10.11 Co-design for HMW Theme 1B

‘Influencing the health outcomes by integrating biomedical knowledge and community practices.’

10.11.1 Objectives and Recruitment The main goals of the first set of co-design sessions in December 2020 was:

  1. To validate and map out rituals and biomedical behaviours along the timeline from Menarche to life after first pregnancy.

  2. Identify behaviours that are more difficult than others for AHSAs to influence along this timeline.

  3. Identify instances where ASHAs are already combining biomedical behaviours and community rituals and practices.

  4. Take inspiration and co-design new concepts that take a ritual lens to combine biomedically recommended behaviours and traditional practices.

For this we recruited 5 sets of Block Community Managers (BCMs), ASHA facilitators, and ASHAs, each in a different block of Samastipur district to join for a series of individual and group calls wherein we explore the different experiences and challenges they face with regards to influencing traditional and biomedical behaviours. After a series of rapport building conversations individually, we held group calls to discuss 1) the perceived difficulty in giving different types of biomedical advice, and 2) access and involvement of ASHA and other influencers in different rituals and traditional practices, then we held individual calls again to explore each ASHAs approach to tailoring biomedical advice, and ended with a group discussion that shared the insights and possible solutions with the group.

Diagram: The process of co-design 1B:

Link to Activity Plan which contains details about each of these sessions.

10.11.2 Remote Co-design considerations

Due to travel restrictions the Create Phase co-designs sessions were conducted remotely, therefore the team used different channels to build connections and relationships with participants, including text, video and audio calls, and sending images over the phone and Whatsapp.

As some participants had better connectivity and digital literacy than others, our recruitment aimed to build a representative sample of participants in Bihar, and not just focus on those with the best connection. This meant that the team needed to be flexible with the choice of methods and timing.

During the sessions we found that rapport building was key to gaining deeper answers. After having explained the project’s objectives and interests during introduction, ask generic unrelated questions in the beginning of one on one calls to build relationships and slip questions about their (individual ASHA’s) family and community organically during conversation. Showing a genuine interest in their lives goes a long way.

  • Spacing the calls over a period of two weeks helped with longitudinal rapport building.

  • The Whatsapp groups to keep light touch during breaks between calls.

  • There was a noticeable increase in respondent’s comfort in talking in last two calls

After the one-on-one calls the last group call saw a significant increase in enthusiasm and creativity in response from participant ASHAs, as they heard all the interesting things they had been discussing, and ignited the possibilities for change. This creativity led to some of the most interesting solutions.

10.11.3 Synthesis

The co-design sessions were documented and translated to English for processing:

  1. Transcription of all sessions to Google Docs.
  2. Organization of all responses across an Excel - each response was categorized first by journey phase, and then clustered.
  3. Synthesis on to miro board Timeline - summarizing the idea clusters and arranging across: Behaviors, Access, Challenges, and Opportunities.

A connecting thread across all these discussions was that the behaviours and practices discussed centered around the women’s life. Therefore the insights from the discussions were mapped on a timeline from Menarche through to the end of the first pregnancy. At each point on the timeline there are notes about the behaviors practiced, the ASHAs access, specific challenges and opportunities that might be leveraged.

This timeline, with all the insights and notes, provided the basis for following brainstorming sessions which resulted in many idea sparks, some of which were developed into concepts.

See Annex for Mothers Timeline