{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T19:10:34Z","timestamp":1776107434851,"version":"3.50.1"},"reference-count":74,"publisher":"Association for Computing Machinery (ACM)","issue":"CSCW2","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/"}],"content-domain":{"domain":["dl.acm.org"],"crossmark-restriction":true},"short-container-title":["Proc. ACM Hum.-Comput. Interact."],"published-print":{"date-parts":[[2023,9,28]]},"abstract":"<jats:p>Seeking to address barriers to in-person care, governments and non-governmental organizations (NGOs) globally have been pushing for scaling chat- or phone-based information services that rely on care workers to engage with users. Despite theoretical tensions between care and scale and the essential role of care workers, workers' perspective on scale and its impact on care provision is rarely centered early on in decisions to scale. In this paper, we examine care and scale from the perspective of medical support executives (MSEs) who support a chat-based health information service for maternal and child health deployed across multiple states in India. We draw on observations of MSEs' work, interviews with MSEs, NGO staff who implement the service, and families who use the service, and speculative design sessions conducted with MSEs. We find that by centering MSEs' perspectives, we can differentiate between growth of the relationships and heterogeneity that enable social impact, versus scale-thinking that promotes the decontextualization of care. We leverage our findings to discuss implications for scale and automation in chat-based health information services, including the importance of human connection, place, and support for care workers.<\/jats:p>","DOI":"10.1145\/3610210","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T15:54:10Z","timestamp":1696434850000},"page":"1-26","update-policy":"https:\/\/doi.org\/10.1145\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Speculating with Care: Worker-centered Perspectives on Scale in a Chat-based Health Information Service"],"prefix":"10.1145","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0355-3041","authenticated-orcid":false,"given":"Naveena","family":"Karusala","sequence":"first","affiliation":[{"name":"University of Washington, Seattle, WA, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-8674","authenticated-orcid":false,"given":"Shirley","family":"Yan","sequence":"additional","affiliation":[{"name":"Noora Health, San Francisco, CA, USA"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2871-0181","authenticated-orcid":false,"given":"Nupoor","family":"Rajkumar","sequence":"additional","affiliation":[{"name":"Aurora Health Innovations LLP, Bengaluru, India"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2182-6285","authenticated-orcid":false,"given":"Victoria","family":"G","sequence":"additional","affiliation":[{"name":"Aurora Health Innovations LLP, Bengaluru, India"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7283-7219","authenticated-orcid":false,"given":"Richard","family":"Anderson","sequence":"additional","affiliation":[{"name":"University of Washington, Seattle, WA, USA"}]}],"member":"320","published-online":{"date-parts":[[2023,10,4]]},"reference":[{"key":"e_1_2_1_1_1","doi-asserted-by":"crossref","unstructured":"Mafruha Alam Cathy Banwell Anna Olsen Kamalini Lokuge et al. 2019. Patients and doctors perceptions of a mobile phone-based consultation service for maternal neonatal and infant health care in Bangladesh: a mixed-methods study. JMIR mHealth and uHealth Vol. 7 4 (2019) e11842.","DOI":"10.2196\/11842"},{"key":"e_1_2_1_2_1","volume-title":"Addressing ethnic and global health inequalities in the era of artificial intelligence healthcare models: a call for responsible implementation. Journal of the Royal Society of Medicine","author":"Ali Mohammad R","year":"2023","unstructured":"Mohammad R Ali, Claire A Lawson, Angela M Wood, and Kamlesh Khunti. 2023. Addressing ethnic and global health inequalities in the era of artificial intelligence healthcare models: a call for responsible implementation. Journal of the Royal Society of Medicine (2023), 01410768231187734."},{"key":"e_1_2_1_3_1","doi-asserted-by":"crossref","unstructured":"John W Ayers Adam Poliak Mark Dredze Eric C Leas Zechariah Zhu Jessica B Kelley Dennis J Faix Aaron M Goodman Christopher A Longhurst Michael Hogarth et al. 2023. Comparing physician and artificial intelligence chatbot responses to patient questions posted to a public social media forum. JAMA internal medicine (2023).","DOI":"10.1001\/jamainternmed.2023.1838"},{"key":"e_1_2_1_4_1","volume-title":"Peter Benjamin, and Yogan Pillay.","author":"Barron Peter","year":"2018","unstructured":"Peter Barron, Joanne Peter, Amnesty E LeFevre, Jane Sebidi, Marcha Bekker, Robert Allen, Annie Neo Parsons, Peter Benjamin, and Yogan Pillay. 2018. Mobile health messaging service and helpdesk for South African mothers (MomConnect): history, successes and challenges. BMJ global health, Vol. 3, Suppl 2 (2018), e000559."},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.1145\/3442188.3445922"},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1145\/3173574.3173984"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1145\/2818048.2820029"},{"key":"e_1_2_1_8_1","doi-asserted-by":"publisher","DOI":"10.18653\/v1\/P19-1090"},{"key":"e_1_2_1_9_1","doi-asserted-by":"crossref","unstructured":"Hamid R Ekbia and Bonnie A Nardi. 2017. Heteromation and other stories of computing and capitalism. MIT Press.","DOI":"10.7551\/mitpress\/10767.001.0001"},{"key":"e_1_2_1_10_1","volume-title":"Optimising mHealth helpdesk responsiveness in South Africa: towards automated message triage. BMJ global health","author":"Engelhard Matthew","year":"2018","unstructured":"Matthew Engelhard, Charles Copley, Jacqui Watson, Yogan Pillay, Peter Barron, and Amnesty Elizabeth LeFevre. 2018. Optimising mHealth helpdesk responsiveness in South Africa: towards automated message triage. BMJ global health, Vol. 3, Suppl 2 (2018), e000567."},{"key":"e_1_2_1_11_1","volume-title":"Challenging orthodoxies: the road ahead for health and human rights. health and human rights","author":"Farmer Paul","year":"2008","unstructured":"Paul Farmer. 2008. Challenging orthodoxies: the road ahead for health and human rights. health and human rights (2008), 5--19."},{"key":"e_1_2_1_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0032329205284754"},{"key":"e_1_2_1_13_1","doi-asserted-by":"crossref","unstructured":"Sarah E Fox Vera Khovanskaya Clara Crivellaro Niloufar Salehi Lynn Dombrowski Chinmay Kulkarni Lilly Irani and Jodi Forlizzi. 2020. Worker-centered design: Expanding HCI methods for supporting labor. In Extended abstracts of the 2020 CHI conference on human factors in computing systems. 1--8.","DOI":"10.1145\/3334480.3375157"},{"key":"e_1_2_1_14_1","doi-asserted-by":"publisher","DOI":"10.1145\/3579514"},{"key":"e_1_2_1_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1367493518757066"},{"key":"e_1_2_1_16_1","volume-title":"Ghost work: How to stop Silicon Valley from building a new global underclass","author":"Gray Mary L","unstructured":"Mary L Gray and Siddharth Suri. 2019. Ghost work: How to stop Silicon Valley from building a new global underclass. Eamon Dolan Books."},{"key":"e_1_2_1_17_1","volume-title":"Against scale: Provocations and resistances to scale thinking. arXiv preprint arXiv:2010.08850","author":"Hanna Alex","year":"2020","unstructured":"Alex Hanna and Tina M Park. 2020. Against scale: Provocations and resistances to scale thinking. arXiv preprint arXiv:2010.08850 (2020)."},{"key":"e_1_2_1_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2023.104512"},{"key":"e_1_2_1_19_1","doi-asserted-by":"publisher","DOI":"10.1145\/3411764.3445130"},{"key":"e_1_2_1_20_1","first-page":"119","article-title":"A doctor in your pocket: health hotlines in developing countries. Innovations: Technology, Governance","volume":"4","author":"Ivatury Gautam","year":"2009","unstructured":"Gautam Ivatury, Jesse Moore, and Alison Bloch. 2009. A doctor in your pocket: health hotlines in developing countries. Innovations: Technology, Governance, Globalization, Vol. 4, 1 (2009), 119--153.","journal-title":"Globalization"},{"key":"e_1_2_1_21_1","volume-title":"Will Technology Such As ChatGPT Improve Health Care Or Exacerbate Disparities? Health Affairs Forefront","author":"Jacobs Wura","year":"2023","unstructured":"Wura Jacobs and Omolola E Adepoju. 2023. Will Technology Such As ChatGPT Improve Health Care Or Exacerbate Disparities? Health Affairs Forefront (2023)."},{"key":"e_1_2_1_22_1","doi-asserted-by":"publisher","DOI":"10.1145\/3532106.3533564"},{"key":"e_1_2_1_23_1","doi-asserted-by":"publisher","DOI":"10.1145\/3462204.3481734"},{"key":"e_1_2_1_24_1","doi-asserted-by":"publisher","DOI":"10.1145\/3411764.3445313"},{"key":"e_1_2_1_25_1","doi-asserted-by":"publisher","DOI":"10.1145\/3313831.3376166"},{"key":"e_1_2_1_26_1","doi-asserted-by":"publisher","DOI":"10.1145\/3544548.3581553"},{"key":"e_1_2_1_27_1","doi-asserted-by":"publisher","DOI":"10.1145\/3491102.3502116"},{"key":"e_1_2_1_28_1","doi-asserted-by":"crossref","unstructured":"T Koulouri RD Macredie and D Olakitan. 2022. Chatbots to Support Young Adults' Mental Health: an Exploratory Study of Acceptability. (2022).","DOI":"10.1145\/3485874"},{"key":"e_1_2_1_29_1","doi-asserted-by":"publisher","DOI":"10.1145\/3492860"},{"key":"e_1_2_1_30_1","doi-asserted-by":"publisher","DOI":"10.1145\/3274372"},{"key":"e_1_2_1_31_1","doi-asserted-by":"publisher","DOI":"10.1145\/3392836"},{"key":"e_1_2_1_32_1","doi-asserted-by":"publisher","DOI":"10.1145\/3313831.3376175"},{"key":"e_1_2_1_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10606-019-09352-1"},{"key":"e_1_2_1_34_1","doi-asserted-by":"publisher","DOI":"10.1145\/3429360.3468203"},{"key":"e_1_2_1_35_1","unstructured":"Alexandra Mateescu and Virginia Eubanks. 2021. Care bots are on the rise and replacing human caregivers."},{"key":"e_1_2_1_36_1","doi-asserted-by":"publisher","DOI":"10.1353\/sor.2019.0022"},{"key":"e_1_2_1_37_1","doi-asserted-by":"publisher","DOI":"10.1145\/3449173"},{"key":"e_1_2_1_38_1","volume-title":"Global Readiness of Language Technology for Healthcare: What would it Take to Combat the Next Pandemic? arXiv preprint arXiv:2204.02790","author":"Mondal Ishani","year":"2022","unstructured":"Ishani Mondal, Kabir Ahuja, Mohit Jain, Jacki O Neil, Kalika Bali, and Monojit Choudhury. 2022. Global Readiness of Language Technology for Healthcare: What would it Take to Combat the Next Pandemic? arXiv preprint arXiv:2204.02790 (2022)."},{"key":"e_1_2_1_39_1","volume-title":"Foundation Models are exciting, but they should not disrupt the foundations of caring. Available at SSRN","author":"Morley Jessica","year":"2023","unstructured":"Jessica Morley and Luciano Floridi. 2023. Foundation Models are exciting, but they should not disrupt the foundations of caring. Available at SSRN (2023)."},{"key":"e_1_2_1_40_1","volume-title":"Lost in Translation: Large Language Models in Non-English Content Analysis. arXiv preprint arXiv:2306.07377","author":"Nicholas Gabriel","year":"2023","unstructured":"Gabriel Nicholas and Aliya Bhatia. 2023. Lost in Translation: Large Language Models in Non-English Content Analysis. arXiv preprint arXiv:2306.07377 (2023)."},{"key":"e_1_2_1_41_1","unstructured":"Siddharth Nishtala Harshavardhan Kamarthi Divy Thakkar Dhyanesh Narayanan Anirudh Grama Aparna Hegde Ramesh Padmanabhan Neha Madhiwalla Suresh Chaudhary Balaraman Ravindran et al. 2020. Missed calls Automated Calls and Health Support: Using AI to improve maternal health outcomes by increasing program engagement. arXiv preprint arXiv:2006.07590 (2020)."},{"key":"e_1_2_1_42_1","doi-asserted-by":"publisher","DOI":"10.1145\/3411764.3445420"},{"key":"e_1_2_1_43_1","doi-asserted-by":"publisher","DOI":"10.1145\/3378393.3402281"},{"key":"e_1_2_1_44_1","doi-asserted-by":"publisher","DOI":"10.1145\/3313831.3376465"},{"key":"e_1_2_1_45_1","doi-asserted-by":"publisher","DOI":"10.1145\/3411764.3445410"},{"key":"e_1_2_1_46_1","doi-asserted-by":"publisher","DOI":"10.1145\/2702123.2702124"},{"key":"e_1_2_1_47_1","doi-asserted-by":"publisher","DOI":"10.1145\/3209811.3209857"},{"key":"e_1_2_1_48_1","volume-title":"Balancing the scales of justice in Tonga. Scale: Discourse and dimensions of social life","author":"Philips Susan U","year":"2016","unstructured":"Susan U Philips. 2016. Balancing the scales of justice in Tonga. Scale: Discourse and dimensions of social life (2016), 112--132."},{"key":"e_1_2_1_49_1","doi-asserted-by":"publisher","DOI":"10.1145\/3411764.3445694"},{"key":"e_1_2_1_50_1","doi-asserted-by":"publisher","DOI":"10.1145\/3469257"},{"key":"e_1_2_1_51_1","doi-asserted-by":"publisher","DOI":"10.1145\/3359277"},{"key":"e_1_2_1_52_1","volume-title":"Designing With ImmigrantsWhen Emotions Run High. In 11th Academy of Design Conference. The Value of Design Research","author":"Salgado Mariana","year":"2015","unstructured":"Mariana Salgado, Helena Sustar, and Michail Galanakis. 2015. Designing With ImmigrantsWhen Emotions Run High. In 11th Academy of Design Conference. The Value of Design Research. Paris, France."},{"key":"e_1_2_1_53_1","volume-title":"The Deskilling of Domain Expertise in AI Development. In CHI Conference on Human Factors in Computing Systems. 1--14","author":"Sambasivan Nithya","year":"2022","unstructured":"Nithya Sambasivan and Rajesh Veeraraghavan. 2022. The Deskilling of Domain Expertise in AI Development. In CHI Conference on Human Factors in Computing Systems. 1--14."},{"key":"e_1_2_1_54_1","volume-title":"Francc ois Yvon, Matthias Gall\u00e9, et al.","author":"Scao Teven Le","year":"2022","unstructured":"Teven Le Scao, Angela Fan, Christopher Akiki, Ellie Pavlick, Suzana Ili\u0107, Daniel Hesslow, Roman Castagn\u00e9, Alexandra Sasha Luccioni, Francc ois Yvon, Matthias Gall\u00e9, et al. 2022. Bloom: A 176b-parameter open-access multilingual language model. arXiv preprint arXiv:2211.05100 (2022)."},{"key":"e_1_2_1_55_1","doi-asserted-by":"publisher","DOI":"10.14506\/ca36.3.11"},{"key":"e_1_2_1_56_1","volume-title":"Automating Care: Online Food Delivery Work During the CoVID-19 Crisis in India. In 2022 ACM Conference on Fairness, Accountability, and Transparency. 160--172","author":"Singh Anubha","year":"2022","unstructured":"Anubha Singh and Tina Park. 2022. Automating Care: Online Food Delivery Work During the CoVID-19 Crisis in India. In 2022 ACM Conference on Fairness, Accountability, and Transparency. 160--172."},{"key":"e_1_2_1_57_1","volume-title":"Nathan Scales, Ajay Tanwani, Heather Cole-Lewis, Stephen Pfohl, et al. 2023 a. Large language models encode clinical knowledge. Nature","author":"Singhal Karan","year":"2023","unstructured":"Karan Singhal, Shekoofeh Azizi, Tao Tu, S Sara Mahdavi, Jason Wei, Hyung Won Chung, Nathan Scales, Ajay Tanwani, Heather Cole-Lewis, Stephen Pfohl, et al. 2023 a. Large language models encode clinical knowledge. Nature (2023), 1--9."},{"key":"e_1_2_1_58_1","volume-title":"2023 b. Towards expert-level medical question answering with large language models. arXiv preprint arXiv:2305.09617","author":"Singhal Karan","year":"2023","unstructured":"Karan Singhal, Tao Tu, Juraj Gottweis, Rory Sayres, Ellery Wulczyn, Le Hou, Kevin Clark, Stephen Pfohl, Heather Cole-Lewis, Darlene Neal, et al. 2023 b. Towards expert-level medical question answering with large language models. arXiv preprint arXiv:2305.09617 (2023)."},{"key":"e_1_2_1_59_1","volume-title":"Plans and situated actions: The problem of human-machine communication","author":"Suchman Lucy A","unstructured":"Lucy A Suchman. 1987. Plans and situated actions: The problem of human-machine communication. Cambridge university press."},{"key":"e_1_2_1_60_1","volume-title":"Handbook of qualitative research in education","author":"Terry Gareth","unstructured":"Gareth Terry and Nikki Hayfield. 2020. Reflexive thematic analysis. In Handbook of qualitative research in education. Edward Elgar Publishing, 430--441."},{"key":"e_1_2_1_61_1","volume-title":"Kabilan Elangovan, Laura Gutierrez, Ting Fang Tan, and Daniel Shu Wei Ting.","author":"Thirunavukarasu Arun James","year":"2023","unstructured":"Arun James Thirunavukarasu, Darren Shu Jeng Ting, Kabilan Elangovan, Laura Gutierrez, Ting Fang Tan, and Daniel Shu Wei Ting. 2023. Large language models in medicine. Nature Medicine (2023), 1--11."},{"key":"e_1_2_1_62_1","volume-title":"failing to support and undermining breastfeeding self-efficacy: Analysis of helpline calls. Maternal & child nutrition","author":"Thorpe Karen","year":"2020","unstructured":"Karen Thorpe, Susan Danby, Ceridwen Cromack, and Danielle Gallegos. 2020. Supporting, failing to support and undermining breastfeeding self-efficacy: Analysis of helpline calls. Maternal & child nutrition, Vol. 16, 2 (2020), e12919."},{"key":"e_1_2_1_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-018-2573-3"},{"key":"e_1_2_1_64_1","unstructured":"E Topol. 2023. When MD Is a machine doctor."},{"key":"e_1_2_1_65_1","volume-title":"Care Infrastructures for Digital Security in Intimate Partner Violence. In CHI Conference on Human Factors in Computing Systems. 1--20","author":"Tseng Emily","year":"2022","unstructured":"Emily Tseng, Mehrnaz Sabet, Rosanna Bellini, Harkiran Kaur Sodhi, Thomas Ristenpart, and Nicola Dell. 2022. Care Infrastructures for Digital Security in Intimate Partner Violence. In CHI Conference on Human Factors in Computing Systems. 1--20."},{"key":"e_1_2_1_66_1","volume-title":"On NonscalabilityThe Living World Is Not Amenable to Precision-Nested Scales. Common knowledge","author":"Tsing Anna Lowenhaupt","year":"2012","unstructured":"Anna Lowenhaupt Tsing. 2012. On NonscalabilityThe Living World Is Not Amenable to Precision-Nested Scales. Common knowledge, Vol. 18, 3 (2012), 505--524."},{"key":"e_1_2_1_67_1","doi-asserted-by":"publisher","DOI":"10.1177\/135050689500200302"},{"key":"e_1_2_1_68_1","doi-asserted-by":"publisher","DOI":"10.1145\/3313831.3376274"},{"key":"e_1_2_1_69_1","doi-asserted-by":"publisher","DOI":"10.1145\/3491102.3502121"},{"key":"e_1_2_1_70_1","doi-asserted-by":"publisher","DOI":"10.1145\/3411764.3445709"},{"key":"e_1_2_1_71_1","doi-asserted-by":"publisher","DOI":"10.1145\/3313831.3376515"},{"key":"e_1_2_1_72_1","doi-asserted-by":"publisher","DOI":"10.1145\/3491102.3517575"},{"key":"e_1_2_1_73_1","doi-asserted-by":"publisher","DOI":"10.1145\/3359272"},{"key":"e_1_2_1_74_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-022-00742-2"}],"container-title":["Proceedings of the ACM on Human-Computer Interaction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dl.acm.org\/doi\/10.1145\/3610210","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/dl.acm.org\/doi\/pdf\/10.1145\/3610210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T04:19:47Z","timestamp":1755749987000},"score":1,"resource":{"primary":{"URL":"https:\/\/dl.acm.org\/doi\/10.1145\/3610210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,28]]},"references-count":74,"journal-issue":{"issue":"CSCW2","published-print":{"date-parts":[[2023,9,28]]}},"alternative-id":["10.1145\/3610210"],"URL":"https:\/\/doi.org\/10.1145\/3610210","relation":{},"ISSN":["2573-0142"],"issn-type":[{"value":"2573-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,28]]},"assertion":[{"value":"2023-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}