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
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
Making Chat at Home in the Hospital: Exploring Chat Use by NursesIn this paper, we examine WhatsApp use by nurses in India. Globally, personal chat apps have taken the workplace by storm, and healthcare is no exception. In the hospital setting, this raises questions around how chat apps are integrated into hospital work and the consequences of using such personal tools for work. To address these questions, we conducted an ethnographic study of chat use in nurses' work in a large multi-specialty hospital. By examining how chat is embedded in the hospital, rather than focusing on individual use of personal tools, we throw new light on the adoption of personal tools at work specifically what happens when such tools are adopted and used as though they were organisational tools. In doing so, we explicate their impact on invisible work [77] and the creep of work into personal time, as well as how hierarchy and power play out in technology use. Thus, we point to the importance of looking beyond individual adoption by knowledge workers when studying the impact of personal tools at work.2020NKNaveena Karusala et al.University of WashingtonConversational ChatbotsSocial Platform Design & User BehaviorCHI
Street-Level Realities of Data Practices in Homeless Services ProvisionQuantification and standardization of concepts like risk and vulnerability are increasingly being used in high-stakes, client-facing social services, also presenting the potential for data-driven tools for decision-making in this context. These trends necessitate an understanding of the role of quantitative data in the work of street-level decision-makers in social services. We present a qualitative study of existing data practices and perceptions of potential data-driven tools in housing allocation, engaging the perspective of service providers and policymakers in homeless services in a large urban county in the United States. Our findings highlight participants' concerns around centering clients' choices and ensuring integrity in a resource-constrained, high-stakes context. We also highlight differences between the perspectives of policymakers and service providers on standardization and fairness in the decision-making process. We discuss how use of and policies around data in social services need to consider the importance of the relationships that client-facing service providers have with other workers in the organization, with their work, and with clients.2019NKNaveena Karusala et al.AI and FairnessCSCW
Engaging Feminist Solidarity for Comparative Research, Design, and PracticeResearch in the fields of Computer Supported Cooperative Work (CSCW) and Human-Computer Interaction (HCI) is increasingly embracing and moving across borders. While universalism in such research is widely rejected, sole focus on the "particular" is also commonly critiqued. Kentaro Toyama unpacks this tension, calling for balance via "deliberate efforts to understand the interplay of human universals and cultural differences, and how it pertains to design." In this paper, one such deliberate effort, we introduce the notion of feminist solidarity, as theorized by Chandra Mohanty, for drawing connections across borders in CSCW and HCI research, design, and practice. To enable contributions in these fields to cross cultures and geographies in productive ways, we draw attention to commonalities in the struggles and processes of resistance operating in different contexts of study. To do this, we present lessons learned from conducting three comparative studies in six contexts, which were located across various borders. The primary contribution of our analysis is to leverage a feminist solidarity-based approach towards extending conversations on comparative, transnational, and feminist CSCW and HCI research, design, and practice. Our focus remains on resource-constrained regions across the world, in both the Global North and South.2019NKNeha Kumar et al.Gender, Narratives, and FeminismCSCW
Engaging Lived and Virtual RealitiesWe examined the integration of VR into informal and less-structured learning environments in Atlanta (USA) and Mumbai (India) through a process of co-design, co-creation, and co-learning with students and teachers where students learned to use VR to engage with their economic, social, and cultural realities. Using qualitative methods, we engaged students and teachers at both sites in VR content creation activities; through these activities, we attempt to uncover a deeper understanding of the challenges and opportunities of introducing low-cost mobile VR for content generation, consumption, and sharing in underserved learning contexts. We also motivate future work that looks at integrating VR in new contexts, using flexible methods, across borders. The larger vision of our research is to advance us towards greater accessibility and inclusivity of VR across diverse learning environments.2019AVAditya Vishwanath et al.Stanford UniversitySocial & Collaborative VROnline Learning & MOOC PlatformsDeveloping Countries & HCI for Development (HCI4D)CHI
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
"Only if you use English you will get to more things": Using Smartphones to Navigate MultilingualismWe contribute to the intersection of multilingualism and human-computer interaction (HCI) with our investigation of language preferences in the context of the interface design of interactive systems. Through interview data collected from avid smartphone users located across distinct user groups in India, none of whom were native English speakers, we examine the factors that shape language choice and use on their mobile devices. Our findings indicate that these users frequently engage in English communication proactively and enthusiastically, despite their lack of English fluency, and we detail their motivations for doing so. We then discuss how language in technology use can be a way of putting forth mobility as an aspect of one's identity, making the case for an intersectional approach to studying language in HCI.2018NKNaveena Karusala et al.University of WashingtonMultilingual & Cross-Cultural Voice InteractionUser Research Methods (Interviews, Surveys, Observation)CHI
Bridging Disconnected Knowledges for Community HealthWe present a qualitative inquiry of the Mohalla (neighborhood) Clinics introduced by the government of Delhi (India) to improve access to healthcare among the "weakest sections of society''. We share our findings from fieldwork conducted in and around two Mohalla Clinics to understand the provision and uptake of healthcare services and healthy practices, uncovering factors that obstruct access and adoption. We thus draw on and extend research that examines challenges facing public health infrastructures in underserved contexts by taking a critical feminist approach. Using Haraway's lens of situated knowledges, we highlight the disconnects present across the partial perspectives of the clinics' stakeholders, including the healthcare providers, community health workers, and patient groups. We also analyze how these disconnects affect collaborations, negotiations, and contestations around healthcare. Finally, we provide takeaways from our research towards bridging disconnected knowledges by way of redesigning healthcare interventions, revisiting patient empowerment, and redefining the role of frontline health workers as key infomediaries.2018AIAzra Ismail et al.Patients and Clinical SettingsCSCW
HCI Across Borders: Paving New PathwaysThe HCI Across Borders (HCIxB) community has been growing in recent years, thanks in particular to the Development Consortium at CHI 2016 and the HCIxB Symposium at CHI 2017. For CHI 2018, we would like to organize an HCIxB symposium that focuses on building the scholarship potential and quality of junior HCIxB researchers---paving new pathways, while also strengthening the ties between the more and less junior members of the community.2018NKNeha Kumar et al.Georgia Institute of TechnologyParticipatory DesignUser Research Methods (Interviews, Surveys, Observation)Computational Methods in HCICHI