Supporting Contraceptive Decision-Making in the Intermediated Pharmacy Setting in KenyaAdolescent girls and young women (AGYW) in sub-Saharan Africa face unique barriers to contraceptive access and lack AGYW-centered contraceptive decision-support resources. To empower AGYW to make informed choices and improve reproductive health outcomes, we developed a tablet-based application to provide contraceptive education and decision-making support in the pharmacy setting - a key source of contraceptive services for AGYW - in Kenya. We conducted workshops with AGYW and pharmacy providers in Kenya to gather app feedback and understand how to integrate the intervention into the pharmacy setting. Our analysis highlights how intermediated interactions - a multiuser, cooperative effort to enable technology use and information access - could inform a successful contraceptive intervention in Kenya. The potential strengths of intermediation in our setting inform implications for technological health interventions in intermediated scenarios in low- and middle-income countries, including challenges and opportunities for extending impact to different populations and integrating technology into resource-constrained healthcare settings.2025LOLisa Orii et al.University of Washington, Computer Science & EngineeringMental Health Apps & Online Support CommunitiesReproductive & Women's HealthSustainable HCICHI
HIV Client Perspectives on Digital Health in MalawieHealth has strong potential to advance HIV care in low- and middle-income countries. Given the sensitivity of HIV-related information and the risks associated with unintended HIV status disclosure, clients’ privacy perceptions towards eHealth applications should be examined to develop client-centered technologies. Through focus group discussions with antiretroviral therapy (ART) clients from Lighthouse Trust, Malawi’s public HIV care program, we explored perceptions of data security and privacy, including their understanding of data flow and their concerns about data confidentiality across several layers of data use. Our findings highlight the broad privacy concerns that affect ART clients’ day-to-day choices, clients’ trust in Malawi's health system, and their acceptance of, and familiarity with, point-of-care technologies used in HIV care. Based on our findings, we provide recommendations for building robust digital health systems in low- and middle-income countries with limited resources, nascent privacy regulations, and political will to take action to protect client data.2024LOLisa Orii et al.University of WashingtonMental Health Apps & Online Support CommunitiesPrivacy by Design & User ControlCHI
Speculating with Care: Worker-centered Perspectives on Scale in a Chat-based Health Information ServiceTechnological scale and human care work are often seen as incompatible. Yet, seeking to address barriers to in-person care, governments and non-governmental organizations globally have been pushing for scaling remote care technologies such as chat- or phone-based helpdesks or telehealth systems that rely on care workers to engage with users. Despite theoretical tensions between care and scale and the essential role of care workers, workers' perspective on scale and its impact on care provision is rarely centered early on in decisions to scale. In this paper, we examine care and scale from the perspective of medical support executives (MSEs) who support a chat-based health information service for maternal and child health deployed across multiple states in India. We draw on interviews with MSEs, NGO staff who implement the service, and families who use the service, as well as speculative design sessions conducted with MSEs. We find that by centering MSEs' perspectives, we can differentiate between growth of the relationships and heterogeneity that enable social impact, versus scale-thinking that promotes the decontextualization of care. We leverage our findings to discuss implications for the design of remote care technologies, including the importance of place and human connection.2023NKNaveena Karusala et al.Health InformationCSCW
Unsettling Care Infrastructures: From the Individual to the Structural in a Digital Maternal and Child Health InterventionInformation services for maternal and child health are increasingly being implemented at scale and integrated into public health infrastructures in Global South countries. These services often disseminate tailored health information and provide channels for families to ask questions to health workers. With increasing uptake, these services are intervening into a highly gendered space and shaping care work and information-seeking in new ways. We present a study of a patient education program and associated WhatsApp-based information service deployed across multiple states in India, drawing on observations, interviews, and analysis of chat records. Building on notions of ``unsettling care'' [63], we examine what it means to deploy such an intervention in inequitable, fragmented health systems. We find that even as the intervention focuses on individual behavior change, it also runs up against structural issues, such as the overburden of health workers, an illegible health system, and gendered power dynamics that extend beyond the realm of the home. We use our findings to unsettle notions of how the intervention provides care, and to reframe how we might think about the design and implementation of health information services to also engage with structural issues.2023NKNaveena Karusala et al.University of WashingtonCognitive Impairment & Neurodiversity (Autism, ADHD, Dyslexia)Mental Health Apps & Online Support CommunitiesDeveloping Countries & HCI for Development (HCI4D)CHI
From Grasshoppers to Second-Hand Cars: Understanding Smartphone-Supported Enterprises in Peri-urban TanzaniaThe evolving socio-technical landscape in peri-urban Tanzania has paved the way for a dramatic increase in smartphone-supported micro and small enterprises. We conduct surveys and focus groups with 46 such entrepreneurs, shedding light on the internal mechanisms and external networks of their businesses. We uncover the new trust dynamics encountered in online interactions, the gendered aspects of this emerging business model, and the means through which people with low capital are reclaiming economic empowerment through entrepreneurship.2023ARAnanditha Raghunath et al.University of WashingtonAlgorithmic Fairness & BiasDeveloping Countries & HCI for Development (HCI4D)CHI
Towards Conviviality in Navigating Health Information on Social MediaHCI is increasingly concerned with health information quality and spread of misinformation on social media. Despite many major platforms having been adopted across the world, the situated evaluation and sharing of health information is underexplored across diverse health systems and cultural and political contexts. Drawing on semi-structured interviews, we study the navigation of health information on social media in urban and rural South India, backdropped by plural knowledges around health and the specific politics and sociality of health and social media in this setting. We use Ivan Illich's concept of tools for conviviality [49] to distinguish between how people creatively use tools versus how tools manage and impose values on people---participants aimed to use health information towards care beyond institutionalized healthcare, but insidious misinformation and information-sharing practices served to commodify, spark uncertainty in, and discipline caring behavior. We use our findings to expand understandings of the use of health information on social media and how positionality shapes how people are affected by and respond to misinformation. We also draw attention to the structural aspects of health misinformation in the Indian context and how the design of social media platforms might play a role in addressing it.2022NKNaveena Karusala et al.University of WashingtonSocial Platform Design & User BehaviorMisinformation & Fact-CheckingTechnology Ethics & Critical HCICHI
"That courage to encourage": Participation and Aspirations in Chat-based Peer Support for Youth Living with HIVWe present a qualitative study of a six-month pilot of WhatsApp-based facilitated peer support groups, serving youth living with human immunodeficiency virus (HIV) in an informal settlement in Nairobi, Kenya. Popular chat apps are increasingly being leveraged to enable a combination of patient-provider communication and peer support in informal contexts. However, how these interventions are experienced in Global South settings with phone sharing and intermittent data access is understudied. The context of stigmatized illnesses like HIV further complicates privacy concerns. We draw on chat records and interviews with youth and the facilitator to describe their experience of the intervention. We find that despite tensions in group dynamics, intermittent participation, and contingencies around privacy, youth were motivated by newfound aspirations and community to manage their health. We use our findings to discuss implications for the design of chat-based peer interventions, negotiation of privacy in mobile health applications, and the role of aspirations in health interventions.2021NKNaveena Karusala et al.University of WashingtonCognitive Impairment & Neurodiversity (Autism, ADHD, Dyslexia)Mental Health Apps & Online Support CommunitiesParticipatory DesignCHI
ReCall: Crowdsourcing on Basic Phones to Financially Sustain Voice ForumsAlthough voice forums are widely used to enable marginalized communities to produce, consume, and share information, their financial sustainability is a key concern among HCI4D researchers and practitioners. We present ReCall, a crowdsourcing marketplace accessible via phone calls where low-income rural residents vocally transcribe audio files to gain free airtime to participate in voice forums as well as to earn money. We conducted a series of experimental and usability evaluations with 28 low-income people in rural India to examine the effect of phone types, channel types, and review modes on speech transcription performance. We then deployed ReCall for two weeks to 24 low-income rural residents who placed 5,879 phone calls, completed 29,000 micro tasks to yield transcriptions with 85% accuracy, and earned INR 20,500. Our mixed-methods analysis indicates that each minute of crowd work on ReCall gives users eight minutes of free airtime on another voice forum, and thus illustrates a way to address the financial sustainability of voice forums.2019AVAditya Vashistha et al.University of WashingtonCrowdsourcing Task Design & Quality ControlDeveloping Countries & HCI for Development (HCI4D)CHI
Threats, Abuses, Flirting, and Blackmail: Gender Inequity in Social Media Voice ForumsHCI4D researchers and practitioners have leveraged voice forums to enable people with literacy, socioeconomic, and connectivity barriers to access, report, and share information. Although voice forums have received impassioned usage from low-income, low-literate, rural, tribal, and disabled communities in diverse HCI4D contexts, the participation of women in these services is almost non-existent. In this paper, we investigate the reasons for the low participation of women in social media voice forums by examining the use of Sangeet Swara in India and Baang in Pakistan by marginalized women and men. Our mixed-methods approach spanning content analysis of audio posts, quantitative analysis of interactions between users, and qualitative interviews with users indicate gender inequity due to deep-rooted patriarchal values. We found that women on these forums faced systemic discrimination and encountered abusive content, flirts, threats, and harassment. We discuss design recommendations to create social media voice forums that foster gender equity in use of these services.2019AVAditya Vashistha et al.University of WashingtonGender & Race Issues in HCIEmpowerment of Marginalized GroupsCHI
"My cousin bought the phone for me. I never go to mobile shops": The Role of Family in Women's Technological Inclusion in Islamic CultureThe intersection of Islam and gender affect technological and social interactions for Muslim women in significant ways and remains an understudied domain for CSCW and related fields. Building on 73 qualitative interviews with low-income women in Punjab, Pakistan, we analyze the complexity of family relationships and the subsequent dynamics of authority around technology uptake and usage by women within non-Western contexts, and, specifically, within the Islamic world. We argue that a Pakistani woman's experience with technology depends on many factors, including gendered roles, generational differences in a family, and wider socio-cultural and religious influences against the backdrop of a culturally conservative and patriarchal society. Our paper highlights the rich family dynamics, including key life events, that transform the roles of both Muslim women and their relatives. Our work is intended to inform scholars, practitioners within development agencies and industry, and other individuals studying technology and development about household dynamics that influence Muslim women's use of technology to encourage them to consider these dynamics during design and implementation processes for technological inclusion.2019SISamia Ibtasam et al.Technological inclusion and non/useCSCW
Digital Financial Needs of Micro-entrepreneur Women in Pakistan: Is Mobile Money The Answer?This paper studies the use of Digital Financial Services (DFS) as a solution to women's financial inclusion in deeply patriarchal, resource constrained communities. Through a qualitative, empirical study we map the financial life cycles of 20 women micro-entrepreneurs in different cities in Pakistan and the challenges they face. We explore how technology is currently influencing these women's businesses and personal lives and reveal how mobile money is not tuned to the problems they face and their financial needs. We present alternate design directions for meeting the technological and financial needs of these women, circumnavigating the patriarchal structures that constrain them.2019MMMaryam Mustafa et al.Information Technology UniversityVisual Impairment Technologies (Screen Readers, Tactile Graphics, Braille)Sustainable HCIEcological Design & Green ComputingCHI
Engaging Identity, Assets, and Constraints in Designing for ResilienceWe contribute to the growing conversation on assets-based approaches to design in Computer-Supported Cooperative Work (CSCW) and Human-Computer Interaction (HCI) with a qualitative study of resilience. Our study is situated within a community health infrastructure in a rural county in southwest Kenya, where health organizations pay community health workers' salaries via digital payments, backdropped by ongoing issues with missing and delayed payments. Through the lens of intersectionality, we examine how community health workers of diverse backgrounds and contracted status respond to the mandated use of digital payment methods and long payment delays. We highlight how resilience in this context is situated in workers' intersecting socioeconomic and professional identities, which shape the assets and constraints that workers engage with in efforts to be resilient. We leverage our findings to discuss how assets-based approaches to design can be further operationalized and used to sustainably support resilience.2019NKNaveena Karusala et al.Health and ResilienceCSCW