IMPORTANCE Home health care workers care for community-dwelling adults and play an important role in supporting patients with confirmed and suspected coronavirus disease 2019 ) who remain at home. These workers are mostly middle-aged women and racial/ethnic minorities who typically earn low wages. Despite being integral to patient care, these workers are often neglected by the medical community and society at large; thus, developing a health care system capable of addressing the COVID-19 crisis and future pandemics requires a better understanding of the experiences of home health care workers.OBJECTIVE To understand the experiences of home health care workers caring for patients in New York City during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTSFrom March to April 2020, a qualitative study with 1-to-1 semistructured interviews of 33 home health care workers in New York City was conducted in partnership with the 1199SEIU Home Care Industry Education Fund, a benefit fund of the 1199 Service Employees International Union United Healthcare Workers East, the largest health care union in the US. Purposeful sampling was used to identify and recruit home health care workers.MAIN OUTCOMES AND MEASURES Audio-recorded interviews were professionally transcribed and analyzed using grounded theory. Major themes and subthemes were identified. RESULTSIn total, 33 home health care workers employed by 24 unique home care agencies across the 5 boroughs of New York City participated. Participants had a mean (SD) age of 47.6 (14.0) years, 32 (97%) were women, 21 (64%) were Black participants, and 6 (18%) were Hispanic participants. Five major themes emerged: home health care workers (1) were on the front lines of the COVID-19 pandemic but felt invisible; (2) reported a heightened risk for virus transmission; (3) received varying amounts of information, supplies, and training from their home care agencies; (4) relied on nonagency alternatives for support, including information and supplies; and (5) were forced to make difficult trade-offs in their work and personal lives. CONCLUSIONS AND RELEVANCEIn this qualitative analysis, home health care workers reported providing frontline essential care, often at personal risk, during the COVID-19 pandemic. They experienced challenges that exacerbated the inequities they face as a marginalized workforce. Interventions and policies to better support these frontline health care professionals are urgently needed.

Survivors of intimate partner violence increasingly report that abusers install spyware on devices to track their location, monitor communications, and cause emotional and physical harm. To date there has been only cursory investigation into the spyware used in such intimate partner surveillance (IPS). We provide the first in-depth study of the IPS spyware ecosystem. We design, implement, and evaluate a measurement pipeline that combines web and app store crawling with machine learning to find and label apps that are potentially dangerous in IPS contexts. Ultimately we identify several hundred such IPS-relevant apps.While we find dozens of overt spyware tools, the majority are "dual-use" apps -they have a legitimate purpose (e.g., child safety or anti-theft), but are easily and effectively repurposed for spying on a partner. We document that a wealth of online resources are available to educate abusers about exploiting apps for IPS. We also show how some dual-use app developers are encouraging their use in IPS via advertisements, blogs, and customer support services. We analyze existing anti-virus and anti-spyware tools, which universally fail to identify dual-use apps as a threat.

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Digital technologies, including mobile devices, cloud computing services, and social networks, play a nuanced role in intimate partner violence (IPV) settings, including domestic abuse, stalking, and surveillance of victims by abusive partners. However, the interactions among victims of IPV, abusers, law enforcement, counselors, and others --- and the roles that digital technologies play in these interactions --- are poorly understood. We present a qualitative study that analyzes the role of digital technologies in the IPV ecosystem in New York City. Findings from semi-structured interviews with 40 IPV professionals and nine focus groups with 32 survivors of IPV reveal a complex set of socio-technical challenges that stem from the intimate nature of the relationships involved and the complexities of managing shared social circles. Both IPV professionals and survivors feel that they do not possess adequate expertise to be able to identify or cope with technology-enabled IPV, and there are currently insufficient best practices to help them deal with abuse via technology. We also reveal a number of tensions and trade-offs in negotiating technology's role in social support and legal procedures. Taken together, our findings contribute a nuanced understanding of technology's role in the IPV ecosystem and yield recommendations for HCI and technology experts interested in aiding victims of abuse.

A growing body of HCI4D research studies the use of SMS communication to deliver health and information services to underserved populations. This paper contributes a novel dimension to this field of study by examining if a hybrid computer-human SMS system can engage pregnant women in Kenya in health-related communication. Our approach leverages the different strengths of both the computer and the human. The computer automates the bulk-sending of personalized messages to patients, allowing the human to read patients' replies and respond to those in need of attention. Findings from a 12-month deployment with 100 women show that our approach is capable of engaging the majority of participants in health-related conversations. We show that receiving messages from the system triggers participant communication and the amount of communication increases as participants approach their expected due date. In addition, analysis of participants' messages shows that they often contain sensitive health information conveyed through a complex mixture of languages and 'txting' abbreviations, all of which highlight the benefits of including a human in the workflow. Our findings are relevant for HCI researchers and practitioners interested in understanding or engaging underserved populations.

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Intimate partner abusers use technology to track, monitor, harass, and otherwise harm their victims, and prior work reports that victims have few resources for obtaining help with such attacks. This paper presents a qualitative analysis of data from a field study of an approach to helping survivors of intimate partner violence (IPV) with technology abuse. In this approach, called clinical computer security, a trained technologist performs a face-to-face consultation with an IPV survivor to help them understand and navigate technology issues. Findings from consultations with 31 survivors, as well as IPV professionals working on their behalf, uncovered a range of digital security and privacy vulnerabilities exacerbated by the nuanced social context of such abuse. In this paper we explore survivor experiences with, and reactions to, the consultations, discussing (1) the ways in which survivors present their tech concerns, (2) the cooperative work required to guide survivors towards understanding probable causes of tech insecurity, (3) survivors' reactions to the consultations, particularly when security vulnerabilities or spyware are discovered, and (4) the role we play as consultants and interventionists in the complex socio-technical systems involved in mitigating IPV. We conclude by discussing some of the broad ethical and sustainability challenges raised by our work, and provide design opportunities for tech platforms to better support survivors of IPV.

Prior research on technology use in the Global South suggests that people in marginalized communities frequently share a single device among multiple individuals. However, the data privacy challenges and tensions that arise when people share devices have not been studied in depth. This paper presents a qualitative study with 72 participants that analyzes how families in Bangladesh currently share mobile phones, their usage patterns, and the tensions and challenges that arise as individuals seek to protect the privacy of their personal data. We show how people share devices out of economic need, but also because sharing is a social and cultural practice that is deeply embedded in Bangladeshi society. We also discuss how prevalent power relationships affect sharing practices and reveal gender dynamics that impact the privacy of women's data. Finally, we highlight strategies that participants adopted to protect their private data from the people with whom they share devices. Taken together, our findings have broad implications that advance the CSCW community's understanding of digital privacy outside the Western world.