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

In the age of the smartphone, communication is becoming more visual. Through the smartphone, the production and circulation of digital visual media have become as costless and accessible as audio and text-based communication. However, as anthropologists, we argue that there is a pressing need to understand local forms of visual communication in the digital age, where the visual has become an essential part of daily communication. A recently published joint article by my colleague Laura Haapio-Kirk and myself addresses this inquiry based on comparative research across China and Japan.

In China and Japan, we are dealing particularly with the rise of visual digital communication among older adults. The ethnographies undertaken across both fieldsites as part of the ASSA project show how visual communication via digital media enables more effective and efficient phatic communication and emotion work. In addition, the ethnographies point to a question about ‘authenticity’ in interpersonal communication. For example, in some cases, the deployment of visual communication via the smartphone is not so much about being able to express ‘authentic’ personal feelings but rather, in being able to effectively establish a digital public façade according to social norms.

A finding from Japan, where Laura Haapio-Kirk conducted fieldwork, focused on stickers being used on the country’s popular LINE messaging platform. These are often personalised in various ways, including through the purchase of tailored sticker sets with a person’s name embedded within the stickers. These are often given as gifts.

A research participant in her late 70s, Wada-san, communicated via LINE messages daily with her daughter who lived in another city, often sending stickers that let her daughter know what she was up to throughout the day. The particular sticker set she downloaded featured a humorous and feisty grandmother character (see photo below). Wada-san’s daughter explained the following: ‘she sends me meaningless things (muimina koto), things that are just part of her daily activities’. Added together, this constant flow of messages made them feel closer in a way that was less burdensome than frequent phone calls throughout the day might be.

Figure 1. ‘Grandmother’ LINE sticker set by ©ushiromae.

Similarly, one of the most common genres of communication among research participants in China consists of daily greetings and festival greetings. One of Xinyuan’s research participants, Suiqing, would wake up, select an image of flowers or natural scenery (taken by herself or sourced from the Internet), edit a greeting text which she would overlay on top of the image (such as ‘good morning’ or ‘I wish you a happy day’) and send it to her various WeChat groups, which are overwhelmed with visual greetings (as can be seen below).

Figure 2. A screenshot of a WeChat group conversation among Suiqing’s old work colleagues. The first image reads ‘good morning, good luck, daisy’, the second reads ‘Friendship is the most precious thing, good morning’ and the third reads ‘be happy and joyful’.

To read the open-access article ‘Emotion work via digital visual communication: A comparative study between China and Japan’, please go to: https://journals.sagepub.com/doi/full/10.1177/20594364211008044