“It’s all about increasing coverage and sustaining the certificate of polio, and measles and rubella control. This achievement is inspirational..."
- On WhatsApp, an EPI (Expanded Programme on Immunization) manager from Southeast Asia describes her daily motivation, with 10 EPI managers from six time zones. These EPI managers – from Central and South America, the Middle East, sub-Saharan Africa and the Caucasus – discuss their shared motivation of working with dedicated teams in difficult conditions to improve the public health of their countries.
In late May of 2018, the Bill & Melinda Gates Foundation presented Gobee Group with a challenge to support immunization managers in effective decision making in the field. Gobee is a social innovation design consultancy based in California. Core to their process, the Gobee team set out to use human-centered design (HCD) to begin to characterize and understand the current decision-making process of global immunization managers. HCD is a collaborative problem-solving approach that provides creative methods for deeply understanding human behavior to develop new ideas and solutions directly for and with the intended user. Ethnographic study to build empathy for the context of users is core to the design of solutions in HCD.
The Challenge: “How might we support immunization managers to make better decisions, leading to more effective and efficient national immunization systems?”
Gobee partnered with Boost (formerly the IAIM Network), a program of the Sabin Vaccine Institute, to create a WhatsApp focus group of global immunization managers to augment additional field research in Guinea, Ethiopia and Columbia. Boost provides online and offline opportunities for immunization professionals to connect, learn and lead. Boost connected Gobee to its diverse network of global immunization professionals to participate in the study.
WhatsApp is a mobile and web chat platform that the Gobee team found was already commonly used by global immunization managers. While WhatsApp is not typically used for ethnographic studies, this simple technology allowed the team to solve for many of the challenges faced in designing appropriate research tools to reach a diverse audience. Global immunization managers operate in many different time zones and are constantly pressed for time with heavy workloads managing immunization events and supply chains. WhatsApp mitigated these challenges by providing a remote, asynchronous platform to gather information. The virtual platform allowed for a rapid ethnographic medium for managers to respond to questions at work and from home. Those with challenges writing in English as a second or third language had time to craft a thoughtful and honest response to each question. Participants could step back from the conversation when needed and re-engage as their availability fluctuated. The platform allowed Gobee to build a collaborative conversation between immunization managers across the globe to observe similarities and differences in their roles specific to their locations.
To start off each day, a Gobee facilitator posed a new question to the group. Participants responded to the question at their convenience, and had the ability to comment on the responses of others. This information-gathering method solved for the challenges of time and resources to build an inclusive, flexible conversation across roles and regions. The conversation started with introductions, including a “selfie,” then alternated between questions about daily work and lifestyle questions around family, weekend plans, and inspiration. The “selfies” and personal questions built community between the participants by humanizing the digital conversation. Gobee asked a new question daily for only 10 days to manage the time demand on the participants. To honor each participant for the time and energy they invested, Gobee presented a certificate of recognition to each participant.
What We Learned
Gobee’s experience leading the focus group demonstrated how new methods of human centered-design research can be used for solving problems, and these methods can be iterated upon. Gobee and Boost observed the WhatsApp focus group participants take ownership of the platform by using it as a resource to ask other managers questions unrelated to the focus group. For example, side conversations on the role of regional surveillance, introduction of the HPV (human papillomavirus) vaccine, and challenges with motivation sprung up between participants. Highly engaged “super users” organically emerged in the conversations. Further testing the research design might leverage these super users to incentivize more participation across the rest of the group. The organic conversations demonstrated an appetite for cross-cultural learning, connection building and information sharing between global immunization professionals, all needs that Sabin seeks to address through Boost. The ability to observe interactions of cross-cultural learning and information sharing is a positive byproduct that traditional ethnographic design research could not provide.
Participant feedback provided valuable lessons on the research design to iterate on future versions of participatory, asynchronous research. A common theme in the feedback provided at the end of the focus group was a request for more time to respond to questions and longer-lasting engagement with the group. As one participant stated, “Immunization Managers are very busy and they usually are very overloaded ... To manage their participation in the active discussion, they need more time.” Future iterations of these remote discussions might dive into certain cross-sections of immunization professionals within specific regions, levels or roles, to gain richer information within a subset of EPI program workers. To facilitate easier conversation for those who have difficulty writing in English, participants recommended the ability to send voice or video messages to each other. While WhatsApp allows voice memo sharing, certain mobile technologies like the Marco Polo application are leveraging the ability to share video conversations.
One important result of this experience is that these lessons around facilitating organic conversations for community building and learning will be incorporated into the new platform. In the coming months, the new Boost platform will continue facilitating organic connections with longer engagement between peers. The platform provides opportunities for collective learning through the sharing of best practices, success stories and curated content.
Caroline Gezon is a dual MBA/MPH student at UC Berkeley. She spent four years consulting in global health delivery with Monitor Deloitte before coming to graduate school and joining Gobee Group as a Summer 2019 Fellow.