Reflections from the

Beyond Bias Project

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Lydia Murithi, PhD MPP

Rebecca Hope, MD MPH

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Integrating Human-Centered Design into AYSRH Projects

Welcome!

Dr. Rebecca Hope

CEO, YLabs

Dr. Lydia Murithi

Beyond Bias Project Director, Pathfinder International

Goal for Today

Share reflections from the Beyond Bias experience on how to set up multi-disciplinary projects to successfully integrate HCD in order to tackle complex AYSRH challenges such as provider bias

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Project Overview

Why Focus on Provider Bias?

28 million sexually active adolescents in developing regions do not want a

child within two years. 60% of these

adolescents have an unmet need for contraception. (Guttmacher 2016)

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Bias—such as a belief that young, unmar- ried people should not be sexually active or that young, married women should prove fertility— is a driver of judgmental and poor quality sexual and reproductive health care.

The status quo approach to changing provider behavior has had limited success.

Photo: Dominic Chavez, CC

Beyond Bias Project

Goal: To design and test scalable innovative solutions to address provider bias toward serving youth ages 15-24 with family planning services in Burkina Faso, Pakistan, and Tanzania.

Technical expertise on AYSRH

Human-centered design for adolescent health

Behavioral economics and evaluation

Segmentation analysis on provider attitudes

Beyond Bias Project Phases

Idea Generation

Rough Prototyping

Design Solutions

Live Prototyping

Pilot and Evaluation

Scale Up

IDENTIFY BEST CONCEPTS

RESEARCH

INTERVENTION DESIGN

IMPLEMENTATION

Literature Review

3 Countries

26 Facilities

3 Countries

229 Facilities

1,000+

Facilities

Design Research

Segmentation

ITERATION

ITERATION

SYNTHESIS

Beyond Bias Intervention

We developed a three-pronged intervention to shift provider bias through the HCD-driven, interdisciplinary process.

SUMMIT

Activate providers’ self-awareness of their own biases

CONNECT

Support providers to apply unbiased practices in their daily work

REWARDS

Publicly celebrate facilities when they achieve progress

ACTIVATE

A story-driven event that activates providers’ self-awareness of their own biases and empathy for young people’s needs.

SUMMIT

APPLY

ACHIEVE

ACTIVATE

A digital and in-person forum where providers problem-solve together to apply unbiased practices in their daily work

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CONNECT

APPLY

ACHIEVE

APPLY

A growth-oriented performance rewards system based on client feedback on provider behavior

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.

ACHIEVE

REWARDS

Photo: Dominic Chavez, CC

ACTIVATE

Behavior Change Strategy

ACTIVATE

Pre-Contemplation Contemplation Determination

APPLY

Action. Relapse

ACHIEVE

Relapse

SUMMIT

CONNECT

REWARDS

BEHAVIOR CHANGE MECHANISMS

EXPERIENCE

PHASE

Humanize bias and hold up a mirror for providers

Improve emotional connectivity with youth

Address providers’ fears of community backlash

Address concerns of fertility delays

Educate around safety of methods for youth

Activate contextualized agency

Create accountability for service quality

Offer visible performance-

based rewards

Shift professional norms

OUTCOMES

(6 Principles Framework)

Sensitive Communication

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Safe, Welcoming Space

Seek Understanding and Agreement

Security of Information

Say Yes to a Safe Method

Simple, Comprehensive Counseling

Evaluation Approach

We used a mixed-methods randomized control trial (RCT) to the evaluate impact of the designed intervention on provider behavior and attitudes in Tanzania, Burkina Faso, and Pakistan over a 12-month implementation period.

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Treatment facilities: 118

Control facilities: 111

Total facilities studied: 229

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Key outcomes of interest:

• Provider attitudes
• Patient-centered care
• Patient perceptions of care
• FP methods received

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Current Status

Examples of implementation assets

The pilot implementation concluded in September 2021. Data analysis is ongoing.

The results and findings will be released in the first quarter of 2022.

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The Role of HCD in Beyond Bias

Beyond Bias Project Phases

Idea Generation

Rough Prototyping

Design Solutions

Live Prototyping

Pilot and Evaluation

Scale Up

IDENTIFY BEST CONCEPTS

RESEARCH

INTERVENTION DESIGN

IMPLEMENTATION

Literature Review

3 Countries

26 Facilities

3 Countries

229 Facilities

1,000+

Facilities

Design Research

Segmentation

ITERATION

ITERATION

SYNTHESIS

Identify Best Concepts

Scale Up

Pilot and Evaluation

Idea Generation

Rough Prototyping

Live �Prototyping

RESEARCH

INTERVENTION DESIGN

IMPLEMENTATION

Iteration

• Global literature search
• 63 publications deemed relevant and reviewed in detail
• 29 interviews with key expert informants

• 373 interviewees, including youth, providers, and community influencers
• 811 survey respondents

Identified:

• 11 major bias drivers
• 6 provider segments
• 8 cross-cutting insights

• 6 Ideation Workshops across 4 countries
• 3-day "IDEACON" with all partners, plus BMGF
• Workshop participants included country stakeholders and global experts
• Generated 100+ ideas

• 7 concepts tested across 3 countries
• 2–3 iterations of each concept tested with 123 providers and youth in total

• 3 concepts refined and tested with 163 providers and youth
• 26 facilities

• 1 integrated intervention
• Adapted for 3 countries
• 227 facilities

1,000+ facilities

Iteration

Review:

Technical Review Board

Review:

Technical Review Board

Identify Best Concepts

Scale Up

Pilot and Evaluation

Rough Prototyping

IMPLEMENTATION

Iteration

• 7 concepts tested across 3 countries
• 2–3 iterations of each concept tested with 123 providers and youth in total

• 3 concepts refined and tested with 163 providers and youth
• 26 facilities

• 1 integrated intervention
• Adapted for 3 countries
• 227 facilities

1,000+ facilities

Iteration

Review:

Technical Review Board

Idea Generation

RESEARCH

INTERVENTION DESIGN

• Global literature search
• 63 publications deemed relevant and reviewed in detail
• 29 interviews with key expert informants

• 373 interviewees, including youth, providers, and community influencers
• 811 survey respondents

Identified:

• 11 major bias drivers
• 6 provider segments
• 8 cross-cutting insights

• 6 Ideation Workshops across 4 countries
• 3-day "IDEACON" with all partners, plus BMGF
• Workshop participants included country stakeholders and global experts
• Generated 100+ ideas

Review:

Technical Review Board

Live �Prototyping

Identify Best Concepts

Scale Up

Pilot and Evaluation

Idea Generation

Rough Prototyping

Live �Prototyping

RESEARCH

INTERVENTION DESIGN

IMPLEMENTATION

• Global literature search
• 63 publications deemed relevant and reviewed in detail
• 29 interviews with key expert informants

• 373 interviewees, including youth, providers, and community influencers
• 811 survey respondents

Identified:

• 11 major bias drivers
• 6 provider segments
• 8 cross-cutting insights

• 6 Ideation Workshops across 4 countries
• 3-day "IDEACON" with all partners, plus BMGF
• Workshop participants included country stakeholders and global experts
• Generated 100+ ideas

• 7 concepts tested across 3 countries
• 2–3 iterations of each concept tested with 123 providers and youth in total

• 3 concepts refined and tested with 163 providers and youth
• 26 facilities

• 1 integrated intervention
• Adapted for 3 countries
• RCT with 227 facilities

1,000+ facilities

Iteration

Review:

Technical Review Board

Iteration

Review:

Technical Review Board

The Value of HCD �for Beyond Bias

HCD offered a structured collaboration process for innovation on a complex challenge where conventional approaches showed limited success.

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The rigorous ideation, prototyping, and iteration processes of HCD set it apart from participatory research approaches currently used in global health.

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The HCD Application Spectrum

Comprehensive Application

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Narrow Application

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• Problem is not well-understood
• Effective solutions are unknown or unproven
• HCD is applied to define the problem, explore diverse solutions, and design a new intervention

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Example: Beyond Bias

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• Problem is well-defined
• Solution strategy is proven, but perhaps adoption is low
• HCD is applied to improve adoption and usability of existing solution

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Example: Refining a visual aide tool to assist provider counseling to low-literacy clients

Reflections and Practical Tips for Integrating HCD

Project Scoping �(or Grant Scoping, for funders)

Kickoff

Design

Scoping

Evaluation

Tips for Project or Grant Scoping

Assess where your focus challenge falls on the HCD application spectrum and plan your budget appropriately. �

If you need a more comprehensive application of HCD, it will require more investment to get the desired value.

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Comprehensive Application

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Narrow Application

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• Problem is not well-understood
• Effective solutions are unknown or unproven
• HCD is applied to define the problem, explore diverse solutions, and design a new intervention

Example: Beyond Bias

​

• Problem is well-defined
• Solution strategy is proven, but perhaps adoption is low
• HCD is applied to improve adoption and usability of existing solution

Example: Refining a visual aide tool to assist provider counseling to low-literacy clients

Tips for Project Scoping

Assess where your focus challenge falls on the HCD application spectrum and plan your budget appropriately.

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Specific tips:

• For funders: Build flexibility into the budgeting and funds approval process. Consider using a phased approach for grant budgeting.
• Budget for 2x person time on project coordination and more time for relationship-building than a conventional single discipline project typically does
• Work with the HCD partner to define the scope of work for the design phase and collaborate closely on project budgeting.

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Project Kickoff

Scoping

Design

Kickoff

Evaluation

Tips for Project Kickoff

Take time to build a foundation of trust among diverse partners and new ways of working

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What this looks like:

• Demonstrate how the HCD process diverges from traditional program development and build enthusiasm for the process by communicating the positive impact HCD has produced in other projects.
• Align expectations about innovation vs novelty – they are not the same thing
• Establish clear communication and a shared vision among partners early in the project lifecycle to enable frank yet respectful discussions when inevitable difficulties arise.

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Tips for Project Kickoff

Set up clear mechanisms for close collaboration between designers and technical experts

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What this looks like:

• Pathfinder’s AYSRH technical experts—including an SBCC advisor—and field offices closely reviewed and helped to develop the technical content of all the live prototypes with YLabs’ designers.
• Our Technical Review Board (TRB) was a committee of Pathfinder SRH experts who convened at key project decision points to press HCD findings against existing evidence, best practices, and implementation knowledge.

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Research and �Intervention Design

Scoping

Kickoff

Design

Evaluation

Tips for Research and �Intervention Design

Ground interventions in existing evidence

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What this looks like:

• Conduct systematic literature review before design research and during research synthesis
• Rapid literature reviews on specific subtopics during the prototyping phases

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Tips for Research and �Intervention Design

Put in place ethical guardrails at each stage of the HCD process when working with youth

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What this looks like:

• Beyond Bias got Institutional review board (IRB) approval for all research and prototyping activities
• Partners conducted a joint risk analysis before research, rough prototyping, live prototyping, and implementation.
• Safeguarding protocols established at project onset ensured that any safeguarding issues that arose during the design phases were quickly addressed.

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Tips for Research and �Intervention Design

Design with an ecosystem lens

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What this looks like:

• From design research through live prototyping, Beyond Bias included youth, providers, parents, and other key gatekeepers, such as clinic managers, in the interviews, ideation sessions, and prototyping.
• This ecosystem approach increased the robustness, acceptability, and feasibility of the intervention when it came time to launch the pilot.

Tips for Research and �Intervention Design

Take time to pause, document, and adjust

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What this looks like:

• Clearly document decision-making rationale throughout the project.
• Build in opportunities for all partners to reflect, offer input, and review evidence after each project phase. This helps ensure that HCD is grounded in evidence, and that each partner’s expertise is respected and incorporated in the process.

Tips for Research and �Intervention Design

Use the participatory value of HCD to build meaningful engagement with youth people, providers, and stakeholders

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What this looks like:

• Providers and youth participated in idea-generation workshops, and then in codesign sessions during rough prototyping
• Several young people were hired to be part of the research and design team during key phases
• A Stakeholder Advisory Board was established in each country, and was actively consulted during each research and prototyping cycle

Tips for Research and �Intervention Design

Design and iterate with scalability in mind

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What this looks like:

• The ExpandNet scalability framework was applied at each phase of the Beyond Bias project (including research and prototyping) in order to bake in scale-mindedness from the beginning
• Country-level Beyond Bias team members participated in activities in their country and in at least one other country (e.g., Pakistan team members joined activities in Tanzania).

Evaluation

Scoping

Kickoff

Evaluation

Design

Tips for Evaluation

Ensure that the evaluation team is part of the prototyping process in order to understand the emerging intervention

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What this looks like:

• The Beyond Bias M&E team (including BERI, the external evaluation partner) participated in all prototyping data sharebacks in order to understand what performance indicators were important, brainstorm how data could be collected, and to give feedback on what was feasible to measure. BERI also contributed to the design process from a behavioral economics lens.

Tips for Evaluation

Be realistic and align expectations about the role of HCD vs conventional methods in the design of the evaluation approach and tools

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What this looks like:

• Beyond Bias used HCD to explore user-centered data collection modalities for low-literacy clients during prototyping, which was helpful to understand how data might be realistically collected during implementation
• However, conventional survey development and validation procedures were necessary in order to create a measurement instrument that would be scalable and rigorous across all �three countries

Summary

Key Takeaways

1. HCD can add immense value in creating innovative, scalable solutions to tackle sticky, persistent social behavioral challenges such as provider bias.
2. Know where your challenge falls on the HCD spectrum, and budget accordingly in order to get desired value.
3. HCD is a valuable complement to - not a replacement of – conventional methods and technical expertise.

How to Learn More

• Read the Briefs: The detailed Beyond Bias HCD Briefs with all these tips and much more can be found at:  https://www.pathfinder.org/beyond-bias-human-centered-design
• Watch our FP2030 presentation: https://www.youtube.com/watch?v=EAmSdqfHk34&t=778s
• Stay in the Loop: The Beyond Bias RCT results will be released in Q1 2022 – Stay in the loop by following Pathfinder’s social media channels.
• Reach out to us:
• Lydia Murithi: lmurithi@pathfinder.org
• Rebecca Hope: rebecca.hope@ylabsglobal.org