Making Effective Education a Habit

My Role
Research, UX Design

Collaborators
Prof. Keyur Sorathia & Chhavi

Duration
4 months (Feb -> May 18’)

The Problem
Community health workers act as the primary tool against child malnutrition, infant/maternal mortality in rural India. But due to insufficient training and non-engaging methods, they’re unable to give effective treatment.

The Solution
To facilitate them to better serve their communities, we designed and built an app called ‘Pragati’ to complement the existing health care ecosystem and develop and improve relevant skillsets among health workers.

Background

Maternal mortality rate is defined by the World Health Organisation as -
”The number of maternal deaths (direct and indirect) in a given period per 100,000 women of reproductive age during the same time period.”

The state of Assam has the highest maternal mortality rate in India, 237. That is the number of women who die during pregnancy or birth.

There has been extensive media coverage of this fact

Meet the Health Workers

The health workers, also known as ASHAs (Accredited Social Health Activist) are instituted by the Government of India.

For rural communities, ASHAs are the primary point of contact care givers. Their knowledge and counselling abilities have direct impact in fighting against health problems and curbing preventable diseases.

Their tasks include motivating women to give birth in hospitals, bringing children to immunization clinics, encouraging family planning and improving village sanitation. However, we found that the problem lied in the training undergone by these ASHA workers. It would often be substandard and erratic.

This would inevitably lead to low retention and thereafter a lack of knowledge transfer for the new ASHAs being trained.

Lack of Contextual Knowledge

The community healthcare workers do not have access to any resources for learning or even sharing the best contextual health practices amongst themselves

Insufficient Training

A lack introductory sessions and revision sessions result in outdated knowledge circulating. This leads to being unsure or ill-prepared to give the best treatment in situations

No Sharing of Taboo Information

ASHAs have difficulty in imparting information like sexual wellness, family planning etc. to community members. This is often due to cultural reasons and low literacy rates

Lack of Education

Limited knowledge and skillset of health workers in maternal and child care often results in less or no information dissemination and unaware health communities

Dull Methods of Training

Traditional lecture based training methods (mostly non-visual) results in an inability to understand complex healthcare concepts and non-engaging training sessions

Based on these insights, we had a set of objectives to provide the ASHAs with a platform which followed the following goals -

Design Goals

They can share knowledge, experiences and learn from peers instead of just doctors or training based learning.
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They can feel a part of a community bigger than their immediate physical community and hence a strong sense of belonging.
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They use it without any external cues and are motivated to learn and engage by themselves. It becomes their habit.
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They can stay updated with the other government schemes and campaigns to better serve their community.

Looking for Inspiration

ASHA workers were not tech savvy. Most of them were still users of phones with T9 keyboards and had never used a “smart” phone before. This proved to be an extremely unique challenge since this meant that most of the UI patterns and mental models I would generally use without much thought, had a chance of not working here.

Since I had never worked with such a constraint before. I looked to other apps which served similar demographics.

KrishiPustak
‍An audio-visual social networking mobile application for low-literate farming populations in rural India

Avaaz Otalo
‍A service for farmers to access relevant and timesly agricultural information over the phone

Video Kheti
‍A video based app to provide audio-video education about the agricultural revolution in India

Krishi Mitra
‍An app which connects farmers of Karnataka to the internet, in their own language, Kannada

Obviously there were some assumptions made. Each group of people are different, with different needs and are shaped by their lived experiences. But since I didn’t have access to the researchers who worked on these applications, analyzing their UI was the next best alternative.
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Studying their interaction models allowed me to try to make connections on why they took certain design decisions. This would help inform my own design rationale later while coming up with the interface.

Two themes which were immediately stood out were providing multilingual support in the app UI itself and also a heavy focus on video/audio input instead of text.

Understanding ASHAs

A set of interviews and focus group studies helped get a better understanding of the various archetypes which existed amongst the healthcare workers. We found out that even within ASHAs, there were people with differing expertise and each of them had a unique story about how they began doing this work.

The findings form these were also helpful later in figuring out incentives, motivations and opportunity areas for our solution to intervene.

Chatting with ASHAs before one such focus group

Introducing Pragati

Pragati is a mobile learning platform for training and providing skill education to ASHAs. It consists of two major parts: educational modules and a complementary peer networking social app.

The modules are based on topics related to maternal healthcare and care of newborn baby. The audio visual modules are immersive and memorable. Every module is followed by a quiz. Each of these modules are available in VR, 360° video and interactive video formats.

The peer learning app is a proposed platform for the community health workers where they can involve in knowledge sharing, self-presentation and feel a part of a larger community.
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My work involved packaging the modules into an app and building the social peer-learning platform to help ASHAs share stories and ask/answer questions.

Bringing the App Together

One of the core insights which we found from our research was that even if we did make the best solution which helps ASHAs with training and learning skillsets, it’ll be short lived if its a one time thing.

Like all healthcare professionals, they needed to come back to old concepts to revise them, and stay updated with new modules being added. This wasn’t the case as of now.

There was no incentive for the healthcare workers to continuously learn new things and revise what they already knew. We realised that Pragati also needed to be a habit-forming app which incentivises learning and being active on the platform.

Using the Habit cycle in Pragati

Information Architecture
A simple and flat hierarchy was kept throughout so that at any point, it’s extremely simple to switch to another part of the app.

Wireframing
A lot of initial wireframes were made to test out novel interaction models which this user group would be the most comfortable with. The idea was to rapidly come up with concepts, prototype them, and then get some feedback from the ASHAs.

We found some surprising reactions. For example, we found that people wanted password protection. We didn’t expect this at all since there wasn’t any sensitive information about the individual on the app itself. Personal data privacy is also something that ASHAs prioritized.

But we found that a lot of times, a single device would be used by multiple members of the household (children, husband) and they didn’t want others to get access to the information and discussions had on the app itself.

We also made decisions based on usability tests (like getting rid of the dashboard)

This obviously led to a LOT of rejected design directions

Building the MVP

After multiple rounds of iterations after getting early feedback from our users on things ranging from the most intuitive icons to the motivation to use the platform, we built the first MVP of the app.

These were some of the many unique factors which we took into consideration specifically for the ASHAs.

The entire app was kept intentionally simple and focused to allow performing actions with ease and avoid cognitive load

Iconography and illustrations were modelled contextually and keeping cultural considerations in mind

The app works great in places with unreliable connectivity, since it is common for ASHAs to be offline for days at a time

The app has a small footprint (<10MB) and is light on data usage. Which makes it attractive for clinic and personal device use

Onboarding
‍The onboarding uses custom illustrations to create some familiarity and context.

I chose to focus on benefits more than features, to tell the ASHA upfront what they’ll get out of this.

Learn Module
The modules designed to train ASHAs on topics related to maternal healthcare and care of newborn baby. Every module is followed by a quiz.
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This was been developed in 3 languages - English, Hindi (used nation-wide), Assamese (native to the state of Assam)

User flow for selecting a module to learn.

QnA Forum & Stories
‍The process of uploading a story/question has been broken down into small chunks so that the whole process feels less daunting to the ASHA.

The uploading flow uses icons and pre-existing notions when it can.

ASHAs can either put up a video, or an image with audio playing in the background. While replying to a question or story, ASHAs can comment through audio to answer a question or appreciate a story.

The “feed” equivalent of the peer-learning platform.

Let’s Workshop That!

We conducted a focus group workshop with ASHAs and their supervisor/trainers to gather feedback on Pragati. In this workshop, we studied the user preferences, positives and negatives of Pragati in comparison to traditional training methods.

We also gathered feedback on their willingness to use a peer-learning platform that allows to share contextual experiences, ask/answer doubts of other ASHAs.

A newspaper article talking about why dating apps make you feel awful

A newspaper article talking about why dating apps are no way to find true love

Some snapshots from the workshop

The feedback revealed a clear affinity for Pragati over the existing systems. There was also a preference for VR modules over interactive and 360° videos.

The ability to share contextual learning, ask or answer doubts was very well received by the ASHAs and their supervisors. Sharing their experiences and participating in the QnA forum led to an increase in their social status and contribution.

The Phase 1 Launch

We launched Pragati in Sonitpur and Bishwanath district in Assam. We conducted training and workshop sessions with around 400 rural health workers. We explained the methods of its field usage to maximise impact in uplifting maternal and child healthcare.
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Within 40 days of it’s launch, there were 610 active rural healthcare workers using Pragati, there had been 500+ views on the modules in VR and 1100+ posts shared within the community (stories and contextual learnings).

What I Learnt

I find myself extremely grateful that got an opportunity to work on something so massive and important, so early on in my career.

I learnt a lot in the course of this project and will always be grateful for my mentor Chhavi and Prof. Keyur who saw an eager and curious boy and gave me so much ownership and responsibility. Trusting me to do the right thing and guiding me when I didn’t.
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Theory ≠ Practice

It quickly became apparant to me that theory and practice are worlds apart. It’s one thing to read about what Nir Eyal talks about in his book, but to actually put that into practice is a whole other beast. Turns out behavioural change is much much more messier!
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Testing is King

Through this experience, I truly learnt what “Fail Fast, Fail Forward” means.
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The countless iterations and design directions which would go down the drain when tested out with users made me realise the value of prototyping, and not to get too attached to my designs

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