University: Baylor University
Description of Work:
In May 2015, I traveled to Uganda with a PhD student in Information Systems to teach a business seminar and conduct research. Our purpose was to find out how ICTs (information communication technologies) might be used to improve healthcare practices in Uganda. Our research participants represented Ugandans who live in two areas—in the city and in small villages. We used a mixed methods approach with focus groups and surveys. We conducted two pilot studies via Skype and had eight locals complete our survey before travelling to Uganda.
Our research focus significantly changed after conducting the two pilot focus groups. We discovered that the healthcare situation of the Ugandans was different from our expectations. From those conversations, we reworked our survey questions and our focus group questions. We are in the process of analyzing our data, having just completed transcribing our videos from the focus groups and tabulating our survey results.
What has been the most surprising finding thus far in the process has been the process. It is a two-fold amazing research journey—as we have heard their stories we have realized their need as a culture for their stories to be heard and we realized that our research process morphed and changed. We began to understand that our experiences with the process were as important as our findings may be when we have completed our analysis. We believe that our field needs to develop a methodology for research in developing countries.
Mobilizing Uganda: What are the technologies that inform Ugandan decisions about healthcare?
Our research informs the overarching question: How can ICTs (information and communication technologies) affect the communication practices related to healthcare for Ugandans? Specifically, what would it look like to include Ugandan patients as users of technology in the design of healthcare initiatives? Understanding cultural norms, fears, http://medicalrhetoric.com/symposium2015/participant-profiles/debra-burleson/and expectations of technologies and also healthcare will inform and guide this research.
We plan to conduct research in Uganda over the summer of 2015, focusing on improving healthcare practices at local clinics. We will gather data using interviews and focus groups. In our review of literature, we found that a lack of understanding about the users’ context in the design of an IT application can cause the project to fail [Rivett et al. 2014]. Their chapter cited examples of engineering projects that were technically successful but failed because the users did not use it. One example was the University of Cape Town’s Department of Computer Science design of a teleconsultation system. The system would provide a way for physicians in local hospitals to communicate with nurses in rural clinics.
Logs from the teleconsultation systems showed that the nurses did not use the systems. Even though the nurses said that they used the system, they seldom did. The authors’ results showed that the project failed due to two reasons: (1) in local cultures, the people do not criticize because it is seen as important to agree, and (2) the nurses distrusted the system because they believed that the doctors used the system to check on their attendance at the clinic. After investigating the reasons for the failure, the engineers soon discovered that the local health department frequently would assign nurses to clinics a significant distance from the nurses’ homes. These nurses would use Fridays and Mondays to travel home and they feared that their might lose their jobs if they were monitored by the teleconsultation system. The authors concluded with a call for including users as co-designers. Our field understands the need for including users in design, but this need includes much more than asking questions of use. It includes understanding the world that the users interacts in and the barriers that might not be readily apparent.
Our main hope is to identify how the underlying infrastructure allows full utilization of smartphone capabilities and how smart phone technology might shorten the length of time that patients have to wait at local clinics. Unlike other projects, however, we aim to involve locals of Uganda in the design of our research effort. To date, we have conducted face-to-face and Skype meetings with researchers in Uganda and they have driven the logistical process. In addition, one of our researchers in the project is Zimbabwean, and provides first-hand experiential insight into the motivations for technological usage in a developing nation and cultural expectations.
From our initial visits, we began to understand the differences in Western perceptions of technology and those of West Africans. One example of a subtle but important use of technology was in a discussion of Facebook. We discussed how social media might play an important role in the dissemination of announcements from the local clinics in Uganda. The discussion quickly moved to the expense of bandwith in accessing Facebook. The workaround for Ugandans (and many Africans) is to use mobile Facebook. Instead of logging onto www.facebook.com, Ugandans access Facebook by logging on to m.facebook.com. The interface is different but what drives the decision is the cost to the user. Sites such as www.webmd.com are not available for Ugandans to access.
However, we also realize that we are uncovering challenges that are sensitive and difficult for Ugandans to talk about. In one of our sessions, a local Ugandan related a story about the power that nurses have in his country. As we asked more questions, he explained that frequently nurses are confrontational with patients because they have the power to administer or refuse care. A review of literature about this topic yield no results. Yet, both the Zimbabwean researcher and the Ugandan discussed it.
Using the search terms of “healthcare,” “Africa,” “patients,” and “technology” in the Journal of Business and Technical Communication since 2005 yielded two results–one article referenced a study about ICTs, focusing on information from India and the other cited an article which included the word “Africa” in its title. In a broader search of Sage publications, the majority of results were articles about technologies, specifically ICTs. For example, Jahangirian and Taylor’s article focused on e-health projects but did not mention or interview patients (2013).
This research will have its challenges in that forty different languages are currently spoken in Uganda, although English is required by law to be taught in school. Compared to the U.S. where one might argue that Spanish is quickly becoming more prominent, English is still the dominant language. As we asked the question, “What would it look like to include Ugandan patients as users of technology in the design of healthcare initiatives?”, we know it is a question for now and also for the future.
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