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Trinidad – The Potential of ‘Online Only’ Ethnography

Daniel Miller21 December 2021

By Daniel Miller and Sheba Mohammid

Open access image CC BY Liftarn

The ASSA project runs until October 2022. Mostly the last year of the project is dedicated to publishing our results, for example The Global Smartphone has now come out in Spanish and Italian, and the monographs from Ireland and Italy are also published. There is also a continuation of applied work such as Charlotte Hawkins’ contribution to a tele-psychiatry project in Uganda. But there is also one final ethnographic project. This is being carried out in Trinidad by Sheba Mohammid with the support of Danny. Sheba is very suited to this work having written her PhD on how Trinidadians use YouTube. As a final project this is more oriented towards completing the trajectory of our mHealth research. The story so far is that the ASSA project began with the intention of studying mHealth apps for smartphones. Over time as we realised older people make very little use of these bespoke apps, the project shifted to the study of how people turn the apps they are comfortable with into health apps, for example, WhatsApp, LINE and WeChat, but also Google and YouTube. For example, Marilia Duque’s manual on the use of WhatsApp for health in Brazil demonstrates how what we learn from the everyday practices of our research participants can then be used to inform others. In Trinidad we are hoping within a one-year project to research smartphone usage, plan and implement an mHealth intervention, and evaluate it – though that is quite ambitious in the limited time period.

The Trinidad project is progressing well and it looks like the emphasis will be on issues of diet in relation to diabetes, hypertension and also concerns over anxiety… we shall see. After three months, however, something quite different has emerged that is worth reporting on. Early on in the pandemic Danny shared a YouTube video on how to conduct ethnography with only online access. Given the stringent covid controls in Trinidad, online methods have been the only way we could conduct our ethnography. The good news was that, at least in this instance, the optimism of that YouTube video has been vindicated. Sheba’s work certainly amounts to conventional ethnography. As well as interviews, she has regularly spent periods of three or four hours online with her research participants, hanging out and chatting about all manner of things.

Sheba conducting ethnography online. Photo by Sheba Mohammid.

The online ethnography has focused upon building relationships, as is aspires to in traditional ethnography, and from this foundation trying to attain greater insight into the practices of participants and the wider ecosystem of social connections in which these are situated. Besides some in-depth formal interviews with participants, Sheba regularly spent time cultivating a better understanding and appreciation of their everyday lives. Participants have spent time with their webcam on, hanging out with her while they attended to childcare, cooking, breastfeeding, arranging appointments on the phone or dealing with the daily minutiae in between their chats. The success of the online ethnography so far has depended on Sheba being flexible and determined to follow up, send reminders and work around participants and their evolving schedules and internet problems etc. More than anything, Sheba has prioritised sensitivity and a privileging of their well-being in a time when it was not uncommon to have participants dealing with Covid19 related deaths in their households, their own infections or economic fallout from job loss and insecurity during the pandemic.

As participants grew closer to Sheba and more interested in our study, a deeper intimacy emerged where participants became eager to share more information and would send her WhatsApp screenshots of interesting feedback they received on their apps or new social media accounts on diet and fitness that they thought she might be interested in. All of this amounted to an ongoing, sustained conversation over the last few months with many participants and an engagement in their lives that buttressed the formal interviews on mobile phones and health with participant observation on their everyday lives. For example, after an interview, a participant may take her phone outside to demonstrate to Sheba how she had been setting up her kitchen garden. There were constraints that Sheba had to work around and be adaptive to in the online fieldwork. For example, she felt that it was often intrusive to ask people to show her their phone screens to look at conversations in the way that then team had done in the past in in-person fieldwork. Sheba instead adapted this method by exploring other opportunities within the online interactions. She was able to go online with participants and look at social media together to gain their perspectives. For example, she would have them walk her through which YouTube fitness accounts they preferred or which Instagram or TikTok influencers they found appealing and why or why not. She followed where this ethnography took her and ended up talking to some key Trinidadian social media influencers that participants pointed out as noteworthy. Many of Sheba’s participants were recruited through recommendations and participants asking their family and friends to talk to her. While she initially used some of her own networks in Trinidad to source participants, she then worked to extend her fieldwork to include a diverse range of participants.

The online ethnography over the past three months has enabled Sheba to gain greater access into a broad demographic of participants in both rural and urban Trinidad and from a broad cross-section of ethnic and socio-economic backgrounds. This was achieved largely through participants themselves helping her to recruit more and more participants. For example, one woman in her 60s living in Port of Spain who worked in a retail store introduced her and shared WhatsApp contacts with the members of her AquaAerobics group or when Sheba was trying to recruit more male participants, a female participant linked her online through WhatsApp to her nephew who helped her get more contacts to further male participants and so on in a true snowballing manner that has taken place through online ethnographic work. This recruitment has only been incentivised through participants deepening their relationship with Sheba and gaining an enthusiastic interest in the project and wanting to see us succeed in collecting meaningful data and translating that into something applied next year. So more on that to come in 2022. It will no doubt be a challenge but it is heartening so far to have been able to create such a supportive network of participants, many of whom are interested in being involved in the applied work so we can achieve our aim of creating something from the bottom up.

Happy New Year from Danny and Sheba!

Stay tuned for more…

Read this before developing an mHealth app: tips on saving time and money by walking in other people’s shoes

Marilia Duque E S15 September 2020

An example of a desire path, a consequence of erosion due to people walking on it rather than taking the pre-designed path. Photo licensed under the Creative Commons Attribution 2.0 Generic license

A few weeks ago, I was invited to mentor a startup. They used the term mentorship, but it was more like an informal talk. They are developing an app to help relatives coordinate the care of their elderly parents. Their motivation for this is genuine. The founders are three siblings who had a hard time when they found themselves having to take care of their mother, who had dementia, for several years. They believe they have learned a lot from their experience and they could help other families by combining all the resources they needed as caregivers into a single app. They did a great job. The app is a combination of a calendar for medication and doctor’s appointments, a chat feature the family can use to talk, a channel for checking health information, another channel that can be used to connect with doctors and caregivers and a function that provides reliable, trustworthy information and medical guidance. They also invited one of the most respected researchers on health and ageing to support them with the development of this tool. So, why do I think this app might fail?

During the ASSA project, I conducted a 16-month ethnography with older people in Sao Paulo. At the beginning of fieldwork, I was expecting to find people using apps specifically designed for health and care. Instead, I found people using WhatsApp to create groups to coordinate the care of relatives and to get medical guidance from friends. WhatsApp is the main means of communication among Brazilians who own a smartphone, so the decision to place conversations addressing health and care onto the platform seems natural, especially among older people, as sometimes, WhatsApp is the only app they feel comfortable with. Centralising multiple tasks on WhatsApp means they don’t have to install a new app. This is relevant because, due to many older people using a second-hand device, mobile phone memory can be a problem. Moreover, the process of downloading an app is itself one of the things that they find can make them feel like they have got stuck. Even if they succeed in downloading a new app, they may face constraints related to the adoption of new technology. As one of my research participants said: “you don’t change a winning game”. They just feel like they are at home when they are using WhatsApp.

That is not the case of the three startup founders I am talking about. They are young and technology is not a barrier to them. However, most of the siblings I met who were taking care of elderly parents were middle-aged. This demands an exercise of empathy, which is not just about identifying what caregivers need. It is crucial to consider where they would like to find what they need. It is important to learn how and where (in which app) they get things done. The eureka moment should then come when developers understand how to improve and add value to the choices the users have already made. Katrien Pype called this ‘smartness from below’[1].

In my research, I work with the term “desire path”[2]. In a park, for example, the desire path is the path users create by choosing a route that is different from the one designed by planners. The desire path is the materialisation of the free will. It can be seen as a kind of disobedience, but there is something really valuable about this unpredictable preference. Observing the desire path is an opportunity to learn what users feel is more appropriate for the experience they want. In that sense, taking the desire path into account can save resources and time and might be a good short cut to succeeding in the challenge of designing an app people are actually willing to use.

Because the app they are planning to develop contains an in-built calendar, one of the questions I asked the startup’s founders was whether they would normally use a calendar other than Google. They said they wouldn’t. So why assume their users would use something different to what they are used to? It is easier to integrate the schedule that caregivers need to keep track of the care they provide (sometimes across multiple family members) into the calendar they already use in their day to day life, rather than persuading them to adopt a new one. In that case, Google Calendar is the desire path and app developers are the ones who should adapt their journey to the use of it. The same occurs with WhatsApp. Based on this experience as well as my observations during fieldwork in Sao Paulo, investigating how doctors, clinics and insurance health plans in the city were using WhatsApp for health purposes, I developed a series of protocols for clinics and hospitals showing how WhatsApp can be used to facilitate their communication with patients when it comes to patient triage, the provision of medical care and patient education. These protocols were published under the title “Learning from WhatsApp: Best Practices for Health” (you can download this for free here). In the 150 pages of the book, I haven’t invented anything. It is just simple and pure WhatsApp. My work was to learn with people and systemise the steps.

Figure 1: Example of how WhatsApp might be used to coordinate remote care. In this case, the nurse in charge of interacting with patients via Whatsapp uses the ‘star message’ function to indicate that the patient’s query is pending, so she can go back to the patient after the image is seen by the doctor. Source: ‘Learning from Whatsapp: Best Practices for Health’, by Marilia Duque.

I also published another book called “WhatsApp for Nutritionists” (the book was only published in Portuguese and it is available here). The book is a result of a project I worked on where my challenge was to rebuild the kind of food diary[3] a bespoke m-Health app provides but using only WhatsApp features. The intervention’s effectiveness was tested by having older people assisted by the UNIFESP Medical School in Sao Paulo trial the new method. Participants were invited to take a picture of everything they ate and drank every day and shared this with the nutritionist via WhatsApp. They didn’t have to learn anything new and neither did the nutritionist, as both were already WhatsApp users. This way, the medical school didn’t have to develop an additional app in order to create a reliable method for assessing dietary requirements and needs. It was a successful and cost-effective intervention.

Figure 2 and 3: Examples of how Whatsapp can be used for nutrition purposes – the user sends the nutritionist a photo of all of their meals, thus creating a visual log of their nutritional intake for the day. These are examples of how nutritionists can visualise a patient’s food diary on their mobile and on WhatsApp Web. Source: WhatsApp® Aplicado à Nutrição, by Marilia Duque.

I do think the app I was invited to talk about is far better than WhatsApp, and it should be, as it was designed specifically for health purposes by people who have experience in the problem they want to solve. My point is that there is no guarantee people will use it. That is why my advice is to observe, learn and respect the desire paths taken by potential users before developing something new. They are the choices people have already made.

 

[1] Pype, Katrien. “Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa.” What Do Science, Technology, and Innovation Mean from Africa?, edited by Clapperton Chakanetsa Mavhunga, The MIT Press, 2017, pp. 97–115.
[2] https://www.theguardian.com/cities/2018/oct/05/desire-paths-the-illicit-trails-that-defy-the-urban-planners
[3] RUCKENSTEIN, M. (2015). Uncovering Everyday Rhythms and Patterns: Food tracking and new forms of visibility and temporality in health care. Techno-Anthropology in Health Informatics: Methodologies for Improving Human-Technology Relations, 215, 28-40.