Many women face a complex set of family, workplace and other social roles that they must balance against their own individual health and education interests and needs. We have found throughout the past four years of working to train women to use telemedicine systems for managing their health that most women care for their own health as well as the health and welfare of their families. This has a broad cumulative societal impact because of the compounding effects of the magnitude of each woman's daily dance on their lives, long-term health status, and participation in the workforce. Through training nearly 150 women in one-on-one settings to learn how to use ICTs for managing their health, we gained insights into society's needs for better understanding of the context within which women are learning and applying technology skills in their daily lives.

On a practical level, our efforts show the importance of providing access to ICTs in multiple settings. In particular, we find that settings where women use ICTs need to support them to manage their social roles as caregivers and workers with their individual health concerns. We also suggest that more attention to the socially-bounded movements of women is needed.

The women we trained during the past four years were extremely mobile, navigating multiple work and social environments often relying on more than one mode of transportation, despite the fact that most were poor, under-employed and disconnected from mainstream societal resources to advance their educations. We taught them to use e-health communication systems that were static in nature. Underlying this approach for improving patient-health care provider communications was a notion that women’s lives are situated primarily in their homes. Because of this, most of the emphasis placed on improving their ICT skills related to their potential to use computers at home and with the support of family members. However, upon working directly with women, we found that relying on the home as the primary and sole locus of computer access and use proved to be an ineffective strategy for many of the women with whom we worked.

Gaining a better understanding of the multiple contexts of women’s lives is an important step in overcoming incorrect assumptions about the geographies of their every day lives. Our societal failure to do so will render many rising health care policies ineffective at improving women's health (as well as their educational opportunities and economic livelihoods). We have found that health care providers are especially attuned to the challenges of communicating across language and cultural barriers. However, we suggest that as of yet this has not translated into effective strategies for overcoming barriers to digital inclusion with regard to managing health and the interrelated concerns that are at the forefront of many women's concerns.

Most of the women with whom we worked were enthusiastic e-technology learners and users, and recognized the potential of e-health systems to improve the quality of their health care. For some, it represented better care than they could receive in person because of the potential to reduce office visits and improve monitoring health conditions. It also represented one of the few opportunities that they encountered to gain e-technology skills they thought were important to advance their educations and work opportunities. Their efforts to use e-health systems meant that they worked to overcome language, access, safety and surveillance, and educational barriers in order to gain a foothold in the rapidly emerging e-health care paradigm.

In our new post on ITSRG Working Papers, we suggest that it is incumbent upon health care providers and technology specialists to account for women’s experiences using these systems to design ones that take into account their particular challenges and concerns. The rapid rate of improvement in mobile technologies holds promise for many, since transportability would seem to address many of the access issues we observed. More direct connections between technology and literacy training seem essential for improving the use of systems among women whose life experiences are situated at the societal margins. Approaches for implementing e-health monitoring systems also need to attend to the safety, privacy and empowerment concerns of women if we truly expect to improve their health outlooks using e-technologies.

Caroline Guigar
Michele Masucci
Temple University

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