An insider's look at the content development and service design for a mobile-based health communication initiative.

1. An insider’s look at
Content Development
& Service Design
for a Mobile-based
Health Communication Initiative
Aponjon
MAMA Bangladesh

2. Let’s see some statistics

3. Everyday, 1,000
women die
in child birth
or in pregnancy
2 out of 5
Children die
During the First Month
of their Life

4. Children Die
From Preventable Causes
Under the Age of 5
29,000
Everyday
21Each Minute
*315 children will die by the time I finish this presentation

5. On the other hand,

6. 3 out of 4 People
Have access to
Mobile Phones

7. 1 Billion Women
in low & middle
income countries own
Mobile Phones

8. On May 3, 2011
Hillary Clinton
Former Secretary of State
Inaugurated MAMA

9. MAMA sends
pregnant women
& new mothers
behavior change
messages via
mobile phone

11. The service was
rebranded as
Aponjon In Bangla it means
Trusted Friend

12. Customization
of this service
for women in
Bangladesh

13. 45%
Women in
Bangladesh
Can’t Read Voice Message
In Local 6 Dialects

14. Let’s listen to
some messages

15. What
voice/style
Women Trust?
A Lady Doctor
Little bit of everything…
Authoritative,
Dramatized, Suggestional

16. A Lady Doctor
Women seek
information from the
most learned person
(in this case a Doctor)
women feel shy with a
male doctor
women like stories
they can relate to
Though this is one way
communication, Aponjon is allowing
for ecological impacts like media and
cultural context as Street (2003)
suggested.
Homophily
Credibility
Evaluation of
health information
Likelihood to
act on advice
They also tried to create the sense of
homophily as suggested by Wang et
al (2008), to increase likelihood of
acting on advice

17. Different Areas
have
Different Vegetables
Different Climate
Messages
suggesting
Food & Clothes
were Localized

18. As Freeman (2000) points out with the example of
the different understanding of the word "Control"
(Metabolic, compliance, & situational) between
provider-patient, it is important to have an
understanding of shared meaning of the messages. If
the content directs a mother to a specific food or
clothing item, which is not available or is called by a
different name in her area the purpose of the
communication fails.
Also, as Airhihenbuwa & Liburd (2006) pointed out
with example of lack of proper healthy food sources
for African-American communities, it is important to
identify localized nutrition sources in locally
produced vegetables
Understanding
Local context &
establishing
shared meaning

19. Households have
mobile phones
Women Don’t
Message for
Gate Keepers
Husband/Mother-in-law
Flexible Timing

20. It is important to
understand the
power dynamics and
level of access
a women has in
Bangladesh
Husbands & Mother-
in-laws influence
decision making
The gate keepers can contribute towards
non-adherence to the messages if they
felt the information is not trustworthy,
Peek et al (2008) observed similar
phenomenon with African American
Women.
Aponjon took the shared decision making
concept of patient-provider
communication (Charles et al, 1997) and
tried using it between the authoritative
gate-keepers and the mothers. They
provided messages both parties so they
can act towards a common goal.

21. women from
conservative families
or hard to reach areas
Don’t Know
about the
Service
Registration
through
Info-Ladies

22. Registering is
difficult
for most women who
are technologically
challenged
2 ways of
Registration
Info-Ladies &
24/7 Call Centers

23. Peer Advocates and
Cultural Humility is key
to recognition of
benefits of the service
& registration
As Golden & Matsaganis (2013)
found true with low income African
American women, recruiting
residents to become peer advocates
work as catalysts. Aponjon recruits
village women and train them to
become "InfoLady“
For the call centers also, Aponjon
recruited educated urban slum/ village
girls. This resonates with Perloff et al’s
(2006) finding that taking a person from
another background and training them in
cultural competence might not result into
cultural humility

24. A large portion
of our target are below
poverty line*
28% in Urban
36%in Rural
can they
afford the service?
Free Service for
extreme poor
disabled
marginalized
Reduced Price for
women headed house
special circumstances
*Earning Below USD 1.25 Per Day

25. Recognizing Need
&
Patient Health
Navigation
Infoladies help women to get
registered and also enable them to
access subsidized care if the family
qualifies for subsidy
Infoladies work as navigators (Cohen et
al (2013) by being bridge between
resources, considering cultural
understandings, and aiding in partner
control tactics. Being from the same
community they are sensitive to their
patients’ spiritual sensitivities.

26. 1.3 million*women subscribe
to the service
today,
*That’s 1.5 times the population of San Francisco

27. Questions?