Implementing an mHealth app to combat hypertension in India's vulnerable populations

Abstract

PurposeThe purpose of this paper is to understand how to build and implement information and communication technology (i.e. ICT) to help vulnerable people when significant social, cultural and economic barriers exist between the stakeholders.Design/methodology/approachThe authors followed an action research approach to design and implement a mobile health hypertension education application to help India's most vulnerable populations. The authors used interpretive analysis, guided by the sustainable livelihoods framework, to uncover key findings.FindingsSuccessfully implementing information and communication technology for development (ICT4D) requires understanding that all stakeholders (i.e. donors, facilitators and the beneficiaries) have important assets to contribute. Facilitators play an important role in connecting donors to the beneficiaries and fostering cultural humility in donors so that the donors will understand the role beneficiaries play in success. Stakeholders may use the ICT4D in unintended ways that both improve the people's health and increase some beneficiaries' financial livelihood.Research limitations/implicationsThis research expands the definition of information systems success when implementing ICT4D in resource-constrained environments. Success is more than creating an mHealth app that was easy for beneficiaries to use and where they learned based on a pre- and post-test statistical analysis. Success involved development in all the stakeholders impacted by the social innovation collaboration. For the beneficiary community, success included getting screened for noncommunicable diseases as a first step toward treatment. For the facilitator, success involved more resources for their community health program. Amongst the donors, success was a change in perspective and learning cultural humility.Practical implicationsAlthough universities encourage faculty to work in interdisciplinary research teams to address serious world problems, university researchers may have to exert considerable effort to secure contracts, approvals and payments. Unfortunately, universities may not reward this effort to build ICT4D and continue to evaluate faculty based on journal publications. When universities undertake social innovation collaborations, administrators should ensure responsive and flexible university processes as well as appropriate academic reward structures are in place. This need is heightened when collaborations involve international partners with limited resources and time needed to build relationships and understanding across cultures.Social implicationsThis study discovered the importance of fostering cultural humility as a way of avoiding potential conflicts that may arise from cultural and power differences. Cultural humility moves the focus of donor-beneficiary relationships away from getting comfortable with “them” to taking actions that develop relationships and address vulnerabilities (Fisher-Borne et al., 2015). This research shows how the facilitator helped the donor develop cultural humility by involving the donor in various initiatives with the beneficiary community including allowing the donor to live in a dormitory at the hospital, work in an urban slum and visit health screening campus.Originality/valueThis study (1) extends the ICT4D literature by incorporating cultural humility into the sustainable livelihoods framework, (2) provides a contextual understanding of developing cultural humility in ICT4D projects with a complex group of stakeholders and (3) describes how facilitators become a catalyst for change and a bridge to the community. The culturally humble approach suggests revising the livelihood framework to eliminate words like “the poor” to describe beneficiaries.