By Hilary Kinka, Technical Advisor, Health Systems Accelerator, PSI
For most consumers navigating the health system, the journey to care is complex. By better understanding their experiences, health needs, and preferences along the way, we can help policymakers shape more responsive health systems and accessible health services.
Journey mapping – a qualitative research approach – can be used to understand consumers’ interactions and relationships with a healthcare system. However, current methods are time and resource-intensive and often focus on a particular health area, project, or delivery channel. This approach fails to provide a comprehensive picture of consumer healthcare experiences, does not track changes over time, and makes it difficult for policymakers and other stakeholders to effectively address health system challenges. To build health systems that respond to individual’s needs, we need a better way of collecting, disseminating, and using consumer insights.
To catalyze consumer-powered care, PSI is designing, testing, and improving more cost-effective and continuous approaches to remotely track the consumer health journey. Using digital solutions, we aim to build a comprehensive overview of users’ experiences as they navigate the health system over time. The generated insights will inform a new approach to journey mapping that can more effectively shape the design and implementation of policies and interventions and assess their impact on users’ access to quality, affordable care.
With funding from Endless Foundation, we developed and piloted a method in Uganda to remotely track pregnant women’s experiences with antenatal and delivery care in urban and rural settings. We used digital communication tools that allow for continuous, near-real-time data collection and have the potential for scale.
To start, we conducted in-person interviews with women who recently gave birth to understand their pregnancy journeys, digital preferences, and phone use. This information informed the development of remote surveys that we sent to 200 pregnant women four times over five months through either WhatsApp or Viamo’s Interactive Voice Response (IVR) service to collect information on their care experiences. We also tested an AI-powered avatar, supported by Fortell.ai, with a subset of in-person participants and sent the avatar remotely to all WhatsApp participants. After the surveys were complete, we facilitated phone surveys with a sub-set of all remote survey participants to assess their experience and satisfaction with the new journey mapping approach.
Through this study, we have the following key findings:
- Participants were more likely to respond to IVR surveys than WhatsApp – For IVR participants, 89% completed at least one survey compared to 11% of WhatsApp participants, even though women initially reported that WhatsApp was their preferred data-sharing method. This may have been due to the cost of data required to complete WhatsApp surveys.
- Open-ended questions had a low response rate on WhatsApp – Among those that did respond via WhatsApp, we saw a steep drop-off when participants reached the open-ended voice recording or written response questions, possibly due to technical issues or perceived burden. However, open responses provided more detailed insights into participant experiences than close response options.
- Respondents need additional support to successfully complete remotely deployed AI-avatar surveys – When guided by a research assistant, we found that women successfully responded to surveys and shared that the AI-avatar provided an opportunity for open and honest responses. However, participants experienced issues navigating the AI-avatar technology remotely through WhatsApp without technical support. Most women preferred using the AI-avatar translated into Luganda. In the future, offering mobile data and providing additional training on how to complete avatar surveys may increase response rates.
- Participants trusted the privacy and effectiveness of the journey mapping tools – Across WhatsApp, IVR, and the AI-powered Avatar, participants reported trusting that their data would be kept private, finding a sense of companionship in the routine surveys, and that their responses could help to improve service delivery. However, some participants needed help navigating the technologies and faced challenges filling out surveys without the ability to ask clarifying questions.
We look forward to validating these results with the Ministry of Health in Uganda and using this study to co-create digitally enabled systems to routinely collect, analyze, and elevate consumer insights.
The initial project in Uganda is in the first phase of an ambitious learning agenda. To provide a more comprehensive picture of consumer health needs, we hope to scale remote data collection methods to more communities throughout Uganda and integrate surveys into national health campaigns to power health education and consumer insights together. With a new approach to remote journey mapping, we can build more person-centered health systems.
Learn more about digitally-powered journey mapping here.