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Sahyogini, first report

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  • 1. SAHYOGINI Interaction Design Project Guide: Asst. Prof. Sharmistha Banerjee Utkarsh Mishra | Vikas Goel | Poorvi Vijay | Shambhavi Deshpande
  • 2. INTRODUCTION
  • 3. Initial Brainstorming Initially, we sat down around a table, with white board, post-its, markers and sketch pens in hand. We gave ourselves 5 minutes, in which each member had to think individually and bring as many ideas as possible. After 5 minutes, all the ideas were discussed. Some were rejected and some were shortlisted. This process was repeated several times until the team had a pool of ideas, decent in quantity and quality.
  • 4. Initial Ideas After going through the series of brainstorming sessions over 3-4 days, we finally came up with the following ideas: - To enhance the learning experience of school going kids (in the school environment) of 3-8 years - To motivate kids to move out of the digital environment and interact with the physical surroundings (7-12 years) - To aid and simplify the learning and communication (so that it becomes easy for them to express their ideas) for deaf and dumb
  • 5. Narrowing down After analyzing all the topics that were shortlisted, team realized that it wants to do something for the society they live in (as a moral responsibility). We wanted to do something for the people of Rural Assam. And we even realized that there are some keypoints which should be taken into consideration while choosing the topic for the semester project. They were: - Easily available users - Problem oriented / Need based - Field trips should be possible After going through all these points, we narrowed down to the topic on which we wanted to work on.
  • 6. project brief The team decided to work on the following topic: “ To make Adolescent girls (11-18yrs) aware of health and hygiene (physical, psychological and hormonal) related issues during puberty. ”
  • 7. literature study
  • 8. brief To understand the situation of adolescent girls and their problems, we went on to study a series of research papers, newspaper articles, medical blogs (by medical companies and hospitals) and government schemes like Kishori Shakti Yojana. After getting some idea, we studied the problems of adolescents of North-East, especially in Assam. However, there was not much documentation on this problem for this part of the country. Hence, to get the exact view, we decided to go for the field trips to the villages of Assam located near to IIT Guwahati. We met with one of the maids of Subansiri named Moon, and talked to her about the problem. By talking to her, we got to know about the health system existing into the villages. Going deep into the conversation, we came to know about the Primary Health Centre established in the North Guwahati Block under National Rural Health Mission (NRHM). We already came across NRHM under our literature study, but we decided to validate the facts that we came across during the Literature Study.
  • 9. Fig 1. Times of India report on the problem pertaining to the adolescents in the society (urban)
  • 10. Fig 2. Report on the ‘Needs and Problems of Adolescent Girls in India’
  • 11. Fig 3. Research Paper - A study on the ‘Prevalance of Anaemia’ in 16 districts of India
  • 12. Fig 4. Research on how the women and adolescent girls could be empowered in developing countries like India
  • 13. Fig 5. A study on the nutritional aspect of the adolescents, specific to the culture of Assam in the Dibrugarh District
  • 14. Fig 6. Research paper on the behaviour of adolescent girls of rural areas to know about their health problems
  • 15. Fig 6. Research paper on the behaviour of adolescent girls of rural areas to know about their health problems
  • 16. Fig 7. Article on Adolescence and its problmes
  • 17. Fir 8. Letter by Governement of India to formally issue the Rajiv Gandhi Scheme for the empowerment of the Adolescent Girls
  • 18. Fig 9. Article on the adolescent girls, their problems and the stats related to it
  • 19. Fig 10. Research on the attitude of parents towards the adolescent girls and their attitude
  • 20. Fig 11. Guidelines by MHRD for the implementation of Adolescent Girls’ Scheme
  • 21. USER RESEARCH
  • 22. brief After the literature study, we realized that there was not much documentation on the problems of Adolescent Girls in this part of the country (North-East). Hence, to get the exact view, we decided to go for the field trips to the villages of Assam located near to IIT Guwahati. We met with one of the maids of Subansiri named Moon, and talked to her about the problem. By talking to her, we got to know about the health system existing into the villages. Going deep into the conversation, we came to know about the Primary Health Centre established in the North Guwahati Block under National Rural Health Mission (NRHM). We already came across NRHM under our literature study, but we decided to validate the facts that we came across through field trips.
  • 23. VISIT TO PHC
  • 24. INFERENCE After the first field trip, we got to know about the structure setup under National Rural Health Mission. We were told that the system is self-sufficient and efficient. However, in order to cross check the facts presented to us by PHC, we planned our second field trip to a subcentre located in Mauryapatti. Primary Health Centre Sub-centres (Auxiliary Nurse Midwives) ASHA Local Community (Pregnant women, Adolescent Girls, Child etc.)
  • 25. VISIT TO sub-centre
  • 26. INFERENCE This field trip made us understand the importance of ASHA (Accredited Social Health Activist). She plays a major role in the hierarchy and most of the work is done by her. She acts as a link betwen the local community and the health providers. Thus, our third field trip was aimed to meet an ASHA worker and understand the system through her point of view.
  • 27. VISIT TO ASHA
  • 28. INFERENCE ASHA (Accredited Social Health Activist) is the most important part of the system. She is a lady who acts as a link between the local community and the health service providers (PHCs, Auxiliary Nurse midwives, hospitals etc.) Her roles and responsibilities include: to take care of pregnant women, adolescent girls, the village community, to make the village health plan, to create awareness of HIV/AIDS, communicable diseases etc. She is a single person in the system who has to perform all these tasks and at the same time prepare all the paperwork for documentation. More appalling is, that ASHA isn’t trained well, as the training programs run only for 20-25 days. ASHA is a part of the community, and everyone in the locality has deep faith in her. People often listen to ASHA over the doctors and what other people say. If ASHA is trained well, then she could easily and effectively transmit the correct information to our target audience of pregnant women.
  • 29. solution
  • 30. problem redefined In the hierarchy set up under the NRHM, ASHA plays a very significant role. People tend to agree and follow to what ASHA say. She has various roles and responsibilities. She is supposed to know about : • Basic health and Hygiene • Basic Sanitation • Nutrition and importance of healthy diet • Pregnant Women: Counseling, Birth preparedness, Tests like Prenatal Screening test, antenatal and post-natal care etc. • Adolescent Girls: Counseling, Awareness about puberty and physical changes in her body etc. • Communicable diseases and how to prevent them • Developing Village Health Plan • Constructing of househeld toilets • Care of new born and management of a range of common ailments • Inform Births, deaths and unusual health problem or disease out break These are a few of many things she should know. However, in reality she hardly knows anything. To get to the root of this problem, the team conducted several field trips in the villages of Assam and surveyed many ASHAs. The ASHAs were found to be enthusiastc about their work, but they were never trained properly. They were not given systematic information through trained personnel. They generally gain their knowledge through experience, and then transfer it to their successors. Their training program runs for about 2-3 weeks, and in some states it stretches to 6 months. The way the ASHA is trained is very unsystematic and not uniform. However, through various interviews of ASHA that were conducted by the team, it was evident that if ASHAs are given proper training, then most of them would be able to transfer the knowledge to the adolescent girls and other people in the community, as they are high on enthusiasm. A solution directly affecting the adolescent girls was not possible as girls were too shy to adapt to new things to teach them about their body. However they shared a good equation with ASHA workers. So, if we train ASHA workers, then they in turn could benefit the adolescent girls and other people of their community by transferring the knowledge imparted to them during Training. Hence, we decided to work on the training of ASHA members, so that all sections of the society could be helped.
  • 31. PERSONA Sonamati Sarkar is an ASHA member from Kating Pahad area in Assam. Her home is far off from the village so she has to walk a lot everyday in order to attend to the pregnant ladies in the village. She imparts all the knowledge she has to the pregnant women and adoloscent girls of the community. ROLE AT HOME Take care of kids and family. Keep a note of hygiene and sanitation of the house. Educate the family to grow better. DEMOGRAPHICS Sonamati Sarkar 6th Standard 34 years Married INCOME No fixed salary. Awarded as Rs.300 after every trimester, if she takes care of the lady properly. If every pregnant women has an institutional delivery in her village, she is awarded as Rs.8000 at the end of the year. RESPONSIBILITIES AS ASHA Provide quality care to the pregnant lady during antenatal, intranatal and postpartum period. Counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization etc. Mobilise the community and facilitate them in accessing health and health related services available at the Anganwadi/sub-centre/primary health centers. Provide health services for children by anganwadi workers and Primary Health Centre (PHC) staff, include regular health check-ups, recording of weight, immunization, management of malnutrition, treatment of diarrhoea, de-worming and distribution of simple medicines etc. Help AWW to complete and update village health register.
  • 32. existing solution Under the National Rural Health Mission (NRHM), ASHAs in different states are trained differently. Training is done through programs, in the form of classroom education. They include workshops, training courses, scientific meetings, seminars, symposia, and so on. In some states, two to three level hierarchy has been setup to train ASHAs. For eg. In Uttar Pradesh, ASHA is first trained by block level trainers. These trainers are further trained by district level trainers who get their information from the state level trainers. (http://www.upnrhm.gov.in/achievements-asha.php) This kind of system wastes a lot of time, and the human resource as well. In some other states, the state government has tied up with certain institutions / organizations, and has given them the responsibility to train the ASHAs. For eg, the Maharashtra Government has tied up with an organization named ‘Sathi’ which trains the ASHAs by calling them together at one place, similar to classroom learning. National Institute of Health and Family welfare (NIHFW) also collaborates with some state governments to help them in training of ASHA. In states like Tripura, there is no particular organization which gives proper and systematic training to ASHAs. They have to depend on Medical colleges, State and District hospitals to train their ASHAs.
  • 33. existing solution The material given to ASHAs while training is in the form of handbooks, print material, documents, pamphlets, brochures etc. Eg. For Anemia, she is provided one handbook (http://nr h m . g o v. i n / i m a g e s / p d f / p r o g r a m m e s / w i f s / g u i d e lines/technical_handbook_on_anaemia.pdf ) , whereas for tests of pregnant women, she is provided another material. And this scenario is also not fixed. It differs in different states. This implies that ASHA is provided with piles of handbooks and documents, which she doesn’t even like to refer and hence, she doesn’t get the full knowledge about her responsibilities. Thus, the training program could be enhanced or replaced so that the information to ASHA flows in a systematic, uniform and logical manner. This would decrease her cognitive load, and will help her in understanding her actual role in the soci ety.
  • 34. proposed solution After analyzing the whole system, the team came to the conclusion to work on the training of ASHAs. The team proposes a simple-to-use, low cost device that would be used by ASHA workers for their training. With the help of interactive videos / animations / graphics, ASHA would be trained by going through all the possible scenarios in virtual reality. The device is made in such a way, that it easily fits into the hand of any normal women, and is easy to carry. ASHA will carry the device with her, and through these interactive tutorials, she would eventually learn what her roles and responsibilities demand. A ‘virtual ASHA’ would be present on-screen of the device, and she would guide the ASHA (to-be trained) by making her visit in all the possible scenarios / situations. This would be interactive, and the flow of tutorial will depends on the way the ASHA responds to the questions asked by the virtual ASHA. The training device would become obsolete once it trains the ASHA well. To get away with this, few features have been added so that the device would assist ASHA in explaining things to people like pregnant women even when her training is complete. This will increase the longevity of device in terms of usage. Virtual ASHA guiding through the tutorial Details of the product The device has following features: • • • • Foldable like laptops 8-inch big screen Big buttons – Each one for a specific function A carry case similar to a purse, so that ASHA could carry the device with ease, and feel personalized with it.
  • 35. proposed solution For the easy understanding, systematic and logical flow of the knowledge – all the information to ASHA will be accessed through buttons. The keyboard of the device is segregated into three parts – ‘During Training’ and ‘Post training’, and ‘General keys’. There are five keys each in ‘During Training’ and ‘Post Training’ parts, each for the following modules: • • • • • Pregnant women Adolescent Girls Children Family Planning and Sex Education Basic health, hygiene and sanitation Each module contains the information and the tutorials related to them. So, in this way the whole information is categorized and logically provided. All the tutorials related to pregnant women will be accessible, as soon as the ASHA presses that button. When the device will be handed to ASHA, the ‘Post Training keys’ would be covered with a lid and screwed. ASHA will not have access to them. It is done to reduce the cognitive load. Low - fidelity mockup of the device
  • 36. PROPOSED SOLUTION ‘General Keys’ section will contain the basic keys like: • • • • • Enter button Navigation Keys – for left and right Health Remedy Button: This button will be a quick access button. In case of some emergencies, ASHA could press this button and get access to list of home remedies. Role of ASHA button: This button would tell ASHA about her roles which are generic and cannot be classified in any of the above modules. For eg. ASHA needs to take a sick person to the hospital, and get him consulted by doctor if the case is severe. Tutorials related like this would be present under this button. Reminder: This is an add-on feature. ASHA will be able to set reminders, so that she could remind herself when to take the pregnant women for the screening tests. Once the ASHA is fully trained, the lid from the ‘Post Training Keys’ would be unscrewed, and now the whole keyboard would be available to ASHA. Pregnant women button of ‘Post Training keys’ would contain the info-graphics / videos that would aid ASHA in explaining the situation of the pregnant women to the women itself. Similar role is assigned for the other keys. Similar shape and colors are used to help in categorizing the similar information. The ‘During Training keys’ are square in shape. The ‘Post Training keys’ are circular in shape. So, there is a clear-cut demarcation of information through basic shapes. Moreover, each module is assigned one color code. For eg. Pregnant women button in both ‘During training’ and ‘Post training’ are of same color. Tutorial / Content in the device On pressing the Pregnant Women button of During Training keys, the ASHA would see a virtual world on her screen with a ‘virtual ASHA’. That ‘virtual ASHA’ would interact with the real ASHA (to be trained) through dialogues and narratives. She would take the real ASHA through all the possible scenarios / situations in the virtual world, and will keep interacting and guiding her simultaneously. The virtual ASHA would ask questions, which she needs to answer. Depending on her answer, the flow of the information will be decided.
  • 37. information architecture Pregnant women Provide quality care to the pregnant lady during antenatal, intranatal and postpartum period. Counsel woman on birth preparedness Importance of safe delivery Breastfeeding and complementary feeding Adolescent girls Regarding nutritions and diet. About contraceptives and sanitation. About the use of Sanitary napkins. Information regarding abdomen pain in girls. Immunization and contraception methods About changes in physical and psychological state. Prevention of common infections including Reproductive Tract Infection/ Sexually Transmitted Infection (RTIs/STIs) Identify danger signs during pregnancy, delivery and postpartum period along with the danger signs in the newborn and provide supportive care prior to referral. Provide them with iodine tablets. Imparting information about the menstruation cycle and bodily changes. Follow routine infection prevention practices during pregnancy and child birth. Role of ASHA ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services and she will create health awareness. Counsel women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization etc. Mobilise the community and facilitate them in accessing health and health related services available at the Anganwadi/subcentre/primary health centers. Will act as a depot older for essential provisions being made available to all habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA) etc. Help AWW to complete and update village health register. To increase institutional delivery by continuing with the JSY( Janani Suraksha Yojna) Scheme. Child Care (0-5 years) To improve the nutritional and health status of children in the age-group 0-5 years. To reduce the incidence of mortality, morbidity, malnutrition etc. Immunization, health check-up, referral services of the kids. Provide health services for children by anganwadi workers and Primary Health Centre (PHC) staff, include regular health check-ups, recording of weight, immunization, management of malnutrition, treatment of diarrhoea, de-worming and distribution of simple medicines etc. Family planing Birth control using contaceptives, permanent contraceptive methods such as surgery of falopian tube. Sterilization Female contraceptions Implants, IUD and Mucus Methods Financial Aspect
  • 38. scenario For a better understanding, a scenario is presented below. This shows how the virtual ASHA guides the real ASHA (who is to be trained) through the tutorial ASHA acts as one of the best friends of the pregnant women and takes care of them, by visiting their house periodically. One of the pregnant women experienced a labour pain, and called ASHA. She rushed to her and consoled her. She called the ambulance from the nearby hospital. Ambulance came to the place within 5 minutes. ASHA took the pregnant woman to the hospital for the safe delivery of the child. Both mother and child are now safe and healthy. This is how the ASHA would be taught about her roles and responsibilities, through the virtual reality.
  • 39. feasibility The proposed device would be a digital system. This is considering the fact that production methods in the digital realm are becoming more and more cost effective with time. Recent mobile phone models like Nokia 101 and Nokia 100 have used this display technology and effectively reduced cost (of the complete device) to a range of Rs. 1000 - Rs. 2000. Small size, low fidelity videos of formats like 3GP, AVI, MP4, WMV, MPEG-4 could be played in this system. The processor would also be capable enough to play small flash animations as well. The battery of the proposed device can be a Lithium Polymer battery, which is rechargable, and roughly estimated to give a playback time of approximately 3 hours. A close example is the Archos 405 video player, which has a screen size of 3.9” x 3.1”, with rest all features almost same, and gives a video playback time of 5 hours. Since the videos / animations are going to be put in the storage card by a single central system, this format could be standardized. In effect, usage of a single video format will reduce the processor load. The proposed device will use data stored from a microSD card. Data storage can be held in a microSD card of 2GB or more. A bulk production will ensure that the memory card cost is around Rs. 100 - Rs. 150 per piece for a 2GB memory card. The proposed device uses an LCD Transmissive screen, which is generally used in simple mobile phones. The display colors will be HighColor (16-bit/64000). As explained in the proposed solution, the video content played on this device will be through simple graphics and 2D animations, so that a High Fidelity video player is not a prerequisite. The processor of this device has to be such that it can support video playback of low fidelity videos, play/pause/stop functions for videos, forward/backward function for videos, volume increase/decrease and setting up of reminder. Thus, requirements are quite low, and processors with these capabilities exist in the market at cheap price. The casing of the proposed device is a Silicone fibre casing, in order to manifest the attributes of the device being light and portable, heat resistant, and adaptable to rough usage. As a part of the system of NRHM, this device can be manufactured in bulk, and thus can be made cost-effective.
  • 40. conclusion The project aimed to create awareness and improve the health of the pregnant women and their child after delivery. After series of user researches, it was analyzed that pregnant women are reluctant to new changes in their society (cultural aspect). However, they listen to ASHA of their locality, as they have trust in her. ASHA, although being an enthusiastic worker is not able to provide correct information and is not able to take proper care of the mother and child as she is herself not well-versed with the details. The reason behind this was improper training program of ASHA. Thus, the team proposes an alternative of training program – a device for ASHA which will make use of virtual reality and train the ASHA by making her visit every possible scenario in the virtual world. The device can be used for different purposes in the future to assist ASHA even more. It could help her in documenting all the things, which is a tedious task and takes months to complete. This device could also be used a source of communication between the ASHA and other higher authorities, by making some minor modifications.
  • 41. references http://www.upnrhm.gov.in/achievements-asha.php http://nrhm.gov.in/images/pdf/programmes/wifs/guidelines/technical_handbook_on_anaemia.pdf http://www.who.int/reproductivehealth/publications/family_planning/9241593229index/en/ http://nrhm.gov.in/ http://nrhm.gov.in/images/pdf/programmes/wifs/guidelines/guide_for_training_master_trainers_on_wifs.pdf h t t p : / / w w w. n r h m a s s a m . i n / p d f / g u i d e l i n e / f a c i l i tors_guide.pdf http://www.nios.ac.in/media/documents/secpsycour/English/Chapter-11.pdf http://www.nrhmassam.in/pdf/guideline/inputs_routine_immunization.pdf http://nrhm.gov.in/nrhm-in-state/state-wise-information/assam.html http://nrhmrajasthan.nic.in/ http://www.ncbi.nlm.nih.gov/pubmed/23198703 http://wcd.nic.in/KSY/ksyguidelines.htm http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=1999;volume=53;issue=10;spage=439;epage=443;aula st=Singh http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784630/ http://www.who.int/reproductivehealth/publications/family_planning/Technical_adaptation_guide.pdf

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