Case Study: Healthcare Communication Tools—Empowering the People of Kibera
Kibera, the second largest slum in the world, is located in Kenya. It is home to about one million people. The slum suffers from a host of poor infrastructure elements that worsen on a daily basis. A typical dwelling is about 12 square feet and houses five or more people. There is no drainage system, so rainwater runoff turns into standing water that becomes a breeding ground for mosquitoes, thus spreading malaria. Furthermore, the build-up of trash is so extreme that in some instances it comprises much of the ground on which residents live.
A number of stigmas concerning healthcare and sanitation exist in Kibera, which this project aims to overcome. Kiberans have three options for seeking healthcare: clinics, chemists and traditional healers. The general notion is that the healers are the easiest and most convenient. However, the reality is that sick individuals often need the attention of a more qualified clinic. Many locals also struggle with trusting large international organizations that provide aid in these areas.
The goal of this project is to provide visual communication tools for the people in Kibera that will help educate and reinforce positive health-seeking habits with regard to malaria. Existing visual solutions often fail to communicate even the simplest of messages due to overly complex narratives and culturally out-of-place imagery. Life In Abundance asked Rule29 to coordinate with Kent State and help lead the design team to create a system of visuals directed toward educating people about malaria treatment and prevention and improving overall sanitation habits.
This project was done in partnership with the nonprofit organization, Life In Abundance, and Rule29 Creative. All design work and project management was completed free of charge. These concepts will be produced with the help of donations and grants, and will ideally be distributed in Africa for free through Life In Abundance.
A rigorous design research process informed primarily by ethnographic research brought an emic perspective to this design process. In order for these concepts to be successful, they had to be informed by the specific cultural context of Kibera. Early discoveries about the priorities and misinformation regarding healthcare in Kibera directed the design prototypes to present accurate and simple solutions geared toward living a healthier life. Because the team could only understand a certain amount of information about Kibera, it was key to present solutions that directed small changes, such as recognizing when you should visit a hospital or clinic rather than resort to alternative medicine, or helping a patient understand how to properly administer malaria medication.
A number of important factors influenced the creation of the prototypes. A comprehensive literature review provided the team with a general context for the environment. Information ranging from the language and religious beliefs of the area, to the inner workings of latrines and perceptions about the spread of malaria, were all discussed in this process. In addition, past case studies were analyzed to extract information that has already been gathered and to help inform the development of our design process and the final deliverables.
Photo ethnography was conducted to understand as much firsthand information as possible. Because traveling to Kibera was not possible for this project, this technique became the primary research tactic. Images and videos were analyzed and marked with tags that classified observations such as signs of visual literacy, evidence of certain sanitation behaviors and conditions of local healthcare institutions.
In addition, local resources such as the Pan-African Studies department at Kent State University and a number of international students from Africa were consulted to inform the development of these prototypes. Early concepts were tested with multiple individuals prior to their initial testing in Africa. Local doctors were contacted to verify the information being presented about malaria. International students from Africa also helped to validate that the visuals being used would speak to the target audience.
The prototypes of this project target two specific groups within the slum: children and adults. Children are a key demographic because they represent the future of the population. There are opportunities to expand on the lessons they learn about health and wellness in school, and to create more memorable experiences that help reinforce this information. Adults, including community leaders, need to be educated with basic facts that will correct misconceptions prevalent in the slum. It’s crucial that these elements come from trusted sources and engage their intended audience in a way that is comprehensible and appropriate.
Malaria information: Dosage guidelines and information leaflet
The research showed that even though the majority of people know what malaria is, many more still have misconceptions about how malaria is spread and prevented. This informational guide highlights what causes malaria, how it is spread, the top three methods by which it can be prevented and common symptoms. The dosage guidelines were redesigned from instructional materials provided by malaria drug distributors. The redesigned leaflets feature a color-coded system for different age groups and stress the correct administration of the medication. Both tools will be distributed via clinics that treat patients for malaria.
Symptom icons: Identification of malaria symptoms
The symptoms of malaria are often misunderstood. Nausea, fatigue and cold sweats, for instance, may seem insignificant when they appear on their own. For this reason, malaria is often detected too late. When these symptoms are followed by a number of other indicators, it is crucial for patients to seek proper medical assistance. The symptom cards are designed as a tool for doctors to communicate the symptoms of malaria with patients. The cards avoid any complex narratives and rely on simplified visuals as the primary tool for communicating, with text used only as a secondary device. Extensive development, along with user testing with doctors from Kibera, has proven the need and success of these icons and also prompted their transformation into a poster and integration onto the malaria information leaflet.
Children’s activities: Interactive board game and activity book
Children are educated about various healthcare practices in school. However, they continue to be misguided by rumors and misinformation they encounter outside of the classroom. The goal of these prototypes is to complement the lessons children receive in school and create more memorable learning experiences to reinforce them. The interactions that take place through the board game and activity book also have the potential to carry over outside of the classroom, creating more dialogue and a better understanding of health-related facts amongst community members.
Brand engagement: Visual identity, pledge wall and various printed elements
An overall campaign aims to make healthcare communication a lasting entity in Kibera, with potential for future development. Familia Kiburi—Swahili for “family pride”— promotes the idea that by attending the clinic and educating yourself on sanitation and malaria, you can build a stronger, better, healthier family and community. By participating in the brand “Familia Kiburi,” one is able to reflect his or her belief in a better future for Kibera. Visual elements such as a pledge wall can be used to raise community awareness and foster participation in creating a healthier Kibera.
The biggest challenge of this project was learning the priorities and behaviors of an unfamiliar culture. Understanding cultural barriers was especially challenging because the design team was unable to experience Kibera firsthand. A number of research tactics were conducted to help inform this unique design process. A comprehensive literature review provided the context for the environment. Information ranging from the language and religious beliefs of the area, to the inner workings of latrines, to the spread of malaria were all discussed in this process. Ethnographic research helped to establish a context for local behaviors and cultural influences. By viewing photographs, videos and documentaries about Kibera, the team was able to better understand priorities and way of life.
Visual literacy was a challenge throughout the development of these prototypes. Early research pointed to the extremely low literacy rate within Kibera. However, upon a thorough photo ethnography investigation, the design team witnessed a much more visually driven landscape of Kibera than expected. Using this information, and the theory that most forms of icon-based communication can be learned quickly, the team used a basic icon system to begin developing visuals.
An initial round of positive feedback based on testing done by Rule29 on location (in country) illustrates the success of these solutions. Doctors on the ground provided feedback that affirmed the need for the malaria symptom icons as a useful tool to help patients identify how they were feeling, and as a learning device to encourage people to seek treatment early if they feel ill. The malaria guide included a simpler depiction of the malaria cycle and provided visuals of the top three prevention methods to help the people protect themselves from the disease. The dosage cards used a color-coded system differentiating the dosage by age or weight to emphasize the proper medication administered to patients. The doctors felt that this approach was a lot easier to understand than the current, text-heavy information provided by manufacturers.
Small iterations are currently being made based on this feedback and additional prototypes will be tested again this summer. The projected plan is to release these tools throughout the area by the fall of 2013.