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The less you know, the more you learn: on teaching smartphone usage to old adults in Santiago

Alfonso ManuelOtaegui26 February 2019

Walking by. Photo by Alfonso Otaegui

Within the frame of the Anthropology of Smartphones and Smart Ageing research project, I have been teaching workshops on smartphone usage for older people at a cultural center for almost a year. Teaching has not only been a very rewarding task, but it has also been a learning experience for me, as I had never taught elderly students before. I have been doing participant observation on how the students interact with their phones not only for the sake of the research project but also to become a better teacher. This opportunity of being in close contact with them for several months, on a weekly basis, when they interact with their phones, has allowed me to spot the main difficulties they face when learning to use this nowadays ubiquitous device.

The enthusiasm and effort of the students are admirable. I had argued a while ago that the experiences of using the phone are as diverse as the people who use it. Some common points can be found however when it comes to the obstacles along the learning curve, which I was able to spot after several months of teaching. One of the main obstacles is, as expected, the stigma of old age, as if ‘technology’ –a word that seems to encompass the totality of this brave new world– were beyond their capabilities: ‘All this is natural for you, the young people, but not for us’ said one student. Soon enough, when the students learn to perform some simple tasks with the phone, their self-confidence grows and allows them to keep learning, even if the stigma is still there, in the back of their minds.

The stigma of old age is not, however, the main obstacle I have encountered when teaching. The most difficult one is, by far, what I name, for lack of a better term, ‘anxiety’. ‘Anxiety’ is a general term to cover several behaviors I observed while they were instructed to do simple procedures. They have in common the underlying feeling of ‘overwhelment’: information or time is handled in a way that the user experience becomes overwhelming and therefore, frustrating.

The clearest example of ‘anxiety’ is getting distracted by too many options, and then blocked to finish the instructed operation. Something that might seem as straightforward as sharing a picture from the Gallery app, has many distracting alternatives along the way if you pay attention to every detail of every screen (most of the students have Android devices). Having opened the app, selected the album and selected the picture, then a series of –too many– possibilities appear, such as a heart, three dots in vertical, three circles intersecting, a square with an arrow, a square with a smiling face and an arrow, a paint pallet, three dots forming a V (the share button), or a trash bin. Even if the students are asked to focus on the share button, some of them may have already tapped on the trash button to delete the image, some others try one or button or another, while most of them ask about what every single button does and do not continue with the task they were learning. Most of the questions they asked me in individual consultations on operations they want to perform could be paraphrased like this: ‘then, I got here, and I don’t know which of all these is the next step’.

So, what can be done from the teacher’s perspective to help them overcome this obstacle? To put it simply, the best solution I have found so far is to deconstruct the garden of forking paths of mobile UI into a single highway. According to a survey and field studies by Leung et al. (2012), old adults prefer manuals for learning how to use mobile devices, as they usually contain step-by-step instructions. That is, in fact, what I ended up doing after a couple of months. With every operation I teach, I organize the web of options into a single line, and then write it down on the whiteboard (we have no screens or projectors at the cultural center), broken down into manageable steps, one after the other. The students copy every step –I usually tweak the instructions for each student, according to the specific UI of their phone–, building their own personal manual. This handwritten reference constitutes fundamental support for the old adult and in a way, it becomes the Ariadne’s thread they need to navigate through the labyrinth of everchanging contextual menus. Ironically, the student needs to ignore options in order to advance. Sometimes, the less you know, the more you learn.

 

References

Leung, R., Tang, C., Haddad, S., McGrenere, J., Graf, P., and Ingriany, V. 2012. How older adults learn to use mobile devices: Survey and field investigations. ACM Trans. Access. Comput. 4, 3, Article 11 (December 2012), 33 pages. DOI = 10.1145/2399193.2399195 http://doi.acm.org/10.1145/2399193.2399195

Enfermeras de enlace y WhatsApp: un ejemplo de ‘inteligencia desde abajo’

Alfonso ManuelOtaegui11 December 2018

Foto de Alfonso Otaegui

Dentro del marco el proyecto Antropología de los Smartphones y del Envejecimiento Inteligente (ASSA), nos hemos comprometido a trabajar colaborativamente con una iniciativa local de salud móvil, o cualquier iniciativa que mejore el acceso a los servicios de salud y el bienestar de las poblaciones con las que hacemos trabajo de campo.

Al principio, aún antes de comenzar mi trabajo de campo, yo imaginaba que esta iniciativa consistiría en la creación e implementación de una aplicación específica de salud móvil, la que respondería a una necesidad observada en el campo. Este abordaje implicaba detectar un vacío en el campo –una necesidad aún no abordada pero advertida por el etnógrafo– y crear una aplicación que llenaría ese vacío. Era en verdad una idea de implementación desde arriba hacia abajo: sería yo quien le daría a la gente algo que necesitaba, pero cuya necesidad ellos mismos desconocían.

Luego de un par de meses, advertí que sería más sensato simplemente describir una aplicación ya en uso –y usada creativamente por la población– y llevar ese uso particular, esa idea local, a otro lugar donde tal idea pudiera ser útil. Este abordaje, que podría definirse como ‘desde abajo hacia arriba’, implica –al contrario del abordaje anterior–  el reconocimiento de la creatividad de las poblaciones locales en la adopción de tecnologías de comunicación, lo que Pype (2017) llama ‘inteligencia desde abajo’. Con el mismo objetivo de llevar buenas ideas de un lugar a otro, también hemos comenzado en el equipo a armar una lista de ‘buenas prácticas’ en atención médica a lo largo y ancho de todos nuestros sitios de campo.

Con este objetivo en mente, pasaré los últimos seis meses de mi trabajo de campo en Santiago llevando adelante una etnografía en un centro oncológico en un hospital público. Este hospital en particular es el único hospital público en Santiago que ha implementado el modelo de cuidado de ‘enfermeras de enlace’ o ‘nurse navigator’ (Devine 2017).

Las enfermeras de enlace trabajan como mediadoras entre los pacientes oncológicos y el sistema médico y burocrático de un hospital público en una zona de bajos recursos. Los tratamientos oncológicos implican dos complejidades para el paciente: la complejidad médica del tratamiento en sí, y la burocracia del sistema de salud pública. Los diversos tratamientos oncológicos pueden tener variados efectos sobre distintos sistemas del cuerpo, por lo que seguir el tratamiento implica manejar mucha información. La gestión del tratamiento implica una serie de procedimientos (diagnósticos de imagen, sesiones de quimioterapia, exámenes de sangre, etc.) que requieren recetas y turnos, que tienen que llevarse a cabo en un orden específico, y dentro de cierto tiempo (si no, las probabilidades de mejora decaen). Las enfermeras de enlace gestionan el tratamiento para el paciente, ya que tienen conocimientos para enfrentar ambos tipos de complejidades.

Según el oncólogo Bruno Nervi, presidente de la fundación Chile sin Cáncer, hay cerca de 100 oncólogos en Chile, cuando se necesitan 400 (55.000 personas son diagnosticadas con cáncer cada año) (‘La Fundación Chile sin cáncer (…)’ 2018). Dado el gran número de pacientes, los oncólogos no tienen el tiempo de explicar todos los detalles del tratamiento. Las enfermeras que trabajan en la sala de quimioterapia enfrentan el mismo problema, ya que tratan de atender tantos pacientes como sea posible. Las enfermeras de enlace, entonces, llenan este vacío al educar a los pacientes sobre los detalles de la enfermedad y su tratamiento y al mediar ente los pacientes y el complejo sistema burocrático de la salud pública de Chile. Ellas hacen todas las citas para exámenes, análisis de sangre y demás –lo que requiere mucho papeleo– y se mantienen en contacto con el paciente en caso de que éste tenga alguna duda o inquietud. Estas enfermeras dedicadas constituyen un factor humano en los servicios de salud que ninguna aplicación puede reemplazar. Las enfermeras de enlace, sin embargo, sí usan una aplicación, la aplicación de mensajería más usada por los pacientes: WhatsApp. Según las enfermeras de enlace, WhatsApp les da la capacidad de usar los varios modos de comunicación según las particularidades y necesidades de cada paciente: algunos prefieren una llamada por teléfono, otros se sienten tranquilos al ver una foto de la receta o turno de examen, algunos necesitan un mensaje de audio que puedan escuchar varias veces hasta entender (muchos pacientes son de bajos recursos con escaso nivel educativo). Además, las enfermeras de enlace están disponibles para los pacientes por cualquier duda o pregunta que puedan tener. Estas enfermeras están ahí para ellos, para responder sus inquietudes y confortarlos, ya que el tratamiento y esta relación de cuidado a distancia puede llegar a durar años.

Daniel Miller, investigador coordinador del proyecto ASSA, escribió en su último libro ‘The Comfort of People’ sobre el uso de nuevos medios de comunicación con pacientes terminales con cuidados paliativos. En ese libro Miller recomienda crear un protocolo de uso de nuevos medios entre paciente y personal de salud (2017: 218). El uso de WhatsApp por parte de las enfermeras de enlace de hecho sigue un protocolo que se fue desarrollando en los últimos años a partir de la experiencia. Yo intentaré describir este protocolo y este uso de WhatsApp y construir un modelo que pueda ser replicado. Realmente tengo la esperanza de poder llevar esta buena idea que se desarrolló localmente a otros hospitales públicos de Chile.

 

 Referencias

Devine, A. (2017, 3 de abril). The Nurse Navigator: A Patient’s Compass On The Healthcare Journey. Extraído de https://nurse.org/articles/nurse-navigator-career-path-salary-job-description/

La Fundación Chile sin cáncer y su contribución para cambiar la historia del cáncer en Chile. (2018, 15 de octubre). Extraído de https://www.uc.cl/es/la-universidad/noticias/31765-la-fundacion-chilesincancer-y-su-contribucion-para-cambiar-la-historia-del-cancer-en-chile

Miller, D. (2017). The Comfort of People. Cambridge: Polity Press.

Pype, K. (2017). Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa. En C. C. Mavhunga (Ed.), What Do Science, Technology, and Innovation Mean from Africa? (pp. 97–115). Cambridge, Massachussetts: The MIT Press.

Nurse navigators and WhatsApp: an example of smartness from below

Alfonso ManuelOtaegui8 December 2018

Photo by Alfonso Otaegui

Within the scope of the project Anthropology of Smartphones and Smart Ageing (ASSA), we are committed to work collaboratively with a local mHealth initiative, or any initiative that will improve the access to healthcare or the wellbeing of the populations among whom we are carrying our fieldwork.

At the beginning, before even starting my fieldwork, I envisioned this initiative as the creation and implementation of a bespoke mHealth app, which would respond to a necessity observed in the field. This approach implied spotting a gap in the site –a need not yet addressed but noticed by the ethnographer– and creating an app which would fill that gap. It was certainly a top-down implementation approach: I would give the users something they needed but were not aware they needed.

After a couple of months, I realized it would be wiser to simply describe an app people already used in a creative way, and bring this local idea to another place, where this idea could be helpful. This approach, which could be described as ‘bottom-up’, implies acknowledging the creativity of local populations in the adoption of communication technologies, what Pype (2017) names ‘smartness from below’. With the same aim of bringing good ideas from one place to another, we have also started in our team to build up a list of ‘best practices’ in healthcare throughout all of our field sites.

With this aim in mind, I will spend the last six months of my fieldwork in Santiago doing ethnography at an oncological center in a public hospital. This particular hospital is the only public one in Santiago having implemented a ‘nurse navigator’ model of healthcare (Devine 2017).

The navigator nurses work as mediators between oncological patients and the medical and bureaucratical system of a public hospital in a low-income area. Cancer treatments mean two complexities for the patient: the medical complexity of the treatment and the bureaucracy of the public health system. Different cancer treatments can have several effects on different systems of the body, so managing the treatment implies handling a lot of information. The treatment is based on a series of procedures (image exams, chemotherapy sessions, blood tests, etc.) which require prescriptions and appointments, and have to be carried out in a specific order, and in certain amount of time (otherwise the probabilities of success decline). Navigator nurses actually manage the treatment for the patient, as they have the expertise to deal with both kind of complexities.

According to oncologist Bruno Nervi, president of the foundation Chile sin Cancer (‘Chile without cancer’), there are around 100 oncologists in Chile, when 400 are needed (55.000 people are diagnosed with cancer every year) (‘La Fundación Chile sin cáncer (…)’ 2018). Given the high number of patients, oncologists do not have the time to explain all the details of the treatment. The nurses working at the chemotherapy room face the same problem, as they try to fit in as many patients on a day as possible. The nurse navigators then, fill in this gap by educating the patient on the details of the disease and its treatment and mediate between the patient and the complex bureaucratical system of public healthcare in Chile. They make all the appointments for exams, blood tests and the like –which requires a lot of paperwork– and stay in touch with patient in case this has any doubt or question. These dedicated nurses constitute a human factor in healthcare that no app can replace. The nurse navigators, however, do use an app that is the most commonly used messaging app amongst patients: WhatsApp. According to the navigator nurses, WhatsApp gives them the chance to use various means of communication depending on the particularities and necessities of every patient: some prefer a phone call, some other need to see the info written in a text message, other will be reassured if they see a picture of the prescription or an exam order, some need an audio message they can listen to several times in order to understand the meaning (most of the patients are low-income people with low levels of education). Besides, nurse navigators are available for the patients for any doubt or question they might have. These nurses are there for them, to answer their questions and to comfort them, as the treatment and this relation of distant care can last for years.

Daniel Miller, principal investigator of the ASSA project, recommended in his last book ‘The Comfort of People’ on hospice patients and the use of new media, that it would important to create a patient/carer charter of new media use (2017: 218). The usage of WhatsApp by these nurse navigators actually follows a protocol which developed out of their experience in the last couple of years. I will attempt to describe this protocol and app usage and build up a model. I really hope it will be possible to bring this locally developed good idea to other public hospitals in Chile.

References

Devine, A. (2017, April 3). The Nurse Navigator: A Patient’s Compass On The Healthcare Journey. Retrieved from https://nurse.org/articles/nurse-navigator-career-path-salary-job-description/

La Fundación Chile sin cáncer y su contribución para cambiar la historia del cáncer en Chile. (2018, October 15). Retrieved from https://www.uc.cl/es/la-universidad/noticias/31765-la-fundacion-chilesincancer-y-su-contribucion-para-cambiar-la-historia-del-cancer-en-chile

Miller, D. (2017). The Comfort of People. Cambridge: Polity Press.

Pype, K. (2017). Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa. In C. C. Mavhunga (Ed.), What Do Science, Technology, and Innovation Mean from Africa? (pp. 97–115). Cambridge, Massachussetts: The MIT Press.