Public Health and Intervention Design
My work seeks to create and improve social and health experiences for individuals and communities thus empathy is a major part of how I do this. I generate evidence to advise on how we should leverage existing donor funds, programs, community, and individual resources to improve the lives of people while building and strengthening strong relationships with the different stakeholders. Generating evidence involves empathizing with the individuals and communities, applying behavorial change theories, constantly reflecting through the data and ensuring the individual and community interest is fully represented.
Adolescent Behavior Change Research and Intervention Design
How do we Improve Adolescent and Young People’s Reproductive Health Experience Safely?
On average, Ghana reports 100,000+ teenage pregnancies each year. This has damning consequences on the health, education, labor force participation, future earnings, and lifetime opportunities for these girls and the general Ghanaian economy. It was of great concern to key stakeholders in governmental and non-profit spaces to alleviate this problem. I worked with a cross-functional team to ideate strategies for this pain point. At the exploration stage, I began with discovery research to identify key stakeholders, threats as well as opportunities. With my team, we conducted a mixed methods study (surveys, in-depth interviews, and focus group discussions) with adolescents, their parents, community leaders and stakeholders to understand their experience. At the analysis stage, we identified context-specific root causes vary across age groups (15-19 and 20+) and the setting (in-school or out of school) thus we created two distinct products; The Girls Talk Program and the Adolescent Health Program.
Adolescent Health Program (Adolescents in-school program, basic school age)
Based on evidence and participation of adolescents, my team created a product to improve access to reproductive health information and services in school in three ways. Capacity building trainings for health educators in the school context, capacity building trainings for health providers in communities and community members/parents to enhance a less-stigmatized access to services. The other product was further informed by a heuristic evaluation to scale up awareness and functionality of the Ghana Health Service adolescent reproductive health app in terms of developing an IOS version of the app, equipping it with live health providers to provide real-time feedback to adolescent questions. The program in summary collaborated with the health and education sectors, to revive and improve the school health curriculum, improve teachers and health workers capacity, reached out to parents in parent-teacher meetings as part of the first phase. The next phase in progress is to provide online counsellors for instant messaging on the reproductive app and use a series of adolescent-led edutainment approaches to keep health information on the minds of young people.
Secure Girls Talk /Campus Reproductive Health Talk (Tertiary aged)
We designed informed by evidence of our qualitative research, youth-led team and behavior change theories, the Girls Talk program was created for young adults in tertiary institutions.
The program was initially created as a girls’ only, strictly by invitation red carpet event led by an obstetrician-gynecologist, a clinical psychologist, and an entertaining moderator. The event featured a session on intimate relationships, contraceptive use, entertainment session, anonymous questions time, one-on-one counseling, and referrals to community hospitals for further help. To measure output, we distributed pre and posts knowledge tests. Although successful, evaluative research conducted by my team and I showed that, financial and human impact will be made if we stripped off the invite only and allowed participation of all genders and school staff in charge of health. We redesigned the program and served more than 20 tertiary institutions and nearly 1000 students in Ghana.
Community-Based Research and Intervention Design
Community Based Reproductive Health
Many women in Ghana have unmet need for contraceptive. Whiles these women do not wish to become pregnant, they are also not using any contraceptives. Discovery research provided general reasons for unmet needs, but contextual inquiry provided more actionable insights for extreme user settings. Using focus group discussions, one-on-one interviews, surveys, and ethnographic studies within these communities over time, we sort to understand these communities, the cultures and the activities of interest of the communities to provide better insight for people-centered programs. Our insights showed that reproductive health services will better be accessed if there were closer relations and trust between health providers within the communities and workplaces, information was provided in a comfortable space at a time when women were relaxed and in certain instances away from spouses. We then designed two product that sought to reach two different groups of women; women who worked a formal job and women who worked informal jobs. We created a design where health workers visited women in their hair salons and formal workplaces on agreed days, provided general health information, personalized one-on-one services and referral to customer centered colleagues in hospitals when needed. Health workers also maintained cordial relationships and were easily accessible through telephone to women who needed help.
These products provided women with reproductive health information and services in the comfort of their workplace or hair salon, brought health workers closer to the community, build relationships between community health nurses/midwives and community members and foster sustainability and program ownership by training salon owners and apprentices as “champions”. We implemented this in various communities in six regions of Ghana, the program continues to partner with 100s of salons, thousands of community members, and hundreds of health workers. Many community women can trust and adopt a contraceptive method when they chose to, and it helped that they are in close connection with health workers to discuss side effects and any other issues they would like.
For women in the workplace time to visit health workers to access reproductive health information could be challenging. We sought to widen access to family planning information, products and services to a population that spends most of their time in the office, and foster relationship between businesses and health providers for prompt service uptake and to improve work-life balance. We continued to shape the product through evaluative studies with users to understand various pain points and how to improve.
The program was widely accepted that some organizations incorporated it into their yearly wellness plan.
Sato Community Project
Community health can be improved through better sanitation practices. Providing people-centered solutions that are affordable, acceptable, and accessible and provide solutions to their needs is part of social change. Sanitation services in some districts did not serve individuals that wanted improved latrines. Existing latrines were shared, old and unpleasant to use. The cost of new latrines was too expensive and competed with other needs. We sought to provide solutions that were cost-effective, easy to implement whiles creating jobs and training for young people and local masons. Working with partners in the sanitation space in both Ghana and United Kingdom and, we conducted a six-months sales trial study that sought to gain actionable insight from a six-month sales trial project. We began with contextual research to understand the cultural context and held ideation sessions to further understand our customers. We identified which channels out of masons, door-to-door sales agents and hardware stores recruited were the best. Together with my team, we trained sales agents in data collection to collect real-time data to monitor and make prompt decision. Actionable insights soon identified a decision tree for faster sales time, better linkage to masons and who oversaw sanitation decisions in a household. We built on insights from this sales trial and conducted one-on-one interviews with other communities to modify this strategy to suit contextual factors as we continued to deliver improve, affordable and dignified solutions.
You can read further here https://cutt.ly/sK8wmBS
Promoting Pregnant Womens’ use of Insecticide Treated Nets (ITN)
Malaria has devastating effects on pregnant women and fatal outcomes some of which include premature delivery, fetal loss, and low-birth weight babies. To promote the consistent use of ITNs in communities with worst malaria cases, ideation sessions were held with key stakeholders and community members malaria control sectors of health to develop prototypes for testing. These prototypes were then handed to my team and I to further ideate and test within three communities worst affected by malaria. We conducted a contextual enquiry using six focus group discussions with three health workers and pregnant women to test which of the prototypes were of high fidelity. We further held one-one one sessions with stakeholder to improve understanding of information from data. After analyzing the data, I presented actionable insights to a cross functional team where we held ideation sessions to complete finalize the high-fidelity prototype.
Stakeholders were invited to an iterative design session and once the contracting team was satisfied, the implementing team leaders delivered the prototype to the extreme users. The project was deemed successful by external evaluators and was scaled up to cover two regions with the worst malaria cases.
Research and Social Marketing of Contraceptives
What would I Want in a Condom?
“It doesn’t look classy. When it is in your room and a lady comes, she will be shocked
and ask; “oh so is this what you use?”
We performed this creative card sorting study to understand condom and an oral pill brand to understand what users and potential users thought of our oral pill and condom brands. We had a condom brand that did not seem to be favored in the market. The oral contraceptive pill had been knocked to second in market share and top of mind awareness in a retail audit and a brand health report performed by external marketing consultants. We were tasked with discovering why.
We recruited users of these two brands and users of other similar brands (who had never used our brands) to understand how they perceived the physical features of the brands amongst other insights. In two levels of studies, we provided participants different variety of condoms and contraceptive pills asked each participant individually to group the brands. We did same in focus group discussions. In all instances, our contraceptive oral pill was amongst groups participants (both sexes) had described as well known, distinguished, and trusted. Our condom brand however was amongst the groups the participants did not favor. They had described it as “archaic and boring” on features. Users had described it as having a “distinct” unpleasant smell and “too hard”. The third level of study and subsequent discussion of findings with stakeholders led to a discontinuation of our distribution of that brand. In our next study, we conducted focus group discussions study to understand condom consumers journey from health decisions to lifestyle decisions and what they looked for in a brand of condom. Going through a design thinking process with a cross functional team, we created a prototype of what an ideal condom brand should be based on insights. Packaging, flavor, ability to be conspicuous, pricing, and other factors seemed to be well favored in our new brand when we tested desirability in a focus group discussion.
How do Socially Market and Advertise Safe Planned Sex?
It is an interesting task to advertise safe sex publicly in a place where majority of the people share strong reservations on “sex before marriage” whiles also trying to maintain users’ interest and attract potential new users. We conducted a concept test study to generate evidence to guide proposed communication materials under creation by the marketing teams. Working with a team of experts, engaged with 127 users and potential users of the brand in focus group discussions regarding the two contraceptive brands. We wanted to understand how old users interacted with the communication materials and if new users would potentially want to try out these contraceptives based on the proposed communication materials. Our findings showed that potential users did not find the information provided through the communication materials enough to address health concerns such as side effects, method failure, ease of access and convenience. Old users and potential users also found the communication materials unattractive as it seemed to be targeting “married couples”, lacked humor and would not be easily shareable through social media. We worked through the analysis and held ideation sessions with the marketing and the sales teams and concluded that materials needed to be recreated through participatory design.
Inclusion and Reproductive rights of People with Disabilities
Often, people with disability are discriminated against knowingly and unknowingly in communities, health care and financial sectors. I conducted this mixed-methods study as part of my dissertation to shed light on what community perceptions and knowledge regarding the reproductive health needs of people living with a physical disability. I interviewed 429 community members in a survey and 20 persons living with physical disability to understand the reproductive health aspirations and common stigma people with disability face as they navigate their sexual reproductive health rights. I found that younger community members and people with low level of education were more likely to have unfavorable perceptions about the marriage of people living with physical disabilities. There was also a strong believe that disability was through spiritual causes. People with disability themselves expressed positive views about themselves and aspired to marriage and full participation in their reproductive rights. I presented my work at the 40th Anniversary of Noguchi Memorial Institute and hope it contributes to policy and sensitization for stakeholders.