Supporting Community Health Workers in India through Voice- and Web-Based Feedback

Abstract

Our research aims to support community health workers (CHWs) in low-resource settings by providing them with personalized information regarding their work. This information is delivered through a combination of voice-and webbased feedback that is derived from data already collected by CHWs. We describe the in situ participatory design approach used to create usable and appropriate feedback for low-literate CHWs and present usage data from a 12-month study with 71 CHWs in India. We show how the system supported and motivated CHWs, and how they used both the web-and voice-based systems, and each of the visualizations, for different reasons. We also show that the comparative feedback provided by the system introduced elements of competition that discouraged some CHWs while motivating others. Taken together, our findings suggest that providing personalized voice-and web-based feedback could be an effective way to support and motivate CHWs in low-resource settings.

Indigenous Women Managing Pregnancy Complications in Rural Ecuador

“…For example, the complex medical terminology was difficult to understand in textual and verbal form in Spanish with little translation available in Kichwa due to its writing limitations. Furthermore mobile technology can offer opportunities to enhance doctor's home visits [34,35,121] and the medication informational order [31,32] (e.g., what, when, how and why to take a medication) at home, and can facilitate the self-management of gestational diabetes to control weight gain [53]. Introducing self-monitoring devices both at the rural subcenters and at home can facilitate the early detection and management of hypertensive disorders during pregnancy [102,103].…”

“…Most digital health initiatives focus on helping community health workers to gather accurate data during home visits, enhance screening and information-seeking practices, visualization of tasks and facilitate communication with women [34,35,76,104,145]. While the digital transformation in maternal health is opening up opportunities for HCI research for development (HCI4D) in South Africa [28,50,100,133], Kenya [113,114], Pakistan [12,99,127], India [35,64,72,73], Bangladesh [138], Lebanon [140,141], Uganda and Tanzania [68], there is limited research looking at women's experiences during pregnancy complications [12] and among indigenous communities [8,57] and Latin America as a region remains unexplored for HCI4D research in healthcare [19,135].…”

The Invisible Work of Maintenance in Community Health

“…In addition, interactive radio shows have also supported frontline health workers to host real-time discussions with the community and localized sharing of experiences [64]. Mobile technology (e.g., calls, SMS, WhatsApp) is also supporting the communication, coordination and sharing of work-related information (e.g., birth notifications) between frontline health workers [56,81], providing simple visualizations of household visits [35], and facilitating data collection practices [90]. ICTs are also enhancing training programs [65,80] and supporting peer learning [144,145] combining different applications and various types of digital content.…”

“…There is a growing interest to design technology to support the work of frontline health workers by assisting with dissemination of health education [77,78,136], providing on-demand feedback of household visits [35], receiving feedback from care recipients [85,86], and providing training and learning opportunities [65,80,144,145]. However, existing interventions mostly focus on literacy, training, data collection, work performance and accountability overlooking the issues frontline health workers face and the wider network of actors, sociocultural practices, disconnected knowledges, material and spatial elements that influence and shape their work practices [54,55,93,117].…”

The Case for Community Health Innovation Networks

“…Instead, we would like to offer a more fundamental reappraisal of how we might embed ICT4D research in the world of practice. Take for example a recent series of papers on the use of digital tools for personalized performance feedback among community health workers in India [25,26]. The investigators undertook an extensive, participatory design process and evaluated their intervention's effects through a rigorous randomized trial.…”