Compensation in HCI research is often the primary ethical interface between HCI researchers and low-income communities. Yet, prevailing models of compensation can perpetuate neocolonial extraction and frame participation as transactional labor. This practice risks creating dependency and obscuring power imbalances, ultimately compromising both research integrity and participant dignity. Drawing on the experiences of researchers working in Africa and the southern African philosophy of Ubuntu, this paper employs a decolonial lens to critique the research economy of participation and compensation. We propose a framework for relational compensation, which re-imagines compensation not as payment for data but as a form of restorative justice and relational accountability. Through analytic vignettes, we examine tensions around community-researcher interdependency, gendered care burdens, and community solidarity. We conclude with principles for relational research economies that prioritize communal benefit, long-term data sovereignty, and co-designed terms of engagement, offering HCI a path toward reciprocal praxis.

As artificial intelligence continues to advance, marginalized communities, particularly in Africa, remain limited in their ability to shape what AI should do, how it should be built, and how it might benefit them. This study adopted a speculative co-design approach with participants from Ocean View, a low-income community in South Africa. The aim was to elicit and facilitate collective visions to reimagine the future of AI and explore ways to make AI technologies more culturally relevant. Our findings reveal participants’ perceptions about AI, which informed a collective vision of AI designs that embed the community’s local language and culture as well as services aimed at improving the community’s economic opportunities. Based on these insights, we identified directions for ethical AI design for marginalized communities that recognise and preserve cultural identity, needs for affordable AI designs, and the potential of AI for their socio-economic advancement as trajectories within AI research.

Abstract Technological artifacts designed by individuals from developing nations often do not flourish in developing regions. Many authors conducting work in these regions have therefore called on researchers to make use of co-design in order to mitigate power imbalances, include the voices of communities in the design of technology intended for them, and design and build more contextually situated technology. Many of these authors also refer to the need for co-design readiness in their work. However, little is known about how co-design readiness can be articulated and achieved, especially when working with rural communities. In this paper, we make use of qualitative meta-analysis to interrogate the data from three distinct case studies in order to investigate co-design readiness. We found that co-design readiness comprises three forms, namely: (1) emotional readiness built through trust, relationship building, and empathy; (2) cultural readiness, which requires that researchers and participants have an awareness and respect for each other’s cultural values and beliefs; and, finally, (3) readiness in terms of confidence and familiarity with the technologies used which can be achieved through careful and strategic methodological decisions. We found that researchers should explicitly plan for readiness and should not assume that readiness will grow organically and that co-design, if planned well is a lengthy process. Finally, we provide learnings from our work to how co-design readiness can be achieved through planning and methodological decisions.

Abstract Pregnant women in the Global South face significant challenges due to lack of resources and informational gaps. In this paper, we take an assets-based lens to examine the experiences of pregnant women in a low-resource setting in Ghana, focusing on the role of information and technology in prenatal care. Through interviews and co-design workshops, we sought to understand the perspectives of multiple stakeholders including pregnant women, their family members, and healthcare professionals. We highlight the complexities involved in making decisions during pregnancy, including the challenges arising from the tensions between traditional healthcare practices and modern Western health services. We discuss opportunities in digital maternal health where we argue for the importance of attending to local needs and values and advocate for recognising community strengths and integrating rural care practices as valuable assets in prenatal intervention design. Our work aims to bridge some of the gaps between the theoretical understanding of digital health and the practical realities of prenatal care in low-resource settings.

Chatbots have the potential to support child health by answering parents doubts and providing tailored information. However, prior work has not studied the deployment of chatbots for this setting. We analysed how parents used the Aurora Facebook Messenger chatbot, designed for Portuguese parents, with an optional subscription to professional support. Our analysis investigated chatbot use, discussed topics, and conversation topics, drawing on user engagement and conversation metrics, text-mining, user satisfaction scores, and conversation content analysis. Results revealed 718 active users (out of 1043), with peak activity during lunchtime and late at night. Most queries pertained to critical situations, including infant sleep (80%), (breast)feeding (13%), or healthcare-related issues (7%). Aurora handled in-domain questions appropriately, but struggled to answer multi-topic queries. Subscription users had 243% more interactions and 162% more extended use of the chatbot. Our research underscores the importance of offering timely and personalised messaging to meet parents’ needs.

Message-based health information dissemination systems can potentially improve maternal and child health (MCH). By conveying health information to parents, SMS- and chatbot-based systems can support parents’ learning and empower them to make better health decisions for their children. However, there is limited design advice for creating message-based dissemination systems for MCH. To help address this gap, we conducted 14 participatory workshops with 42 parents from Portugal and South Africa, exploring how parents learned to care for their children’s health. Our findings showed how parents reflected on the health advice they received, by assessing the fit of the advice to their child’s characteristics, their values and beliefs, the advice’s feasibility, or the intention and competence of the advice giver. Based on these insights, we propose four design implications for creating message-based health information dissemination systems tailored to parents and their children.

We explored the use of digital stories to support empathy skills training in maternity health workers. Our digital stories build on an existing in-person training approach; the Secret History (SH) that was developed by the Perinatal Mental Health Project. During SH training, health workers are invited to enact scenarios with patients, examining their reactions and responses as they learn more about the "history" of their patients and of their assumed characters as health workers. This training has resulted in improvement in empathic skills for health workers, but opportunities to scale the intervention are limited. The SH is costly to implement, requiring in-person workshops and facilitator training for small groups of workers. Our mobile application may either supplement or introduce the SH concepts at scale to health workers. The stories have been co-designed with mental health experts, midwives, and other trainers, and employ a "choose-your-own-adventure" approach, slowly revealing the histories of the characters, as in the original SH protocol. To inform decisions of the app design, data was collected through interviews, co-design workshops and focus group discussions as detailed in the methods section.

Community Networks (CNs) worldwide are promising low-resource communities new ways of connecting and interplaying with technology. The embedded infrastructures of the CNs are derived from the sociocultural, political, spatial, and economic practices of the people they are built with and the communities they are located in. CNs situated in an area are not only followed by the technical requirements and possibilities of making the networks alive and accessible but are also shaped and moulded by the people and their practices. Community members’ lived experience and awareness of the local knowledge and local practices materialize the network in the situated realities. Yet the knowledge and experiences of the communities are often invisible and not considered in future research agendas for infrastructure and technology developments. In this workshop, we aim to bring together community members from around the world working on the frontlines of CNs as experts to share their local knowledge and experiences of designing, developing, negotiating, and maintaining the network, while opening the space for early career researchers and students to listen and learn from the ground.

In this demo, we will show how a mutual credit-based community voucher or currency integrated with a community-owned network and a local content server could incentivise users to become better custodians of commons infrastructure. This could lead to the generation of more locally relevant digital content and the expansion, use, and stability of a community voucher to support wider local markets that embrace local digital and physical goods and services.

Especially in developing regions, parents are rarely given a direct voice in the design of digital maternal and child health (MCH) interventions. Instead, MCH needs and requirements are driven by organizations and health workers. In this research, we engage with both rural and urban parents and community leaders to better understand their challenges and priorities for digital MCH and propose a parent-centered agenda for human-computer interaction research. This paper reports on the community-based, digital MCH priorities identified in our research, and describes how we approached community discourse and co-design of digital initiatives for these priorities, through parent-centered workshops with low-resource South African communities. Furthermore, we provide the parent-centered design opportunities and tensions we discovered for digital MCH in South African contexts, such as designing for local contexts and languages, designing for accessibility and connectedness, and highlighting the underdeveloped digital MCH niches. Finally, we highlight the importance of including facilitators for co-design workshops, such as using intermediaries and design cards.

Isolation contributes to deteriorating health outcomes during the first 1000 days of a child's life (the period from conception to two years). Mothers and their growing babies are at risk of pregnancy-related complications and malnutrition during this sensitive period due to inadequate information. This study describes how a faith-based organization (FBO) in Cape Town leverages available resources in both physical and virtual spaces to support mothers through antenatal classes. We observed seven small groups in their physical spaces, interviewed seven mothers and analyzed fifteen WhatsApp chat groups to understand the group structure, dynamics, and interactions. When the model was introduced to the mothers in the physical and virtual spaces simultaneously, cohesion was achieved and sustained. However, during the COVID-19 pandemic, where strong indications of stress and isolation were evident, a strange paradox was noted: all groups showed weak ties (with minimal communication among members). It was hard to explain the non-commitment despite efforts from the moderators to encourage sharing among mothers. We identified two underlying causes: a minimal sense of belonging to the group and bandwidth constraints. Further analysis showed that bandwidth constraints digitally excluded some mothers from active participation. These findings indicated the need for HCI and technology designers to design less bandwidth-intensive interactive platforms for inclusivity.

research-article Open AccessPoster: Lessons from Doing Fieldwork with Bandwidth-constrained communities Online Share on Authors: Sarina Till University of Cape Town and Independent Institute of Education, South Africa University of Cape Town and Independent Institute of Education, South AfricaView Profile , Melissa Densmore University of Cape Town, South Africa University of Cape Town, South AfricaView Profile , Toshka Lauren Coleman University of Cape Town, South Africa University of Cape Town, South AfricaView Profile , Nervo Verdezoto Dias Cardiff University, South Africa Cardiff University, South AfricaView Profile Authors Info & Claims COMPASS '21: ACM SIGCAS Conference on Computing and Sustainable SocietiesJune 2021 Pages 445–448https://doi.org/10.1145/3460112.3471979Online:23 September 2021Publication History 0citation50DownloadsMetricsTotal Citations0Total Downloads50Last 12 Months50Last 6 weeks20 Get Citation AlertsNew Citation Alert added!This alert has been successfully added and will be sent to:You will be notified whenever a record that you have chosen has been cited.To manage your alert preferences, click on the button below.Manage my AlertsNew Citation Alert!Please log in to your account Save to BinderSave to BinderCreate a New BinderNameCancelCreateExport CitationPublisher SiteView all FormatsPDF

This poster presents iNethi, a community wireless network deployed in a peri-urban township of Cape Town, South Africa. Initial usage clearly indicates a demand for Internet-based external services and, to a lesser extent, local services. We focus on the initial months of our deployment, and interaction with locally installed INethi services, as well as the impact of access to the Internet. We present data from our traffic logs, captured during a period of six months. We observed that a large proportion of data is being consumed by software or antivirus updates. The data collected and trends observed will allow iNethi operators to make necessary adjustment to the networks.

Designing mobile applications for breastfeeding mothers can be challenging; creating spaces to foster co-design -- when a mother's primary focus is on her child rather than on design activities - is even more so. In this paper we discuss the development of the Milk Matters mobile application, a tool developed to motivate women to donate their surplus breast milk to the local milk bank. We look at the importance of different approaches to understanding the mothers, comparing workshops, surveys, and cultural probes. Through our work we identify three factors to consider when co-designing with and for mothers: 1) interrupted interactions 2) elements that might distract a baby and 3) the importance of empowering mothers through positive reinforcement. Based on these factors we examine our methodological approaches, suggesting ways to make future research with breastfeeding mothers more productive.

There is already strong evidence that mobile videos are a good vehicle for public health information dissemination, but there remain open questions around sustainability, appropriate target users, consumption patterns, content, and usage models. We analyse log and interview data of 42 community health workers (who were first time smartphone users) from a longitudinal 17-month deployment to better understand how the utility of mobile videos played out over time in rural Lesotho. During the study period, videos were viewed at an average of 170 times per month, for a total of 2898 views. Through this data we draw these primary findings: a) pausing is not contextually necessary, b) age is not a barrier to usage, c) the primary predictor of popularity of a given video is topical relevance and national campaigns, d) there is no apparent relationship between video length, popularity and completion rates, and e) new videos have only a short-lived novelty effect. Furthermore, we affirm that regular engagement with CHWs has an impact on continued usage, in addition to being important for reducing attrition due to technical issues.

Behavior change support systems (BCSS) and persuasive technologies for healthcare often entail users interacting with mobile devices. However, especially in developing countries, the target community is unfamiliar with and often intimidated by new technologies. In this paper we propose the use of intermediaries to facilitate interaction with a mobile phone-based application and to motivate ongoing use by the target beneficiaries. The application incentivizes utilization through gamification techniques, using badges, scoreboards, and other rewards. For example, a young girl might help her father keep track of his walking and diet, maintaining participation as much for her father's health as for the social awards given by the app. We explain how intermediaries can be leveraged to improve utilization and engagement of the beneficiaries, and describe factors affecting interaction between the participating pairs and interaction with the application. This study highlights the importance of social rapport - typically through a familial relationship - as a key component of the intervention. Finally, we discuss the implications of designing for the motivation of two different users: gamification, personalization and utility play different roles for the intermediary and the beneficiary but ultimately combine to make a more effective application for the beneficiary than one targeting the beneficiary alone.

At the beginning of an ICT4D project where mobile phones will be used, the question that researchers and practitioners ponder is: what mobile device will be best for the project? In this paper, we present guidelines for making this choice, based on lessons drawn from a review of 30 ICT4D projects, and the reflection of our own work with Community Health Workers in Lesotho in the last four years, during which we used three types of devices in the field. We discuss the considerations that can guide the process of selecting the best device or mobile platform for each project and context, and discuss the recent upsurge of smartphone preference over feature phones in ICT4D projects, and the factors to consider when selecting smartphones for fieldwork.

Computerised clinical practice guidelines are a key component of effective clinical decision support systems, especially in low-resource regions such as Malawi. To address shortages in staffing and budgets for training, the practice of task-shifting, the clinical practice guidelines (CPGs) enable health workers with limited training to provide a standardised level of care. However, CPGs are tradition-ally paper-based, with only a few CPGs having been computerised for Malawi's national electronic health record system. These CPGs have been hard-coded into the system, necessitating significant additional work to add support for future and revised CPGs. We further investigate CPG computerisation challenges in order to understand the motivations for the current computerised CPGs implementation. We use semi-structured interviews, code reviews, and observations in Malawi. Most significantly, we extend existing understanding of software engineering principles to the context of low-resource environments, noting that the tensions between conflicting stakeholder requirements, deadline and deliverable expectations, and good software engineering often result in systems that are harder to maintain, further exacerbating potential problems with longevity of ICTD deployments. We further suggest that a component-based approach in conjunction with communities of open source developers might help alleviate this problem by providing more scalable and robust CPG support.

What are rural farmers in sub-Saharan Africa's current attitudes towards their mobile phones? We draw from qualitative studies of smallholder farmers in Kenya and Zambia to answer this question. A review of ongoing efforts to develop mobile phone services for farmers paired with critiques of the "colonial impulse" embedded in future-oriented visions of technology use guided our study. Our findings suggest there is a mismatch between the design of mobile phone applications and our participants' perceptions and usage of their devices. We also discovered several understudied barriers that hinder adoption of mobile services: the influx of counterfeit and substandard mobile phones, distrust of the content being delivered via SMS and reservations about the spiritual and health consequences accompanying phone use. We use these findings to encourage Information and Communication Technology and Development (ICTD) researchers and practitioners to re-examine the mobile phone. Specifically, we suggest developing interventions that teach farmers how to better use phones and present recommendations for improving their design.

When engaged in ICTD research, it is often simpler to focus efforts on a single specific technology, whether that entails computers for telecenters, mobile phones for data collection, or text messages for public health education. In practice, however, people and organizations use a variety of technologies together, smoothly interweaving them as they navigate their lives. In this paper we analyze the ways in which a health financing organization in Uganda integrates a variety of communications technologies together to achieve reliable communications with their partnering health facilities distributed throughout Southwest Uganda. Based on four years of participant observation, we describe two communication scenarios in this organization to illustrate braided communications at work. We find that stakeholders work together to develop and maintain effective relationships using many different communications channels together in parallel, a combined channel we describe as braided communications. Braided communications have three primary characteristics. Firstly, they use co-existing channels, employing each as best suits a given set of goals. Secondly, they are co-dependent, or co-reinforcing, with strengths of individual channels reinforcing weaknesses of other channels. Finally, they are co-evolving; as available technologies and the ways in which they are used change, the nature of the braided use changes as well.

This paper seeks to bring scrutiny to 'Jugaad' as concept of user driven innovation in the context of ICTD research. We collate and organize a variety of definitions denoting adoption and innovation of technology in constrained eco systems. We attempt to bring a nuanced understanding of contextual processes supporting or hindering use adoption and innovation of ICTs by probing the multi-meanings of Jugaad as ground-up processes of technology adoption

Mobile devices are increasingly powerful and flexible tools for computing and communication. When ICTD workers are given a mobile phone "for work", what else do they do? And to what extent can or should an employer shape that use? This note presents research in progress, focused on rules that development projects impose to govern use of mobile devices. This work maps these rules against actual instrumental (work-related, non-prescribed) and non-instrumental (personal) device use, and enforcement of these rules, in eight projects using a popular mobile-based job aid, CommCare. We present early insights from qualitative analysis of two such deployments in India identifying a range of often conflicting policy choices that affect device use for project mission and/or professional and personal empowerment. We explore tradeoffs for morale, work quality, mission, and device integrity. We identify user remote availability, soft intimidation, and validation as mechanisms to shift authority and credibility of information sources. The implications of our findings are increasingly important as governments and NGOs arm frontline workers with mobile devices as tools to improve service delivery.

This paper looks back at the deployment of Claim Mobile, a smartphone-based data collection application developed for a non-governmental organization (NGO) in Southwest Uganda. This NGO subsidizes health facilities by paying for medical services on the basis of claims submitted after the patient consultation, targeting treatment of 99,000 clients between 2006-2011. I successfully tested Claim Mobile in Summer 2008, processing 35 claims over two weeks, and then discontinued it six months later, when it became apparent that integration and scale-up of the technology would be problematic for the NGO. In addition, many issues we hoped to address through technology had been addressed through program management changes instead. I find that a) the context motivating the technology changed over time, b) simpler solutions can be as effective as new technologies, and c) prioritizing the needs of the NGO required abandoning the deployment of Claim Mobile. Thus this paper presents the value of learning from failure in the process of designing for users in developing regions.

Claim Mobile is a platform designed to support a project that subsidizes healthcare by reimbursing health service providers in Uganda for treatment of patients with sexually transmitted infections. As with many development projects, the Uganda Output-Based Aid (OBA) project involves a number of stakeholders: the service providers, the project implementers, the financiers, and the Ugandan government. Design of an appropriate solution requires meeting the various and conflicting requirements of all of these stakeholders. In this paper we detail the rapid design and testing of a pilot implementation of a mobile and web-based system for processing claims forms, based on two prior field visits to Uganda. Based on a comparative device study, semi-structured interviews, health clinic surveys, and a brief deployment, we affirm the selection of the mobile phone as a platform from the health clinic perspective, and further suggest that effective design for development requires more than addressing requirements of the the “users” of the mobile phones but also all the other stakeholders involved, who may have conflicting requirements.

This paper examines two parallel case studies to promote remote medical consultation in Ghana. These projects, initiated independently by different researchers in different organizations, both deployed ICT solutions in the same medical community in the same year. The Ghana Consultation Network currently has over 125 users running a Web-based application over a delay-tolerant network of servers. OneTouch MedicareLine is currently providing 1700 doctors in Ghana with free mobile phone calls and text messages to other members of the medical community. We present the consequences of (1) the institutional context and identity of the investigators, as well as specific decisions made with respect to (2) partnerships formed, (3) perceptions of technological infrastructure, and (4) high-level design decisions. In concluding, we discuss lessons learned and high-level implications for future ICTD research agendas.

Computer-mediated communication systems can be used to bridge the gap between doctors in underserved regions with local shortages of medical expertise and medical specialists worldwide. To this end, we describe the design of a prototype remote consultation system intended to provide the social, institutional and infrastructural context for sustained, self-organizing growth of a globally-distributed Ghanaian medical community. The design is grounded in an iterative design process that included two rounds of extended design fieldwork throughout Ghana and draws on three key design principles (social networks as a framework on which to build incentives within a self-organizing network; optional and incremental integration with existing referral mechanisms; and a weakly-connected, distributed architecture that allows for a highly interactive, responsive system despite failures in connectivity). We discuss initial experiences from an ongoing trial deployment in southern Ghana.