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Coronavirus and social isolation: 16 insights from Digital Anthropology

GeorgianaMurariu20 March 2020

Source: Unsplash https://unsplash.com/photos/tDtwC11XjuU

Blog post by ASSA (Anthropology of Smartphones and Smart Ageing) team

We recently conducted nine 16 month studies on the use of smartphones by older people, which is the main source of insights here. You can read more about the project here.

This is a summary of insights from our previous research intended to be on benefit for individuals or institutions considering  digital health initiatives for older people. It is a preliminary list and we hope to deepen our contribution through subsequent blog posts.

Additional insights are also drawn from Daniel Miller’s The Comfort of People (Polity, 2017), a book about the social universe of hospice patients, which includes recommendations for how to use new media to assist isolated older people to maintain social relationships.

1) USE EXISTING APPS

Our research found that older people are often very reluctant to use a new app. When trying to assist older people in using online resources it is best, if possible, not to suggest new apps. Find a way of achieving your aims through an app they already regularly use, such as WhatsApp.

2) EMPATHY

Social isolation has been a common experience for older people, especially those who have lost a partner. Isolation is particularly common in the UK. One result of this virus is that people of all ages are now experiencing isolation. They may thereby gain greater empathy with the lived experience of older people living alone or in isolation.

3) POLYMEDIA

Our research shows that today each individual has particular preferences for how they prefer to communicate. For example, a person might be fine with the webcam, but only if you text first so that they are prepared. It is important to learn about an individual’s media preferences and then respect these.

4) FORUMS

The hospice research found that people who are struggling (in that case it was mainly cancer patients) find forums of considerable value. But they divided into two equal groups. One group only wished to exchange such intimate problems when the forum was entirely anonymous; the other was only comfortable communicating with identifiable others. We need to develop and proliferate both kinds of forums.

5) FREQUENCY, NOT CONTENT

For many older people what matters is not what is contained in communication, but its frequency. Knowing that people are interested enough to make some kind of contact is far more important than anything those people actually say.

6) THE FINE LINE BETWEEN CARE AND SURVEILLANCE

This point applies to personal relationships, where older people may appreciate being in constant contact, but care greatly about autonomy and dignity. It also applies to the macro level, as where some people regard China’s response to the virus as unacceptable authoritarianism, and others see it as an entirely justified expression of how a state cares for its citizens.

7) SMART FROM BELOW

Most policy suggestions are implemented by policy experts in a ‘top-down’ manner, thereby affecting the bulk of the population, but the widespread use of digital technologies produce a democratising of creativity and ingenuity. Anthropologists seek to learn from the creative responses of ordinary people, accumulate examples (e.g. https://covidmutualaid.org/) and use these to educate others.

ASSA will soon be publishing a 150-page manual of protocols on how to use WhatsApp for health, created by Marilia Duque, who is a researcher on our team. These are not her own ideas, but best practice examples gathered from 16 months of observing how older people in Brazil used smartphones for health purposes. We need to establish platforms where people can share what they are learning from the creative response of ordinary people.

8) CARE AT A DISTANCE

Digital technologies have made the practice of care at a distance commonplace. This occurs in different ways. For example, working with older people in China and Japan, we found they have shifted to much greater use of visual communication, such as stickers and short videos, as a way of expressing care. These people found it easier to convey affection through these means, rather than through more conservative traditions of face-to-face encounters.

9) WHATSAPP SUPPORT

Today many people form WhatsApp groups with family and friends to support isolated people or patients. This is highly effective. So we need to ensure that everyone is aware of its benefits. Marilia Duque is advocating a system of `WhatsApp Angels’ in Brazil in response to the virus. As it happens, Whatsapp has already created a ‘Coronavirus Information Hub’ which includes examples of how to use the app to stay in touch with loved ones or seek up-to-date health information on the virus. The Information Hub can be accessed here.

10) WEBCAM

In a phone call, older English people traditionally tend to say they are fine, even if they are at death’s door. There are many advantages to connecting via webcam, which allows one to see how a person is actually doing. Many might find it helpful to have their webcam switched on even when people are not actually talking, since this is more akin to co-present living together.

11) NON-TECH-SAVVY ELDERLY PEOPLE

Coronavirus is about to cause a crisis for those elderly people who may never learn to use smartphones, as access is stopped for visitors to care homes. A helpful device is the Amazon Echo Show, since it can conduct webcam conversation through simple voice commands such as ‘Echo, videocall Mary’. Set-up requires another person using an Alexa App and is quite complex but the technology does work.

12) FACEBOOK

Facebook has shifted from a young person’s platform to use more by older people and community groups. At this point, the main advice is for young people to remain on Facebook where they will be able to share more family information, jokes, and other material with those older people.

13) CONFIDENTIALITY IS LESS IMPORTANT

The hospice research mentioned above suggested that, so far from protecting people, an obsession by institutions with privacy and confidentiality has become a major source of harm. People who are ill were more concerned to ensure that relevant people were informed about their condition, rather than that strangers might also know about their condition. Privacy is important, but tight controls over data because of concerns over litigation can cause considerable harm to patients.

14) PATIENCE AND PATIENTS

Older people may want and need to learn about how to use smartphones and similar skills, but they mainly reported that young people do not help teach them. They become irritable and impatient and take the phone away to make changes. With social isolation it will become even more important to help people learn to do things for themselves.

15) KITEMARKING

Googling for health information is now a ubiquitous part of how people respond to illness or the fear of illness. Users, influenced by commercial sites or scare stories, can end up more anxious and misinformed. Kitemarking has improved with the foregrounding of more authoritative sources and is promising to do more. Google have already implemented this, prompting UK-based internet users to consult the WHO and NHS pages when the term ‘covid 19’ is entered into Google. However, Google health enquiries are still often headed by commercial and sponsored sites.

16) A GLOBAL EXPERIMENT

Right now, the world is embarking upon a vast global experiment, by default: a massive shift of education, work and sociality to online. This is an important time for digital anthropology to try to help assess any associated problems that arise from these strategies, as well as any long-term benefits.

How to use your smartphone: Insights from a pilot course in Dar al-Hawa

MayaDe Vries Kedem6 March 2020

Blog post written by Maya de Vries and Laila Abed Rabho

Please note that the participant names used in this blog post, as well as the neighbourhood name ‘Dar al-Hawa’, have been pseudonymised for reasons of anonymity and confidentiality. Dar al-Hawa is the pseudonym for a neighbourhood of 10,000 people in al-Quds (East Jerusalem).

One of the very first observations we had in the field site of Dar al-Hawa was that most people, young and old, own a smartphone. However, when delving deeper into the ways in which they used their phones, we discovered that their digital skills were very limited, and the use of different apps other than WhatsApp, is almost non-existent. Following the goals of the ASSA project, it was clear to us that part of our fieldwork should be to enable individuals to learn and improve their digital skills – an aim also aligned with what Kurt Lewin (1964) called research action in the fieldsite.

It took us more than a year to bring everything together, including finding the right organisation, the right space, getting the timing right, and finding future participants willing to join the course. When it finally happened, we were able to create a pilot course consisting of 12 meetings running for 3.5 hours each. Each of these sessions focused on one thing only, and that is teaching students how to use a smartphone. We partnered with a local organisation called “Good Thought”, a non-profit organisation established in 2003 which aims to reduce social gaps in Israel by providing teaching technical and digital skills to underprivileged groups. Good Thought already teaches similar courses, but they are usually aimed at helping students learn how to use a computer. When we approached them, it was after having spent a long time in the fieldsite, visiting people’s homes and seeing and hearing from different individuals who told us that they don’t have computers or laptops, just smartphones. Hence, we insisted that the course should be focused only on the smartphone. Because of this, the project was effectively a pilot one for the staff of Good Thought as well.

The first meeting took place on the 25th of November at the community centre in Dar al-Hawa, where 17 people arrived to receive information about the course. Eventually, only 15 people registered to attend the course – 4 women and one man. Since the state of Israel has previously declared that it aims to encourage its population and institutes to become more ‘digital’ and thus increase ‘digital equality’[1], we were lucky to receive significant subsidies for the course, meaning each participant only paid 20 NIS for the 12 meetings (NIS = Israeli New Shekel, this is the equivalent of about £4.41).

The leading instructor was N’, a Palestinian woman from al-Quds (East Jerusalem) who is a teacher by profession. Maya de Vries was her assistant throughout the course. In terms of participation and attendance rates, the course was a big success, as more than half of the participants attended 100% of the meetings, and the second half attended around 80-90% of the meetings. This indicates that participants were pleased with the content of the meetings and found it meaningful and helpful. Throughout the course, participants shared these feelings with us and told us how happy they are to be part of it. They also shared with us the fact that this course gives them a reason to get out of the house, and reduces some of the loneliness and boredom they experience on other days of the week when they don’t have other activities planned. One of the participants,  Malak (aged 78) said the course “was something to wake up in the morning and feel happy for”. Here, the act of learning and developing digital skills as part of a group with a mutual goal provided sociality as well, which is something that can be lost in older age.

N’ and de Vries also came to learn difficult it is for individuals who do not speak Hebrew or English to control their smartphones, even if the language of the device itself was set to Arabic. During a lesson about how to use the MyVisit app (a government app assisting users in booking appointments with various formal institutes like electricity companies or the National Insurance Institute etc.), we did not manage to find an Arabic version of it. Hence, those who did not learn Hebrew or English at school were excluded from this particular lesson and completely depended on their group mates as well as N’ and De Vries, to help them.

Figure 1: The MyVisit App (in Hebrew). The smartphone is held by one of the participants. Photo by Maya de Vries (CC BY)

We also came across several government-provided apps and websites which either did not have any Arabic content or had little Arabic content. Furthermore, only 3 out of 15 participants had an email account, and many government-provided apps require email registration to use. Although now each participant has an email account, which they created as part of the course’s assignments, they still found it more difficult to use these. Thus, if the government wants to increase digital participation among different groups, they should think about Whatsapp as an easier-to-use, more functional tool.[2]

In addition to the matter of digital inequality, we also considered the sociopolitical gaps related to the geopolitical conditions of Dar al-Hawa and al-Quds in general[3]. For example, we discovered how difficult it is for this age group to both click on the touch screen as well as wait for their ‘request’ to be uploaded. Many times, we had to explain to our students that they need to be more patient and wait for the app to upload their request, or for the website to appear. We repeated this instruction until our very last meeting – we do not think there is a clear solution to it other than continuing to practice using these tools.

Figure 2: Learning how to turn on the flashlight/torch on their smartphone (Photo by Maya de Vries CC BY)

WhatsApp is the most used app on participants’ phones – they all have it and they all know how to use its basic features such as sending messages and forwarding messages and photos. Nevertheless, we dedicated two lessons to WhatsApp use, including taking photos and selfies, which were not practicalities most of the participants were familiar with. We also taught them how to create a new group and how to record messages. Following WhatsApp, the second most popular apps were Facebook Messenger and Youtube. No one had any health apps on their phone, not even apps related to their health clinic, which has an Arabic language app.

One of the ASSA project’s findings across various field sites, including Japan and Ireland, was that ‘step counter’ apps are in widespread use among the populations studied. These step counters were not used by our participants, not even the versions that are free and built into their phone, although some had heard of step counting and the fact that there was an app on their phone that did just that. No one had actually opened the app, however.

Unfortunately, 12 meetings are simply not enough to teach participants all that smartphones can offer their users. This was something our participants felt during the course as well, and during the final session, they asked to have a second round of the course so they can learn more and develop their skills by learning how to use things like digital banking as well as other features we did not have the time to teach.

Going beyond the skills taught to the participants, as we quoted Malak before, we also heard, in the final session, how happy the students were when coming to the course and learning new things that can assist them in becoming less dependent on their children and grandchildren. Such feelings around the practicalities of independence should be more present among the older population in Dar al-Hawa. Thus, by creating more similar future courses, we are also hoping to make local older people’s lives easier and happier by increasing their knowledge in the digital arena.

Figure 3: The last session’s feast: participants brought home-cooked food to celebrate their achievements during the course. Photo by Maya de Vries (CC BY)

 

 

[1] See more here (in Hebrew): https://www.gov.il/he/departments/digital_israel
[2] We hope to create a greater change and solve this problem.  At the end of March, we are meeting with a representative from the E-Government office (Mimshal Zamin in Hebrew), thus hoping to work with them on both the language gaps, specific the Arabic one, but also on other accessibility issues for older people.
[3] The asymmetry in the education system has a long history, mainly starting after the 1967 annexation of East Jerusalem. For more, see the following Ir Amim report at http://www.ir-amim.org.il/sites/default/files/Education_Report_2017-Fifty_Years_of_Neglect.pdf