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Work
Increasing Accessibility of Maternal Health Information for Kenyan Mothers
Project Summary
PROBLEM
Expectant mothers in Kenya currently underutilize a text-based application that provides them with pregnancy health information, even though using this resource has been shown to result in healthier outcomes.
GOAL
Design a  system using telecommunication technology that will increase engagement with maternal health information.
RESULT
My research found the lack of engagement using the text-based application was due to  negative perceptions of the Kenyan maternal healthcare system. This gave rise to a lack of trust because of limited access, privacy concerns, and lack of respect from care providers. I addressed this medical hesitancy by designing a voice user interface service that featured birth stories, frequently asked questions, and regular nurse-patient condition updates.
ROLE
Lead Experience Designer, User Researcher, Communications,
Graphic Designer
DELIVERABLES
Research Report, Design Proposal, Project Poster.
TIMELINE
January 2022 — June 2022
TEAM
Microsoft Global Health Access, Microsoft Africa Research Institute, Amen Aiwekhoe, Adoniah Carmeline, Drew Nevins
Process
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Initial Research
We started this project with no access to users, the existing text-based application, or any user data. Also, we operated under the assumption that the existing application worked perfectly and any issues with it were cultural. In addition, we used secondary research methods, as well as subject matter expert interviews and academic literature, to conduct our research.
"Preventative care is not a concept believed to be important. On less than ten dollars per day and barely scraping by, preventative care is only if it affects your life. It costs opportunity and travel to care." -Microsoft Health
Three Delay Model
The three delay model shows that the goal of the application is to persuade the mother to seek medical care.
Patient Activation Measure
The patient activation measure is a measure of engagement and consists of 4 elements as shown below. In practice, text messaging has not allowed expectant mothers to habitually use it as a form of healthcare information. Also, mothers in Kenya do not have confidence in  the application because they do not primarily rely on using skilled birth attendants, which is what the application advocates.
Research Synthesis -Journey Mapping
Journey mapping was used to combine the different research findings from across the team. This method emphasized that Kenyan women culturally do not reveal much about their pregnancy, traditional birth attendants are a preferred homeopathic alternative, and delivery sites are often different facilities from their antenatal care check-ups.
Ideation - Storyboarding
Giving the patient a voice was integral to the concept of patient-centered care and was a core aspect of increasing one's patient activation measure. I created the following storyboards as an idea of how the system should be used.
Ideation - User Flow
Browsing behaviors were a perceived benefit of a voice user system compared to its text-based counterpart. Therefore, features were conceived to allow the mother to interact with the system even when they have no questions in mind.

Eric: With browsing behaviors in mind, as well as the contrast of a voice user system to its text-based counterpart, we developed more accessible features to allow the mother to interact with the system even when they had no specific health-based questions in mind. This, in turn, would allow them to learn more about healthier lifestyle practices before and after pregnancy.
Prototyping - Role playing Conversation
To understand the conversational user interface, I asked my team to role-play what it would be like to be a mother who uses the app and the voice response. This method revealed questions such as: how do we know if the mom is picking up the phone, how long until the mom gets a response, and how should the mom receive an answer to a previously asked question.
Ideation & Prototyping - Co-Creation Session
I moderated a remote, co-design session with Kenyan mothers to identify how they approach pregnancy related information and the viability of voice user interface. The responses are blurred for privacy reasons..
"Is it a human or a robot? I would like a robot so other people don't hear about my problems."‍-Kenyan Mother
Prototyping -
Voiceflow
I built a chatbot in Voiceflow but was considered ineffective without using the medical content currently used by the text-based application.
Final Deliverables
Primary User Persona
A persona was created from interviewing people who work in public health in Sub-Saharan Africa and a literature review of health seeking behaviors among Kenyan women. I used the persona to synthesize research findings and understand the needs of the Kenyan women. It summarizes patterns that we viewed through our research methods.

Many mothers had a negative perception of public health clinics, despite maternal health care being a free service in Kenya. There are prevalent rumors of lack of privacy, overcrowding, and insensitive providers. Additionally, it is often difficult for mothers to share their own symptoms during pregnancy as there is a slight risk of being blamed for any issues by their community. It's important to note that mothers are very passionate about their baby's health. But many believe that other resources, such as homeopaths, are more reliable and convenient resources.
The Voice User Interface
Text-based platforms cannot be a stand alone solution as they lack engagement and privacy (especially in a social context where many families share phones). However, the biggest threat to a text-based system that promotes maternal health occurs when a mom believes that the she doesn't want to go to the medical provider.  There are no safeguards to let the mom know that anti-hospital sentiments are valid while emphasizing that despite rumors, delivering with a skilled birth attendant will decrease risk of maternal mortality by 50%.
‍
I designed the integration of a voice user interface to transmit pregnancy-information while targeting medical hesitancy. Giving the system a voice allows the mother to build trust with formal medical care. Additional features help in making the health information more actionable and provide opportunities to explore information.
Ecosystem Map
The ecosystem map describes how to build the interactive voice response system, the goals of each function, and how it interacts with the existing text-based texting system. The implementation is left broad to allow for flexibility with the existing system.
Service Blueprint
Despite, maternal health care being a free service in Kenya, it is a widely underutilized resource. Interviews with stakeholders and academic research  revealed a negative connotation associated with the public health clinics. I designed the integration of a voice user interface to help transmit maternal health information for Kenyan mothers.
References‍

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