Not A Blank Slate(NABS)
Not A Blank Slate(NABS) is the pilot project initiative taken up by Caregiving Labs team at Noora Health. It aimed at discovering how to work around the various myths & misconceptions of the caregivers and patients that result in barriers to them following medical advice.
2021 | Design Research, Service Design, Social Design
Topic
Pilot project NABS by Caregiving Labs at Noora Health started to explore generative and exploratory design research on health-based myths and misconceptions, inspired by insights coming from
on-ground experiences by the Implementation Team of the Care Companion Program (CCP) & other programs.
Scope
Focusing on Noora's strength in Mother & Child Health, the NABS team split the project into two phases:
(1) gather information from Noora's research, design, and implementation teams;
(2) validate and generate insights in the field.
Team
Caregiving Labs' interdisciplinary team of designers and researchers engaged in an extensive and stimulating brainstorming and design process throughout NABS. We also leveraged support from Noora Health's translation, implementation, and research teams for tasks like translating discussion guides, recruiting participants, and validating data.
Team Members : Jax, Manju, Anagha, Yeshaswini, Minha, Harleen, Sri, Anjali
Role & Activities
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Focusing on Noora's strength in Mother & Child Health, the NABS team split the project into two phases: (1) gather information from Noora's research, design, and implementation teams; (2) validate existing assumptions and generate new insights from the field.
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In the realm of Project Support, I devised design research methodologies, managed their execution throughout the design process, and handled research data organization and documentation. I also created activity materials and oversaw project content and documents.
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In my role as a Design Researcher during Phase 1 and Phase 2, I led the creation of materials for ethnographic interviews and online workshops, with a focus on the diverse backgrounds of our end users.
1. In Phase 1, I assisted with secondary research, adapted insights for design comprehension, conducted workshops, and developed methodologies for data analysis and synthesis.
2. In Phase 2, I crafted research plans, designed screeners and discussion guides, translated fieldwork materials into regional languages, prepared the team for fieldwork, managed data for brainstorming sessions, and guided sense-making sessions.
Tool Used
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Notion (Project Tracking)
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Figma (Creation of Design Materials)
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Google Docs (Content Creation & Collaboration)
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Google Sheets (Resourcing & Recruitment)
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MIRO (Brainstorming & Team Ideation)
How might we help patients and caregivers overcome barriers to following medical advice that is driven by myths & misconceptions?
Objective
Describe Problem Space
Initial findings from intercept interviews and secondary research revealed a prevalent reliance on faith, alternative medicine, and observed systemic barriers(affordability, caste, religion, location etc) and gender bias in healthcare decision-making. A key reason driving this reliance on alternative sources is the pervasive lack of trust in medical professionals.
Why it’s important
Strong belief in concepts of ‘everything is predetermined by fate’, miracles, non-medical practices to treat urgent, crucial ailments & diseases cause more fatalities than necessary due to lack of treatment on time & proper medical guidance.
Why it’s important
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Documenting field-validated myths and misconceptions to improve Noora's knowledge materials for Government Hospitals.
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Assessing ways to address beliefs sensitively and respectfully, fostering trust in medical professionals without causing offense to patients and caregivers.
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Exploring potential research topics to delve deeper into caregiving nuances for Caregiving Labs.
Design Process
In a diverse team of designers, researchers & visual designers - we got around to defining a methodology which
a) involves and incorporates contribution of all team members,
b) is translatable and executable in action by the team members.
As all members were not from design background, the role to share & educate on design research practices was also undertaken by me as the designated design researcher .
With the usual double diamond design process, we reformed our design process into two phases -
Phase 1
Phase 1 of NABS was to look at information & knowledge we already had from our implementation team from Noora Health. On-ground realities, anecdotes and stories from the field which were beyond the programs of Noora’s CCP were our playground for deriving the direction and research problem of the Phase 2 of the project. We also interviewed stakeholders who work in Healthcare but are not affiliated to Noora to get a broader understanding and sense of the essence of our research question.
Phase 2
- NABS Phase 2 is where we went into the field to validate our hypothesis and generate more insights for our questions and insights. We ventured into the field - in the remote Government Hospitals of Sehore & Vidisha district in Madhya Pradesh & Gadchiroli district in Maharashtra to understand the nuances of our objective and address our overarching research question. This stage also involved methodical synthesis of all insights and coming up with project opportunities.
Design Phase I
Define-1 | Discover-1 | Sense making-1
Discover-1
In-person Workshops, Intercept Interviews, Contextual Inquiry, Online co-creation workshop, Desk Research
Sensemaking-1
Wall of Belief Statements, Impact vs. Approach Matrix, Key Derivations (Insights) Board, HOW MIGHT WE? Insight statements.
Participants
Hurdles/Difficulties
Analysis Approach
Affinity Mapping, Writing insights, Key Themes board, How Might We?, Risks & Scope
Time limitation, Availability of participants, validation of field insights, scope for some exploratory primary research
Internal Noora Stakeholders (relevant; Research, Design & Implementation Team), ASHA workers, Nurses affiliated with Noora
Delivery of Insights
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Documentation of key belief statements which can be reformed and addressed while being incorporated into
Noora’s knowledge sharing for on-ground material. -
Possible areas of focus to venture into to deeply understand various nuances of caregiving.
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Major two HOW MIGHT WE questions that popped up to be explored upon in Phase Two.
Photo Gallery of Phase 1 Design Process
Design Phase II
Define-2 | Discover-2 | Sense making-2
Discover-2
Sense making-2
Participants
Patients, Caregivers, Nurses & Doctors
Affinity Mapping, Thematic analysis, Synthesis document, ‘SO WHAT’ methodology
Contextual Interviews, Card Sorting, Visual Prompts, Artefact Analysis
Analysis Approach
Deriving insights out of findings while being respectful and mindful of user’s demographic and privacy, Detailing out insights with descriptive influencing factors and stories/anecdotes from the field that HEAVILY support them, Crafting ‘SO WHAT’ questions to get ‘WHAT IF’ statements to venture into borderline solutioning and probing out areas of opportunities.
Hurdles/Difficulties
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Language barriers (I had to spontaneously conduct most interviews in Marathi! A possibility we kept but didn't expect)
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Ease of availability of participants as they were either pregnant or had a newborn child
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Availability of Doctors for interviews
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Operational difference in two hospitals of the same district(proved very helpful in the myriad level of findings though!)
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Transcription of interviews(limited common language knowledge among team members)
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Recruitment of participants, keeping internal bias and privilege of all team members working in check.
Delivery of Insights
a. Detailed documentation of major insights, detailed influencing factors and individual anecdotes/stories from the field to validate the insights.
b. A detailed board of all transformative Insight statements including actionable & prioritized statements which have potential to venture into as future prospective projects by Noora & Caregiving Labs.
Photo Gallery of Phase 2 Design Process
Outcome
How do we translate insights into project opportunities and recommendations?
Who all collaborated on these?
With limited availability of the team by the end of the project, the document was mainly created by Yeshaswini (Design Researcher) & Anagha (me, Sr. Design Researcher) under the instructional guidance of our Project Lead.
What would I have done with the outcome if I had access to changing different metrics in a perfect world?
Ideally, I’d have wanted to consider every major project opportunity that came up as a different exploratory project for Noora Health and Caregiving Labs. I’d have taken up a different approach to address the topics as prospective short projects and collaborated with respectful needful teams inside and outside Noora Health.
I feel there’s a huge disconnect in truly empathizing and understanding the biggest and truest barriers to healthcare such as affordability, knowledge, approachability of medical professionals, socio-economic policies and its impact on healthcare, gender bias, influence of caste & class dynamics etc. There’s only so much a healthcare organization can do in its preferred limited resources & time to address these dynamics in their own practice. I hope collaboration with other non-profits, organizations etc would have given a more structured approach to these upcoming future project opportunities along with more credibility & integrity to the work.
The insight statements also make up for really good topics to explore from the point of Social Design & Systemic Design. With more access, I’d have invested in forming a team with more reformed socio-cultural knowledge & honest practice with their process & approach - such as keeping one’s privilege in check, understanding one’s own bias, knowing to limitedly contribute if one has limited knowledge on a topic or experience, groundedness in personal practice and behaviour etc. These aspects are important because those working in government hospitals have a very different life & challenge and one should truly be humble & grounded in order to understand those challenges with the intent to address them.
Learning & Reflections
What do I know now?
Designing for Public Healthcare is challenging with two extremely opposite practices impacting it the most - an ever evolving, one solution fits all policy for public health and extreme lack of resources & means for healthcare setups in the most remotest of areas. While these feel like the grim realities of life, I feel with time and with better planning - there can be some change.
My work in the project didn’t encompass being able to solve systemic issues but systemic issues lied at the end of everything we studied. Public Health needs more customized, considerate & resourceful implementation in its policies. As a Designer, I learnt that no amount of prep can fully prepare you for fieldwork. Sometimes you have to be spontaneous with stuff.
Like in one of our interviews, the interviewee wasn’t opening up easily
about her consulting a ‘baba’ because of the fear she may be judged or scolded by the nurse accompanying us (nurse was taking care of the baby). But after a while when she got comfortable, she spoke about her experiences with babas and how alternate medicine by a baba caused the demise of her first child and wished she had come to a hospital sooner. It was a learning moment for me too as interviewing requires patience for someone to open up about something so personal and holding that safe space for them is crucial as an interviewer.
Being on the ground in Gadchiroli and visiting the most remote villages actually opened my eyes to the state of healthcare. Seeing a suicide case coming in front of your eyes, people dealing with language barriers, an X-ray machine that’s not being repaired etc just make you realise that,
even if you can’t solve the issues directly - it’s very important to be honest & maintain integrity in your findings from the field because it’s not just ‘data’ you’re gathering but nuances of people’s lives which are deeply personal and heavily impacted by the helplessness of the system.
What could I have done better?
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Planned on making the Discussion Guides sooner and delegated work for creating it better.
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Synthesis stages and walkaround of the design process.
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Learned better on recruitment and contacts regarding the same. (I was in a support role for recruitment and it was the first time for all of us as a team so it was a bit challenging, so a lot of interviews were intercept interviews).
What lesson do I carry forward into future projects?
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Better delegation of tasks among team members based on strengths and learning.
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Pointing out bias & unfair/insensitive remarks as a conversation/discussion
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Owning up to work done and also the mistakes that accompany.
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Kindness, accommodative attitude and ‘help each other grow’ attitude.