Mobile-izing health workers in rural India

CHI, pp. 1889-1898, 2010.

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ict interventioncultural forcepositive effecthealth servicerural maternal health systemMore(10+)
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The mother-in-law of a pregnant woman stood at a distance watching the Accredited Social Health Activist and client talk, but did not engage in the discussion, even when she was invited

Abstract:

Researchers have long been interested in the potential of ICTs to enable positive change in developing regions communities. In these environments, ICT interventions often fail because political, social and cultural forces work against the changes ICTs entail. We argue that familiar uses of ICTs for information services in these contexts a...More

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Introduction
  • India has a comprehensive approach to maternal health in the village through its National Rural Health Mission [18]
  • This program mandates that one woman from each village should serve as an Accredited Social Health Activist (ASHA) who encourages pregnant women to utilize health services.
  • Due to the ASHAs’ own limited education, training and status within the community, their effectiveness, judged by maternal health indicators, is limited
  • They are committed to change but need help with motivation, measured as self-efficacy, because of significant challenges they face in trying to bring change about.
  • In India, over 60% of all deliveries are still conducted at home, without a skilled birth attendant [14]
Highlights
  • There is much recent enthusiasm in the research and design communities around the use of information and communi-

    John Canny University of California, Berkeley,U.S.A.

    While many of these interventions often focus on immediate affordances of India cutrell@microsoft.com cation technologies (ICTs), like information or knowledge transfer, we argue that ICTs for development can instead directly address barriers to change
  • In one situation, the mother-in-law of a pregnant woman stood at a distance watching the Accredited Social Health Activist (ASHA) and client talk, but did not engage in the discussion, even when she was invited
  • The ASHA was pausing and repeating the points shown in the video
  • Primary Role of Persuasive and Motive ICTs We argued that especially for innovations that target the rural poor, a major challenge for ICTs is their conflict with traditional practices and power structures
  • Our specific example was the rural maternal health care system in India, where a specialized worker, the ASHA, acts as a change agent toward village women. We believe this a good example of a more general pattern: an innovative practice is introduced which conflicts with tradition, and it is mediated by change agents (ASHAs)
  • The persuasive videos enabled improved ASHA-client discussions, and video creation encouraged the participation of other key community players
Methods
  • To better understand needs in this space, the authors conducted two months of field work in 2008.
  • The authors conducted one focus group session with the ASHAs, and observed a total of six house visits during which ASHAs used both the anemia video and testimonial prototypes ASHAs were asked to record their own videos starring anyone in the village they felt would be influential
  • The authors shared their videos as a group and voted on a favorite.
  • The authors translated the videos into English and used the transcripts for analysis
Results
  • It was necessary for them to do some training for the specific tasks the authors designed, the phones were used extensively for other tasks.
  • They took on average 35 photos and 23 videos each, and in total downloaded 148 MP3s and 74 video clips.
  • The authors were curious to see to what extent they would embrace the idea with minimal instruction
Conclusion
  • Motivating Discussion and Enhancing Persuasion

    As described earlier, when the authors first observed ASHAs on their house visits, they had no idea what to say or do.
  • The authors' specific example was the rural maternal health care system in India, where a specialized worker, the ASHA, acts as a change agent toward village women.
  • The authors believe this a good example of a more general pattern: an innovative practice is introduced which conflicts with tradition, and it is mediated by change agents (ASHAs).
  • While the videos were specific to the ASHA’s task, the authors believe the approach is quite generic
Summary
  • Introduction:

    India has a comprehensive approach to maternal health in the village through its National Rural Health Mission [18]
  • This program mandates that one woman from each village should serve as an Accredited Social Health Activist (ASHA) who encourages pregnant women to utilize health services.
  • Due to the ASHAs’ own limited education, training and status within the community, their effectiveness, judged by maternal health indicators, is limited
  • They are committed to change but need help with motivation, measured as self-efficacy, because of significant challenges they face in trying to bring change about.
  • In India, over 60% of all deliveries are still conducted at home, without a skilled birth attendant [14]
  • Methods:

    To better understand needs in this space, the authors conducted two months of field work in 2008.
  • The authors conducted one focus group session with the ASHAs, and observed a total of six house visits during which ASHAs used both the anemia video and testimonial prototypes ASHAs were asked to record their own videos starring anyone in the village they felt would be influential
  • The authors shared their videos as a group and voted on a favorite.
  • The authors translated the videos into English and used the transcripts for analysis
  • Results:

    It was necessary for them to do some training for the specific tasks the authors designed, the phones were used extensively for other tasks.
  • They took on average 35 photos and 23 videos each, and in total downloaded 148 MP3s and 74 video clips.
  • The authors were curious to see to what extent they would embrace the idea with minimal instruction
  • Conclusion:

    Motivating Discussion and Enhancing Persuasion

    As described earlier, when the authors first observed ASHAs on their house visits, they had no idea what to say or do.
  • The authors' specific example was the rural maternal health care system in India, where a specialized worker, the ASHA, acts as a change agent toward village women.
  • The authors believe this a good example of a more general pattern: an innovative practice is introduced which conflicts with tradition, and it is mediated by change agents (ASHAs).
  • While the videos were specific to the ASHA’s task, the authors believe the approach is quite generic
Tables
  • Table1: Roles reported by ASHAs during interviews
  • Table2: Influencers Starring in Testimonials (left) and Testimonial Content (right)
Download tables as Excel
Related work
  • Technology for Rural Health Workers Many research projects have looked at the use of ICT to support health workers in developing regions. An overview of many uses of mobile phones for healthcare workers is found in [4]. Healthline is a landline phone system for health workers in Pakistan to get information in their native language using automated speech recognition [24]. In the 1990’s a large PDA-based system was developed to support Auxiliary Nurse Midwives (ANM) in India organize and schedule house-visits [12]. Another project in Tanzania called eIMCI looks at the use of a PDA for guiding health workers through protocols [8]. Results show that using the system, health workers adhere to the protocols more strictly and prefer to use the device rather than flip through paper references in front of patients. These projects in general target health workers with higher training3 - not limited-schooling health workers among whom issues in training and status are far more acute, and motivation comes to the fore.
Funding
  • This material is based upon work supported by the National Science Foundation under Grant No 0915705
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