Please Mind the Sociotechnical Gap: Building, Contextualizing and Scaling Mobile Technologies Towards Improved Human Outcomes at the Margins

Abstract

Structural inequities and systems of exploitation at global and national levels profoundly shape the health and economic trajectories of billions in the Global South, creating an urgent need to support marginalized communities as they navigate and resist these intersecting forces. This dissertation explores the design, contextualization, and scaling of mobile and artificial intelligence-based technologies to improve health and economic outcomes of marginalized people. In the domain of artificial intelligence-enabled diagnostics, it first develops a community health worker-centered artificial intelligence model for atrial fibrillation screening using mobile electrocardiograms, optimized for low-cost deployment within real-world workflows. Next, it contextualizes large language model-based medical chatbots in urban India, finding that patients often reject bots offering clinically validated advice when the advice conflicts with local treatment norms, but the introduction of context-aware nudges significantly improves adoption. Finally, it investigates the challenges of scaling artificial intelligence-driven tools in low-resource health systems, identifying misalignments between institutional expectations of artificial intelligence-enabled care and the constraints of existing healthcare infrastructure through interviews with Nepali health officials. In agricultural information systems, it conducts a large-scale survey of rural farmers and focus groups with periurban entrepreneurs to examine mobile technology access, comfort, and use in northwest Tanzania. Using this understanding, it designs and builds a dual-platform agricultural directory, connecting 1,000 farmers to 10,000 local agricultural businesses. It examines usage in context, showing that even smartphone owners often prefer the feature phone-based directory despite its limited user experience at scale. To bridge this gap, it reconceptualizes mobile money agents as general-purpose intermediaries that help farmers navigate the menu-based application and access the information they need. Across both domains, this dissertation shows that scaling impact at the margins requires much more than innovation, access, or thoughtful design. By bearing witness to human infrastructures, institutional realities, and sociotechnical constraints, it provides a nuanced perspective on creating and sustaining digital interventions that can bring us closer to a just world for all.