Design Research for Global Health

Dry gin, wet soap & focus groups

A couple weeks ago a friend invited us to help her with a take-home activity she was assigned in advance of a focus group that she was doing for some extra cash. A UK-based firm had been contracted by a company that makes one of the products pictured above to understand how they might reposition the product. [Hint: not the one that is useful for combating ring-around-the collar.] This photograph was my main contribution to the activity since the one reminded me of the other.

As design researchers we constantly focus on empathy, but during this exercise I began to wonder how much we really empathize with the customer/user/client in their role as study participant. During the hour on the roof, there was quite a bit of rich interaction and discussion about the product - some positive, some negative, some tangential, but probably all useful. Our friend had been given a thick packet of questions to guide us through the activity - she was supposed to write answers to the questions by hand and was "free" to take photographs. More than one person mentioned that the questions seemed repetitive. It seems much of that rich social interaction was lost in the process of burdensome transcription, in part because of the quantity and quality of the questions. How much would that hour with us (live or by video or audio recording) have been worth to the client?

I talked to that friend again yesterday about the focus group itself. The research firm used it as an opportunity to test out new product concepts. At one point they brought a bottle of something green and she said, in reference to the above photograph: "My friend doesn't want to drink anything that looks like dish soap". The bottle was quickly whisked away. Another one of her observations: the focus group - like other focus groups she has participated in previously - was dominated by 1-2 people. An observation that suggests we should be more careful about how we use focus groups. It would be unfair to generalize about focus groups based on this sample, but it does suggest that we need to ensure that we appreciate the importance of good facilitation.

The Global Downturn Lands With a Zud on Mongolia's Nomads (WSJ)

The Global Downturn Lands With a Zud on Mongolia's Nomads, from the Wall Street Journal (thanks Sara for the pointer). The story is about herders defaulting on loans due to decreased demand for cashmere in the midst of the global economic crisis. The title is a reference to "financial zud", a rather stark metaphor that compares the current situation to an extremely harsh winter in which many livestock die: zud on Wikipedia, the 1999/2000 zud as covered by BBC. The article focuses on the story of an individual herder in Tsogt sum in Govi Altai who has lost his animals to the bank. The piece includes a video (embedded below) and a photo slideshow - much more coverage than Mongolia typically gets. The photo above is from the slideshow and shows a bagiin emch at work. Given my interest in bagiin emch, this is notable - certainly the first time a bagiin emch has gotten his or her photo in the Journal. To see the full version of the above, see photo 7 in the slideshow (some excellent images in this set). For even more, see the photographer Josh Chin's Mongolia set on Flickr.

More research on bagiin emch (from HSUM Mongolia)

An MPH student from the Health Sciences of University of Mongolia recently contacted me on the recommendation of one of her faculty from the Department of Social Sciences. The reason? She was doing research on bagiin emch - aka bag feldshers - and I was one of the few people who had done any research on this group. Exciting stuff for me. With Khostuya's permission, I am posting the English language abstract of her Master's thesis here, along with keywords in English and Mongolian:

WORKLOAD AND JOB SATISFACTION OF BAG FELDSHERS

B.Khostuya, Kh.Damdinjav
School of Public Health, HSUM (Mongolia)

Purpose: 
To determine the workload and job satisfaction of Mongolian bag feldshers (bagiin baga emch), to summarize the results, and to develop recommendations for improvement.

Methods:
The study involved in total 88 bag feldshers (2 soums from all 21 provinces for a total of 42 soums; 3 bag feldshers from 4 of these soums and 2 bag feldshers from the remaining 38). We conducted the research using both quantitative and qualitative methods. Collected data were analyzed using SPSS 12.0. We registered working hours and activity by direct observation. Upon analysis, we clarified basic and additional work structure through document analysis and interviews.

Conclusions: 
The workload of bag feldshers varies by season, week, and day.  It is not possible to determine their workload and job satisfaction using timing methods. Medical services are limited because 40.9% of bag feldshers involved in our study live at the soum center. The workload of those bag feldshers living at the soum center is less than those living in the countryside. Although bag feldshers tend to be satisfied with their job, there are persistent issues with support for social services.

Keywords: Bagiin baga emch, work conditions, workload, satisfaction, working environment

Түлхүүр үг: Багийн бага эмч, ажлын нөхцөл, ажлын ачаалал, сэтгэл ханамж, ажиллах орчин

Dissertation talk on 21-Apr

I'll be giving my dissertation talk tomorrow in Berkeley:

Title: Serial Hanging Out in Mongolia: Information, Design & Global Health

Speaker: Jaspal S. Sandhu, University of California, Berkeley

Adviser: Professor Alice M. Agogino

Date: Tuesday, April 21, 2009

Time: 12:00-1:00PM

Location: Berkeley Institute of Design (BiD), 360 Hearst Memorial Mining 

Building (directions)

ABSTRACT

Many global health disparities persist not from a lack of technical solutions, but from an inability to effectively implement existing measures. While financing and human resources are critical concerns, so too is the need to better understand and adapt to the people who execute and benefit from these solutions. There is a significant opportunity here for applied ethnographic methods from design (design research) to examine the norms, knowledge, and needs of these individuals and groups. Despite interest in such an approach by organizations such as PATH, The World Bank, and the Bill and Melinda Gates Foundation, we still have a limited understanding of design research methods in the context of global health and development.

This dissertation aims to improve our understanding of these methods. It is a case study of a design research project examining the information management practices of “bagiin emch”, nomadic health workers in rural Mongolia. The design research was conducted between June 2006 and August 2008 in Mongolia in cooperation with the Ministry of Health and the Asian Development Bank’s Second Health Sector Development Program (HSDP-2). Although study participants included bagiin emch who received handheld computers from HSDP-2, the emphasis of this research was not on technology, but on innovation - the development and adoption of new information management solutions.

The primary field method was serial hanging out: multi-day, design-oriented participant observation. Serial hanging out is a novel approach to design research well suited to global health, so the contextual examination of the method is a primary contribution of this dissertation. The dissertation also operationalizes theoretical saturation for participant observation, providing empirically-based guidance for sample sizes, as had only been done for semi-structured interviews (reproductive health research) and focus groups (market research) prior to this study. This dissertation demonstrates how these methods achieve a richer understanding of people and phenomena, and how that is relevant to improving population health. At the same time, the dissertation explores how to use these methods most effectively, including an examination of design research capacity-building.

Korean tacos and Twitter

Relevance to the theme of the blog? An innovative model of using new media to motivate the masses. Might sound like a stretch, but Dr. V from Aravind often talked about emulating the McDonald's model and when I was at Kaiser's Innovation Center last month, they discussed how they visited In-N-Out to learn from their operations model. 

More from the LA Times on Kogi. (And Yelp.)

Photos below from last week in Venice: