Designing for Collaborative Type 2 Diabetes Care in Nigeria

: A WhatsApp-Enabled Study

Abstract

Type 2 Diabetes (T2D) affects over 400 million adults globally, leading to serious complications and rising healthcare costs. In Africa, urbanization, dietary shifts, and limited healthcare infrastructure contribute to its growing burden. In Nigeria, around 3.6 million people live with T2D, many of whom require long-term, community-based care. This thesis adopts a culturally sensitive perspective to investigate collaborative care practices and design opportunities, using Port Harcourt, Nigeria, as a case study. It engages people living with T2D, their caregivers, and community pharmacists through a three-phase mixed-methods study that includes WhatsApp-based activities alongside more conventional data collection methods. WhatsApp was selected due to its accessibility, widespread use, familiarity, and ease of adoption in low-resource settings. The thesis makes three key contributions to Digital Health and Care. First, it provides insight into the everyday dynamics of collaborative T2D care and identifies design opportunities by surfacing often-invisible acts of collaboration. Second, it contributes to Human-Computer Interaction (HCI) by presenting cross-culturally grounded methods for designing collaborative T2D care technologies. This is achieved through a research-through-design approach, which involves adapting design materials and activities in culturally meaningful ways and integrating cultural sensitivity into the design process, resulting in the creation of Okuma, a mobile applica- tion prototype that supports collaborative T2D care. Third, it offers a practical methodological approach for conducting inclusive user research in low-resource contexts using familiar platforms like WhatsApp, supporting the development of accessible, culturally relevant digital health interventions and scalable design practices. Ultimately, this thesis reveals
that collaborative care occurs unconsciously and without regulation within Nigeria’s fragmented healthcare system, highlighting opportunities to support these practices through culturally sensitive mobile health tools. It also demonstrates that WhatsApp is a suitable platform for conducting research and design in low-resource settings, offering a practical model for leveraging other pervasive communication technologies in digital health research.

Date of Award	16 Oct 2025
Original language	English
Awarding Institution	University of Bristol
Sponsors	Engineering and Physical Sciences Research Council
Supervisor	Aisling A O'Kane (Supervisor), Paul Marshall (Supervisor) & Jonah Aprioku (Supervisor)