Fig 1: Screen showing Covid-19 prevention messages in a UN office in Ouagadougou. Photo credit: Charles Somé.

A few days ago, I came across a rather unusual document. It is a compilation of different technologies put together by the European Investment Bank, entitled Covid-19: Africa’s digital solutions[1]. It was published last year, with the support of the United Nations Development Programme (UNDP), and it sets out to identify the digital solutions currently on offer in the response to Covid in Africa. Several things strike me as I read this document: firstly, the breadth of these initiatives seems to reflect a faith in the ability of technology to respond to the health crisis. The inventory reports that about 100 digital solutions have already been ‘implemented’ or tested as of 20 June 2020. It also gives an estimate of the investment needed to implement such ‘high-impact’ solutions.

Then, there are different types of tools being promoted in different countries. There are collaborative tools such as Zoom and Skype, which have multiplied greatly, and use messaging apps such WhatsApp in professional contexts such as education, has also gone up. Traditional media, such as television, for example, has remained important due its ability to reach a great number of people during the crisis. Innovations also include tracking applications based on geographic information technology for epidemic surveillance purposes. On page 15 of the document, contact tracing apps are described as follows: “These applications, which often use geolocation data from telecommunications companies, help to identify contacts of people who have tested positive and help to locate areas where the virus is spreading.” We learn that applications have been developed and put to use in Kenya, Morocco and Rwanda among other countries. FabLab, an innovation hub in Kenya, has developed an application called Msafari, which can track public transport users.

Other digital tools have been used for mass communication and self-assessment of risks and symptoms. In Sierra Leone, for example, an existing public platform using unstructured supplementary service data (USSD) has been expanded to allow citizens to self-assess their symptoms and get alerts on developments on the COVID-19 front in the country.

The use of drones has also been experimented with to deliver pharmaceutical products or to transport PCR tests from remote areas to laboratories in big cities like Abidjan in Côte d’Ivoire or Kigali in Rwanda.

But are all these innovations and techno-digital solutions going to make a difference in the medium or long term? Firstly, let us recall that there is a gap between the international presence and publicity around various technological innovations, some of which can even be award-winning, and what actually happens on the ground.  Throughout our 18 months of fieldwork in Yaoundé for the ASSA project, we noted this significant gap, which says something about the difficulty of digital applications and solutions when it comes to capturing the attention of users.

The profile of a young Snapchat user in Cameroon. The screen shows various COVID-19 messages superimposed onto a photo of the user. Photo sent to the author by research participant.

In most of these countries, although tracking applications were received with curiosity, they nevertheless worried public opinion because they raised problems of data use and privacy. Not only are they worrying, but they are not always seen as appropriate solutions for the local context. Interfaces such as the one in the picture above, where COVID-19 related messages fit into the user interface seamlessly, work well in the context because they fit into the social media landscape. Young people want to show concern about the virus and they might adopt features of a social media network that support COVID-19 messaging for a few hours occasionally during the outbreak. But for that, they also need to be reminded by other channels of support and communication that the crisis is still there. The resonance of this issue is strongly linked to the strategic orientations of African countries in terms of their politics, economic situation and sensitivity to innovations.

Another part of the current debate concerns the mistrust of not only technological solutions but also of vaccines against COVID-19. For example, medical anthropologist Alice Desclaux and a team of French researchers [2], who undertook an exploratory study among 215 people in four African countries this year, found that 2 out of 3 participants said they would refuse to be vaccinated against Covid-19. They say: “reasons for refusal included firstly fear of any side effects hidden by the pharmaceutical companies, and secondly the perception of the vaccine as a tool in a plot by Bill Gates to reduce the African population or by a coalition of the powerful (states, global institutions) to enslave populations and ensure a “new world order” using corrupt authorities in African countries (“coronabusiness”). The study also found there was a preference for endogenous solutions to control SARS-CoV2, such as traditional medicine or the protection provided by religion.” There is therefore an urgent need to study more seriously the sources of the constant doubt surrounding the surveillance of epidemics, which are reflected and accentuated at pivotal moments such as Ebola or recently, Covid-19.

The central hypothesis of this is that the operational responses of nation-states are aligned with a policy of systematically using surveillance (biometric) and the tracing of infected persons (mHealth) as the preferred institutional response to emerging epidemics. However, this response has underestimated the capacity for the circulation of alternative interpretations of epidemics favoured by an abundance of content conveyed via social networks and smartphones. The direct access of the public to this content reinforces a widespread suspicion of local governments that are seen as corrupt and that accept servile compromises with the leaders of large pharmaceutical groups to the detriment of ‘African solutions’. Therefore the solution for helping people accept technological and digital solutionism to the crisis is not just to blame them for pharmaceutical nationalism, or their non-openness to innovations, but rather like anthropology and the ASSA team’s approach, making an effort to understand and carefully analyse not only people’s perceptions of the vaccine and the Covid outbreak, but also the intertwining of the logics behind them.

References

[1] European Investment Bank (EIB): Africa’s digital solutions to tackle COVID-19, found at: https://www.eib.org/en/publications/african-digital-best-practice-to-tackle-covid-19

[2] Desclaux A, 2021, « Covid-19: En Afrique de l’Ouest, le vaccin n’est pas le nouveau « magic bullet », available at: https://vih.org/20210202/la-mondialisation-des-informations-et-la-fabrique-des-opinions-sur-les-traitements-du-covid-en-afrique/

Photo by Bonneval Sebastien on Unsplash

Technology as intuitive design

The word ‘intuitive’ has become a go-to adjective for design that is perceived to be user-friendly and easy to use. Some claim this is the secret to Apple’s success – they design and manufacture products that people almost instantly ‘know what to do with’ when they get their hands on them. The Internet-of-Things and smart homes are also touted as being intuitive ways of automating household-related tasks such as stocking up on ingredients or controlling central heating, although they still have not been adopted en masse (at least not in Europe).

Sure enough, intuitive design as a set of principles does exist, and intuitiveness is what we often imagine we want from a device: to pick it up and simply know what to do. Indeed, inclusive design is often perceived as being the manufacturer’s responsibility, and many will be aware that they have a myriad of consumer segments, not all of whom are necessarily proficient at using technology. It is common, then, for manufacturers and tech companies to conduct extensive user research for the purposes of developing a product that meets a minimum number of requirements, is widely accessible and helps meet their needs. This often involves researchers giving tasks to users and watching them figure out how to complete them. This can test whether the options, paths and menus laid out before them give sufficient information to allow them to progress to through the different stages of the task. You might say they are, to some extent, testing whether the device or software in question is ‘intuitive’.

This research is vital. However, it may not always be enough to provide an in-depth social context as to why certain users behave the way they do, which is where ethnographic fieldwork comes in.

Can ethnography help us better understand creative uses of devices?

In the ASSA project’s upcoming collaborative monograph ‘The Global Smartphone: Beyond a youth technology’, my colleagues describe the ways in which their ethnographic insights are based on ‘holistic contextualisation’. That is to say, that in order to reflect the reality of people’s lives, they studied with people in their normal life circumstances rather than say, in the context of a focus group. As the fieldwork was conducted over a fairly long period of time (16 months) and many of the researchers became good friends with the people who participated in the research, they were able to observe the many and varied ways in which older adults used smartphones. There were participants who were proficient and there were many who were new to the devices, but more than that, the anthropologists were also privy to the deeper, more specific context around their device-related behaviour – whether that was something to do with a specific event within their family, or the way they thought about retirement.

ASSA team members Marilia Duque, Alfonso Otaegui, Maya de Vries, Pauline Garvey, and Daniel Miller all volunteered at local cultural centres where they taught older adults how to use smartphones. All of their projects included a particular emphasis on certain vital tasks such as sending or sharing photos as well as messaging apps such as WhatsApp. Several of them have all written about their experiences: here (Maya), here (Marilia) and here (Alfonso), and Marilia has published an extensive manual that takes her ethnographic observations and formulates a set of best practice protocols for adapting a ubiquitous app like WhatsApp to health purposes, such as doing a rapid evaluation of a patient via messaging and photos. I recommend downloading this (which can be done for free) here and going through it. It is an instructive piece of work that shows how something like WhatsApp can potentially be adapted for use in clinics, hospitals and other healthcare settings. More importantly, it highlights the importance of meeting users where they are, rather than building a new app, since the great majority of older people in Brazil are already on WhatsApp.

Even before COVID-19 hit, in-person free training for older people in many regions was already quite limited. This means that older people or people who had recently started using smartphones (now that these are increasingly affordable) had to rely on family members and friends to teach them how to use the device. Alternatively, they could learn how to use it themselves – not an easy feat if one is starting from scratch, even if one grew up with technologies such as early computers. The issue with this, which is another one of the findings of the ASSA project, is that family members often lack the patience or time to teach older adults how to use their phones, often assuming that the user will work it out for themselves, as smartphones are ‘meant to be’ quite intuitive. This may ring true as an expectation to users who have gone through the many different iterations of phone-related upgrades and improvements which mean that the phone is now better equipped than ever to respond to their needs. But those who are just starting out might question why it should be considered intuitive for something like the ‘share’ button or icon, represented as dots connected by lines (see below) to mean one wants to share a file. What about the three dots/lines makes it obvious something is about to be shared? This finding comes from Alfonso Otaegui, whose students did not always find it easy to choose the best option for going forward when they were in their phone’s Gallery app, where they faced a multitude of options, all represented by various icons.

An example of how the option to share a file is typically depicted on Android phones. Image from the Noun Project (created by David Vickhoff)

In their smartphone use courses, the team members who taught older adults were able to help their research participants gain confidence in a device that doesn’t always ‘make sense’. In Alfonso’s class, to take an example, some students took notes on paper – this may appear ‘counterintuitive’ to someone who is an experienced content creator and sharer, but what it does is show the ways in which ‘learning by doing’ is not always effective. This is especially the case if the ‘doing’ relies on the user decoding symbols and actions that are considered by many to be intuitive but do not make sense to them. The ASSA project’s collaborative book ‘The Global Smartphone’, due to come out 06 May 2021, discusses claims and narratives around the concept of the intuitive phone in more depth.

A preview of the cover of the Global Smartphone

“Is my grandmother using this tablet incorrectly or is she just being creative?”

To bring a more personal anecdote into this, I was recently discussing a friend’s grandmother and her newfound use of tablets. The grandmother in question lives alone in her home country, while her son and grandchildren are abroad. She is not particularly mobile and relies on a carer and friends/neighbours to do her shopping and other tasks. Not having used any technology beyond a basic Nokia mobile phone until the age of 80, she was given a very basic tablet a few years ago, which she began using at home, initially by borrowing the neighbours’ wi-fi. Not having a particularly good understanding of what the internet is and what can be done through it, she began using the tablet in what she considered to be instinctive ways, quickly understanding that information can be sought on Google and music videos can be played on YouTube.

However, when she talks about her tablet use to her son and grandchildren (on the phone), they discover they barely have anything in common when it comes to their understanding of technology. For example, she has been saying she has made friends with a young girl who is a member of the diaspora in Chicago and who is giving her virtual tours of the city. She is hugely appreciative of this, as it gives her something to do and allows her to travel to countries she has never been to. Her grandchildren do not understand how this virtual connection could be possible, as it is unlikely she is proficient enough to be visiting chatrooms and meeting new people. They, therefore, conclude that she may have stumbled across a live-streamed event which is likely being regularly broadcast on Facebook. They do this by piecing together her different descriptions of the event: there were many people on the screen, everyone seemed friendly, and the host got into her car and drove around the city for a few hours whilst on video.

Similarly, when she received multiple photos of a family pet which looked similar but were taken from different angles, she insisted these were multiple cats. This was quickly revealed to be a ploy to amuse other family members by making them believe she was extraordinarily bad at technology. It gave her a reason to ask for more photos of the pet to be sent so she can check the likeness. This also encouraged her family members to stay in touch more frequently. Here, it becomes apparent that being familiar with the social and familial context behind her behaviours is crucial to understanding the way she uses her tablet: one could easily say she is simply ‘not a good user of the device’ yet. However, family members and others who know her well have observed that she is simply using the device as best she can (and sometimes tactically/strategically) in a context in which she has no formal training or teaching. While she found googling to be fairly ‘intuitive’, tasks such as sending photos are more difficult, further highlighting that these should not necessarily be thought of as universally intuitive.

While the above is far from being a complete ethnographic account, it can act as an example to illustrate the importance of the full context behind her use of the tablet.

Smartphones, ageing and intuitive tech

As mentioned above, the ASSA project’s Global Smartphone book expands on this topic much more broadly and with more evidence from across all of the 10 fieldsites the team did research in.

Although it can be said that technology design is trying to become more inclusive and accessible, it is impossible for it to be free of bias or exclusion. Where possible, paying attention to the ways in which users adopt creative ways of making an app or device work for them can be particularly useful and ethnographic research is a great tool through which this can be done. Longer-term ethnography has the great advantage of giving the researcher the opportunity to build the depth of relationships necessary for them to contextualise particular behaviours to do with technology, such as a user refusing to use a particular app or feeling the need to ‘tidy’ their home screen in the same way they would tidy their home (to take an example observed by Patrick Awondo in Cameroon). Once some of the researchers had built a good enough relationship with their research participants, they were even able to get them to ‘open up’ their smartphones to them and go through the different apps they had acquired over the years, talking about their use or non-use of each one in more detail.

There is a lot of guidance out there for designing more inclusively and designing for users with what is termed ‘low digital literacy’. This guidance is vital and very important, but I would argue that where anthropology can make a real difference is in providing the necessary methodology, context and empathy that are needed to go beyond observing behaviours and situating these within a more holistic context, be it cultural, social, material or political.