Designing Culturally Sensitive Collaborative Care Technologies for Type 2 Diabetes
This study focuses on exploring the collaborative roles in care between people with Type 2 Diabetes (PWT2D), community pharmacists, and caregivers. It specifically examines their use and appropriation of existing technologies and explores their perspectives on emerging technologies. This will provide a broad understanding of the demographic and socio-cultural context of pharmaceutical and technology-enabled collaborative care, thereby informing future designs that could be relevant in similar research contexts.
The project attempted to answer research questions (RQ):
RQ1: What are the current practices and socio-cultural factors shaping collaborative T2D care in Port Harcourt, Nigeria?
RQ2: How can socio-cultural insights from collaborative T2D care in Port Harcourt inform the design of culturally sensitive digital health technologies?
RQ3: How can we leverage pervasive tools like WhatsApp to answer the preceding research questions?
Research Contributions
This project provides three key research contributions based on the characterisation of different types of contributions in Human-Computer Interaction (HCI) research: one empirical, two methodological, and one artefactual.
The empirical contribution offers insight into the scope of collaborative T2D care and identifies design opportunities for supporting collaborative T2D care. Building on these opportunities, the second contribution presents a cross-cultural design approach, constituting a methodological contribution, which led to the development of a mobile application prototype. The third contribution is methodological as well, detailing how WhatsApp was used to facilitate both the empirical investigation and the creation of the artefact.
Empirical Contribution: Culturally Sensitive and Context-Driven Collaborative Care and Design Opportunities for Managing Type 2 Diabetes in Nigeria
The first contribution is a mixed-methods (quantitative and qualitative) account that describes the current scope of T2D care in Port Harcourt, Nigeria, by examining socio-cultural factors that influence T2D care and identifying opportunities for designing collaborative T2D care interventions. Valuable insights were obtained from the qualitative study, as I learned about the role of pharmacists, the contribution of complementary healthcare providers in the provision of care, and the varying needs and challenges faced by different participants in seeking care and using digital health resources. Potential design opportunities based on the findings of this study include creating platforms to promote diabetes-related health information, particularly regarding diet, weight management, drug therapy, and collaborative diabetes care, in an accessible and equitable context-specific format, e.g., mobile applications.
Additionally, given the scarcity of research addressing the sociodemographic factors influencing the need for and use of technology in T2D care within the research context, the quantitative study aimed to highlight significant opportunities for fostering collaborative care through technology. This approach unveiled key relationships between contextual and epidemiological factors of the condition and how they influenced health-seeking behaviors and care practices. From this study, I concluded that although digital health literacy was generally low (e.g., most participants were only familiar with glucometers), many people with T2D residing in Port Harcourt were receptive to technological interventions for managing their condition to varying degrees.
Methodological and Artefact Contribution: Designing Cross-Culturally Transferable Mobile Solutions for Collaborative Type 2 Diabetes Care
This contribution entails a research-through-design approach that resulted in the creation of a mobile application prototype for collaborative T2D care. Drawing on empirical findings from the first contribution, which highlighted the importance of mobile interventions for accessibility and the need for solutions adaptable to Nigeria’s multicultural landscape, I engaged in cross-cultural design activities to develop the prototype. To achieve this, I examined the nuances of T2D care among people with T2D, caregivers, and community pharmacists through various design activities. Recognizing the complexity of developing culturally appropriate interventions, I prioritized creating design materials and activities with representatives from the target population, ensuring they were informed by primary research, aligned with participants’ needs, and adapted to the research context. In doing so, I aimed to ensure that all design processes were culturally relevant, integrating insights from diverse participants to broaden the applicability of the intervention. This approach not only produced methodological insights into how cross-cultural design for African communities can be effectively conducted, but also informed the artefact contribution of this PhD: a mobile application prototype featuring three major components. These components, while considered necessary and effective, led to varying perceptions across different Nigerian cultural groups during its evaluation, highlighting the complex interplay between culture and digital health adoption.
Methodological Contribution: WhatsApp for User Research
This contribution offers insights and practical recommendations for leveraging everyday communication platforms such as WhatsApp to conduct inclusive and accessible user research. By organising interviews, surveys, design workshops, and think-aloud sessions via WhatsApp during my two-year study on T2D care in Port Harcourt, I demonstrate how flexible, technology-driven methodologies can make research more situated, responsive, and relevant. My experience highlights the need to adapt research practices as user behaviors and communication technologies evolve. While WhatsApp proved effective for a range of research activities, it also introduced limitations, including ethical considerations, technical setup challenges, managing group dynamics, and handling interaction disruptions. These were carefully mitigated through measures such as pseudonyms, disappearing messages, and iterative study design adaptations. Based on these experiences, I provide guidance for conducting user research using similar everyday platforms, advocating for approaches that foster normalcy, minimize participant burden, and broaden engagement. This methodological contribution speaks to both HCI and the social sciences, emphasizing how user research can remain inclusive amid the changing landscape of pervasive and ubiquitous technologies.
This study was funded by the Engineering and Physical Sciences Research Council through the Centre for Doctoral Training in Digital Health and Care, University of Bristol (Research Grant Number: EP/S023704/1)
