences contained within it, mostly those of her children and family whom she connected with through the smartphone. At the same time, the smartphone was an ambiguous object, which she felt guilty about using so much. Throughout the research, participants expressed a range of concerns about privacy, surveillance, dis/misinformation and online bullying, while simultaneously feeling that the smartphone had become quite central in their lives, particularly throughout the Covid-19 pandemic where digital communications took on a heightened significance amid experiences of lockdown.

As such, the book teases out some of the contradictions, affordances, and problems the smartphone poses for people at different ages and stages of life. In another respect, the smartphone is implicated in the ways in which people confront the ethical dilemma of: ‘where should I be?’ with regard to social commitments and care responsibilities, played out in different places offline and online. For Noor, in her early fifties, who was born and grew up in Egypt and who has been living in Milan with her family for over a decade, the smartphone was implicated in her broader reconciling of place, work, and care. The smartphone presents no ready answers to these dilemmas, but in many cases, it is there, adopted in diverse ways, as a ‘constant companion’ in the figuring out of life and the multiple entanglements of the life course.

Figure 3: Watching a popular online cooking programme on YouTube. Photo by Shireen Walton.

 

References:

  • Elliott, Anthony., Urry, John. (2010). Mobile lives. New York, NY: Routledge.
  • Van House, Nancy, A. ‘Flickr and public image-sharing: distant closeness and photo exhibition’ in In CHI ’07 extended abstracts on human factors in computing systems, 2717–22. New York: ACM Press.