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Long abstract:

Digital technologies in Southern Africa addressing issues such as healthcare, peer-to-peer transactions, transportation, banking, and others alike have offered alternative means of completing tasks, providing service, and improving connectivity. In a space bearing the effects of colonialism and poor governance, this region, however, presents myriad inequalities affecting the utilisation and accessibility of such technology. Focusing on digital technology addressing maternal health in Zambia, this paper draws from ethnographic insights to show the breadth of inequalities impacting users’ accessibility to and usability of technology that serves them. Several inequalities can be gleaned from the adoption of a maternal health app used predominantly in urban Lusaka, which encompass language and literacy, ICT infrastructure, and limited epistemological coding of the app. Multiple languages exist in Zambia, and although the support of apps is translated into a few vernacular languages, this overlooks other literacies such as users’ ability to read. Fragmented ICT infrastructure points to socio-economic differences across users, their device models, and Internet accessibility depending on users’ location. One area of inequality rarely discussed points to coded technology supporting health using biomedicine to frame well-being despite the existing medical plurality in communities. The precedence of biomedicine in digital health marginalises or excludes other aetiologies of care, providing space to epistemologically interrogate the accessibility of digital technology in a diverse space. This discussion thus unpacks the physical and metaphysical inequalities presented by digital technologies that serve a Southern African community despite purported benefits.

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Short abstract:

Digital healthcare risks becoming a tool for exclusion for digitally marginalised groups due to dominant discourses in research and policy failing to forefront equity and justice. Feminist STS and systems approaches can transform mechanisms of exclusion into opportunities for inclusion in policy.

Long abstract:

Digital care strategies in the Netherlands are rapidly accelerating. Whilst eHealth can usually be viewed as a niche innovation, it is currently recognised by the incumbent regime as a promising tool to address burgeoning issues in Dutch healthcare, thus mainstreaming it in such a way that it is undergoing a niche-to-regime transformation. Whilst eHealth is suitable for most, there are still many individuals who face exclusion from healthcare due to a myriad of intersectional factors that stem from an inherently exclusionary socioeconomic and political systems. These underlying mechanisms of exclusion are often ignored, due to dominant frameworks on digital exclusion taking a “user deficit” perspective, where failures in the dissemination of eHealth are framed as the fault of those who cannot use them. This is also reflected in literature, where authors adopt an individualised focus in framing barriers and solutions to low eHealth uptake, as well as in Dutch policy, where digital transformations are distanced from conceptualisations of health equity. In our ongoing research, we use systems and feminist STS approaches to uncover the mechanisms of exclusion used in policy to actively co-create new trajectories for the policy sphere that better include people at a distance to the online world. It is critical prevent eHealth implementation from becoming a persistent problem at this critical moment of transformation in the Dutch healthcare system.

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Short abstract:

Hospitals are adopting self-check-in kiosks to streamline services, but their implementation in a Dutch university hospital raises concerns. While effective for some, vulnerable patients face challenges. The kiosks lack flexibility and may affect the efficiency and the access to quality care.

Long abstract:

In response to labor shortages and rising health care costs, hospitals increasingly use self-check-in-kiosks to streamline service delivery, improve efficiency and enhance patients’ experience. This study reflect on the implementation of self-check-in-kiosks in a Dutch university hospital, particularly in relation to access to care for more vulnerable patients and intended efficiency goals. This ethnographic action research employs desk research, participatory observations and semi-structured interviews. We followed a ‘technology-in-practice’ approach to better understand how this new technology shape care practices in relation to in/exclusion. Our results show that although self-check-in-kiosks work well for some patients, large groups experience practical and psychosocial difficulties. Especially those with sensory, motor or cognitive impairments, go through a complex care pathway, are low-literate, or have limited digital skills. Kiosks are not yet attuned to these patients, and typically leave little flexibility and room for negotiation and personal comfort in what for many is a foreign environment. Patients and staff employ varied (unexpected) strategies to make the machine operational in practice, such as seeking assistance from relatives or already busy staff, or by placing written notes on the counter or on the machine to guide patients. In conclusion, this research show that innovating within a healthcare system already under pressure, due to staffing shortages and budget cuts, carries risks, as it may unintendedly threaten access to and quality of care for patients. Due to the extra work this generates for such patients and for care professionals, the workload reduction aspired seems also elusive, or is, at the very least, unequally distributed. This raises questions about which process to digitize in the healthcare sector.

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Long abstract:

Digital devices have become instrumental to contemporary cultures of communication. Health and social care providers, who benefited from education programmes in which Information and Communication Technologies (ICTs) have increasingly become pivotal, pertain to the relatively enskilled users of digital devices. These providers, and the institutions they work at, have increasingly proposed digital means to communicate with service users. Apps dedicated to health promotion, text messages to provide critical information about appointments or subsidies and internet-based appointment services now permeate the health and social system. For the enskilled ICTs user, it can be difficult to conceptualize the barriers to care that these developments in provider-user communication form. Drawing from an anthropology of skills and knowledge-making and based on an ethnography concerning how immigrant mothers use or renounce to use ICTs, this presentation will explicit the complex and overlooked knowledges essential to operate basic ICTs. These technologies and their operational tools such as windows, tabs, fonts or icons, constitute visual and spatial affordances which meaning relies on situated cultural clues. Far from being obvious, the interpretation of these affordances demands shared cultural representations and experiences between creators and users. For immigrant mothers who originally use another alphabet or code, as for instance in semitic languages such as Tigrinya, the communication through ICT in French or English requires a multilayered learning process. Immigrant mothers are hence often deprived of critical information regarding the access to health and social care, thus contributing to reproductive injustice.

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Long abstract:

This study explores the role of the digital platform REACT-NOR as a boundary object in connecting caregivers of patients suffering from psychosis with clinicians. Drawing on concepts from STS, specifically the notion of boundary objects and Actor-Network Theory, the research investigates how REACT-NOR facilitates collaboration and information exchange between caregivers and clinicians within the complex network of actors involved in mental healthcare. The platform serves as a boundary object for social inclusion by providing a shared space for caregivers and clinicians, transcending the diverse perspectives, interests, and expertise within the mental health ecosystem. Utilizing Actor-Network Theory, the study examines the interactions and relationships formed among caregivers, clinicians, and the digital platform itself. It considers the platform as an active participant in the network, shaping and mediating the connections between different actors. Through qualitative analysis of user experiences and interviews, this research seeks to understand how REACT-NOR influences communication, coordination, and knowledge sharing between caregivers and clinicians. The study aims to uncover the dynamics of the network, examining how the digital platform both reflects and shapes the practices and relationships in the context of psychosis care. Findings from this research will contribute to the broader discourse on the role of digital platforms as boundary objects in healthcare settings, shedding light on their potential to enhance collaboration and communication between diverse actors. The study also underscores the importance of considering technology as an active actor within networks, influencing how caregivers and clinicians interact and collaborate in the complex domain of mental healthcare.