COMMUNITY DEMAND FOR HEALTH SERVICES
Journey to Health �& Immunization
HCD MASTER CLASSES
ABOUT HCD
OBJECTIVE
RAPID INQUIRY
PERSONAS
IDEA GENERATION
PROTOTYPE & FEEDBACK
SYNTHESIS
AREAS OF INQUIRY & DISCUSSION �GUIDE
JOURNEY MAP
PILOTING & ITERATION
What stands �in our way? What are opportunities?
TOOLS:
Who are we targeting? What is our objective?
TOOLS:
What do we think we know? What do we still need to know?
TOOLS:
How could we respond? What do people think?
TOOLS:
How could we measure? How could we improve?
TOOLS:
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AN ITERATIVE PROCESS WITH SIMPLE TOOLS
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HUMAN CENTRED DESIGN TRAINING
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Journey Map
WHAT IS A JOURNEY MAP?
The ‘Journey to Vaccination’ is a framework to consider every point of the vaccination experience: before, during and after the point of vaccination.
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Journey to Health and Immunization
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HUMAN CENTRED DESIGN TRAINING
THE JOURNEY TO HEALTH & IMMUNIZATION
Practical knowledge, norms and values, trust in vaccines and providers
Practical competencies, norms and values, perception of clients
Decision-making power, self-efficacy
Motivation/satisfaction, social recognition, community respect
Logistics of remembering, transport, childcare, juggling competing priorities, social
& opportunity costs
Preparing, getting to clinic/outreach site, opportunity costs
Appropriateness and convenience of services, service hours, social distance
Training, job aids, workload, facility/flow
Information on AEFI and when & where to return, sharing +/- experience with community, reinforcement of vaccination as norm
Family and community respect, celebration of achievements, supportive supervision
IPC and treatment by health workers, physical conditions, use of home-based records, client satisfaction
Interpersonal communication skills, trust building, pain mitigation, training and experience, social distance
CAREGIVER
HEALTH WORKER
UNICEF, 2018
Practical knowledge, norms and values, trust in vaccines and providers
Practical competencies, norms and values, perception of clients
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HUMAN CENTRED DESIGN TRAINING
Decision-making power, self-efficacy
Motivation/satisfaction, social recognition, community respect
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HUMAN CENTRED DESIGN TRAINING
Attention scarcity: People focus on the most pressing challenge now, which may not be a routine health service.
Logistics of remembering, transport, childcare, juggling competing priorities, social & opportunity costs
Preparing, getting to clinic/outreach site, opportunity cost
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HUMAN CENTRED DESIGN TRAINING
Appropriateness and convenience of services, service hours, social distance
Training, job aids, workload, facility/flow
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HUMAN CENTRED DESIGN TRAINING
IPC and treatment by health workers, physical conditions, use of home-based records, client satisfaction
Interpersonal communication skills, �trust building, pain mitigation, training and experience, social distance
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HUMAN CENTRED DESIGN TRAINING
Information on AEFI and when & where to return, sharing +/- experience with community, reinforcement of vaccination as norm
Family and community respect, celebration �of achievements, supportive supervision
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HUMAN CENTRED DESIGN TRAINING
Journey Map
WHY WE USE A JOURNEY MAP:
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Use the Journey map to identify barriers & enablers, then apply these to starting ideas
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MAP ENABLERS
MAP BARRIERS
STARTING IDEAS
Identify ‘barriers’ to seeking/supporting immunization
Identify ‘enablers’ to positively support or make attending immunization services easier
Identify starting ideas at each stage
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3A
Identify ‘barriers’ to seeking/supporting immunization
Barriers can be experienced by each persona at every step of the Journey. There are barriers to seeking immunization (caregivers) and barriers to supporting immunization (influencers).
JOURNEY MAP
BARRIERS
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Map barriers to the intent to seek immunization (for caregivers)
example: The mother heard from her neighbor that the health workers use expired vaccines on the children in public facilities.
Map barriers to the intent to support immunization (for influencers)
example: The father doesn’t know if people in his community support immunization, so he follows what his peers and elders tell him.
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HUMAN CENTRED DESIGN TRAINING
3B
Identify ‘enablers’ to positively support or make attending immunization services easy
Enablers are also experienced by each persona at every step of the Journey. Enablers are people, platforms, or activities that provide positive influences that make attending services easier.
JOURNEY MAP
ENABLERS
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People are enablers that create social norms
example: Who they listen to or look to for advice when a barrier arises (HCW, family, community leader, religious leaders, etc). �
Platforms are enablers that provide social influence
example: Mass media channels that they tune into, social media channels they follow, traditional celebration or folk theatre they attend, etc.�
Activities are enablers that make services easier to remember and attend
example: Concrete thinking on action steps to help ‘automate’ attending each appointment.
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Showing ideas early invites feedback on existing ideas and generation of new ideas. These are rational hunches for what might work.
JOURNEY MAP
3C
STARTING IDEAS
Identify starting ideas at each stage
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Identifying starting ideas BEFORE research allows us to:
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HUMAN CENTRED DESIGN TRAINING
STARTING IDEAS
BARRIERS TO ACTION
Fathers in the community have misconceptions about the vaccines; who should receive them, when/where vaccines are available and what the side effects are.
STARTING IDEA
Organize peer to peer sessions for discussion and guidance.
Organize regular father group gatherings during which fathers can discuss their fears and share positive experiences.
Fathers
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HUMAN CENTRED DESIGN TRAINING
STARTING IDEAS
BARRIERS TO ACTION
Mothers have many children and many other responsibilities and minor inconveniences can deter them from acting on their intentions.
STARTING IDEA
Provide non-monetary incentives that reduce the “cost” of going to the immunization clinic.
For full immunization:
a set of tin plates
For immunization visit:
small bag of lentils
Caregivers
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HUMAN CENTRED DESIGN TRAINING
STARTING IDEAS
BARRIERS TO ACTION
Lack of recognition can be demotivating and make health workers less effective.
STARTING IDEA
Create recognition and a tracking system so they can easily see their progress
Health workers
Provide feedback on progress and a way for health workers to see their own progress.
Create recognition and a tracking system so they can easily see their progress.
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HUMAN CENTRED DESIGN TRAINING
STARTING IDEAS
BARRIERS TO ACTION
Using or participating in this health service is not a common or supported practice.
Caregivers do not see or hear of others going for immunization and do not know community rates.
STARTING IDEA�
Provide social proof displays and feedback on the community to caregivers.
Badge:
My child is immunized!
8 of 10 children in this community are fully vaccinated
Community
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HUMAN CENTRED DESIGN TRAINING
CATALOGUE OF BEHAVIORAL NUDGES
Use language that highlights the caregiver’s identity as a protector.
Commitment devices: Provide prompts to write down and create commitment.
Provide trainings to health workers on interpersonal communications and how to engage with marginalized groups.
Provide non-monetary incentives that reduce the “cost” of going to the immunization clinic.
Present the choice on vaccination with presumptive language, with vaccination being the default.
Provide feedback on progress and a way for health workers to see their own progress.
Provide social proof displays and feedback from the community to the caregiver.
Organize peer to peer sessions for discussion and guidance.
Practical knowledge: Provide timely and attention-catching reminders to the caregiver.
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HUMAN CENTRED DESIGN TRAINING
In application
The team will identify ALL obstacles, all enablers and multiple starting ideas at each stage. Complete the journey for EACH of the personas.
In a training
The trainer asks teams to identify ONE obstacle, one enabler and one starting idea at each stage. Focus on the journey for ONE persona only.
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JOURNEY MAP
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In your group:
(1) Think about your ONE persona and identify at least ONE obstacle and one enabler at each stage of the journey.
(2) Think of one starting idea per stage that could help you solve the obstacle (if needed, use the catalogue of behavioral nudges and adapt them to your obstacle and your persona).
(3) Select the best ideas, the ones that are most relevant to your persona, obstacle and enabler.
TRAINING PRACTICE
JOURNEY MAP
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BARRIERS
ENABLERS
STARTING IDEAS
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Knowledge & Awareness
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Intent
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Preparation, Cost & Effort
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Point of Service
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Experience of Care
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After service
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JOURNEY MAP
BARRIERS
ENABLERS
IDEAS
PERSONA:
HUMAN CENTRED DESIGN TRAINING WORKBOOK
Identify ‘barriers’ to seeking/supporting immunization
AVOID: beliefs (too general)
INSTEAD, TRY: Misinformation from HCWs - health workers pass on misinformation due to traditional beliefs. Fear of the community’s reaction.
Identify ‘enablers’ to positively support or make attending immunization services easy
AVOID: information (ignores full journey)
INSTEAD, TRY: Fathers, if well informed can support the caregivers’ decision to immunize. Health workers have the authority to improve service schedule and delivery.
Identify 1-3 starting ideas per persona
AVOID: community consultation (unrealistic, doesn’t respond to human motivations)
INSTEAD, TRY: SMS text reminders to health workers to show appreciation and provide links to quick refresher videos. SMS text reminders to caregivers to remind them of the vaccination schedule.
Journey Summary
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WORKING SESSION
Complete activities 1 and 2
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COMMUNITY DEMAND FOR HEALTH SERVICES
See you tomorrow!