HCI researchers have increasingly studied how technology might improve the lives of marginalized workers. We explored this question through a qualitative study with home health aides in New York City, a vulnerable group of frontline caregivers whose work with patients is poorly paid and highly stressful, often involving life-or-death situations. To elicit the perspectives of aides and their supervisors on how technology interventions might contribute to moving aides towards a better future, we created a design provocation that centers aides' needs and suggests more equitable roles for them within the home care ecosystem. Findings from design sessions with 16 aides, nurses, and aide coordinators illuminate the ethical and pragmatic dilemmas inherent in this complex ecosystem, and show that designing technology for equity requires attention to structural problems in addition to workers' stated needs. We analyze our findings through the lens of social justice-oriented interaction design, and discuss how our work extends key strategies within this framework.

Home health aides (HHAs) increasingly being used by adults with heart failure for long-term assistance and post-hospitalization care. Despite being heavily involved in numerous aspects of heart failure management, most HHAs have not received heart failure training. They also struggle to get in touch with supervising nurses or other members of the care team when they have clinical questions, which may result in unnecessary visits to the emergency room. In addition, despite serving as a backbone in the health system for patients, HHAs, who are mostly women and minorities, are a marginalized and vulnerable group of frontline caregivers, enduring erratic employment, low wages, discrimination, and high levels of burnout. Although digital technologies could help to address many of the challenges HHAs face, little is known about the current impact of technology on HHAs work practices. To this end, we conducted a multi-stakeholder qualitative study with 38 participants in New York City using semi-structured interviews and focus groups. We uncover the ways in which technology is used, the complex socio-technical factors that underpin heart failure care, and stakeholder suggestions for how technology could improve HHAs work. Building on these insights, we synthesize design opportunities for researchers and designers interested in developing tools that support the delivery of home health care for patients suffering from life-threatening diseases like heart failure.

This paper explores the design space of feedback systems that connect care recipients to the community health feedback loop. While related work in this vein has often emphasized gathering feedback for the sake of transparency alone, our study emphasizes opportunities to integrate the collection and use of feedback in ways that may improve the quality or equity of routine health services. We conducted a qualitative study using semi-structured interviews and focus groups with 23 participants in Kenya. Our field study makes current feedback practices visible; and reveals barriers faced by beneficiaries, community health workers, and their supervisors. Our findings identify relevant socio-technical complexities, and we outline concrete opportunities to design feedback systems that support and augment current practices. These contributions to the ICTD literature hold potential to inform the design of feedback systems that engage underserved populations in a systematic and equitable manner.

Community health programs in low-resource settings (like rural Kenya) aim to provide essential health services to vulnerable populations. However, to date, there has been limited research that explores the design of mechanisms that enable care recipients to provide feedback regarding their satisfaction with the services they receive. Such feedback has the potential to increase the motivation of community health workers (CHWs), enhance training procedures, detect fraudulent behavior, and inform key performance indicators for health programs. Our paper explores the design and deployment of a USSD-based system that allows anyone who possesses a basic mobile phone to provide feedback regarding the health services and quality of care they received from a CHW or during a hospital visit. Our system was designed through iterative fieldwork in rural Kenya that engaged with multiple stakeholder groups, including care recipients, CHWs, and high-level decision makers. After designing and testing the system, we deployed it for seven weeks in Siaya, Kenya, collecting both quantitative system usage data and qualitative data from six focus groups with 42 participants. Findings from our deployment show that 168 care recipients engaged with the system, submitting 495 reports via USSD. We discuss the broader factors impacting deployment, including the feasibility of USSD, actionability of feedback, scalability, and sustainability. Taken together, our findings suggest that USSD is a promising approach for enabling care recipients to submit feedback in a way that balances privacy, equity, and sustainability.

Evaluations of technological artifacts in HCI4D contexts are known to suffer from high levels of participant response bias---where participants only provide positive feedback that they think will please the researcher. This paper describes a practical, low-cost intervention that uses the concept of social proof to influence participant response bias and successfully elicit critical feedback from study participants. We subtly exposed participants to feedback that they perceived to be provided by people 'like them', and experimentally controlled the tone and content of the feedback to provide either positive, negative, or no social proof. We then measured how participants' quantitative and qualitative evaluations of an HCI artifact changed based on the feedback to which they were exposed. We conducted two controlled experiments: an online experiment with 245 MTurk workers and a field experiment with 63 women in rural India. Our findings reveal significant differences between participants in the positive, negative, and no social proof conditions, both online and in the field. Participants in the negative condition provided lower ratings and a greater amount of critical feedback, while participants in the positive condition provided higher ratings and a greater amount of positive feedback. Taken together, our findings demonstrate that social proof is a practical and generalizable technique that could be used by HCI researchers to influence participant response bias in a wide range of contexts and domains.

Digital overuse on mobile devices is a growing problem in everyday life. This paper describes a generalizable mobile intervention that combines nudge theory and negative reinforcement to create a subtle, repeating phone vibration that nudges a user to reduce their digital consumption. For example, if a user has a daily Facebook limit of 30 minutes but opens Facebook past this limit, the user's phone will issue gentle vibrations every five seconds, but the vibration stops once the user navigates away from Facebook. We evaluated the intervention through a three-week controlled experiment with 50 participants on Amazon's Mechanical Turk platform with findings that show daily digital consumption was successfully reduced by over 20%. Although the reduction did not persist after the intervention was removed, insights from qualitative feedback suggest that the intervention made participants more aware of their app usage habits; and we discuss design implications of episodically applying our intervention in specific everyday contexts such as education, sleep, and work. Taken together, our findings advance the HCI community's understanding of how to curb digital overload.