mHealth and pandemic communication in the Global South: A culture-centered study of India’s community health workers’ meanings of smartphones during the COVID-19 pandemic

Mobile health (mHealth) initiatives gained prominence during the COVID-19 pandemic, often relying on community health workers (CHWs) to implement digital tools. Such initiatives are, however, typically top-down and expert-driven, overlooking the voices and structural realities of marginalized CHWs in the Global South. Guided by the culture-centered approach (CCA), this study co-creates insights with India’s CHWs known as Accredited Social Health Activists (ASHAs)—an all-female health workforce from the communities they serve—on the meaning of smartphones during the pandemic. ASHAs faced coercive pressures to procure smartphones to document COVID-19 work, despite lacking financial means or infrastructural support. This introduced what the study terms digital burden—the compounding of labor, surveillance, and moral obligation without enabling resources. While earlier literature celebrates mHealth efficiency, this study critiques such narratives by highlighting how imposed digital expectations can reproduce infrastructural violence. Despite these constraints, ASHAs drew on cultural and relational resources—such as family and community support—to navigate structural barriers. The findings offer a global critique of neoliberal health governance, cautioning that mHealth initiatives disconnected from local realities risk deepening inequality rather than addressing it.