ThinkPlace - Research & insights

Improving the safety of Australian medicines

Daniel Silkstone — Mon, 28 Oct 2019 02:28:09 +0000

Work

Improving the safety of Australian medicines

Service

DigitalResearch & insights

People

Sector

Healthy Societies

More than 250,000 Australians are hospitalised each year, and another 400,000 present to emergency departments, because of medication errors, inappropriate use, misadventure or interactions, according to the Pharmaceutical Society of Australia’s Medicine Safety: Take Care report.

As these figures make clear, usability of clinical systems is an important factor in patient safety, and information about medicines, allergies and adverse reaction is among the most critical health data available in Australia’s My Health Record system.

A poor clinical experience when accessing or entering this health data can have extremely serious consequences.

THE CHALLENGE

The complexity of the health digital ecosystem involves multiple points of care across public and private hospital networks, community pharmacies, general practice and aged care services – using different systems, different levels of digital maturity and complex interoperability challenges.

The Australian Digital Health Agency approached ThinkPlace to provide research and user-centred design capability to improve the display, usability and clinical safety of this information across the sector and to develop a roadmap to guide the agency, clinical stakeholders and developers through implementation now and in the future.

OUR RESPONSE

To gain a deep understanding of the challenges clinical users face, and how they need medicine-related information to be presented at the point of care, ThinkPlace undertook research within clinical environments – talking to doctors, hospital administrators, emergency workers, pharmacists and aged-care workers across Australia.

We also engaged in ongoing discussions with the Agency’s core team of around 30 systems and data specialists and clinical advisors to understand the interoperability of data, policy and clinical safety requirements that needed to govern the emerging designs.

HOW WE DID IT

Insights gained from our research activities were described in journey maps and a series of detailed design hypotheses.

We then took these hypotheses and used them to develop interactive prototypes, conducting further evaluation with users through a series of agile design iterations.

Throughout this process we tracked the evolution of the designs through the lenses of usability and clinical safety and communicated findings through weekly meetings with the Core Design Team, keeping track of the evidence, decisions and outcomes through team collaborative tools such as Trello and Confluence.

“This design process enabled a deep and collaborative user-centred design approach to efficiently and effectively inform decision making, with all decisions being made from a solid and shared understanding of the evidence base.” Project Lead Darren Menachemson.

KEY FEATURES

Contextual enquiry with real-world users provided deep insights into the needs of clinical users at the point of care
User research was tracked and communicated using shared online tools by the project team
Living and collaborative project tools enabled a clear line of sight and record of decisions made through research, prototyping and the final roadmap.
Continuous research and validation feeding into collaborative decision making meant issues relating to governance and clinical safety were quickly identified and efficiently addressed
The collaborative agile design methodology informed the roadmap from immediate release to future strategy.
Evidence-based decision making meant easier prioritisation of features aligned to user need and clinical safety concerns

THE IMPACT

Changes to My Health Record, contributed to by ThinkPlace, have been hugely impactful.

“We are already seeing benefits being realised around improved medication management, improved decision making, reduction in adverse events and savings in time in collecting medical information at the point of care.” ADHA

One such benefit: When serious flooding washed over Townsville in early 2019 many people were cut off from resources, including patients who could not visit their regular pharmacy for essential medications.

“The biggest problem for pharmacists is people being cut off from their home pharmacies – so they’re presenting at whatever pharmacies are open, without much knowledge of their medicines and without their prescriptions,” Pharmacist Paul Willis told ajp.com.au.

“So at the moment, My Health Record is absolutely shining. The doctors are loving it, the nurses are loving it, the traditional relationships between GPs and patients don’t really exist at the moment so everyone’s trying to help each other and My Health Record is able to provide a consistent medication profile.”

The ADHA reports that: “The Medicines view was a key enhancement that has helped ADHA drive their pharmacist adoption rates over the last year... now they have nearly 5,000 pharmacies registered using the system.”

Australian pharmacies signed up to the My Heath Record system in record numbers in the 12 months to April 2019. In April 2018, only 33% of pharmacies were registered with My Health Record. A year later that figure stood at 83%.

Pharmacists are also uploading and viewing My Health Record more often, with a 667% increase in the number of dispense records uploaded to My Health Record and a 942% increase in the number of record views, comparing April 2018 to April 2019.

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Monday, 4 November 2019

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User-centred research for an iconic Kiwi brand

Daniel Silkstone — Tue, 24 Sep 2019 02:55:03 +0000

Work

User-centred research for an iconic Kiwi brand

Service

Measuring ImpactResearch & insights

People

Nature Baby is an iconic Kiwi brand that is loved by many and looking to grow. The company has been exporting to Australia for many years selling via e-commerce, department stores and boutique retailers. 

Nature Baby wanted to grow and mature its business and appreciated the value of understanding customer needs and experiences in achieving this.

But could Auckland-based Nature Baby assume the same things that motivated customers and consumers in their native New Zealand would hold true for other markets?

Better by Design, a New Zealand Government scheme that helps businesses create market value through design processes, engaged ThinkPlace to develop a deep understanding of the experience of current and potential Nature Baby customers in Sydney, Australia.

THE CHALLENGE

The aim of the engagement was to deliver insights that could help Nature Baby understand how parenting experiences for people living in Sydney were both similar and different to those in Auckland.

The research focused on understanding how parents research and make decisions around baby purchases. 

ThinkPlace designers specialise in conducting research with hard-to-reach or sometimes-vulnerable groups. Over time, this has included cohorts ranging from people with lived experience of disability to people from diverse linguistic and cultural backgrounds, people in remote locations and indigenous peoples around the world.

This project presented a different challenge: How to conduct meaningful research and discovery with another complex group: not just parents but parents and their babies.

OUR RESPONSE

ThinkPlace used an innovative set of methods to help deliver meaningful insights.

Semi-structured interviews uncovered deep contextual information about participants’ behaviours and attitudes. A variety of probes and generative tasks were used in each interview.

Interviews were conducted in parents’ homes  to allow for observation of the home, baby’s clothing, care products, dresser/closet and bathroom.

Researchers also spent time in public areas around Sydney to observe where parents spent their time outside the home.

At the conclusion of the research, the field team ran a full day synthesis session with the Nature Baby team to make sense of what was heard and to uncover potential opportunity areas to move from insights to action. 

HOW WE DID IT

Insights from the research were presented in a format to help the design team make sense of what the field team learned, explore what it means for the business strategy and what the next steps are to move from insights to action.

The insights report also included a customer journey map highlighting key milestones and purchasing behaviours of mothers as well as five distinct personas to help guide and inform future design decisions.

The personas were mapped to the Diffusion of Innovation Model. Adoption of new ideas, behaviours, or products is a process where some people are more likely to adopt the innovation than others. The model helped frame our personas and identify “adopter” groups who adopt an innovation early compared to others who do so later or not at all.

THE IMPACT

Our research produced nine key insights that provided crucial pointers for how Nature Baby could better connect with parents and potential customers in Australian markets.

Some of the areas we uncovered included how shopping frequency changes during different stages of pregnancy, the difference in behaviours of first time mums compared to mothers with more than one child and how Australian mothers perceive organic and ethically produced baby products.

When promoting a new idea, behaviour, or product, there are different strategies used to appeal to different adopter categories to help the Nature Baby business grow in Australia.

Overall, the process was successful in producing beneficial and actionable insights, while building a foundational capability in design research and synthesis for the Nature Baby team.

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Tuesday, 1 October 2019

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An award-winning approach to Aboriginal place naming

Daniel Silkstone — Thu, 19 Sep 2019 21:55:16 +0000

Work

An award-winning approach to Aboriginal place naming

Service

Experience & Behavioural DesignInclusive Co-design & EngagementResearch & insights

People

Sector

Vibrant Communities

What’s in a name? If you are an Aboriginal person in Bendigo, Victoria and have to regularly walk past a local creek that carries an offensive racial term as its name you might think quite a lot.

All around Australia the names of things -- roads, waterways and geographic features -- serve as reminders of our past. In many instances place names reference acts of violence or displacement against Aboriginal people.

Changing this situation can address past and present wrongs but also carries exciting potential for the future. A greater integration between place-naming and Aboriginal culture and languages can help all Australians be better connected to the land they are living in.

THE CHALLENGE

“Some of the names in our landscape are racist and offensive. Some are just plain wrong in terms of how they are said or spelled,” says Susanna Collis, who worked on the project as a representative of the Victorian Aboriginal Heritage Council.

“This actually does matter to Traditional Owners. They feel it.”

In some cases, geographic features are named after colonial settlers who participated in atrocities against Aboriginal people. In others, names may appear harmless enough but by their simple existence may be effectively obscuring or erasing Aboriginal culture.

Beyond righting historical naming wrongs there is another -- equally pressing – need. Across Australia, we name a lot of things. New streets in new residential communities. New bridges and parks and water courses and hills.

It turns out, we are not very imaginative about how we do it.

“We keep giving the same types of names to new places, new roads,” says Susanna. “Often we know that these places already have names. They’ve had names for thousands of years. Not using those names is denying a truth. Using them highlights the continuity, presence and importance of Aboriginal culture.”

Naming authorities have too often been confused by how to engage with Aboriginal communities. At the same time, communities have felt unvalued, ignored and degraded by a lack of engagement and unaware of how decisions about naming are being made.

The challenge for ThinkPlace was to create a space and a process that would allow diverse people and interests to come together, using innovative methods and resources to drive shared understanding and purpose.

OUR RESPONSE

ThinkPlace was engaged by the Victorian Aboriginal Heritage Council and the Department of Environment, Water, Land and Planning to create and run a process that would encourage and facilitate more inclusion of Aboriginal people, language and custom in place-naming throughout Victoria.

We designed a process – Our Languages Matter -- that has brought together Traditional Owners, naming authorities and other stakeholders in a way that is both pragmatic and symbolic, to reshape how things are named and why.

This is the first time anyone in any jurisdiction has attempted to do this anywhere in Australia. (Susanna Collis)

ThinkPlace’s design work offers a breakthrough in creating a new naming practice that is collaborative, inclusive and truthfully reflects Australia’s complex history.

HOW WE DID IT

We were initially asked to design an opportunity for people to know more about guidelines for naming and to promote opportunities for Aboriginal place naming in the future. This brief was initially limited in scope but -- with collaborative effort and extensive consultation – we were able to push beyond it.

ThinkPlace worked with Traditional Owners and other stakeholders to co-design new frameworks for Aboriginal people to connect with government, and a new kind of conversation -- running sessions across Victoria where Traditional Owners engaged with local councils, surveyors, developers, planners and more.

“This was about getting the right people in the room for the first time but also about inventing a process for them to understand each other and collaborate together,” Susanna says.

Sessions began with Welcome to Country and, where possible, smoking ceremonies. Traditional Owners then hosted the opening session of the workshop and shared language and other cultural heritage knowledge. It was important to commence the workshop with Traditional Owners framing the context and scope of discussions, as it set the agenda for participant collaboration throughout the remainder of the day. This approach meant that each workshop was unique, with discussions localised to the place in which we were convening.

The Victorian Aboriginal Corporation for Languages also participated by supporting discussions about revival and maintenance of Aboriginal languages and the importance of local cultural heritages.

Recognising the different languages (including technical languages) and cultures in the room we worked together to create shared understanding, shared intent and shared direction by depicting sessions visually, rapidly scribing with a mix of pictures, diagrams and words.

It is a design process and an end product that has now won recognition from the Good Design Awards jury, awarded a prestigious ‘Tick’ trophy.

“This is a project that applies co-design approaches to a sensitive and complex topic, and the adoption of visual techniques to work around language challenges,” the awards judges said.

“The Jury appreciated the connection between participation and positive impact for the communities involved - creating value through both process and outcome. It's heartening to see both social impact and the potential for economic advancement. Well done.”

THE IMPACT

DEWLP reports that the sessions have produced value beyond their original hopes.

We fully expect as a result of this project there will be an increase in the use of Aboriginal languages to name roads, features and localities across the state. (Rafe Benli)

Reinstating Aboriginal names for places has led to new signage and interpretation which the department says is already opening up new business opportunities for Traditional Owners around tourism and interpretation.

The process has:

- Created meaningful, ongoing engagement between Aboriginal communities and naming authorities.

- Increased the ability of stakeholders to understand, pronounce and value Aboriginal place names.

- Given a platform for Traditional Owners across Victoria to register their objections to offensive local place names

- Initiated a process of replacing offensive names with appropriate ones.

The project has provided placename authorities, such as local and state governments, national parks agencies and water authorities with the tools and motivation to productively engage with, and build enduring relationships with, Aboriginal communities in all naming processes.

“This has been an incredibly cohesive process for participants,” says Rafe. “They came expecting to be bored and left invigorated”.

“From the live scribing to the talks about language and culture it created delight. And that shared delight got everyone connected to what we were doing and why.”

These sessions have achieved what years of effort had failed to do: creating shared purpose, developing understanding and designing a shared approach that enables all interested people to create change together.

“Our cultural heritage is best understood through demonstrating respect for Traditional Owners – our knowledge, our skills, our appreciation of our heritage,” says VAHC Chairperson Rodney Carter.

“The practicing of our culture and traditions makes us stronger and this strength offers all Victorians opportunities to value, understand and celebrate the unique cultural heritage we care for on behalf of all of us.”

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Friday, 27 September 2019

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Innovative market research for a loved NZ brand

Daniel Silkstone — Wed, 18 Sep 2019 02:34:02 +0000

Work

Innovative market research for a loved NZ brand

Service

Experience & Behavioural DesignInnovation AmplifiedResearch & insights

People

How does a NZ children’s shoe company cut through in a crowded, competitive and established market on the other side of the world?

Bobux, a New Zealand company founded in 1991, offers a range of shoes for babies and toddlers and has experienced success with its products in New Zealand and some other markets.

The company wanted to know what it needed to do and how it needed to present its products in order to establish a successful export business in Northern Europe.

THE CHALLENGE

Bobux was keen to maximise the market opportunities created with the onboarding of their new Northern European based distributor. They had a small market share of enthusiastic consumers and wanted to extend their geographical footprint and grow market share.

Leveraging the New Zealand Trade and Enterprise network in Europe, they accessed data that gave detailed information about their target market in Europe. This pointed them in the direction of Germany and in particular the cosmopolitan city of Hamburg to deep dive into their assumptions and find out more.

OUR RESPONSE

Through the Better by Design programme offered to New Zealand export companies by NZTE (a human centred research approach to a deeper understanding of people’s needs, behaviours and experiences in off-shore markets) Bobux embarked on a journey to understand their German customer directly.

ThinkPlace recruited a German based human centred research team, designed the research approach with Bobux and introduced them to the team here in NZ , prior to them all convening in Hamburg. It was important to have a local team who spoke German and to understood nuances of the language, location and behaviours observed.

HOW WE DID IT

The German based research team spoke to Hamburg parents in their homes, seeking information about their childhoods, their children’s needs, their thoughts on children’s foot health and their preferences when putting their own children in shoes - from learning to walk to school and sports shoes.

They also discussed their weekend activities, where they spend time and what they do.

Engagements took place in-home and over 1-2 hrs. The research teams encouraged parents to show them their shoes, their children’s bedrooms, their closets and storage.

Our research team went to parks and other child friendly spaces and gathering points to observe what children were doing and what footwear they wore. Their Distributor also accompanied them to the in-store environments to see the context for Bobux shoes being sold and in particular how they were being displayed.

THE IMPACT

Bobux gained an understanding into the lives of Hamburg parents and a real deep-dive into their thoughts and behaviours.

Informed by this research the team came back to NZ and upacked their findings. Armed with insights from the research we iterated their 3 -5 year strategy to incorporate innovations they wanted to make across the business.

An intentional focus on responding to their gathered insights has seen some quick innovation cycles that included adding additional shoes to their range to be more in tune with seasonal requirements in Northern Europe. The creation of a stand-alone display system to help differentiate their shoes in the crowded store environments they saw. Marketing materials were also tweaked to reflect the weekend activities observed in Hamburg which were so important to their family life.

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Wednesday, 25 September 2019

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Rethinking safety in New Zealand workplaces

Daniel Silkstone — Fri, 13 Sep 2019 06:27:06 +0000

Work

Rethinking safety in New Zealand workplaces

Service

Strategy & policy designResearch & insightsOrganisation Transformation

People

Sector

Healthy Societies

The Accredited Employers Programme is the premium injury prevention and management programme for NZ’s highest performing workplaces, responsible for continuously and sustainably improving everyone’s health, safety and wellbeing.

A number of features of the programme were not functioning as intended and this was having a negative impact on health, safety and wellbeing for employees of some of New Zealand’s largest employers.

THE PROBLEM

Instead of being a programme consisting of the best health and safety performers, the AEP was being used as a cost saving programme.

Some of these businesses are just not investing in H & S or trying to prevent injuries and it is causing people serious injuries and sometimes death. (client)

ACC needed a compelling redesign which positions the worker at the centre of the programme and provides ACC with assurance that members are high performers in the health, safety and wellbeing space.

OUR RESPONSE

ThinkPlace had worked with ACC in the discovery phase of the AEP redesign work, which meant we already were aware of some of the existing issues as well as the impact they were having. We leaned heavily on our previous expertise and knowledge so we didn’t ‘start from scratch’. Instead we leveraged the fact we already had a number of experts on the current AEP and the state it was in.

We implemented a sprint approach where we compartmentalised features of the programme and spent two weeks on one area, diving deeper into the problems, the impacts and what a better design would be from a worker, employer, ACC and Government point of view.

Most of the business hadn’t ever worked on something this big and in such a short amount of time, it was a great experience and enlightening. (client)

HOW WE DID IT

Key stakeholders within ACC, including senior leaders, subject matter experts and operations staff actively participated in the co-design process over a 14-week period. The team relied on user typologies (developed from qualitative and quantitative research) to ensure the voice of workers and employers was considered at all times.

The team used current behavioural insight approaches and modern regulatory approaches to ensure the newly proposed Target Operating Model was best practice for this type of programme and future proofed.

To ensure appropriate governance and senior leader buy-in, there were weekly demo sessions to walkthrough the redesigning features and to get their input into the design. This avoided any surprises once the sprint cycle was finished and ensured buy-in throughout the entire project. We were proposing wholesale changes to the operations side of AEP within ACC. These weren’t minor tweaks but transformational discussions so getting senior leaders across this thinking early helped to set the direction and gave the project team permissions they needed.

THE IMPACT

The team developed a cohesive story and rationale for the proposed TOM design. The TOM was used to socialise the case for change with the ACC executive team and the Minister for ACC.

ThinkPlace has since been contracted again by ACC to refine the design further. This work is ongoing and the refined design is due to be completed by October 2019.

Hearing that we won the contract for the next round of design work for AEP made the team feel proud. All the hard work and devotion ThinkPlace had was obviously noticed and valued too. (project manager)

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Friday, 20 September 2019

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Improving testing for Malaria in Guyana

Daniel Silkstone — Fri, 13 Sep 2019 05:43:33 +0000

Work

Improving testing for Malaria in Guyana

Service

Scaled systemic changeExperience & Behavioural DesignInclusive Co-design & EngagementResearch & insights

People

Sector

Healthy Societies

While malaria remains endemic in the country, Guyana has made significant gains in the fight against the disease.

But despite this progress, 93% of all new cases of Malaria are found in just four of the country’s regions: 1, 7, 8, and, to a lesser extent, region 9.

What these regions have in common is a high concentration of mining, logging and Amerindian communities in remote areas of the Guyanese hinterlands.

THE CHALLENGE

In order to increase access to malaria testing and treatment services in the most affected regions, the Guyanese Ministry of Public Health (MoPH), Pan American Health Organization (PAHO), and Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) are working together to introduce rapid diagnostic tests (RDTs) and treatment for malaria into mining camps and the surrounding communities.

OUR RESPONSE

As part of the USAID-funded Breakthrough ACTION consortium, ThinkPlace was engaged to lead a human-centred approach to deeply understanding the motivations and behaviours of these communities, and to ultimately develop interventions that improve access to malaria services that can be implemented at scale.

A collaborative Breakthrough ACTION design team consisting of ThinkPlace designers, practitioners from Johns Hopkins University Centre for Communication Programs (JHU CCP), local MoPH officers and regional Vector Control officers conducted a total of 108 interviews across 14 locations in two endemic regions of Guyana.

HOW WE DID IT

From the initial discovery phase, eleven insights were identified that would inform the development of multiple intervention ideas and prototypes. It was found that the malaria parasite was deeply misunderstood for a variety of reasons, and this had a significant effect on care seeking and treatment adherence behaviours.

Through several days of intense co-design workshops, the design team worked with representatives from a range of local organisations to generate 792 raw ideas and refine these into eight emergent concepts to be prototyped.

An iterative ‘Design and Test’ process allowed the design team to develop and sharpen these concepts based on feedback from the communities visited during the discovery phase. Ultimately five interventions were recommended to the MoPH, ranging from comprehensive and targeted communication campaigns, to job aids for volunteer testers, to product-based adherence initiatives.

THE IMPACT

ThinkPlace has assisted in the rollout of high-fidelity pilots of these interventions in specific communities throughout Regions 7 and 8.

Based on the deep learnings from the discovery phase, the interventions currently being piloted cut across all stages of a community member’s experience with malaria and interacting with the health system: from building awareness the need for testing and treatment, to improving access to services, to becoming advocates and spreading accurate information to their peers.

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Friday, 20 September 2019

Position

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Researching water storage in Jamaica to prevent mosquito-borne illness

Daniel Silkstone — Fri, 13 Sep 2019 05:21:55 +0000

Work

Researching water storage in Jamaica to prevent mosquito-borne illness

Service

Scaled systemic changeInclusive Co-design & EngagementResearch & insights

People

Sector

Healthy Societies

Forty-five and fifty-five gallon drums are ubiquitous with Jamaican culture, generally used for storing household water.

In many fringe-urban and rural homes, this is the primary source of water, while in urban homes water is kept in drums “just in case” - although water supply is often much more reliable.

But these drums make for ideal breeding sites for the Aedes aegypti mosquito, the primary transmitter of Zika, Dengue and Chikungunya viruses. This typically-Jamaican cultural practice is contributing to the transmission of diseases that could be preventable with some behavioural change.

Covering water sources is often promoted as a simple solution to preventing mosquito breeding, however many challenges remain in consistently achieving effective covering.

While the Jamaican Ministry of Health (MoH) Vector Control Unit has identified water drums as one of the most proliferous sources of mosquitoes on the island, there is a strong need to understand the full extent of the environmental, structural and behavioural challenges related to water storage.

THE CHALLENGE

To change behaviour around water storage it is important to know how that behaviour functions and why.

The MoH tasked ThinkPlace, alongside Johns Hopkins University Centre for Communication Programs (JHU CCP) as part of the Breakthrough ACTION consortium, with undertaking a human-centred design approach to uncover rich insights around the use of water storage drums and around water storage behaviours more generally in areas of Jamaica with inconsistent access to piped water.

The ultimate goal? To design and test interventions that could be implemented by the MoH to improve water storage practices throughout Jamaica, diminishing ideal breeding sites for the Aedes aegypti mosquito.

Although much research has been conducted on water storage and mosquito breeding sites, the human-centred approach is novel in the Jamaican context as it allows for solutions to be developed iteratively with community members, rather than developing solutions in isolation for them, which has been the traditional practice to date.

OUR RESPONSE

The discovery research was led by ThinkPlace and also involved a team from CCP and was assisted by local researchers. It uncovered, among other crucial insights, that many misconceptions exist about how mosquitoes breed and why people cover some water containers and not others, as well as deeply-rooted social norms around water storage.

This new understanding of the behavioural challenges surrounding water storage pointed the team towards a range of opportunities for intervention.

HOW WE DID IT

Following a collaborative ‘Imagine’ workshop with key stakeholders from the MoH and Vector Control Services to generate, develop and refine ideas, eight concepts emerged that were tested in-situ with both urban and peri-urban communities surrounding Kingston.

Through this iterative testing process, it was found that some of the ideas were desirable by community members but not feasible, and experimentation with these concepts was discontinued.

Ultimately, four interventions emerged as having the most potential to create sustained behavioural change around water storage practices: a complete revision of the vector control workflow, a multi-channel communication program, a drum exchange program, and a group of structural and product-based solutions.

THE IMPACT

The MoH was provided with comprehensive recommendations and implementation plans for the four interventions, along with briefs for contracting creative agencies to tackle the communication program and product design challenges that remained.

Feedback from the MoH’s involvement throughout the project was very positive.

You have given us much to work with, not just with the solution but with the methodology used and your approach. It was great. A job very well done.

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Friday, 20 September 2019

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World-leading behaviour change to save lives

Daniel Silkstone — Fri, 13 Sep 2019 02:25:12 +0000

Work

World-leading behaviour change to save lives

Service

Scaled systemic changeExperience & Behavioural DesignMeasuring ImpactResearch & insights

People

Sector

Healthy Societies

Every day, around the world, people die from preventable illnesses.

How many lives could be saved by working with them to change their behaviour?

Whether it is sleeping under mosquito nets in malaria-ravaged communities, storing drinking water safely in regions prone to Zika virus or using self-testing kits in places with high HIV rates, attempts to change harmful human behaviours into helpful ones have proven stubbornly difficult.

That’s where Breakthrough ACTION comes in.

WHAT IS BREAKTHROUGH ACTION?

Breakthrough ACTION is a 5-year, $300 million mission to address those challenges using a world-first alliance of human-centred design, strategic communication, behavioural economics, marketing science, digital health and community mobilisation and engagement.

It is the flagship social and behaviour change program for the world’s largest public funder of international development, USAID. And it’s a hugely-ambitious initiative that spans 25 countries across the globe.

ThinkPlace is the global human-centered design lead for this project, which is led by Johns Hopkins Center for Communication Programs and features a consortium of partners. This unprecedented collaboration is driving change that will save lives and create better health outcomes across Africa, Central America, the Caribbean and Asia.

OUR RESPONSE

For ThinkPlace, this project represented an opportunity to apply the stages of design thinking (research, ideate, prototype, reiterate, test, measure, apply) on an unprecedented scale to an intractable set of problems.

Beginning with co-design workshops at each site we set shared intent, creating pathways for stakeholders and users to participate and shape prototypes.

These early-stage prototypes are then aggressively tested and revised in real-world settings across a series of design sprints.

RAPID FIELD PROTOTYPING

Working with our partners we have created a new way of running the design process – Rapid Field Prototyping -- to fully integrate the communities involved: designing, testing and iterating solutions from within their midst.

We have brought our expertise in behavioural insights, behaviour change and communication design to the project, allowing communities to co-create change in real-time.

In complex systems it can be risky to go too far down a design path before testing how an intervention sits in a system. Rapid Field Prototyping begins with an intense period of ideation and research but moves quickly to early prototyping (often within 48 hours).

This allows us to test a broad range of imperfect and experimental responses with humans in the system; in the kinds of challenging environments thrown up by developing countries. Prototypes are often made from cardboard or modelling clay. We make changes to them in real-time in a rolling fashion.

By engaging community members in the processes of research, making and testing we are helping to build local capacity so that the interventions we craft together can be implemented, scaled and retained over time.

THE IMPACT

Human centredness is at the heart of this project. Each intervention that ThinkPlace has designed begins with spending significant time on the ground in local communities, talking with people about how they live, what motivates them and what blockers exist that prevent them adopting healthier behaviours.

We are currently in year two of the five-year project and already we are seeing impact from our work in places such as Nigeria, Zambia, Jamaica and Guyana.

NIGERIA

Nigeria accounts for 13 per cent of all child deaths worldwide. In just this one Breakthrough ACTION site our work (around child health and nutrition) is having a profound impact.

Over a 2.5-week period in Nigeria, we conducted over 290 interviews in homes, workplaces, health facilities and more. These were synthesised into 10 key insights around maternal child health and nutrition that will now form the basis for interventions to be prototyped and tested.

Elsewhere in Nigeria, we have developed designs to increase health seeking behaviour for signs and symptoms of tuberculosis – reducing the stigma associated with being tested and treated. Pilots of these initiatives are currently being rolled out at scale.

ZAMBIA

In Zambia we have implemented interventions that have reduced barriers to adoption of six key behaviours (family planning among adolescents, accessing HIV testing, condom use, optimal complementary feeding for children under two years, timely care-seeking for children under five and insecticide-treaded net use for malaria prevention).

Working with the community we co-designed 40 innovations for tackling HIV prevention, maternal and child health, family planning, malaria and nutrition, prototyped 8 and then refined to 4 after testing.

Using persuasive techniques from advertising we created the Umbrella Campaign, based on what Zambian families see as precious in their lives and using social media to sway ingrained behaviours around reproductive health, contraception and disease prevention.

JAMAICA

In Jamaica we have designed integrated initiatives to increase safe storage of water to minimise the risk of Zika and other mosquito borne diseases.

Our initial research showed many people had little idea about how to prevent Zika, by changing methods for storing water and thereby removing mosquito breeding sites. That has changed.

Our partner, Jamaica’s Health Ministry says: “This was one of the highest quality projects we have seen. What you produced was impressive. You have given us much to work with, not just with the solution but with the methodology used and your approach.”

GUYANA

In Guyana we have created interventions that will improve community access to malaria testing and treatment services in remote regions of the country.

Across all these projects we have facilitated a co-design approach which brings together various agencies and non-government organisations to collaborate in ways that have not been possible previously.

DESIGN FOR LASTING CHANGE

ThinkPlace has helped develop the Breakthrough ACTION Social and Behaviour Change FlowChart. The flowchart incorporates elements of the design thinking process along with methodologies from behavioural economics, community engagement, marketing science and strategic communication for a world-first hybrid approach.

Collaborating in this hybrid way, harnessing the expertise of Breakthrough ACTION consortium partners, allows us to create new methods and maximise impact at scale.

Breakthrough ACTION largely works in locations and communities where human-centred design and co-design are unfamiliar. The project is building new capabilities that will endure.

In-country partnerships are allowing innovations that are created, implemented and scaled. Partnerships are built so that in-country organisations can continue to drive change after current interventions expire.

The processes we have brought to this project are helping to create a systematic but innovative wave of change across numerous countries. While many local differences exist, we are seeing the emergence of an integrated and broadly-applicable methodology that spans national borders and connects on a human level.

Many of the world-first interventions that make up this program have broad potential to be applied elsewhere and scaled up. Breakthrough ACTION will have a direct impact on the lives of real people, but it is also a sandbox for innovation and experimentation.

By deploying a hybrid solution that draws on many methods and approaches we are showing that innovation for impact is not always about new technology. Methods that bring together the right people and put them in position to design and implement change for their own communities can be far more powerful than a fully-technical solution.

Internationally relevant

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Friday, 20 September 2019

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A demand creation model for family planning services

Daniel Silkstone — Tue, 10 Sep 2019 07:52:06 +0000

Work

A demand creation model for family planning services

Service

Experience & Behavioural DesignInclusive Co-design & EngagementResearch & insights

People

Sector

Healthy Societies

Mozambique’s modern contraceptive prevalence rate remains low at 25.3%, with only 14.1% among 15-19 years old.

These are facts that dramatically impact the opportunities and experiences open to girls and young women in this part of Africa.

The unmet need for family planning is further accentuated in rural areas, partially due to the lack of knowledge, as well as strong cultural factors.

ThinkPlace is working with Population Services International in Mozambique, on a project aimed at developing a “demand creation model” to increase uptake of family planning services among adolescent girls aged 10-19 years in rural areas.

THE CHALLENGE

Our task is to build an inclusive and scalable model, which is tailored to respond to the wide-ranging needs and behaviours of adolescent girls, and ultimately results in a 33,650-net increase in current users of family planning. Rather than supply family planning services to an unwelcoming cohort we used behaviour change techniques to try and create demand for such services.

OUR RESPONSE

We began by conducting 3 weeks of immersive research in Gaza and Nampula provinces. Our primary target was adolescent girls age 10-19 years old, and our aim was to understand different profiles of girls including married versus non-married, children versus no children, in school versus out of school, current family planning users versus non-users.

Our secondary target group aimed at getting a better understanding of the influencers in their lives, which included individuals in positions of power (community and religious leaders), partners, parents or caregivers, health service providers and individuals involved in family planning education (community health workers, teachers).

Through this research we gathered insights about our users’ intrinsic motivators and obtained information on a wide range of barriers and enablers within their ecosystem, which included knowledge of influencers in their lives.

These findings revealed gaps in trusted and consistent information around family planning. Sexual and reproductive health (SRH) is a taboo topic, only openly discussed when a girl gets her first menstruation.

In Nampula province in northern Mozambique, this conversation occurs through traditional initiation ceremonies lead by a “madrona” or matriarchal female figure in the community. In Gaza in the south, adolescent girls are taken by their mothers to the health facility to receive information and often family planning methods before fully comprehending the purpose.

If I would have known that my daughter had her first menstruation, I would have taken her directly to the hospital. - Mother of an adolescent girl, Gaza

Mothers and female influencers are considered key role models in a young girl's life; however, when it comes to helping a girl make informed choices about her health and future, mothers lack the confidence and information to navigate difficult conversations with girls.

Mothers expressed an interest in learning ways to engage with their daughters, and daughters shared a need for approval or consent from their mothers in order to uptake new services. Additionally, peers serve a source of influence in a young girl's life, but adolescents hold a set of ‘truths’ about SRH and FP methods that are plagued with myths and misconceptions based on rumours leading many girls to make misinformed choices.

I started having sex because my friends told me I was missing out, so I tried it and I liked it. Adolescent girl, Nampula

It became clear through our conversations with girls around sex and interactions with the health facility that girls wanted to feel informed and confident in making decisions about their health and their bodies, but most information they trust lacked technical accuracy.

We discovered that while the strength of cultural beliefs varies by region, fertility remains an important aspect, promoting a young women’s status within her family circle and community.

In both areas, girls highlighted having children as their primary goal. Once a woman has her first child, she has proven her fertility and worth in a community. Therefore, messaging aimed at young girls with no children using the term “family planning” does not resonate with our target group, and aspirational messaging pertaining to the future and beyond family does not resonate because children are considered to be every girl's future.

Family planning is mostly seen as an option for married women who already had their first child.

I don’t have any children, so I don’t want to take FP. (Adolescent girl, Nampula)

HOW WE DID IT

Once we identified emerging themes and uncovered insights, we entered the ideation phase where we built upon the insights to form potential interventions to address the needs and desires of our user. These ideas were then further developed into prototypes for multiple rounds of user testing and iterations in Nampula and Gaza province.

Our prototypes focused on the following areas

Providing private and confidential spaces where girls can access youth friendly information and services,
Improving parental consent and engagement in discussions with adolescent girls around SRH and FP, and
Leveraging peer influence to disseminate accurate information and inspire positive behaviour.

We achieved the first objective through mobile events, which took girls on a journey through sessions teaching them entrepreneurial skills, life planning and then an interactive health session highlighting the link between their dreams and the choices they make.

THE IMPACT

All sessions led to a private opt-out counselling session with an on-site nurse. In the last design sprint during medium fidelity prototyping we reached a total of 396 adolescent girls in rural Mozambique, of which 43% of the eligible girls (211 who had had their first menstruation) went for family planning services on the same day as the events.

We discovered the success of such events in these rural communities relied heavily on parental buy-in meetings held one week before and mobilization through existing trusted networks in the community.

We also tested two other interventions during medium fidelity prototyping. The first of these was the +Mãe kit. This kit is a tool designed to give mothers and female influencers the training and information they need to initiate conversations with their adolescent daughters (included a bag or purse with condoms, information brochure for mothers and daughters and a calendar for girls to track their next method use).

The second of these prototypes was testimonial videos featuring characters who represent different girls in their communities talking about the decision-making process they followed to uptake family planning methods.

We discovered all of these prototypes can complement each other by either creating pre-awareness amongst peers/parents and/or a referral system to other ongoing activities such as events in the communities.

The next steps include handing over this set of demand creation interventions and tools to be integrated into the existing service delivery system and piloted across Mozambique.

Internationally relevant

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Expiry

Tuesday, 17 September 2019

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Redesigning a critical interface with citizens

Daniel Silkstone — Tue, 10 Sep 2019 03:57:05 +0000

Work

Redesigning a critical interface with citizens

Service

DigitalInclusive Co-design & EngagementResearch & insights

People

Sector

Strong Economies

A year can be a long time when it comes to digital. A decade is more like an eternity.

So when a website becomes outdated and is no longer fit-for-purpose, the ripples of impact can spread throughout an entire organisation.

Such was the case at the Department of Finance, a critical part of Australia’s government interface with citizens that had not redeveloped its website in ten years.

Perhaps unsurprisingly, the website was considered cumbersome to navigate and content difficult to find. And that meant staff spent valuable time responding to a high volume of support calls for low value tasks that an otherwise highly functional website would support.

Users would rather have dealt with their queries in a faster, more efficient manner. And staff would rather have had more time for complex requests that could not be dealt with easily by a website. There was a clear and demonstrated need for change.

THE CHALLENGE

Finance’s corporate website had last been redeveloped in 2008. Changes to the department’s functions, as well as ongoing content changes had led to the information architecture degrading since that time.

There wasn't a clear and supported guide for how content created and published, which had resulted in the current website being outdated and laden with poorly-targeted content.

The client had a strong internal desire to shift towards a self-serve model that reduced the demand for low value support to higher valued support.

The department was evaluating how it operates and supports the APS - and hoped that the website would play a pivotal role as a communications channel to signal the positive shift to the APS. There was also a strong push to align the future website with the next release of GovCMS.

OUR RESPONSE

ThinkPlace conducted a series of stakeholder engagement sessions to identify the goals and expectations of internal and external users of the Finance website through interviews, focus groups, workshops and contextual enquiry research.

Our design team took an agile-sprint based approach with weekly sprints involving development, usability testing, synthesis, showcase and retros with the clients and partner teams.

HOW WE DID IT

ThinkPlace began by conducting a Discovery workshop with about 30 external and internal stakeholders to understand the research insights, and identified and prioritised a set of design challenges and ideas.

Based on the insights gained through the research, we developed personas to understand the different profiles of users. These artefacts created a robust evidence base that was used to generate Information Architecture, navigation and content concepts.

The high value concepts were developed into paper prototypes and eventually HTML prototypes that were tested with about 28 internal and external stakeholders in a series of weekly usability testing sessions.

Information Architecture was tested through online tree-jacking tests that involved nearly 90 people. Content Guide Focus Groups were conducted with 20 content writers across Finance to build a content strategy and guide for users.

The whole report is great and has all the information we requested. I’ve already used it to have some high-level discussions with other business areas and they are all impressed with the direction we’ve plotted and the features we’ve been exploring. (client)

THE IMPACT

This project delivered a design that was evidence-based and which demonstrably improved usability and functionality of the website https://www.finance.gov.au/. A compelling co-designed content strategy was created to guide development work for the next phase.

The client and their stakeholders were impressed with the features we explored and the direction that we took the website in.

Internationally relevant

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Expiry

Saturday, 30 November 2019

Position

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