Applying Critical Reflection to Reimagine Global Health

Abstract

Global health structures are steeped in power asymmetries, where much of the funding, leadership, and evidence-based interventions originate in the global north. Despite increasing calls for adopting reflexivity to critique existing approaches, few interventions exist to help global health practitioners engage in critical reflection. This dissertation leverages scholarship from the fields of Human-Computer Interaction (HCI), Feminist Theory, and Critical Technology Studies to inform the design of an interactive technology called the (re)imaginator that guides global health practitioners in reflective practices. HCI’s emphasis on critical reflection and its extensive research on designing for reflection offers global health important evidence, and it can guide global health in building mechanisms to interrogate the current practices, explore alternatives, and reimagine interventions. This research investigates how critical reflection can be leveraged to reimagine global health by answering three questions. First, it examines how design for reflection literature from Human-Computer Interaction (HCI) can inform the development of an intervention for global health practitioners (RQ1) and then utilizes this evidence to build a prototype reflection tool called (re)imaginator. Second, it explores how practitioners engage with and perceive this tool (RQ2), and, third, gauges the extent to which (re)imaginator provokes global health practitioners to rethink and reimagine their work (RQ3). One key contribution of this dissertation is weaving Feminist Theory, particularly Patricia Hill Collins’ Matrix of Domination framework, into the design of the intervention. These theories ground this tool so that it can be used by a diverse set of global health practitioners—from health project designers to implementers to evaluators to funders—to provoke critiques across this interdisciplinary field. This dissertation demonstrates that critical reflection interventions like (re)imaginator support global health practitioners to think about their work in new ways and commit to take more equitable actions. It also demonstrates that these interventions help participants see that their colleagues question their beliefs, suggesting that reflection interventions can support practitioners in recognizing the shared appetite for changing thinking and practices across their organizations. Insights from this study can also inform the design of future reflection tools to more effectively encourage sustained critical thinking and behavior change. Critical reflection tools offer new pathways for practitioners to unpack their own contributions, recognize ways their work reinforces the field’s inequities, and begin to identify changes to their practice that can help shift the course of global health.