mHealth for maternal mental health: Everyday wisdom in ethical design

Abstract

Health and wellbeing applications increasingly raise ethical issues for design. User-centred and participatory design approaches, while grounded in everyday wisdom, cannot be expected to address ethical reflection consistently, as multiple value systems come into play. We explore the potential of phronesis, a concept from Aristotelian virtue ethics, for mHealth design. Phronesis describes wisdom and judgment garnered from practical experience of specific situations in context. Applied phronesis contributes everyday wisdom to challenging issues for vulnerable target users. Drawing on research into mHealth technologies for psychological wellbeing, we explore how phronesis can inform ethical design. Using a case study on an app for self-reporting symptoms of depression during pregnancy, we present a framework for incorporating a phronetic approach into design, involving: (a) a wide feedback net to capture phronetic input early in design; (b) observing the order of feedback, which directly affects value priorities in design; (c) ethical pluralism recognising different coexisting value systems; (d) acknowledging subjectivity in the disclosure and recognition of individual researcher and participant values. We offer insights into how a phronetic approach can contribute everyday wisdom to designing mHealth technologies to help designers foster the values that promote human flourishing.