skip to main content


Title: Digital Health–Enabled Community-Centered Care: Scalable Model to Empower Future Community Health Workers Using Human-in-the-Loop Artificial Intelligence
Digital health–enabled community-centered care (D-CCC) represents a pioneering vision for the future of community-centered care. D-CCC aims to support and amplify the digital footprint of community health workers through a novel artificial intelligence–enabled closed-loop digital health platform designed for, and with, community health workers. By focusing digitalization at the level of the community health worker, D-CCC enables more timely, supported, and individualized community health worker–delivered interventions. D-CCC has the potential to move community-centered care into an expanded, digitally interconnected, and collaborative community-centered health and social care ecosystem of the future, grounded within a robust and digitally empowered community health workforce.  more » « less
Award ID(s):
2026614
NSF-PAR ID:
10393673
Author(s) / Creator(s):
; ; ; ; ;
Date Published:
Journal Name:
JMIR Formative Research
Volume:
6
Issue:
4
ISSN:
2561-326X
Page Range / eLocation ID:
e29535
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. Abstract

    In this paper, I analyze the experiences of the world's largest all‐women community health workforce through the lens of liminality. Originally used to describe transition from one state to the other, the concept of liminality in the study of work and organizations can frame workers' experiences of being in‐between established structures and roles in varying degrees, times, and/or places. India's ASHAs, or Accredited Social Health Activists, are community women at the frontlines of the state's health care provisioning. But the state does not categorize them as workers or employees. ASHAs are considered volunteers. Instead of salaries, they are paid task‐based incentives. Based on 14 months of ethnographic fieldwork, including 80 interviews, I find that ASHAs' liminal occupational status as ‘paid volunteers’ produces conditions of chronic underpayment and control for them, further lowering their already low wages. This has implications for how we understand the gender wage gap. I argue that we need to consider not just how much women are paid, but how the payment is structured, and how that places marginalized women workers in relation to others in the workplace. Moving beyond whether liminality is a negative or positive experience, future research should delineate the conditions under which liminality is negative or positive.

     
    more » « less
  2. Abstract

    Community health workers (CHWs) are central to the global health response to crises like the AIDS epidemic. Yet community health work remains undervalued and undercompensated worldwide owing in large part to the gendered and racialized contexts of care work. This paper investigates the possibility of occupational security for CHWs by comparing two cases from South Africa's response to AIDS. The first draws on ethnographic research (2007–2009) in rural KwaZulu‐Natal province and documents the fraught formation of a union representing CHWs. The second examines legal action in the Free State province for a group of CHWs known as the Bophelo House 94, who were arrested and criminally charged in June 2014 after protesting their sudden dismissal by the government. This case comparison finds that collective action has thus far had limited effects on CHWs' position as a nascent occupation. The South African Ministry of Health has obstructed CHW professionalization, and non‐state actors' involvement has been a mixture of benefit and impediment: some social justice agencies have facilitated CHW advocacy, while many AIDS service organizations have cooperated with the state and exacerbated the precarity of CHWs' working conditions. However, the consolidation of CHW work roles—owing to advances in AIDS prevention and treatment—holds promise for future CHW collective organization.

     
    more » « less
  3. Between 2018 and 2021 PIs for National Science Foundation Awards # 1758781 and 1758814 EAGER: Collaborative Research: Developing and Testing an Incubator for Digital Entrepreneurship in Remote Communities, in partnership with the Tanana Chiefs Conference, the traditional tribal consortium of the 42 villages of Interior Alaska, jointly developed and conducted large-scale digital and in-person surveys of multiple Alaskan interior communities. The survey was distributed via a combination of in-person paper surveys, digital surveys, social media links, verbal in-person interviews and telephone-based responses. Analysis of this measure using SAS demonstrated the statistically significant need for enhanced digital infrastructure and reworked digital entrepreneurial and technological education in the Tanana Chiefs Conference region. 1. Two statistical measures were created during this research: Entrepreneurial Readiness (ER) and Digital Technology needs and skills (DT), both of which showed high measures of internal consistency (.89, .81). 2. The measures revealed entrepreneurial readiness challenges and evidence of specific addressable barriers that are currently preventing (serving as hindrances) to regional digital economic activity. The survey data showed statistically significant correlation with the mixed-methodological in-person focus groups and interview research conducted by the PIs and TCC collaborators in Hughes and Huslia, AK, which further corroborated stated barriers to entrepreneurship development in the region. 3. Data generated by the survey and fieldwork is maintained by the Tanana Chiefs Conference under data sovereignty agreements. The survey and focus group data contains aggregated statistical/empirical data as well as qualitative/subjective detail that runs the risk of becoming personally identifiable especially due to (but not limited to) to concerns with exceedingly small Arctic community population sizes. 4. This metadata is being provided in order to serve as a record of the data collection and analysis conducted, and also to share some high-level findings that, while revealing no personal information, may be helpful for policymaking, regional planning and efforts towards educational curricular development and infrastructural investment. The sample demographics consist of 272 women, 79 men, and 4 with gender not indicated as a response. Barriers to Entrepreneurial Readiness were a component of the measure. Lack of education is the #1 barrier, followed closely by lack of access to childcare. Among women who participated in the survey measure, 30% with 2 or more children report lack of childcare to be a significant barrier to entrepreneurial and small business activity. For entrepreneurial readiness and digital economy, the scales perform well from a psychometric standpoint. The summary scores are roughly normally distributed. Cronbach’s alphas are greater than 0.80 for both. They are moderately correlated with each other (r = 0.48, p < .0001). Men and women do not differ significantly on either measure. Education is significantly related to the digital economy measure. The detail provided in the survey related to educational needs enabled optimized development of the Incubator for Digital Entrepreneurship in Remote Communities. Enhanced digital entrepreneurship training with clear cultural linkages to traditions and community needs, along with additional childcare opportunities are two among several specific recommendations provided to the TCC. The project PIs are working closely with the TCC administration and community members related to elements of culturally-aligned curricular development that respects data tribal sovereignty, local data management protocols, data anonymity and adherence to human subjects (IRB) protocols. While the survey data is currently embargoed and unable to be submitted publicly for reasons of anonymity, the project PIs are working with the NSF Arctic Data Center towards determining pathways for sharing personally-protected data with the larger scientific community. These approaches may consist of aggregating and digitally anonymizing sensitive data in ways that cannot be de-aggregated and that meet agency and scientific community needs (while also fully respecting and protecting participants’ rights and personal privacy). At present the data sensitivity protocols are not yet adapted to TCC requirements and the datasets will remain in their care. 
    more » « less
  4. null (Ed.)
    Flexible, contingent, or 'agile,' working arrangements provide workers with greater autonomy over when, where, or how to fulfill their responsibilities. In search of increased productivity and reduced absenteeism, organizations have increasingly turned to flexible work arrangements. Although access to flexible work arrangements is more prevalent among high-skilled workers, in the form of flextime or co-working, the past decade has also witnessed growth of independent contractors, digital nomadism, digitally enabled crowdwork, online freelancing, and on-demand platform labor. Flexible work arrangements reduce commutes and can enable workers with care-responsibilities to stay in the workforce. Younger workers also see flexibility as a top priority when considering career opportunities. Flexible working arrangements can also be mutually beneficial, enabling organizations to scale dynamically. Specific skill sets can be immediately accessed by turning to freelancers to fill organizational gaps. A growing number of organizations and workers rely on short-term and project-based relationships, using online platforms such as Upwork or Fiverr to connect. However, flexible work arrangements often come entwined with precarity cloaked in emancipatory narratives. Fixed salaries and benefits have given way to hourly rates and quantified ratings. Flexible workers often face unpredictability and uncertainty as they carry more risk and responsibility, and are burdened with a great portion of administrative costs (that is, overhead) associated with organizational support systems. Flexible workers at Google, for instance, outnumber full time workers but face far more unpredictability. Current formulations consider organizations as relatively fixed 'containers', which encapsulate the work performed and the information and communications technology (ICT) systems used to perform it.12 However, flexible work arrangements take place outside of organizational containers. In this new sociotechnical dynamic, flexible workers interact with a diversity of digital tools that defy centralized, top-down standardization or governance. We capture this diversity of digital tools through the concept of Personal Digital Infrastructures (PDIs), which denote an individualized assemblage of tools and technologies, such as personal laptops, smartphones, cloud services, and applications brought together by workers to perform their work tasks. Yet, flexible workers constantly reconfigure their PDIs as the technology landscape, client-relationship, and task requirements shift. For flexible work arrangements to be mutually beneficial, PDI integration in ICT systems for work is increasingly necessary, beyond a narrow focus on enterprise systems supporting standard work. Our collective research on flexible work arrangements indicates that PDIs present non-trivial challenges, but a more effective design of ICT systems for work can facilitate the integration of these bottom-up infrastructures. The nuanced understanding of PDIs presented here highlights their interplay with flexible work arrangements across key dimensions (spatial, temporal, organizational, and technological) and suggests key priorities for technology and platform developers. 
    more » « less
  5. null (Ed.)
    Sickle cell disease (SCD) is a genetic disease that has multiple aspects including public health and clinical aspects. The goals of the research study were to (1) understand the public health aspects of sickle cell disease, and (2) understand the overlap between public health aspects and clinical aspects that can inform research and practice beneficial to stakeholders in sickle cell disease management. The approach involved the construction of datasets from textual data sources produced by experts on sickle cell disease including from landmark publications published in 2020 on sickle cell disease in the United States. The interactive analytics of the integrated datasets that we produced identified that community-based approaches are common to both public health and clinical aspects of sickle cell disease. An interactive visualization that we produced can aid the understanding of the alignment of governmental organizations to recommendations for addressing sickle cell disease in the United States. From a global perspective, the interactive analytics of the integrated datasets can support the knowledge transfer stage of the SICKLE recommendations (Skills transfer, Increasing self-efficacy, Coordination, Knowledge transfer, Linking to adult services, and Evaluating readiness) for effective pediatric to adult transition care for patients with sickle cell disease. Considering the increased digital transformations resulting from the COVID-19 pandemic, the constructed datasets from expert recommendations can be integrated within remote digital platforms that expand access to care for individuals living with sickle cell disease. Finally, the interactive analytics of integrated expert recommendations on sickle cell disease management can support individual and team expertise for effective community-based research and practice. 
    more » « less