Why Understanding Culture is Important for Developing Effective Online Health Support: the Brazilian Context Clarissa M. de A. Barbosa
Carla Faria Leitão
Clarisse S. de Souza
Departamento de Informática / PUC-Rio Brazil, R. de Janeiro 22453-900
[email protected]
Departamento de Psicologia / PUC-Rio Brazil, R. de Janeiro 22453-900
[email protected]
Departamento de Informática / PUC-Rio Brazil, R. de Janeiro 22453-900
[email protected]
Abstract This paper reports an analysis of several successful online health support communities in Brazil. It suggests that cultural differences may generate distinct needs and wishes from members of such communities. We also discuss how cognitive and semiotic approaches to HCI typically handle the cultural dimension of the development of online communities in different ways, and conclude that approaches that explicitly take culture into account may add valuable contributions to the design and evaluation of effective online communities.
1
Introduction
Online communities often involve intense social interaction among their members. The interaction is usually characterized by widely varied purposes and the participation of members from different cultures, which poses several challenges to the development of successful online communities. Preece (2001) set about to outlining sociability and usability determinants of success for online communities in general. More recently, Abras (2003) extended on Preece’s research, taking into consideration the specificities of various types of online communities, depending on their purposes and goals. Part of Abras’s research contributions is a set of usability and sociability guidelines for creating, maintaining, and evaluating successful online health and academic communities. The guidelines have been drawn from community participants’ perspectives, in North America. They have, however, been tacitly proposed as a tool to guide the design and evaluation of online health and academic communities in general. Some of the questions motivated by such previous work were: Do the guidelines also apply to Brazilian online health and academic communities? In other words, is it possible to establish ideal conditions for the design of such types of communities, independently of their cultural context? The impetus for the study reported in this paper was a preliminary exploration in search for answers. We were interested in the influence that culture may exert on the design of online communities, as well as on the role of application designers in the future of technologically-enable social relations. This study started in October 2003 and spanned over eight months observing a number of Brazilian online health support communities. The observation was guided by our knowledge of and experience with semiotic engineering (de Souza, 1993; 2005), discourse analysis (Wetherell, Taylor & Yates, 2001), and online communities (Preece, 2000). In January 2004 we analyzed 4 successful Brazilian OHSCs (i.e. communities that perceive themselves as successful, that have existed for a long time, and promote intense interaction among members), namely Breastfeeding Online1 (“Amamentação”, 2005), Multiple Sclerosis Sufferers Society (“Sociedade”, 2005), Lupus Online (“Lupus”, 2005), and Alzheimer Disease (“Mal”, 2005)2. Firstly, we evaluated them according to Abras’s sociability guidelines for the design and evaluation of OHSCs. Secondly, we contrasted our findings from the first stage with other results in Brazilian contemporary sociology and anthropology (Barbosa, 1995; DaMatta, 1984; Sorj, 2000). At this stage we identified some characteristics of the Brazilian culture that can help us explain the results obtained in the previous stage, and that ultimately indicate that cultural differences may generate distinctive needs 1
The name of the communities analyzed has been translated into English by the authors. The original name can be found on the communities’ website. 2 We believe the name of the communities conveys, in short, the purpose of each one. This information is sufficient to grasp the result of the study carried out.
and wishes from the members of OHSCs. We then speculated on the extent to which sociocultural values can or should be taken into account in the design of technology for online communities, as well as on what should be the role of the system designer during the technology design process. In the next section we describe each stage of analysis for 4 successful Brazilian OHSCs. Then we discuss how cognitive and semiotic approaches to HCI typically handle the social and cultural dimensions of the development of online communities. We conclude the paper by suggesting that understanding culture may bring valuable contributions to the design and evaluation of effective online communities.
2
Analysis of Successful Brazilian OHSCs According to Sociability Guidelines for the Design and Evaluation of OHSCs
The first stage of the analysis consisted of evaluating asynchronous communication among members of each one of the 4 selected OHSCs based on Abras’s sociability guidelines for the design and evaluation of OHSCs. Given the content of both the website and the messages exchanged by members, we checked if each of the guidelines was apparently (P)resent, (A)bsent, or could not be observed (NO) due to time limitations of the study or lack of enough information. Table 1 summarizes the results of this evaluation. In it, each communication tool is represented by the first significant word of name of the community, followed by a sequential number in case the community offers more than one assynchronous communication tool to its members. The guidelines marked with asterisks (**) were absent from almost all Brazilian OHSCs evaluated. Table 1: Summary of the results of the evaluation of successful Brazilian OHSCs according to sociability guidelines for the design and evaluation of OHSCs Sociability heuristics for OHSCs
Multiple 1
Multiple 2
Breastfe eding
Lupus 1
Lupus 2
Alzhei mer
Members and Community Discussions New topics introduced regularly
P
P
P
P
P
P
NO
NO
NO
NO
NO
NO
Natural and active discussions
P
P
P
P
P
P
Deep or light discussions depending on topic
P
P
P
P
P
P
Community's Commitment Community keeps users interested
P
P
P
P
NO
P
Community able to attract new members
P
P
P
P
NO
P
Information on the Web site updated regularly
A
A
P
P
P
A
**
Community should reach out to lurkers
A
A
A
A
P
A
**
Being able to ask questions in a secure environment Members in control of discussions not moderators
P
P
P
P
P
P
P
P
P
P
P
P
Members' Commitment Members should visit the community frequently
P
P
P
P
NO
P
Members committed to the process
P
P
P
P
P
P
NO
NO
NO
NO
NO
NO
P
P
P
P
P
P
Dynamics of interactions close to f2f interactions
Members should participate in discussions when necessary Reading messages without posting should be allowed Connections Strong ties present between members not important Weak ties present between members is important Need to feel connected to others
A
A
P
A
A
P
NO
NO
NO
NO
NO
NO
P
P
P
P
P
P
**
Multiple 1
Multiple 2
Breastfe eding
Lupus 1
Lupus 2
Alzhei mer
Policies Community has strict rules of behavior
A
P
A
A
A
A
Feedback from other members is important
P
P
P
P
P
P
Clear policies
A
P
P
A
A
A
**
Prominently displayed policies
A
P
A
A
A
A
**
Policies being enforced
A
P
NO
A
A
A
**
NO
NO
NO
NO
NO
NO
P
P
P
P
A
P
P
P
P
P
P
P
NO
NO
NO
NO
NO
NO
P
P
P
P
P
P
Sociability heuristics for OHSCs
Policies and Purpose
Web site contains valuable information and links Purpose Purpose clearly stated Purpose relevant to members' lives Social Representation Purpose changes and evolves with the community Putting one's photograph or avatar on the board not important
P
P
P
P
P
P
NO
P
P
NO
NO
P
Empathy and Support Password needed to access the community
A
A
A
A
A
A
Need to feel support
P
P
P
P
P
P
Need to feel empathy
P
P
P
P
P
P
Need a caring atmosphere
P
P
P
P
P
P
Members should have user profiles
A
A
A
A
P
A
Members should have a consistent identity
P
P
P
P
NO
P
Feeling a sense of belonging Community adapts and changes to fit the needs of the group
**
**
**
Trust and Privacy Discussions being positive Trust that the medical information provided is not shared with others Trust the information provided
P
P
P
P
P
P
A
A
A
A
A
A
P
P
P
P
NO
P
Privacy of my medical information
A
A
A
A
A
A
Feedback Need to share experience with others
P
P
P
P
P
P
Feedback from moderators not necessary
P
P
P
P
P
A
Moderators are active in the discussions only to guard against flaming
A
A
A
A
A
A
P
P
P
P
P
P
NO
NO
NO
NO
NO
NO
**
**
**
Interesting Topics Topics of discussions are interesting and helpful Information Information provided by moderators and administrators is accurate
The sociability guidelines have been proposed as a tool for helping not only designers to create successful OHSCs, but also community managers and moderators to maintain and nurture OHSCs. They can also help users identify successful OHSCs (Abras, 2003). Our evaluation of successful Brazilian OHSCs, however, revealed that some of the guidelines were not followed by either application designers or community managers, and still the community viewed itself as successful. Do cultural aspects play a role in this picture? In order to help us interpret the results obtained in this first stage of the analysis, we looked for research contributions from contemporary Brazilian
sociology and anthropology. In the following we present some important characteristics of Brazilian sociability, and show why they might be related to the results of the evaluation. Formal associations play a secondary role in Brazilian society (Sorj, 2000). Historical and social factors have influenced, and still do influence the way associativism manifests itself in Brazil. From a social perspective, the unique style of Brazilian sociability may explain the peripheral role played by formal associations in this country. Some characteristics of the sociability “made in Brazil” are: (I) It values informal personal relationships (Barbosa, 1995; Sorj, 2000). Brazilians enjoy spontaneously getting to know other people, and interacting with them in informal settings, such as the guys in the bar, the football team, or the group of friends who get together to prepare a barbecue. Brazilians usually have difficulty dealing with formal social relationships. Sometimes they even reject the institutionalization of existing informal groups. People plan their activities based on their friends’ appointments, and whenever they have any kind of problem (e.g., social, financial, emotional), they confide to one another. Thus, the spontaneous ties of affection and the resulting good will and solidarity form the basis for dealing with personal and social issues. (II) Brazilian sociability also values family relationships very highly (DaMatta, 1984). Brazilians consider family to be formed by members of the nuclear family (parents and children), more distant relatives, and even individuals with whom they have a strong tie, but no kinship (e.g., close friends’ parents who are referred to as “aunt” or “uncle”). Children, parents, grandparents, cousins, godparents and close friends, for example, interact regularly, and form a family nucleus broader than the one observed in North American and European families. In addition, adult children live with their parents for a longer period of time than in other countries. All of them help each other deal with daily issues, such as money, work, health, etc. (III) Finally, Brazilian sociability centers around groups with no clearly defined boundaries (Sorj, 2000). Friends from different contexts mingle with each other. For instance, close friends interact intensively with each other’s family members, and colleagues tend to become more than co-workers. When facing a problem, Brazilians usually contact their friends, and each one helps however possible. They prefer to get support from members of existing informal groups (smoothly transitioninng from one group to another, and at times merging some of them) rather than create or join a private group, specifically created to address a certain problem. Brazilian society is extremely cohesive, though not favoring formal associations, and places a high value on social relationships (Sorj, 2000; DaMatta, 1984). It seems reasonable to assume that the characteristics of Brazilian sociability influence significantly the way Brazilians handle the hardship arising from health problems. Although further research is needed to confirm our assumption, the informality of social and affective relationships that cut across each other seem to be an important feature in the analysis of Brazilian OHSCs. For example, it might tell why 4 Brazilian OHSCs are perceived as successful in spite of the absence of (or disregard for) some sociability guidelines perceived as important in North America. The preference for spontaneous social and affective relationships as well as the resistance to formalization of social networking seem to be the reason why there were no strict and clearly defined policies in almost all analyzed communities. It appears that their members let the policies arise spontaneously and/or did not bother to live with only implicit rules and structures. These characteristics may also help us explain why, as a rule, community members introduced themselves informally in the messages they posted, instead of opting for filling out member profile forms and setting up a formal persona. The great value assigned to family relationships and friendship, which are the basis for dealing with personal issues, seems to lie behind the fact that in more supportive communities, members developed very strong affective ties with each other. It might also help us explain why members usually prefer to get information about the disease by exchanging messages with each other rather than searching the information available on their website. Lastly, Brazilian sociability is characterized by fluid groups, i.e. groups with no rigid boundaries. In the context of the analyzed OHSCs, this characteristic seems to manifest itself in considerate behavior towards lurkers, the participation of moderators in the discussion (not only to guard against flaming, but acting more firmly as facilitators and promoters of a friendly and welcoming atmosphere), and the open access to the communities’
conversation (i.e. no password is needed to read the exchanged messages). The latter might explain the relative lack of attention to privacy matters with respect to disclosing medical information. All the observations above suggest that cultural differences may indeed be associated to very distinct needs and wishes from members of OHSCs across the world. Furthermore, they suggest that taking cultural characteristics of the community into consideration in the design of the application that will support its activities is important for developing effective OHSCs. To illustrate this point, it suffices to imagine the trouble and exasperation caused by some technology designed in Brazil and used in North America, if it did not supply fine-grained personal information disclosure control methods (because Brazilian communities are not particularly aware of privacy issues). Conversely, some technology designed in North America might easily lead Brazilians to exasperation if, before any relevant contact were established with other members, one were required to fill out lengthy forms for personal profiling and formal acceptance/rejection of dozens of privacy control options. In the next section, we discuss how cognitive and semiotic approaches to HCI help us deal with culturally-dependent design issues such as these.
3
Cognitive and Semiotic Engineering Approaches to Culture
Cognitive approaches to HCI mainly spring from cognitive science, an interdisciplinary scientific realm dedicated to the study of the mental processes of acquiring knowledge and thinking. In its traditional approach, it believes that these processes occur in a stable and objective world, and consequently that it is possible to specify the nature of the mind in stable and universal terms, as well as predict with relative certainty human behaviors (“Stanford”, 2005). The social and cultural aspects of these processes can be studied insofar as they are decomposed into elements that can describe stable and objective experiences (Kirshner & Whitson, 1997), which imposes some important limitations on the opportunity to explore knowledge and thinking as social and cultural processes. Aligned with this theoretical basis, cognitive approaches to HCI perceives computer system as a cognitive artifact, and aims at understanding and representing the cognitive processes involved in user-system interaction (Norman, 1986; Hollan et al., 2000). Cognitive tools for the design and evaluation of interactive systems are predictive, i.e. they intend on objectively identifying the conditions HCI professionals should meet in order to develop usable systems. The conditions are regarded as stable, and amongst them are, for instance, the users’ needs and wishes with regard to the system. The conditions are generally presented in the form of design guidelines, and typically result from statistically significant empirical studies that aim at associating certain features of interactive software with particular kinds of user experiences (e.g. heuristic evaluation (Nielsen, 1994), eight golden rules (Shneiderman, 1998), usability and sociability determinants of success in online communities (Preece, 2001)). Cognitive approaches to HCI recognize that different social and cultural contexts generate distinct needs and wishes from users. Therefore, cognitive tools usually take users’ sociocultural characteristics into account, but within the limits of cognitive science. This entails decomposing these characteristics into fixed and objective elements, which is usually done by defining significant cultural variables that can be used as objective and stable measures to predict the success of technology in different cultures (e.g. Griffith, 1998; Komlodi & Carlin, 2004). A typical product of this research practice are design guidelines specific to each culture, as for example the usability and sociability guidelines for the design and evaluation of online education and health support communities (Abras, 2003). Semiotic approaches to HCI, as its name implies, draw on semiotics, a discipline devoted to studying signification and communication phenomena. Signification is the process through which certain sign systems are established (i.e. contents are systematically associated to expressions) on the grounds of social and cultural conventions adopted by their users. Communication, on its turn, is the process through which users make use of existing sign systems, or even non-systematized signs (i.e. invented or used in unexpected ways), to express intended meanings. It follows that the social and cultural dimensions of the phenomena studied by semiotic theory are inherent in the theory itself. As a consequence, semiotic approaches to HCI (Nadin, 1988; Andersen et al., 1993; de Souza, 1993; 2005), by nature, consider that both user-system and user-user interaction (through the system) occur in a specific sociocultural context. Thus, they offer HCI professionals tools for the design and evaluation of interactive systems that naturally handle the social and cultural aspects intrinsic to the development of such systems.
Amongst the semiotic approaches to HCI, we focus on semiotic engineering (de Souza, 1993; 2005). The concepts of sign (Peirce, 1931-1958) and unlimited semiosis (Eco, 1984) are part of its ontology, and allow us to know that there is no unique and fixed meaning for a sign (i.e. anything that stands for something else to somebody). Therefore, semiotic engineering perceives computer system as an intellectual artifact, resulting from highly contextualized decisions taken by designers on the basis of their current understanding of the problematic situation to which solution or improvement they should contribute. In order to be able to use the system efficiently, users should understand the design vision which underlies its design. Following this reasoning, semiotic engineering considers user-system interaction a particular type of computer-mediated metacommunication (i.e. a communication about communication itself), in which the designer sends users a message about how they should interact with the application in order to achieve a certain range of goals and experiences which the system has been designed to support. This message tells the users the designer’s design vision, i.e. his/her understanding of who they are, what they need or wish to do, how they prefer to do it, and why. Another implication of the presence of the concepts of sign and unlimited semiosis in semiotic engineering’s ontology is the perception that HCI design problems are unique (Schön, 1983), and, therefore, that designers should understand the problematic situation, elaborate a unique design solution for it, and convey their design vision to users through the interface of the application. Thus, design and evaluation tools derived from this theory help designers formulate HCI design problems and questions, and elaborate their own solutions and answers. They are called epistemic tools, as they act on the designers’ knowledge, increasing their understanding of the problem itself and possible solutions. The way these tools help designers deal with the social and cultural dimensions of the development of online communities is by leading them to think over the dimensions during design. Designers will probably know more the sociocultural characteristics of the community, and take them into account when making design decisions. In the following, we briefly present the semiotic inspection of multi-user applications (de Souza, 2005), an epistemic tool that leads HCI professionals to ponder on the cultural characteristics of the group, and on how they may influence the design of such applications. The semiotic inspection of multi-user applications is a systematic walkthrough of the content involved in the designer’s message to users of multi-user applications, conveyed through (and implicit in) the technology itself. It can be paraphrased as: “Here is my understanding of who you are, what I’ve learned you want or need to do, in which preferred ways, and why. And this is the system that I have therefore designed for you, and the way you can or should use it in order to fulfill a range of purposes that fall within this vision. You can communicate and interact with other users through the system. During communication, the system will help you check: • • • • •
Who is speaking? To whom? What is the speaker saying? Using which code and medium? Are code and medium appropriate for the situation? Are there alternatives? Is(are) the listener(s) receiving the message? What if not? How can the listener(s) respond to the speaker? Is there recourse if the speaker realizes the listener(s) misunderstood the message? What is it?”
The semiotic inspection can trigger reflections on important dimensions of computer-mediated communication, including the cultural ones. It consists of four sets of questions related to the metacommunication message content. Each questions is accompanied by guidance notes which point out to aspects of computer-mediated communication that should be considered at design and evaluation time. The notes also serve as examples of how the inspection can be carried out, and may give rise to myriads of other reflections. Each set of questions focuses on one or more elements of communication: sender, receiver, message, code, channel and context (Jakobson, 1960). Jakobson’s model calls our attention to the fact that communication occurs in a specific context. Thus, reflections triggered by the questions of the semiotic inspection take the context of communication into consideration. In order to illustrate the potential power of the semiotic inspection, let us suppose that the designer of a new online community follows the inspection procedure. The first set of questions focuses on the interlocutors. In short, the questions draw the designer’s attention to the importance of representing the participants of communication, and highlight some important factors involved in the choice of the representation, as for example how to represent the
presence and activity of users, the qualitative aspects of social relationships (e.g., tense, relaxed, positive attitudes), and the scope and nature of control users have on the way they and their respective activities are represented. The first question, “Are interlocutors represented?” motivates the designer’s reflections along certain paths such as “Who are the interlocutors? Everyone who visits the website, or only a subset of the visitors? Should members know the complete set of interlocutors? In other words, should the community accept lurkers? What information about the interlocutors should be represented? Are all interlocutors allowed to post messages? etc.”. In his/her search for appropriate and solid answers, the designer will be faced with sociocultural characteristics of the community that he/she will need to know, either by asking prospective community members or resorting to contributions from corresponding disciplines. The semiotic inspection of multi-user applications is both a design and an evaluation tool. A walkthrough of its questions systematically leads professionals to think over the tight relations among diverse elements of design, and helps them gain awareness of the importance of such relations to the success of applications. Therefore, the inspection procedure also motivates professionals to look for solid information on which they can rely to find appropriate answers to each of the suggested questions (and follow-up questions that may arise in their reflection).
4
Final Remarks and Future Research
Our analysis of the 4 Brazilian OHSCs ultimately suggests that cultural characteristics may be a crucially important requirement for developing effective technology to support OHSCs. Both cognitive and semiotic approaches to HCI recognize the need to consider social and cultural aspects in the development of online communities. However, they differ in the way they handle this issue. Cognitive approaches try to capture cultural variables that influence the development of online communities, assign to each of them culture-specific values, and foster the development of computer applications that incorporate such values. On the other hand, semiotic engineering aims at helping designers know about the social and cultural aspects of target communities, comprehend how they might influence design, take this knowledge into consideration while making design decisions, and finally communicate their design vision (which includes their understanding of these aspects) to users in an effective way. The concepts of sign and unlimited semiosis help us see that users’ needs and wishes with regard to any system are constantly changing. They also allow us to see that the results of empirical studies carried out in order to capture such needs and wishes are strongly dependent on the investigator’s own interpretation of facts. Consequently, the product of such studies must not be taken as a comprehensive, immutable and universal representation of what users really need and wish from any system, but only as valuable contingent information to inspire design decisions that must meet evolving requirements. We believe that semiotic engineering epistemic tools supplement predictive tools inasmuch as they trigger the professionals’ reflection on numerous and unique problematic situations. By so doing, such tools enable them to make an informed use of predictive tools, to increase their knowledge and ability for handling decision-making process, and thereby to improve the quality of interactive applications. Another aspect in which epistemic tools supplement predictive ones is by way of their explanatory power. It has already been said that predictive tools typically result from statistically significant empirical studies that aim at associating certain features of interactive software with particular kinds of users’ reactions. These tools usually do not have any commitment to describing how these features relate to each other and to the reactions they may evoke in the users. Their explanatory power is causal in a very strict sense, i.e., they typically provide explanations based merely on co-ocurrence. As a consequence, predictive tools do not offer enough information for HCI professionals to make various conscious design decisions (e.g. when it is not possible to meet all of the requirements, how should they be prioritized, and why – i.e. at what cost). On the other hand, as semiotic engineering should explain observable HCI phenomenon, epistemic tools derived from this theory assume the commitment to representing the knowledge about the relations among elements of the specific phenomena they have been designed to explain. Epistemic tools, thus, offer professionals information that enables them to make design decisions in view of a wider range of possible consequences. The latent message to HCI professionals is that one should investigate the cultural characteristics of communities one designs for, and comprehend their impacts both on the technological design and the subsequent success of online communities. This implies shifting the focus from capturing to understanding culture.
We are now engaged in developing Manas, a conceptual architecture model to inform the elaboration of further design-support tools for multi-user applications. Manas is an epistemic tool meant to leverage the designers’ knowledge about the influence of the designed technology on the history and dynamics of the target group. Its purpose is to increase the designers’ understanding about the impacts of group-related design decisions on the variety and quality of base communication (and, consequently, relations) among group members. Manas intends to achieve this purpose by enabling designers to express their design vision about certain aspects of the group communication, leading them to reflect on the possible effects of their design vision upon group relations, and consequently on group history and dynamics.
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The study was conducted in November 2003.
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