From our studies, we have come to understand that the Health Navigators are part of a bigger framework. They play an important role in their family. They are important members of the community and they work between primary healthcare officials like Doctors in both private and public sectors. This work is based on a large repository of Client data, from the readings from HN – Client meetings at their homes. However we have seen that these interactions are not limited to the Client or HN’s homes. They can meet in public spaces like places of worship, transport, market etc. In these cases, the HNs do not have the Client’s data to refer for their meetings.
The team at work on this project consists of Students and Facilitators from Srishti and the Health Navigators from Channapatna. In this particular team, along with Srishti students – Nannini Lee. Balakrishnan and Ashwin S. there are three Health Navigators; Jayalakshmi, Meeraj and Sowmya.
Jayalakshmi comes from a community work background as she was trained under the ASHA scheme. Both Jayalakshmi and Meeraj have more than two years experience with Maya Healthcare. Sowmya is fairly new and has just completed training. She is now ready to step out into the field to meet clients and register some of her own.
This project follows a design process that has been inspired by collaborative community design projects. The different phases in this process all leverage the power of collaboration between the participants.
The process fl from data collection for scenario building to making sense of the collected data and Synthesising the scenario in the context. The process then moves to ideation phase. From there concepts begin to surface and they are developed based on specific merits. This concept is then tested for feedback after which it ultimately moves to the Final Concept stage. Once the final concept is arrived at, it is defined using multiple parameters like the core of the concept, sketches, future possibilities and touch points.
As mentioned in the NEEDS section, Participatory model of design was taken for this project for the main reason that the primary stakeholders being the Health Navigators. On the one hand the project aims to equip these women with the tools for creative problem solving in their community work related issues. However these Health Navigators are the people who work on the front lines with the clients. Participatory design leverage the position and power that the Health Navigators have created for them in the community to provide the inputs and insights necessary to carry out the design project. They are also familiar with the hierarchy and power structure of the communities they serve. This serves as a significant resource while designing for a social enterprise, where the community they work for is their primary stakeholder.
The process aims to understand the stakeholders of the project within the context of their interactions. The HNs, their clients, MAYA Healthcare and the community are some of the key stakeholders. In order to place the design process in the correct frame of reference, it becomes necessary for their stories to be learned from as close as possible.
This phase mainly deals with data collection and organization. This data is collected from interaction with the HNs, observation of interaction between HNs and their Clients and understanding the dynamic within the Health Navigators network.
Certain tools were used to bring the data together. These tools and activities need not be carried out in a linear way. It can be non-linear and situational. Feasibility also plays a big role in carrying out these activities.
Before embarking on the journey with the health navigators, it was essential to understand and anticipate the various aspects that the project could take on.
In order to get a better understanding of the framework, time was spent on researching on Maya Organics, Maya Healthcare and the Health Navigators program. Most of this research was secondary in that it was done over the Internet. There were also certain aspects that were discussed during the briefing that Naveen and Catalina had given .
SITE VISIT: 1
The first site visit was carried out doing introductions between the HNs and Srishti team. The project briefing was also done both in Kannada and English for the benefit of everyone in attendance.
The path to participatory design began that day. The introductions were carried out in a way that was going to become a model for work for the rest of the project. The HNs and Srishti team worked in their respective groups. Each member had to discuss their likes and hobbies but sketch them instead of writing it down. Different teams took different approaches to encourage the HNs to start sketching.
The time between the first site visit and the second was spent in understanding the interactions that took place on-site in Channapatna. The studio space was set up to document the project journey in the form of a timeline. This timeline would serve as a visual cue for the entire journey from beginning to the end.
SITE VISIT: 2
DAY IN A LIFE:
The objective of this activity is to study the events and activities from the perspective of the participant. It is carried out by sketching the activities, people, spaces and objects on a timeline that starts with them waking up and ends when they go to sleep at night.
The first Day in a Life was conducted with the HNs in order to frame the context in which they operate. The HNs themselves were asked to take the front seat in doing this activity. After a brief discussion about the purpose of this activity and how we were going to go about it, we began. Though the HNs were reluctant at first, after Ashwin and I drew some of the first sketches, they took it up and set a momentum to the activity.
The data collected in this activity served as our first resource set to begin work on a template for the Learning Kit. Once the template was ready, the second round of Day in a Life was carried out by the HNs with their clients. We observed and recorded this interaction with a two-fold agenda; one was to observe the interaction between the HNs and their Clients and the second to see how the template fared on site.
With this second artifact, there was enough data to continue improving the templates for the learning kit. It also helped us build a frame around the context to better understand it.
The emphasis on sketching out notes was made since this improved visual thinking skills. Visual thinking is one the precursors for design thinking. It has been observed that sketching leads to longer data retention and also to bring about the nuances of the scenario that is being sketched. For example if the participant eats food while being seated on the floor, the drawing of mealtime would be them sitting on the floor with plates and bowls in front of them. However the drawing will look drastically different if the participant owns a table and uses it while having a meal. Such nuances become key artifacts during synthesis stage.
Sketching also allows them to add details rather quickly than if they were to write it all down in words.
Just as the Day in a Life was used to collect data, the Experience Map is another method to collect data, though in terms of experiences and feelings. The participant sketches out the various objects, people and spaces where interaction takes place during their day. This is then mapped using terms like happy, sad, concern, satisfaction etc.
The Experience map records the experiences and feelings the participant is subjected to during their day. This map serves as a pool of information that can identify the pain and pleasure points. It is with this data that a need is recognized.
The Experience Map was done along with the Day in a Life activity, both with the HNs and between the HN and their Clients. Template was also designed for this activity, which was used in the field visit to the Client’s homes.
One of the overarching goals of this project is to facilitate the incorporation of design thinking into the Health Navigator’s work culture so that they can identify and resolve issues on their own. For this reason a Learning Kit was envisioned to serve as a blueprint for the HNs to put to use in a different context.
Click the link below to see the Day in a Life done by HNs exported to the Template
SITE VISIT: 3 (Client Visit)
The site visit was dedicated to observe the interaction between the HNs and their Clients. This observation would serve the Srishti team to gather data that would frame the context that included the Clients in it.
Since the Key Stakeholders in the Health Navigators’ service model are those members from the community who have registered for their services. In order to understand the needs of the HNs it is important to understand the dynamic they have with their clients.
At this stage, we are also acting as primers to get the HNs used to the tools of design thinking like recording Day in a Life and Experience Map. In the previous site visit, they had been introduced to these tools. Now we observe how they use these tools and do the activity but with the Clients as their subjects.
On observing the work of the HN’s on the template, we found out the icons were
too structured and created a disconnect between their drawings. This we felt might discourage them to think about sketching as a tool to think visually and gather information.
To rectify this, we created hand drawn icons and placed it on the template, this allowed the HN’s to come up with their own icons and drawings which made it easier for them to draw or record data on the template visually.
Therefore the decision was made to use only hand drawn images in the templates throughout.
This is the phase where we make sense of the data collected. The insights collected from the previous step help organize the data in clearly defined pain areas.
In data synthesis phase the stories and narratives from the previous step is marked into green and red frames. The green frame is for marking those instances that are happening well (pleasure points) and the red for pain points, where there is tension and something is not going well.
Assimilating the scenario and finding tension points within them is part of the synthesis phase.
SITE VISIT: 4 (Stories)
Interactions and observations can lead to a multitude of insights. However before one can jump into an insight, it is necessary to understand the environment (both physical and psychological) that enables these interactions. Stories are a great way to put the data collected into perspective. It is also another way to collect information that was missed before. Like sketching, narrating a story brings out the smaller details in
the setting, the details that might prove to be a pain area that was not considered before. It could also be the imperceptible cause of a pain area that was marked earlier.
In this activity, we discuss the details of the HNs, their clients and dig around for interesting facts and connections. We pick up a few of these points and frame a narrative around it. The HNs help set the stage for these stories, as they understand how the channels of communication work.
Three stories were made from this activity, which led to insights as shown below:
- The Health Navigators play multiple roles in their life; a friend, a mother, a wife, a colleague; but she is also a community worker in parallel in all these roles. This leads to an added load to the work she normally has to take on.
- Interaction between Health Navigator and client can happen outside of the Client’s homes. They can be at their place of prayer, at the market or at some other public place. This translates to the fact that these Health Navigators have to be prepared at anytime to do her duties and that she has to carry her materials at all times, adding to the physical load that she has to carry around.
- The community recognises her role as a Health Navigator. They understand the effort she puts in for the welfare of the community. Hence the community gives back in their own way. This leads to satisfaction and happiness for the Health Navigator in doing her duty.
The studio time post the first storyboarding exercise was used for documenting the data collected till then. We recorded the insights and observations we obtained from working with our HN teams.
Scanning and templatising became the standard work-flow during studio time. A brainstorming session was conducted to formulate a template for the storyboarding activity.
SITE VISIT: 5
Synthesis of gathered continued in this site visit. The HNs were now familiar with story building and stories are collected with special emphasis on scenarios that they face where things don’t go as well as they expect.
Discussions are done about various aspects of their work with the community and specifically about issues they face. It is important to give equal importance to things that go well in their service. This could be potential strengths that can be leveraged to bring stability to their service as well as to any concept that we come up with.
We began this step after the storyboards were prepared. Recognising issues were based on certain criteria, namely hierarchy of the issue with respect to other issues, frequency of the issue or if the issue presents a unique or interesting opportunity.
From the storyboards, the HNs picked out the issues that they felt were important based on the above criteria.
All the issues collected from the site visit were compiled into stories for the next phase of the design process.
Template for storyboarding was used to take the HN’s drawings and use them for the stories. Each story was created to highlight a particular issue. The stories had a title that showed what the issue was.
Three stories were made from the previous stages and to be taken for the next site visit.
Ideation is one of the crucial points in this process. If the collected data and insights are not strong enough, coming up with ideas will be all the more difficult. In this design process, the ideation stage takes inspiration from the work of Eva Brandt Camilla Grunnet at The Interactive Studio, Sweden.
Their work with the design process using props and dramatisation helps the designer to have a better understanding of the situation than if the designer were to just look at it from a third person perspective.
We picked up the Dream Tools props described in the paper and set up the props for a Magic Show.
WHY MAGIC SHOW?
Looking into the context of the people at Channapatna and the Health Navigators, we have observed that their interaction with technology has been minimal. Everybody owns a phone (mostly feature phones) but they are aware of what and how a smartphone works.
Without this basic understanding of technology, many solutions may never be a practical approach in the eyes of the Health Navigator. If the question of practicality can be removed from this process for the HNs, they could come up with ideas that may be fantastic, however with technology it may be possible to make it a reality.
Hence the Magic Show.
SITE VISIT: 6 (Magic Show)
Once the initial set of data has been collected and made sense of, the design process heads
over to recognising the crucial pain points. Here we ask the participants to look for issues that more important in their sense of issue hierarchy; issues that are unique and interesting; frequently occurring issues etc.
In this exercise it is important to let the HNs pick out the issues, as they are the closest to the scenarios we have sketched in the stories. The issue recognition was combined with the ideation stage. This was to bring a sense of totality to the process. Rather than identifying issues on one day and then generating ideas on another, we combine the process.
The activity was also carried out with all the groups working together. This improved participation and also makes the ideas more diverse as there is cross-participation between the four different groups on all issues that are brought up.
The ideation phase is when the participants bring out any and all ideas that can bring about a change with respect to an issue that they have identified. The fundamental idea that backs this phase is to generate as many ideas as possible whether it is non-functional, impractical or improbable. No idea is a bad idea.
In this design process, the ideation is carried out using the Magic Show as described before. Everyone participates and takes on the role of the magician, identifies an issue from the stories that were created; use the different magic tools to devise an idea that could bring about change in the situation.
From the observations done during the ideation session (Magic Show) the Srishti team brainstormed on how to make the Magic tools more appealing and accessible to the participants by making it closer to their understanding.
The idea of a hat, crystal ball and a magic box were identified as western. This was relatively new to them, as they have not seen a magician that performs in these outfits. Also their understanding of seeing through a crystal ball was minimal. Hence the tools were structured in a different way in a linear process. The flow from issue recognition to idea generation was redesigned as shown here:
The template was also re-designed from a simple box-like template to something that is more interactive and relate-able to the participants. An emphasis on the need to sketch these ideas was also impressed upon in these templates.
In this stage we pick up one issue among those collected in the group and develop concepts to attend to them. The method we used for this phase is Enactment.
Enactment is a mode of dramatizing the situation in order to drive the concept development with the ground realities intact. There are several ways in which concepts are arrived at. Many of them are verbal deductions, some through brainstorming, through idea elimination, algorithms etc. However these methods tend to look at the technical aspect of the outcome.
In the context of the project, the people that are concerned and their related feelings and experiences are indispensable for a functional concept. Enactment lets you feel the fit of the shoe that you are designing for your client along with the change in experiences with the change in settings. Here, enactment helps us see and feel like the HNs and the Clients do and thereby design concepts that fit better into their lives. It helps us put the concept in perspective of the stakeholders.
The enactment took three tries to perfect. On the first try, the emphasis was to capture the story and make a short movie out of it. The stress on finding pain points and enacting the concepts was drowned in the effort to work around the unscripted enactment with the HNs.
The second try was a bit more structured. While one of the groups enacted the narrative, the other three groups would ideate on the issues and concepts. This however failed to stay time bound and the enactment took on paths that fizzled out the essence of concept development.
Third time was indeed the charm. The idea was to arrive at a tension point in order to give time for rapid prototyping. We created a narrative that was scripted to be short and simple with two to three tension points. Along with the HNs we made few changes to it and enacted. The enactment was stopped at the tension point – “How to get data on the move?” The other three groups began making for this and in the end had four concepts were arrived at.
When it was time for our group to make while the other groups acted, there was a clear distinction between the ideas generated by the Srishti part of the group and the HNs. The ideas that came from the HNs were more grounded and close to the existing context. Technology was not their forte. Nevertheless, at this point, the participatory mechanism wavered a bit. Even while the making was happening, the HNs were reluctant to take front seat.
A detailed log of the enactment spread across the three visits are as below:
SITE VISIT: 7 (Enactment 1)
The idea was to incorporate the issue and depict it in a story. For this we chose the
story that showed the clients putting more trust in the doctors and disregarding the role of the HN in their well-being. The HNs themselves chose this as an issue that needed more attention than the others we had come up with. One of the reasons for this imbalance in trust was that the doctors could refer them to diagnostic centres that do a variety of tests for the patients. This according to the clients carry more value for them than the tests that the HNs carry out. An issue that came up from the HNs in this case was that lab tests were an inconvenience for the clients. It takes a long time for the results and the client has to spend time and money to go back to the lab to collect their results.
After the observations from the first enactment session it was found that a well-defined script was essential to carry out the enactment in a timely manner. There was also a decision to model generic prototypes for data display, data collection, data storage, making sense etc. These models were built out of thermocol and labels made for identifying which model stood for what. Prototypes in the size of a monitor, a tablet and a phone were made.
Initially the script contained imprints of our concepts in a vague form. However we were instructed not to put in the concepts into the script, as it had to happen along with the HNs and during the prototyping stage. The script was then changed to portray the scenario in a series of panels to identify the issue.
SITE VISIT: 8 (Enactment 2)
The second session of enactment was by way of perfect
ing this phase of the design process. The last time enactment was attempted, the emphasis was on making the story and not on the issue.
This time, an example was provided on how to enact a scenario and use any objects that was around to use as props to keep making changes and develop into a concept. HNs were also asked to get something from their homes. The idea was to give the enactment as much material as possible. This would give us ideas on how to use everyday objects to assist in making changes to issues that we had observed.
Three teams had not enacted till that point and the process of enactment had to be streamlined. The work-flow for the enactment was defined as a 5min enactment followed by a 10min rapid prototyping. We collected different materials that could be used during the prototyping session like cardboard boxes, coloured papers, newspaper and different tools to aid the prototyping.
During this studio time, we began developing the Learning Kit. The Kit was a collection of
templates we had used up until then and were created using the loosely structured format. At the same time emphasising the importance of sketching at each step.
To provide continuum and context to these templates, we were guided to think of Method Cards that would help them connect the activity to the issue at hand. Use of images with minimum text was advised. Yet this created disconnect between the template and the method card, as an HN who is new to the process may not be able to understand how to go about it.
For this reason an Example Card was proposed. This would provide the necessary connection between a method card (illustration and short description) and the template. The Example card would have an image of the HNs during the corresponding activity, examples of the type of question or conversation they would be conducting and a detailed instruction of how to go about doing the activity.
To create a process overview that would show these activities from beginning to end, an Index card was created. Hand drawn illustrations were used in all of the cards. A flag was also part of the learning kit that served as a STOP signal during the enactment activity to point out tension points and begin rapid prototyping.
Copies of this Learning Kit were to be given to the HNs for a trial use it in one of their other projects. They could then give feedback on how it worked and what needed changing.
SITE VISIT: 9 (Enactment 3)
This is an activity that is essential to understand the usability of the concept in the
development stage. The activity is done simultaneously with enactment. When a team enacts and arrives at a specific tension point, the observers (other teams) raise the flag to denote the tension point and then begin the rapid prototyping session.
The session is short and timed, ideally 10mins. The tension point presents a point in the narrative that needs improvement. The improvement is what is being modelled in this making session, with everyday materials like cardboard and paper. All teams went through this prototyping exercise.
With the concepts decided, we documented the various aspects of the concept. The studio time was spent in preparing for the Concept feedback with the client. A template was prepared for this activity. We had to capture the usability of the concept with the actual Users.
The prototype made from Enactment was modified for better utility and presence. This was then fashioned to take to the Client for feedback.
In order to capture the entire range of emotions during the usage, we decided to use a modified experience map. This recorded what the client and the HN said, felt, thought and did while interacting with the concept.
SITE VISIT: 10
CONCEPT FEEDBACK WITH USERS
With the concept in hand, it is essential to understand it from the point of view of the Users. In order to develop a concept that is highly functional and effective it has to be tested with the User and feedback taken.
Concept feedback is obtained using an experience map that tracks what occurs when the interaction occurs between the concept model and the User. The activity begins with the enactment of the same scenario done in Concept Development stage. However this time, it is between the Client and the HN. At the point of tension as devised in the script, the concept model is introduced. The HN and Client interact with this model and a discussion ensues.
During this discussion, the HN quizzes the client on his/her experiences. The HN also records their experience under the following:
We now have the concept and the feedback from client and HN. Now we moved ahead to prepare for the concept definition. For this, we devised a template that was comprehensive in terms of the various aspects that a concept definition could take.
The template took the form of a visual window into the concept. There was space provided for the Problem Statement, Current and Desired scenarios, Concept definition through 5Ws and 1H, Technology (later changed to Touch Points) and Further Possibilities.
The Final Concept is the stage where we define the concept that we have arrived at. The work that is done till then is reviewed for consistency and the artefacts from concept development is consolidated. To this, any improvements suggested by the client or HN is added. The concept is then ready to be defined.
Using the template designed, the concept was defined based on the 5Ws and 1H (Who, Why, What, Where, When & How). Current and desired scenarios are depicted using storyboards that show how the concept improves the situation.
Throughout the concept definition template, sketches are to be used to convey the message.
SITE VISIT: 11
In this activity, all the team participants sit together and review what has been
done through the entire projects. All the artefacts are scanned and the flow of the project evaluated.
The concept is then reviewed based on the suggestions and feedback from the Client and the HNs. Final changes and improvements can be made to the concept at this stage. Once the changes are made, the template is filled using sketches.
At the end of the project, we have come up with two outcomes:
- Conceptual solution to improve the quality of the meeting between the Health Navigator.
- A Learning Kit that serves as training material for future HNs to get started on Design Thinking for creatively solving problems.
One of the overarching goals of this project is to facilitate the incorporation of design thinking into the Health Navigator’s work culture so that they can identify and resolve issues on their own. For this reason a Learning Kit was envisioned to serve as a blueprint for the HNs to put to use in a different context.
Several things had to be kept in mind while conceptualizing this Learning Kit. First on the list was to keep it as unstructured as possible to get the HNs to work out a pace and affinity to the process on their own.
Secondly visual literacy was a concern since most of the work was to be done in sketches. This led to the question of how we might inspire the HNs to start a sketching habit.
Finally the Learning Kit must serve as a guide not only to the HNs who worked with us but also to the new HNs also to take to.
DEVELOPMENT – STRUCTURE
Many types of structures were thought of to create the template structure. We had to keep in mind the ease of transportation, the time taken to fill it and the ease of storage as important criteria for making the template.
However beyond these explorations, the decision was made to keep it very open ended and make a grid with instructions and icons for reference.
DEVELOPMENT – ICONS
In order to help the HNs get started with sketching their ideas, it was essential to give them an aid for easy sketching. Of particular importance were objects, people and spaces that were identified from the Day in a Life and Experience Map drawings they made from Site Visit 2.
At first, the icons were taken from the internet (flaticons.com). This was tested out and we found that the icons were too structured and foreign to them that some of them did not understand what each icon meant. For instance, the disabled icon was interpreted as a sign for going to the toilet.
This posed a problem with the visual literacy and also an impedance to getting them interested in drawing. For this reason, the icons were hand drawn, scanned, vectorised and put in the place of the earlier icons.
With the new icons, the HNs took to sketching very without any apprehension. They also improvised at some point and began sketching objects using minimal lines and shapes.
Towards the end of the project, the HNs had taken to certain ways of representing the HNs themselves, their Clients and few objects like their equipment, mobile phones, transportation, meals etc.
DEVELOPMENT – INDEX CARD
In order to give the overview of the entire design process, an index of the process flow was created.
This is a simple flow that shows the progress of the HNs going from problem to concept. The illustrations were initially very generic but it was redone in the context of Channapatna. We illustrated the HNs in the image of the Channapatna toys.
DEVELOPMENT – METHOD CARD
One of the main reasons to provide the HNs a Learning Kit is to equip them with tools that they can use in the future; to transfer the skills they gathered during our sessions together for the issues that concern them later on.
However more women are meant to join this trained team of HNs. The knowledge of this design process is to be transferred to them. For this, a series of information assistance was devised. Through our brainstorming with Naveen and Cata, we came to the conclusion that the template would be introduced by a Method Card, with a visual and short description. The Method Card will also have a QR code that would lead the participant to a video tutorial.
The Method Card would serve as a quick access card to know what the tool is supposed to do. It is mainly a refresher card for HNs who have gone through the process at least once. This would mean that there must be something to aid the new HNs through the process even without the presence of an HN trained in the design process.
DEVELOPMENT – EXAMPLE CARD
In order to connect the Method Card and Template further, an Example Card was envisioned. This would contain more information that would help someone new to get started with the tool / activity.
The Example Card would have a visual cue, like an image with relevant conversational cues to give a hint on the type of questions to ask, the way a conversation must lead, how to prompt the subject for information. The Example card will also have a comprehensive instructions to carry out these activities.
DEVELOPMENT – VIDEO TUTORIAL
Sometime visuals don’t tell the complete story. Certain ideas like ways of enactment, the way a conversation goes in a particular activity can only be captured using video.
This is created through Video Tutorials that serve as a timed reminder of what the activity and using the tool actually looks like. This step is to further strengthen the core principles of this design process.
The videos are short (30seconds) video footage that was captured while the activity was being done during the course of this project. In the end, the template is shown and notes that hep the viewer to fill it is given.
DEVELOPMENT – PROJECT BOOK
The final piece of this Learning Kit is the Project Book. This book carries with it the entire plethora of information that was obtained during the course of this project. The book is divided into sections based on the Site Visits and activities that were done together between Srishti students and the HNs.
The book also carries data about the studio time at Srishti where activities like the development of the templates, documentation, prototype building are captured.
The book would not be complete without reflections from the HNs. The HNs gave their reflections in Kannada and this was added to the project book as well. The project book will serve as a helping hand to guide the HNs when there is a need to throw light upon how to approach a certain project and to take examples from how issues were tackled within this project.