methods and methodologies for research in digital writing and rhetoric

enculturation

A journal of rhetoric, writing, and culture, search form, you are here, methodologies and methods for research in digital rhetoric.

Crystal VanKooten , Oakland University

(Published November 22, 2016)

In 1992, Gesa Kirsch characterized research in the field of rhetoric and composition using the phrase methodological pluralism : writing researchers were drawing from a variety of research traditions and fields, including literary studies, history, education, linguistics, psychology, sociology, and anthropology (“Pluralism” 247). Debates about practices, epistemology, and ideology related to the various methodologies for inquiry into writing and its processes were then just beginning, yet similar discussions continue today, and even more so as the study of rhetorical practice shifts to focus on texts composed in and through the digital medium. Just as it was in 1992, current approaches to methodology shape how we might observe and analyze texts, acts of composition, and learning—our methods affect what new knowledge we are able to make. Methodological considerations take on particular significance for the growing group of scholars who study, practice, and teach digital rhetoric. Digital rhetoricians examine, create, and theorize digital texts and the myriad practices surrounding them, a process that, in its complexity, necessitates developing new and hybrid methodologies. 

Literacy researchers and videographers Bump Halbritter and Julie Lindquist describe methodology as “a way of imagining inquiries into particular questions” (174); methodology is the big picture of how research is theorized and framed, and it encompasses the systems that inform particular research practices, which are the research methods themselves. Those methods, the particular practices, for Halbritter and Lindquist, “are examples of local processes; methodologies are examples of global operations” (174). Digital humanist Tom Scheinfeldt has talked about the “seasonal shifting between methodological and theoretical work” in fields as they emerge over time (57). Digital Humanities (DH) scholars, he points out, “traffic less in new theories than in new methods,” playing with digital materials, tools, techniques, and modes (58). Is digital rhetoric, then, like DH, in a similar place of methodological experimentation? What are the global operations , the methodologies, of digital rhetoric? Subsequently, what are the local processes that those studying digital rhetoric are using to enact methodologies? And when we begin to take stock of the methodologies and methods of digital rhetoric, how might a consideration of these operations and processes help us to do the work of defining digital rhetoric as an emerging field? 

In this article, I use a case study to work toward answers, examining the research methodologies and methods of the thirty presenters at the Indiana Digital Rhetoric Symposium (IDRS), held at Indiana University in April 2015. My analysis of their work reveals that the methodologies and methods of digital rhetoric are rooted most firmly in rhetorical theory and the analysis of written and digital texts, but these methods are beginning to expand to include more experimental, interdisciplinary approaches to research that include digital composition, empirical observation, and self-definition.  

Research Methods

I started my inquiry into the methodologies and methods of digital rhetoric by mapping out several research questions: 

1. What research methodologies (global operations) and methods (local processes) are in use by digital rhetoricians? 

2. How do research methodologies and methods define the work of digital rhetoric? 

3. Are researchers in digital rhetoric drawing on methodologies from other fields? 

4. What might distinguish the methods of digital rhetoricians from other methods in the digital humanities, rhetoric and composition, or other fields?

To address these questions, I treated the work of the thirty speakers at the IDRS as a case study, as one site that can speak to how we are defining and enacting methods and methodologies for digital rhetoric.

First, I examined the content of the IDRS presentations as represented in the IDRS abstracts , asking questions about what methods and methodologies I could observe being used. I supplemented information from the abstracts with other descriptions of digital rhetoric scholarship and research found via a web search and a library database search. To find this additional information, I googled the names of the speakers on the IDRS program and read through the results, which included professional and school-based websites, CVs, academia.edu profiles, and Facebook and Twitter profiles. Through the library, I looked up the presenters’ books and articles and scanned the abstracts. 

After examining and taking notes on this data set, which included the IDRS abstracts, presenters’ web materials, and books and articles authored by IDRS participants, I wrote up a phrase for each presenter that described his or her methodological approach to research (I used multiple phrases for the work of some IDRS presenters that fell into multiple categories), and I grouped each person’s work with other similar work. Online, some IDRS participants talked directly about a methodological orientation for their research, and others did not. When needed, I intuited methodological stance(s) based on what I saw and read. Once presenters were grouped based on over-arching methodology, I put together lists of particular methods and modes of delivery used for each group based on what I could observe in the work. I also compiled a list of academic fields with which each presenter was affiliated. Four over-arching categories of methodological approaches emerged from this analysis: 1) hermeneutics, 2) digital composition, 3) empirical observation of human experience, and 4) self-definition. I explore each of these methodologies, along with their related methods and modes of delivery, in detail below.   

Hermeneutics

The first methodological approach to digital rhetoric can be labeled hermeneutics : the science and theory of textual interpretation, often related to biblical, literary, or philosophical texts. The work of twenty-three out of thirty IDRS presenters fits within this category, and the methods employed within this methodology include analysis of written theoretical texts (notably rhetorical theory) along with analysis of digital or material texts, all used to theorize aspects of digital-rhetorical experience. These twenty-three scholars weave together analysis of written and digital texts to theorize about how digital texts communicate and about the practices that users and authors participate in when they compose or consume digital texts, and they deliver their work via book and article manuscripts and oral conference presentations. 

As Table 1 indicates, those using a hermeneutic approach to digital rhetoric are drawing most often from written rhetorical theory, but also at times from composition theory, philosophy, social theory, and law writing to articulate their own theories. The digital and material sites of analysis, in contrast, include a wide range: these scholars are looking closely at social networking sites and activities (Facebook, Twitter, and other online discussion forums); at webpages, algorithms, and the code behind webpages; at mobile, interactive, and GPS software, applications, and devices; at photography; at works of architecture and sound art, and even, in a few cases, at historical texts. The sites of analysis for hermeneutic inquiry are diverse, but they are all linked to how digital texts communicate to authors and audiences—through the web, through mobile devices, and through images, structures, and sounds. 

Digital Composition

The second methodological approach that came to the fore in this case study is digital composition. Digital composition as methodology for inquiry involves various methods, some of which begin to become visible through the work of seven IDRS presenters. Through the use of non-discursive, alternate forms of analysis and synthesis, these methods go beyond using digital composition only for delivery. Methods include, for example, the combination of modes of expression such as words, images, and sounds as a form of analysis, as well as the creation, collection, juxtaposition, and repurposing of media assets and objects as synthesis. Additionally, these methods are enacted in digitally-mediated spaces: on video and audio, in digital books, through repurposed digital objects like the Gameboy camera, or through digital sculpture. As Table 2 indicates, there are seven examples of IDRS scholars and researchers that use digital composition as a methodology for inquiry. Notably, five out of seven use a form of video, perhaps in part because hardware and software for video composition have become more accessible and usable in the past decade—a video author no longer needs a computer lab or specialized equipment to experiment, analyze, and compose with video. 

It is noticeable that only seven of thirty IDRS participants are using digital composition itself as a methodology in highly visible ways. In 2004, computers and writing scholar Cheryl Ball stated:

composition and new media scholars write about how readers can make meaning from images, typefaces, videos, animations, and sounds, but most scholars don’t compose with these media. It is evident from the scholarship available that compositionists are interested in new media. Yet, they do not seem to value creating new media texts for scholarly publications to explore the multimodal capabilities of new technologies. (407) 

The multimodal capabilities that Ball references include the ability of digital composition to function as methodology , as a site for various local processes and methods of inquiry, including those listed above and more. However, based on the findings of this case study, Ball could still be talking to many digital rhetoricians in 2015: relatively few of today’s scholars in digital rhetoric are doing the work of digital composition and exploring its methodological potential. Composing with and using digital media for analysis as academics, of course, is complex. There are tenure requirements. There are the kinds of texts that journals solicit and publish. There is the learning curve for new or unfamiliar technologies and the extended time required to use many digital tools. There can be a bias against multimodal, digital scholarship and in favor of written scholarship. Even so, along with Ball, I continue to call digital rhetoricians to do the work of enacting scholarship through digital composition, to use composing with multiple and digital modes of expression as a methodology for inquiry into how digital texts communicate. Digital composition is a way of making new knowledge that digital rhetoric might tap into with more regularity. 

Empirical Observation of Human Experience with Digital Texts and Digital Composition

Seven IDRS presenters are doing empirical, observational work of others’ experiences with digital texts and digital composition. As shown in Table 3, the various empirical methods they use include direct observation and analysis of community or classroom experiences, interviews, observation and aggregation of online discussions through corpus analysis, and ethnography. While the line between hermeneutics and empirical observation can sometimes blur, what sets an empirical approach apart from other methodologies is a focus on observing or documenting human experience with digital texts. Where others seek evidence in written theoretical texts and digital objects, empirical researchers do so through direct observation of others, at times using interviews, pedagogical documents, or compilations of records of online interaction. 

The use of empirical methods for digital rhetoric parallels the turn to methodological diversification that has been occurring in rhetoric and composition more broadly over the past several decades. Kirsch tells us that currently in writing studies, “no longer do scholars apologize for using, adapting, or borrowing methods that originated in the social sciences,” but instead, writing researchers offer critiques, insights, reflections, explanations, and arguments for new, hybrid approaches to research ( Foreword xv). Empirical research based on systematic observation has thus become more and more common in rhetoric and composition, and more and more rigorous, and this shift is beginning to show itself in digital rhetoric, as well. 

In 1996, computers and writing scholar Scott DeWitt pointed out the dearth of empirical research that addressed what was then called “hypertext” and composing practices. DeWitt wrote that within computers and composition studies, “ we see only a sparse tendency towards carefully designed empirical research studies—where research questions and research methodologies are explicitly stated and collected data analyzed, as well as where student experiences are revealed, and pedagogical agendas exposed” (70). Like Ball, DeWitt could still be making these same comments today about digital rhetoricians, nineteen years later, as this case study reveals. While some of the work in digital rhetoric parallels the turn to empirical research within rhetoric and composition, there is a need for more carefully designed empirical studies that focus on digital composition and rhetorical expression in digital spaces, on the uses of technologies inside and outside of schools, and on the teaching of digital rhetoric so that theories and practices can move beyond the anecdotal. More empirical observation would allow digital rhetoricians to look systematically across multiple experiences with digital texts and to be more clear about why and how they choose sites and methods of inquiry. 

Self-Definition

The final category that came to the fore in this case study is the methodology of doing self-definitional work, of defining what digital rhetoric is and how digital rhetoric is enacted. Two IDRS presenters, Doug Eyman and Elizabeth Losh, are doing this work most directly in ways that were evident in the IDRS abstracts and other published work. In Digital Rhetoric: Theory, Method, Practice , for example, Eyman turns to definitions through a discussion of rhetorical and media theory and through examining pedagogical materials including course descriptions and syllabi. Losh, in Virtualpolitik , explores four areas of the study of digital rhetoric: 1) the conventions of new digital genres, 2) public rhetoric, 3) the emerging discipline of digital rhetoric, and 4) mathematical theories of communication from information science (47). At IDRS, Losh then extended this work through analysis of the complex texts of online transnational remixers who compose on Twitter, YouTube, and within online games. Both Eyman and Losh invite digital rhetoricians to extend our inquiries—to look to the pedagogical, to public discourse, to information science, and to online spaces to extend definitions of what digital rhetoric is and how it is enacted. 

Digital Rhetoric as an Emerging Field

The findings thus far provide one answer to the first research question of what methodologies and methods digital rhetoricians use. To summarize, most of the scholars in the case study are using a hermeneutic approach to digital rhetoric, discussing how digital texts communicate as they draw on rhetorical and other written theories and on the analysis of digital texts and their uses in various spaces. Some within the sample are exploring multimodal forms of analysis and synthesis through composing digital texts, and others are using qualitative and empirical methods to begin to more systematically inquire into how humans use digital technologies to communicate and persuade. A few are defining digital rhetoric as it emerges as a field stemming from and related to several other fields and discourses.

As illustrated in Table 4, most of the IDRS presenters use rhetorical theory in their research – twenty do so directly. Even so, there are voices from other fields in the mix: from composition, philosophy, communication, programming, architecture, and law, for example. In this way, perhaps digital rhetoric may be headed in a similar direction as the Digital Humanities. Matthew Kirschenbaum has explained that DH projects are interdisciplinary and collaborative at their core, they “ depend on networks of people” (6) that aren’t necessarily from the same discipline. The work of IDRS presenters shows some movement in such a collaborative, cross-disciplinary direction: some of the work is already collaborative; some of the work relies on knowledge not only from rhetoric but from other fields and disciplines.  

Below, Figure 1 represents how this case study has helped me to think about digital rhetoric’s relationship to sister fields and discourses as it begins to emerge as a field of study of its own. The work of digital rhetoric shows some movement toward a “methodological experimentation with digital tools” phase, like that which is occurring in the Digital Humanities; digital rhetoric also includes some interdisciplinary work as is more common in DH. From rhetoric and composition, digital rhetoricians bring a recently developed openness to new and diverse research methods. But what makes digital rhetoric unique is a strong foundation in rhetorical theory that speaks to how and why authors might compose and experiment with tools or design new or hybrid methods for inquiry. 

Figure 1: Digital rhetoric’s relationship to sister fields and discourses

Limitations 

Of course, drawing conclusions about the status of digital rhetoric as an emerging field based on one case study has limitations, one of which is the sites for data collection. I drew from IDRS participants’ published or public scholarship, examining IDRS presentations, peer-reviewed journal articles and books, and online self-published materials. Excluded from the data set is work that is in progress, unpublished, or that occurs within the classroom. For some, digital composition, experimentation with digital tools, and empirical observation might occur in alternate, less publically visible spaces. A second limitation may be the terminologies in use to solicit, define, and classify the work of digital rhetoric. Some scholars, for example, explicitly call themselves digital rhetoricians , and many of these individuals responded to the IDRS call for papers. Others within communications, rhetoric and composition, information science, or related fields might be participating in the kind of work that is labeled digital rhetoric here, but instead using shifted labels and terminologies such as computers and writing , digital composition , digital humanities , digital media , multimodal composition , new literacies, new media , and more. The specific terminologies in use, then, may have limited the data set in some ways.  

Using the work of the presenters at IDRS as a case study reveals that the methodologies and methods for digital rhetoric—both the global operations and the local processes—are in flux; they are as yet emerging. Many digital rhetoricians take a hermeneutic approach to research through analysis of written theory and digital examples, and this aligns us with more traditional methodologies within the humanities and within English departments. Some digital rhetoricians are beginning to use digital composition as a methodology, to design new methods for observation and data collection in digital spaces, and to draw on fields outside of rhetoric and writing that have built knowledge about the digital. This movement mirrors the current methodological experimentation phase of the Digital Humanities, which looks across disciplinary boundaries more readily. These new methodological movements for digital rhetoric are located in somewhat unfamiliar spaces, spaces populated by colleagues from the learning and social sciences, from cinema studies and design, and from information science. Even amidst such uncertainty, however, it is exciting to see where digital rhetoric might go from here, to see who digital rhetoricians might work with and what they will compose, and to see the new and assembled methodologies and methods that they might design to learn more about how digital texts are composed and experienced in the world.

Ball, Cheryl E. “Show, Not Tell: The Value of New Media Scholarship.” Computers and Composition , vol. 21, no. 4, Jan. 2004, pp. 403–425.

Dewitt, Scott Lloyd. “The Current Nature of Hypertext Research in Computers and Composition Studies: An Historical Perspective.” Computers and Composition , vol. 13, no. 1, 1996, pp. 69–84.

Eyman, Douglas. Digital Rhetoric: Theory, Method, Practice . University of Michigan Press, 2015. muse.jhu.edu , https://muse.jhu.edu/book/40755 .

Halbritter, Bump, and Julie Lindquist. “Time, Lives, and Videotape: Operationalizing Discovery in Scenes of Literacy Sponsorship.” College English , vol. 75, no. 2, Nov. 2012, pp. 171–198.

Kirsch, Gesa. “Foreword: New Methodological Challenges to Writing Studies Researchers.” Writing Studies Research in Practice: Methods and Methodologies , edited by Lee Nickoson and Mary P. Sheridan, Southern Illinois UP, 2012, pp. xi–xvi.

---. “Methodological Pluralism: Epistemological Issues.” Methods and Methodology in Composition Research , edited by Patricia A. Sullivan and Gesa Kirsch, Southern Illinois UP, 1992, pp. 247–269.

Kirschenbaum, Matthew. “What Is Digital Humanities and What’s It Doing in English Departments?” ADE Bulletin , Sept. 2015, pp. 1–7.

Losh, Elizabeth M. Virtualpolitik: an Electronic History of Government Media-Making in a Time of War, Scandal, Disaster, Miscommunication, and Mistakes . MIT P, 2009.

Scheinfeldt, Tom. “Theory, Method, and Digital Humanities.” Hacking the Academy: New Approaches to Scholarship and Teaching from Digital Humanities , edited by Dan Cohen and Tom Scheinfeldt, U of Michigan P, 2013, pp. 55–9. muse.jhu.edu , http://muse.jhu.edu/chapter/833159 .

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Digital Rhetoric: Theory, Method, Practice

Douglas Eyman

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The goal of Digital Rhetoric: Theory, Method, Practice is to gather, synthesize, and critique current work that stakes a claim to “digital rhetoric” as field or methodological approach. Digital Rhetoric: Theory, Method, Practice argues for a view of digital rhetoric as an emergent, interdisciplinary field of practice that has developed in parallel forms in a wide range of disciplines, including rhetoric and writing, composition, technical communication, digital game studies, literacy studies, media (and new media) studies, and human-computer interaction, among others. After tracing developments in these fields and providing a working definition of “digital rhetoric” and its relationship to digital literacy, new media, and digital humanities approaches, Digital Rhetoric examines theories of digital rhetoric, research methods for digital rhetoric scholarship, and a series of case studies of digital rhetoric practice. In addition to a synthesis and critique of current work on “digital rhetoric,” this project calls for the development of new theoretical frameworks and new “born-digital” research methods.

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Douglas Eyman is Assistant Professor of English at George Mason University and Senior Editor of the open access scholarly journal Kairos: Rhetoric, Technology, Pedagogy .

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Methods and Methodologies  explores how researchers theorize, design, enact, reflect on, and revise digital writing research. The contributors to the two volumes of this edited collection explore how digital technologies can be used to solve problems, challenge the status quo, and address inequities. In some cases, they do so by using familiar digital technologies in novel ways. In other cases, they explain the use of relatively new or less familiar technologies such as digital mapping apps, Twitter bots, audio-visual captions, and computer programming code. By reflecting on the lessons that emerged from their work—and in particular on their own positionality—the authors provide methodological narratives that are personal, professional, and individual yet foundational. By combining attention to human positionality and digital technology,  Methods and Methodologies  addresses important social issues and questions related to writing and rhetoric.

Victor Del Hierro  is assistant professor of Digital Rhetoric and Technical Communication in the English department at the University of Florida and associate director of the TRACE Innovation Initiative. His research focuses on the intersection between hip-hop, technical communication, and community. Previous work has been published in  Communication Design Quarterly ,  Composition Studies Journal , and   Bilingual Review .

Crystal VanKooten  is associate professor of Writing and Rhetoric at Oakland University in Rochester, MI, where she teaches courses in the Professional and Digital Writing major and in first-year writing. She serves as comanaging editor of  The Journal for Undergraduate Multimedia Projects  ( JUMP+ ) and her publications appear in journals that include  College English, Computers and Composition, Enculturation,  and  Kairos . She is the author of  Transfer across Media: Using Digital Video in the Teaching of Writing.

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Methods and Methodologies  explores how researchers theorize, design, enact, reflect on, and revise digital writing research. The contributors to the two volumes of this edited collection explore how digital technologies can be used to solve problems, challenge the status quo, and address inequities. In some cases, they do so by using familiar digital technologies in novel ways. In other cases, they explain the use of relatively new or less familiar technologies such as digital mapping apps, Twitter bots, audio-visual captions, and computer programming code. By reflecting on the lessons that emerged from their work—and in particular on their own positionality—the authors provide methodological narratives that are personal, professional, and individual yet foundational. By combining attention to human positionality and digital technology,  Methods and Methodologies  addresses important social issues and questions related to writing and rhetoric.

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Victor Del Hierro  is assistant professor of Digital Rhetoric and Technical Communication in the English department at the University of Florida and associate director of the TRACE Innovation Initiative. His research focuses on the intersection between hip-hop, technical communication, and community. Previous work has been published in  Communication Design Quarterly ,  Composition Studies Journal , and   Bilingual Review .

Crystal VanKooten  is associate professor of Writing and Rhetoric at Oakland University in Rochester, MI, where she teaches courses in the Professional and Digital Writing major and in first-year writing. She serves as comanaging editor of  The Journal for Undergraduate Multimedia Projects  ( JUMP+ ) and her publications appear in journals that include  College English, Computers and Composition, Enculturation,  and  Kairos . She is the author of  Transfer across Media: Using Digital Video in the Teaching of Writing.

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visualization and digication

"digital rhetorics" at sbu, digitizing rhetorical methods.

Eyman begins by delineating the differences between the New Critical method of “close reading” with Franco Moretti’s contemporary supposition of “distant reading.”  Close reading—methods of analyzing the formal qualities of a text—has traditionally been associated with print text; yet, Eyman claims that it nearly always acts as a fundamental method within digital contexts. As an aside too, digital contexts have expanded our abilities to close-read; check out Amanda Visconti’s dissertation on Ulysses .

However, Eyman also claims that instead of reading the “text-as object” as most New Critics might, reading the formal qualities of a digital text must “include those [qualities] specific to different media.”

Eyman also describes the inverse of close reading—Franco Moretti’s concept of “distant reading.”Eyman explains that “distant reading takes a long view, examining the text as one among many and considering a much larger corpus whose contexts and relationships give rise to different forms of meaning.”  Seeing reading, according to Franco Moretti, as “a condition of knowledge” allows scholars to form a methodology that creates connections between computational analytics and data visualizations.

It also seems that Kurt Vonnegut did, however, have his own view of “distant reading” before Moretti: check it out!

The evolving field of digital composition engages multiple modes and media; thereby digital composition and rhetorics emerge as collaborative activities that provide broad opportunities for publication and circulation.  Eyman recognizes, then, that from professional writing and research, digital rhetoric follows two research traditions: genre studies and usability.

Genre studies privilege “a multilayered approach of both micro- and macro-level interactions,” while usability takes both system and user into account and therefore “provides a methodology for studying both writing practices and writing pedagogies.”  By engaging these methods, Eyman contends that theorizing new digital methods will account for modes of professional composition and rhetoric as well as the multimodal, multimedia networks of the digital world. Thus, Eyman notes an increasing amount of research that suggests, obviously, that the very definition of writing and composition have changed in the digital age.

The chapter concludes by explaining a variety of interdisciplinary methods that may be appropriate for assembling digital rhetoric methods. I have listed them below.

1.) C.O.D.E and Network Administration Tools: the study of the networks of digital rhetoric both material and immaterial. C.O.D.E. stands for “Comprehensive Online Document Evaluation,” and unfolds both the geographies and owners of networked systems.

2.) Studying Web Usage via Server Log Analysis: this method analyzes the log files of users; server log analysis reveals quantitative data that shows the change in a site’s traffic data. This shows the relationship between a digital text and its audience.

3.) Social Network Analysis: this is a research approach that focuses on patterns of relationships among people, and it studies relationships in context with other relationships in a network.

4.) Hypertext Network Analysis:  HNA is a form of social network analysis that only looks at nodes and ties of digital texts as instantiated in websites and web links. Basically, it analyzes hyperlinks.

5.) Bibliometrics and Cybermetrics: these methods trace the use and value of texts through citation analysis.

6.) Content Analysis: this method is similar to social network analysis, except it focuses on the relationships within an individual text rather than between texts.

7.) Data Visualization: a method used to structure data in ways that visually reveal patterns.

Despite the fact that Eyman is hopeful that many of these methods can be assimilated for digital rhetoric methods, he does cite a few complicating factors. First, he identifies accessibility as an issue: “Accessibility can be impeded by intellectual property gatekeeping (restricted access to networks and texts that circulate in  and through those restricted systems, as well as cost-prohibited fees on certain content), but it is also an issue when considering the format of the rhetorical objects themselves.” Second, Eyman also claims that the ephemeral nature of digital texts makes tracking and tracing difficult.

1.) How do some of Nakamura’s claims complicate the theorization of digital rhetoric methodologies?  What other elements should we consider here?

2.) The lack of traceable exigence within digital rhetoric seems to be a problematic factor. The inability to trace origins fosters a synthesis of roles within immediate rhetorical situations. While classical or modernist views of rhetorical situations rely on the stability of such categories as “rhetor,” “audience,” and “message,” postmodernist and immediate views of rhetorical situations assume these divisions are arbitrary and in constant flux.

How can our methodologies account for this? How does the lack of origin change the ways in which we study rhetoric? Explain.

3.)  How might a consideration of these methods help us to do the work of defining Digital Rhetoric as an emerging field?

4.) Eyman’s move towards interdisciplinary methods suggests collaborative, cross-disciplinary research.  Yet, how do these methods complicate global versus local forms of knowledge? Can you think of positive and negative consequences of this?  How does this affect the field of the humanities in general?

5.) Do you have any specific concerns regarding any of the methods outlined by Eyman?

Works Cited

Gries, Laurie E. “Iconographic Tracking: A Digital Research Method for Visual Rhetoric and Circulation Studies.” Computers and Composition 30.4 (2013): 332–348. ScienceDirect. Web. 15 Nov. 2013.

4 thoughts on “ Digitizing Rhetorical Methods ”

Fantastic job on summarizing the highlights of the material and for finding the Kurt Vonnegut video!

Thank you:)

Thanks for the great summary and insights. I think that both close and distant reading of texts has their place in their analysis. This is especially true give the different learning styles of readers. As usual, the true picture of a text’s meaning and message will lie somewhere in between. (P.S. Thanks for sharing that great book on the visuals of distant reading.)

Thanks Phyllis. And thank you for asking a question, too! It helped me out during my discussion!

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Digital Rhetoric

Theory, method, practice.

A survey of a range of disciplines whose practitioners are venturing into the new field of digital rhetoric, examining the history of the ways digital and networked technologies inhabit and shape traditional rhetorical practices as well as considering new rhetorics made possible by current technologies

Description

What is “digital rhetoric”? This book aims to answer that question by looking at a number of interrelated histories, as well as evaluating a wide range of methods and practices from fields in the humanities, social sciences, and information sciences to determine what might constitute the work and the world of digital rhetoric. The advent of digital and networked communication technologies prompts renewed interest in basic questions such as  What counts as a text?  and  Can traditional rhetoric operate in digital spheres or will it need to be revised? Or will we need to invent new rhetorical practices altogether? Through examples and consideration of digital rhetoric theories, methods for both researching and making in digital rhetoric fields, and examples of digital rhetoric pedagogy, scholarship, and public performance, this book delivers a broad overview of digital rhetoric. In addition, Douglas Eyman provides historical context by investigating the histories and boundaries that arise from mapping this emerging field and by focusing on the theories that have been taken up and revised by digital rhetoric scholars and practitioners. Both traditional and new methods are examined for the tools they provide that can be used to both study digital rhetoric and to potentially make new forms that draw on digital rhetoric for their persuasive power.

Douglas Eyman is Associate Professor and Director of the PhD in Writing and Rhetoric at George Mason University and Senior Editor and Publisher of Kairos: A Journal of Rhetoric, Technology, and Pedagogy .

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• Open access
• Published: 26 April 2024

Exploring the perspectives and practices of humanitarian actors towards the Participation Revolution in humanitarian digital health responses: a qualitative study

• Jennifer Benson   ORCID: orcid.org/0000-0001-8909-1233 1 , 2 , 3 ,
• Meret Lakeberg 1 , 2 &
• Tilman Brand 2  

Globalization and Health volume  20 , Article number:  36 ( 2024 ) Cite this article

Metrics details

As crises escalate worldwide, there is an increasing demand for innovative solutions to enhance humanitarian outcomes. Within this landscape, digital health tools have emerged as promising solutions to tackle certain health challenges. The integration of digital health tools within the international humanitarian system provides an opportunity to reflect upon the system’s paternalistic tendencies, driven largely by Global North organisations, that perpetuate existing inequities in the Global South, where the majority of crises occur. The Participation Revolution , a fundamental pillar of the Localisation Agenda , seeks to address these inequities by advocating for greater participation from crisis-affected people in response efforts. Despite being widely accepted as a best practice; a gap remains between the rhetoric and practice of participation in humanitarian response efforts. This study explores the extent and nature of participatory action within contemporary humanitarian digital health projects, highlighting participatory barriers and tensions and offering potential solutions to bridge the participation gap to enhance transformative change in humanitarian response efforts.

Sixteen qualitative interviews were conducted with humanitarian health practitioners and experts to retrospectively explored participatory practices within their digital health projects. The interviews were structured and analysed according to the Localisation Performance Measurement Framework’s participation indicators and thematically, following the Framework Method. The study was guided by the COREQ checklist for quality reporting.

Varied participatory formats, including focus groups and interviews, demonstrated modest progress towards participation indicators. However, the extent of influence and power held by crisis-affected people during participation remained limited in terms of breadth and depth. Participatory barriers emerged under four key themes: project processes, health evidence, technology infrastructure and the crisis context. Lessons for leveraging participatory digital health humanitarian interventions were conducting thorough pre-project assessments and maintaining engagement with crisis-affected populations throughout and after humanitarian action.

The emerging barriers were instrumental in shaping the limited participatory reality and have implications: Failing to engage crisis-affected people risks perpetuating inequalities and causing harm. To advance the Participation Revolution for humanitarian digital health response efforts, the major participatory barriers should be addressed to improve humanitarian efficiency and digital health efficacy and uphold the rights of crisis-affected people.

As humanitarian crises continue to escalate [ 1 , 2 , 3 ], on a global scale [ 4 ], there is an urgent demand for innovative approaches to improve humanitarian outcomes. In today’s increasingly digitalised world, technology offers a broad potential to respond to this challenge. Within the humanitarian health arena, digital health tools refer to diverse digital solutions that leverage technology to enhance healthcare delivery, access, and outcomes for crisis-affected people (CAP). These technologies can include but are not limited to mobile apps, telehealth platforms, electronic health records, wearable devices, remote monitoring systems, and communication tools. The WHO supports the integration of such digital interventions in the pursuit of universal health coverage and health systems strengthening [ 5 ].

Digital health tools can prove valuable in a number of humanitarian crisis contexts. Examples include disasters with damaged healthcare infrastructure, conflict zones with disrupted healthcare access, disease outbreaks with curtailed movement, or displacement settlements away from support structures [ 6 ]. In these scenarios, digital health tools can enable remote consultations, patient management, outbreak surveillance as well as health promotion and disease prevention communications. This can be delivered freely, around the clock, in a number of formats, directly to those who need it, all without a physical presence. Across these situations, digital health tools offer promising solutions to bridge healthcare gaps, enhance communication between providers and CAP, and ultimately improve healthcare delivery in resource-scarce and challenging environments. Whilst these aspects assert that digital health tools are inherently a positive and benevolent force, it is crucial to recognise the nuanced implications of these statements. The convenience of digital tools carries with them often unseen paternalistic undertones. For example, offering ‘free of charge’ digital health services may go along with expectations of gratitude and conceal how user data becomes the currency of using digital health tools [ 7 , 8 ]. This leads to ethical considerations such as safeguarding data and navigating language and literacy barriers or power differentials which may impact an individual’s participation understanding or agreement. Providing local communities with an active role in both the development and delivery of digital services could overcome such paternalistic tendencies, adding to their digital empowerment whilst improving health outcomes.

However, introducing digital tools into crisis contexts is not a humanitarian response panacea. Recognition of this reality is crucial when considering pre-existing digital divides that persist even in high-income countries. In such contexts, digital exclusion prevents certain segments of the population from fully benefiting from technological advancements [ 9 , 10 ]. This exclusionary dynamic is likely to be exacerbated in crisis settings where economic instability, limited access to hardware and constrained support for utilising digital tools become pronounced challenges. This acknowledgement prompts critical reflection on the potential pitfalls associated with the widespread introduction of digital technologies in the context of humanitarian crises. Increased reliance upon digital solutions may exclude vulnerable populations, further marginalising those already disproportionality affected by crises. Thus, a nuanced and context-specific approach is essential to mitigate the risks associated with digital interventions to ensure that technologies contribute towards a more equitable, ethical and inclusive humanitarian response.

Whilst crisis prevalence sits within the Global South, the humanitarian system is primarily driven by Global North organisations [ 11 , 12 , 13 ]. As such, response efforts tend to be paternalistic [ 14 , 15 ] and perpetuate the very structural inequalities they aim to address, deepening power imbalances and failing to reach those most in need [ 16 , 17 ]. Recognising the imperative for transformative change within the humanitarian system, the Localisation Agenda (2016) was introduced [ 18 ]. A central tenet of this Agenda is the Participation Revolution [ 19 , 20 ], enshrining the fundamental right of CAP to participate in decision-making that affects them [ 21 ], to facilitate an effective humanitarian response. The Participation Revolution represents a paradigm shift away from the conception of inactive beneficiaries and towards CAP as empowered, active change agents. While participatory action in general gains traction, key guidelines, such as WHO’s Recommendations on Digital Interventions for Health Systems Strengthening [ 5 ], do not extend this far. The importance of digital acceptability according to context and culture is outlined, however the processes behind achieving this are not explored.

In the humanitarian sphere, community engagement and participatory activities are approaches that can bring response organisations and CAP together in designing and delivering response activities. Arnstein’s model of Citizen Participation categorises participatory events according to the influence and the overall power that citizens hold within them. The model ranges from the lowest levels with no participation, to the mid-levels, with a tokenistic level of participation and minor influence, and the top, ideal level, being citizen control and empowerment [ 22 ]. This model can be incorporated into humanitarian response design, integrating meaningful participation to increase legitimacy and accountability, gain community trust, foster a sense of ownership, and reinforce the ethical principles of respect and dignity.

Local cultures and contexts play a pivotal role in health interventions: For example, socio-cultural factors can profoundly influence health behaviours and epidemiological outcomes. This necessitates the incorporation of unique cultural and context-specific aspects within response efforts to successfully address health challenges [ 23 ]. Participatory and collaborative approaches can bridge cultural and contextual divides, enabling CAP to have a role in tackling their own healthcare challenges and fostering not only effective interventions but also ethical and culturally sensitive responses.

Various guidelines, including the Red Cross Code of Conduct (1992) [ 24 ], the Humanitarian Charter (2000) within the Sphere Standards [ 25 ], the Good Donorship Principles (2003) [ 26 ] and the Interagency Standing Committee’s (IASC) Commitments For Accountability To Affected People [ 27 ] all emphasise the importance of meaningful participation to achieve transformative change. In today’s increasingly digitalised world, the shift towards localisation and participation is gaining traction in both humanitarian and digital health spheres. Technology offers a unique opportunity to foster greater collaboration with CAP in response to efforts, contributing towards the Participation Revolution .

Meaningful participatory activities, challenging knowledge hierarchies and incorporating greater reflexivity are approaches that can enable redistribution of power from providers to communities, promoting local ownership and decision-making. For instance, Lokot and Wake [ 28 , 29 ] found that collaborative co-production methodologies between humanitarian actors and CAP can further enhance stakeholder buy-in, foster two-way capacity development and establish long-term partnerships [ 12 , 30 ]. Capacity development in this respect extends beyond mere technical skills. Firstly, it involves empowering communities to actively participate, assert and demand their rights, and engage in decision-making processes affecting them. Secondly, it entails enhancing the implementing agencies’ appreciation of the context, culture, and recognition of influencing factors within the implementation environment. By considering communities as experts in their own rights and leaders of locally driven health solutions, this approach can address power imbalances and promote more effective and sustainable outcomes. These approaches align with Robehmed [ 31 ] and Moore [ 32 ] in moving away from traditional top-down approaches, fostering more inclusive and responsive humanitarian action [ 14 ].

Putting these approaches into practice, Greenhalgh et al. [ 33 ] outlined numerous frameworks and guidelines for participatory action and local adaptation. Alongside this, they highlighted how these can maximise project benefits, empower and protect vulnerable groups, and build intervention legitimacy [ 33 , 34 ]. Similar frameworks have been successfully implemented in various humanitarian settings, as identified by Rass [ 35 ] and Joseph [ 36 ] who found that such participatory approaches led to more sustainable and impactful interventions.

One such framework, the Localisation Performance Measurement Framework (LPMF) [ 37 ] captures active CAP participation within two qualitative indicators (section six), encompassing the involvement of CAP in assessing needs, prioritising assistance, identifying recipients, providing feedback and informing key policies and standards [ 37 ]. Such frameworks contribute towards capturing and measuring progress towards transformation change in humanitarian interventions.

Despite the growing literature, a recent qualitative study [ 38 ] revealed a paradoxical humanitarian reality where practitioners recognise the importance and benefits of involving CAP in humanitarian action whilst simultaneously failing to involve them in any meaningful manner. A similar dearth of participatory action was identified within a recent scoping study [ 39 ] that sought to discover and critically analyse participatory action in digital health interventions. These findings were consistent with other related digital health and humanitarian literature [ 35 , 36 , 38 , 40 ], highlighting the gap between participation rhetoric and practice. This gap illustrates the need for a deeper exploration of participatory barriers and bottlenecks, which motivates this study’s investigative aim.

The emergence of the Participation Revolution within humanitarian consciousness alongside an increasingly innovative digital landscape provides a worthwhile juncture to explore how these phenomena intersect; to cooperate or collide [ 41 , 42 ]. Despite increasing attention, there remains a disconnect between the rhetoric and practice of involving CAP meaningfully [ 40 ]. Exploring the Participation Revolution from the organisational perspective of current digital health practitioners can reveal the participatory reality in digital health interventions in low-or-middle-income country (LMIC) crisis contexts. Understanding this can highlight areas for improvement and further innovation in an increasingly digitalised landscape. Therefore, this study aims to explore participatory action, as outlined in the LPMF qualitative indicators [ 37 ], within contemporary humanitarian digital health projects in LMIC crises. The specific objectives are to: (a) investigate how participatory action manifests within contemporary humanitarian digital health projects, according to the perspectives of humanitarian health practitioners, and (b) within these findings, to explore the breadth and depth to which CAP participate in these projects, and (c), to identify barriers to CAP participation and key lessons in the humanitarian sphere of digital health interventions.

Study design

We conducted online semi-structured key informant (KI) interviews with 16 humanitarian and health practitioners and experts with experience in digital health projects in LMIC crisis contexts. To achieve the objectives of the study, the interview guide (additional materials 1 ) was structured according to the LPMF qualitative indicators [ 37 ] (section six). These are (1) the participation of CAP in humanitarian response [ 37 ] and (2) the engagement of CAP in developing humanitarian policy-setting [ 37 ]. Ethical approval was applied for and received from the University of Bremen Ethics Office prior to the study’s commencement (reference: 2022-26). This research was guided by the Criteria for Reporting Qualitative Research (COREQ) [ 43 ] (additional materials 2 ).

Eligibility and sampling

This study sought out current humanitarian and health practitioners with experience in health projects that relied upon digital health tools in LMIC crisis contexts. The eligibility criteria included those people from any country with recent (within the last ten years) experience at any project stage, and in any capacity, of any digital health tool projects where CAP use the tools themselves to address/ prevent/ promote/ manage any health issue in any LMIC with crisis or displacement context. KIs were identified through purposive sampling from internet searches, online professional platforms, and relevant published studies. This was followed by snowball sampling with recommendations and connections from others.

Recruitment and consent

The team aimed for at least 20 KIs. Over 200 invitations were sent via email or online messaging requesting study participation for themselves or for recommendations of relevant contacts with an accompanying information sheet outlining the purpose and practicalities of the study. The final sample size was 16 due to a lack of willing or eligible participants. Reasons for declining the invitation included a lack of crisis or digital experience or the infancy of the digital health tool. Eligibility was assured through a set of questions to all those who responded positively to the invitation. Following this, a plain language consent form was sent out via email, and all KIs returned a signed copy before data collection commenced. There was no personal or professional relationship between the study team and the KIs.

Data collection

Data was managed under the General Data Protection Regulation (GDPR) [ 44 ]. Interviews with KIs were held between January and June 2023 using online conferencing technology (Zoom and Microsoft Teams) (JB). They lasted between 40 and 90 minutes , were recorded, and then transcribed verbatim. Following this, transcripts were quality checked and anonymised, removing identifying characteristics and replacing them with generic markers. At this point, the original interview recordings were deleted.

Data analysis

Analysis was both inductive and deductive: Transcribed, anonymised interviews were subjected to a familiarisation process in which the entire dataset was read. The transcripts were then imported into MAXQDA 2020 software and deductively coded according to the LPMF qualitative indicators (JB) and grounding characteristics (JB). Inductive coding and analysis were carried out according to emerging themes elicited from the interview discussions due to the recurring presence or relevance to the investigated topic (JB).

A second coder (ML) carried out a quality control review of the coding in MAXQDA 2020, adding additional themes and completing any gaps in coding. A consensus was agreed upon between the two reviewers based on the completeness of the coding. From here, the thematic codes were grouped under a parent-child hierarchy (Fig.  1 ), which developed into the final thematic framework according to the stages of the Framework Method [ 45 ].

Thematic framework outlining the emerging barriers to greater CAP participation in the humanitarian sphere of digital health interventions, along with main findings and lessons learnt

LPMF progress

In relation to the LPMF indicators, KIs reported a limited level of CAP participation and influence in determining the type of humanitarian assistance they received. Generally, KIs stated that CAP were not actively involved in assessing humanitarian needs, prioritising decisions, identifying recipients, deciding upon assistance types or developing humanitarian and health policies and standards.

“We didn’t involve the actual sample community or population. They had limited influence” (KI 19).

In order to comprehensively explore the relatively limited LPMF progress further, findings have been structured according to the four major emerging themes. These are weak project processes, lack of health evidence, limited technology, and limiting contextual factors. Within these themes are the individual barriers and bottlenecks relating to greater involvement with CAP in digital health interventions, as identified by the KIs (Fig.  1 ). To accompany this, the characteristics of the KIs, the crisis contexts and a summary of the digital health tools can be found in additional materials 3 .

Project processes

Rather than participatory planning and collaborative project development, response efforts were reportedly pre-planned and designed by the humanitarian organisations themselves, largely through a top-down approach.

“I think that [the] management team kind of decides on how we want to, whether we want to start it, whether we want to continue, whether we want to scale it up or shut down” (KI 17).

However, there were a couple of notable exceptions to this where CAP discussed their daily lives in relation to their health statuses as a method to understand digital behaviours and social challenges to inform project designs.

“We’re engaging patients in co-creation throughout the entirety of the process ” (KI 11).

Despite a relatively low level of influence reported in general, the degree of participatory power that CAP experienced increased during testing phases, validating, and monitoring digital health prototypes and pilot projects. This mainly took the form of focus group discussions, house-to-house surveys, and interviews. With a few exceptions, participatory engagement was limited to specific project milestones, including monitoring and testing events, and did not extend throughout the project lifecycle or post-intervention.

The selection and eligibility criteria for CAP participation activities were not always clear. Convenience sampling and involving team acquaintances were common methods for prototype testing. Furthermore, sample representativeness in relation to social or crisis dimensions and whether they were incentivised was not well known.

“Certain community members are cherry-picked to test prototypes on, and [we] incorporate their feedback into the application” (KI 16).

There were few dedicated mechanisms for capturing and considering CAP feedback or complaints and few systematic approaches for integrating feedback.

“Complaints were reported ad-hoc… Sometimes these are not reported or not reported properly” (KI 16).

“a lot of it is…just based on one person’s power” (KI 17).

Differences between the digital provider’s working hours and the times that CAP used the digital tools did not always align, which challenged full participatory engagement in provider-led or scheduled services. However, stand-alone digital tools offered greater convenience in their flexibility. One digital health tool was registered as a randomised trial, which hindered it’s flexibility in being adapted according to emerging intervention findings.

The short-term duration of humanitarian projects was identified as a contributing factor to the limited involvement of CAP in participatory activities. The time constraints associated with short timeframe projects and the need for rapid assistance delivery with limited budgets left minimal opportunity for meaningful community engagement and understanding of CAP or the crisis context. Consequently, the focus tended to prioritise technical tool development and testing over comprehensive engagement with and learning from CAP. KIs acknowledged that this resulted in knowledge gaps regarding CAP digital literacy, health literacy, as well as cultural and context information.

“I think due to time constraints and various other elements at play, a lot of the focus ended up going into the technical development. And maybe not enough attention went to the actual content. The technology is really just a vessel for what you put in it” (KI 11).

KIs reported that digital health tools were no longer supported despite ongoing health needs when project grants expired due to insufficient health evidence, highlighting an ethical shortcoming where participation or community engagement could have informed decision making.

“The NGO didn’t really plan for the future of how they would use that. They only want to use something that has been shown to be effective.” (KI 19).

Health evidence

In some contexts, the novelty of digital health tools caused a lack of community understanding regarding their benefits, hindering participation and uptake. This was exacerbated by a lack of evidence demonstrating improved health outcomes as a result of using digital health tools.

“The engagement with available services was a huge issue… some of the study coordinators said [to CAP], “You all said you wanted treatment, we offer it, and you don’t take it, what’s wrong?” (KI 19).

Likewise, not all providers were convinced regarding the feasibility of digital health tools over more traditional methods. Most evidence bases relied on anecdotal reports without meaningful participation of CAP.

“A lot of factors go in. And in a vulnerable setting or in a resource-limited setting, it’s very difficult to make that corroboration. So, we kind of rely more on the qualitative aspects” (KI 17).

This created a disconnect with broader health services and hindered management-level buy-in. Consequently, parallel systems were utilised, resulting in increased or duplicated workloads. Despite this, digital health projects were discussed favourably by KIs for reducing patient waiting times, improving health communications, delivering up-to-date health information, and supporting CAP in health decision-making.

The limitations of the technological environment meant that some digital health tools failed or were functionally curtailed by technological infrastructures and therefore did not produce the anticipated outcomes. In turn, this impacted the willingness and interest of CAP to participate in the development and uptake of tools that were not fully functional or reliable within their context.

A lot of times, a lot of NGOs come with this very sophisticated, very high design innovation prototypes and models. And those aren’t exactly very tech friendly for either implementing partners or for the patients or for the whole ecosystem in general… (KI 17) .

However, where appropriate digital mediums were operationalised, users appreciated the discretion offered by digital tools in addressing stigmatised health issues over face-to-face services.

“Because there’s a stigma with accessing mental health services. So, some of them said they don’t really want other people to know about that… It’s [the digital health tool] more discreet ” (KI 19).

During the COVID-19 pandemic, participatory activities with CAP for the purpose of learning or monitoring and evaluation were largely halted. Similarly, some traditional healthcare routes were put on hold or closed completely in line with restrictions. Whilst this reduced in-person healthcare access in general, it motivated a greater drive towards a digitalised healthcare service provision.

“One of the best outcomes is that all the [targeted digital health users] in [the digital health programme] got significantly more sessions [than those in traditional treatment programmes]. Because they could get them even when the roads were closed” (KI 19).

However, participatory events with CAP were not digitalised in the same way. Instead, these were generally deprioritised and did not receive the same attention. This resulted in both participation and response gaps for harder-to-reach communities and groups without digital access.

Key informants’ lesson learned for leveraging successful digital health interventions

There were two key participatory lessons reported by KIs following their digital health experiences that were reported as enabling factors for successful digital health interventions. The first lesson discussed the importance of understanding CAP and the crisis context from the beginning to inform health projects.

“I was just kicking myself that I should have done some qualitative evaluation to understand more the dynamics” (KI 1).

“My first strategy would not be to just jump in [to the crisis context] and just implement it. I would really want to engage before I actually want to build on it. And that’s not usually how a lot of international organisations will do. They just think they have a good idea. And so, it needs to be implemented everywhere they go. And that’s like the worst thing that you can do in this kind of a situation. They create more damage than good in such situations” (KI 17).

The benefits of initial assessments were reported.

“if you do a very thorough in-depth assessment before you actually implement, chances are that it would succeed. You need to have an understanding of the context where you’ll be working. You need to have an understanding of the demographics that you’re working with, the healthcare providers that you will be supporting …all of those are aspects that can really help in moulding the way that you want to build your project” (KI 17).

The second key lesson reported was that working in proximity to CAP throughout the whole project cycle is the preferred method due to the ongoing contextually and culturally beneficial information that could be gained from these interactions.

“You need to keep them engaged as much as possible…because I think they’re the ones who kind of understand what the needs are and understand how you can contextualise it or adapt it as much as possible” (KI 17).

Progress towards the participation indicators

The LPMF sets forth the aspiration of achieving a “fuller and more influential involvement of affected people in what relief is provided to them, and how” [ 37 ]. According to the framework, this can be accomplished by ensuring that CAP actively shape and participate in humanitarian response initiatives [ 37 ]. . The findings of this study indicate that despite digital health practitioners having a positive perception of participatory action and the benefits it can yield, participatory events were primarily limited to specific, pre-defined project milestones rather than spanning the entire project lifecycle or at the pre- or post-intervention points. In general, participation within the humanitarian digital health sphere manifested as focus groups, surveys, and interviews, and included assessments and testing. CAP influence within these events was curtailed and limited according to organisational boundaries. For the most part, CAP were not actively engaged in needs assessments, prioritisation decisions, or shaping humanitarian and health policies. As a result, CAP held limited influence or power over problem identification, goal definitions, strategy selection or policy shaping. However, notable exceptions were identified, where co-creation activities were enacted with CAP to gain insight into broader lifestyle and digital realities to inform project planning and decisions prior to design phases. , Despite these noteworthy instances, in the context of the LPMF, this study found the overall progress towards participation indicators remains far from a revolution.

Summary of emerging themes

Participatory barriers emerged as major themes: Project processes, technological limitations, contextual issues, and a lack of health evidence all influenced the participatory reality of digital health projects in LMIC crisis contexts. Key participatory lessons for successful digital health interventions were acknowledging the importance of and acting on in-depth pre-intervention assessments, in conjunction with maintaining ongoing proximity and meaningful engagement with CAP during and after interventions to understand the intervention against evolving humanitarian needs. Our findings indicate that substantial disparities persist between these participatory best practices and the realities of digital health humanitarian action [ 46 , 47 ].

Systemic issues

Many of our thematic findings stem from systemic issues. This is symptomatic of the challenges with the current response ecosystem [ 16 , 17 ] and, thus, distracts us from the human dimension that should be at its core. As a result, incorporating the fundamental right of CAP to participate in decisions that affect them meaningfully has become deprioritised. Consequently, this study emphasises the necessity to move away from a systemic master, and instead towards a person-centred approach. Enhancing collaboration between humanitarian health actors and CAP could surmount identified obstacles and harness the potential offered by digital health tools in addressing humanitarian crises. As an alternative focus, integrating the participation of CAP through the key benchmarks laid out in the Core Humanitarian Standard [ 48 ] unlocks a number of ethical gains, such as respect for cultural and contextual norms, equitable representation and diversity inclusion, as well as accountability, non-maleficence, beneficence and mutual reciprocity, informed consent and decision-making powers.

Overcoming participatory barriers

Barriers to CAP participation caused by project processes include limited time and resources, inflexible working practices, top-down decision-making, and cherry-picking community involvement. Drawing upon the experiences documented by Fitz-Gerald and others [ 16 , 17 ], our study underscores the persistent challenges of the paternalistic humanitarian system acting in its own interests and restricting the quality and quantity of participatory events [ 49 ]. This highlights the tensions between the dominant system approach, and how neglecting contextual and human dimensions undermines adherence to humanitarian principles of humanity, impartiality, neutrality, and independence [ 50 ] and impedes progress towards meaningful transformation.

Our research echoes the concerns raised by Ehrenzeller [ 51 ] and others [ 52 , 53 , 54 ] regarding the intersectionality of localisation required to effect change. To overcome these barriers, digital health projects should embrace all dimensions of the Localisation Agenda , centred by the Participation Revolution , including decentralising funding, visibility, relationship and capacity building [ 53 ]. Enacting these dimensions simultaneously can support the development of a more human-centric approach at all stages and overcome existing constraints.

A lack of digital health evidence posed a barrier for both digital health providers and CAP. This limitation led providers to establish parallel data collection and reporting systems. In turn, this was said to be responsible for community scepticism and lack of trust rather than acceptance of and participation in digital health tool interventions. This contrasts with findings from other feasibility studies [ 55 , 56 , 57 ] that showed positive community assessments of digital health tools, highlighting the need for further exploration.

To address this lack of health evidence, digital health projects could actively engage healthcare providers and CAP in recognising the potential impacts of digital tools on health outcomes. Implementing co-production initiatives presents an opportunity for this and can foster interest and trust by reporting outcomes and interpreting results collaboratively. This approach can promote a learning culture that strengthens support for digital health initiatives and ensures their alignment with real-world challenges.

In settings with considerable technological limitations, as observed in several studies [ 35 , 58 ], barriers such as poor connectivity pose a considerable challenge to both digital health interventions and digital participatory action. When technology and infrastructures do align, digital health tools become powerful facilitators in addressing specific health issues, particularly for stigmatised problems such as mental health, offering privacy and discretion [ 59 ]. This represents a considerable strength for digital health tools, considering the high burden of mental health issues found within crisis contexts [ 60 , 61 ].

However, as our exploration highlights, the reality of aligning tools within limited techno-ecosystems is not always feasible and underscores the importance of designing interventions according to local contexts. Incompatible digital tools that are not tailored to the hosting environment are indicative of hierarchical provider-led decision-making rather than user-led approaches prioritising the needs and desires of CAP [ 62 , 63 ]. As WHO outlines, digital tools are only a platform, not a means to an end [ 42 ]. A greater understanding of existing digital behaviours in relation to socio-economic aspects, such as gender, ownership, and literacy can inform appropriate digital platform selections and local hosting capabilities [ 61 ]. An important consideration here is that certain contexts may not be viable for digital health tools, and traditional methods may be more appropriate. This decision should be locally led.

As outlined by other studies [ 64 , 65 ], in regions with ongoing conflicts, accessibility challenges between responders and CAP can hinder access to services [ 66 ] as well as traditional participatory activities [ 67 , 68 , 69 ]. In such contexts, greater community engagement and improved participation can provide protection and access to humanitarian responders. This must go hand-in-hand with principled action but can act as a mechanism in which assistance can continue to be delivered to communities within these areas.

However, given the shrinking humanitarian space, increasing human rights violations, and attacks on responders [ 67 ], proximity with CAP may not always be possible. In these cases, digitalised health services offer the potential to transcend some of these barriers virtually, as demonstrated during the emergence of the COVID-19 pandemic. The pandemic served as a catalyst for digitalising health and humanitarian sector services, and as a result, digital interventions may have extended the reach of health services and fostered greater inclusion of CAP in humanitarian response efforts [ 70 ]. This is a notable achievement and may become increasingly important in the future. Establishing best practices and effective digital health platforms that also incorporate digitalised participatory engagement opportunities would be highly advantageous in this evolving landscape.

It is crucial to acknowledge that while increased digitalisation may have broadened inclusion for some communities in accessing services, it risks excluding others [ 71 , 72 ]. As outlined by Boza-Kiss et al. [ 73 ], the lack of access to digital technology in low-income crisis contexts disproportionately affects socio-economically disadvantaged communities. Consequently, balancing the benefits of digital health solutions with addressing disparities is crucial to ensure equitable and effective support for all CAP during crises.

Implications

Insufficient CAP participation in digital health projects has several critical implications. Firstly, poor participation with CAP can result in unrepresentative local information lacking cultural and contextual nuances, limiting project design and development. Secondly, the lack of engagement may limit the targeted users’ adoption of digital health tools. Thirdly, without the meaningful involvement of CAP, digital health tools may not be fit for purpose, technologically, economically, ethically, or socially. This may mean that intended groups are not reached with humanitarian response efforts or that ethical lines are crossed, which could result in adverse outcomes.

This study’s findings align with existing literature and best practices in health and humanitarian endeavours [ 74 , 75 ] in highlighting two critical lessons learned for the success of digital health projects: Firstly, conducting comprehensive population and context assessments with CAP before project initiation is crucial for ensuring appropriate design and implementation: Building on the lessons learned from the West African Ebola outbreak [ 76 , 77 ] and COVID-19 Pandemic [ 78 , 79 ], we emphasis this as an ethical approach for deeper, more holistic understanding of community needs. In this way, CAP participation can help to reduce power imbalances and systemic paternalism whilst bridging the divide between global resources and local solutions [ 80 ].

Secondly, maintaining close proximity and ongoing interaction with CAP throughout and after humanitarian actions is essential [ 66 , 81 , 82 , 83 ]. Previous studies have shown that it is not enough to simply develop and implement a digital health tool [ 84 ]. Instead, ongoing engagement is required to facilitate trust and legitimacy whilst enabling continuous adaptation and improvement, maximising the potential benefits of digital health interventions within evolving and dynamic environments. Incorporating these lessons into digital health projects can uphold a rights-based approach that increases accountability to CAP whilst contributing to more effective and impactful response efforts.

Strengths and limitations of the study

In seeking to understand the organisational perspective of the Participation Revolution , this study engaged with digital health and humanitarian organisations, recognising their pivotal role and access to resources required for an accountable and effective response. As highlighted in much literature, the interest of CAP to participate is high [ 85 ], and whilst our study offers a valuable organisational perspective, the limitations of not including CAP in this study are acknowledged. Participatory rights are the cornerstone for the realisation of numerous fundamental ethical and human rights, including, but not limited to, the right to non-discrimination, the right to healthcare and the right to freedom of expression. Further research in this field should explore this topic from the CAP perspective, exploring CAP’s awareness of their rights in relation to health, digital and humanitarian response efforts. Investigating participatory evaluation mechanisms as indicators of success, measured by CAP, for humanitarian and digital health interventions could contribute towards the evolving discourse on inclusive and rights-based humanitarian and digital health interventions. Furthermore, given the diversity of health issues addressed by technology, additional analysis of these and their crisis contexts to understand their potential participatory opportunities could enhance this research field.

We recognise this study’s small sample size as a limitation for generalisability and as such cannot tease out differences between technology types, health issues, and crisis contexts. However, considering this against the diversity of CAP and crisis contexts globally, we consider this study a baseline for greater exploration in this sphere. Considering the complexity of the topic, this study’s strength lies in the rich diversity of perspectives from several humanitarian crises, crisis context types, types of digital health tools and health issues.

The lack of health evidence from digital health tools within humanitarian contexts challenges the very notion that they benefit health outcomes. Further research to demonstrate their ability to affect positive health change could garner greater traction as well as highlight opportunities for further CAP participation in response efforts.

This study has highlighted the gap between participatory rhetoric and practice and highlighted the barriers that shape the extent and form of participation within humanitarian digital health response efforts. Despite widely accepted participatory benefits, this study found only a few examples of strong participatory practices. To further the Participation Revolution within the digital health humanitarian paradigm, systemic tensions with project processes, contexts, technologies, and health evidence should be addressed to achieve a more inclusive and collaborative humanitarian response. This paper has offered a number of strategies to overcome or minimise participatory challenges and humanitarian digital health interventions could benefit from these through greater promotion and prioritisation of meaningful, powerful participation with CAP across the intersectionality of the Localisation Agenda.

Abbreviations

Application (digital)

Crisis Affected People

Criteria for Reporting Qualitative Research

Coronavirus Disease 2019

General Data Protection Regulation

Interagency Standing Committee

Internally Displaced Populations

Key Informant(s)

Low- and Middle-Income Country/ies

Localisation Performance Measurement Framework

Non-Governmental Organisation

Qualitative Indicator(s)

Short Message System

Standard Operating Procedure(s)

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Benson, J., Lakeberg, M. & Brand, T. Exploring the perspectives and practices of humanitarian actors towards the Participation Revolution in humanitarian digital health responses: a qualitative study. Global Health 20 , 36 (2024). https://doi.org/10.1186/s12992-024-01042-y

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