I asked Lina Aspen, industrial designer, to write some reflections following her trip to Uganda where she mapped end-user needs for Picterus. Here is what she wrote:
- Empathy for the end user and who is really the end user?
To make a successful solution for health workers in low resource settings, I needed to truly understand and empathize with the problem at hand and the people experiencing it every day. Designing for a context and users located 4.5 thousand miles away is both risky and difficult. One thing is to obtain a more correct understanding of the context and its limitations, and the end users and their needs and motivations. In addition it evolves around empathy for the user through personal interaction with the end user and acquiring firsthand experiences of the user context, which all add up to a better foundation to base design decisions on.
After my first visit to the national hospital in Uganda, I learned so much about the challenges and daily life at the maternity ward that my perspective of the whole project itself shifted. The national hospital had the equipment for diagnosing jaundice, but not the time to complete the procedure due to staff shortage and crowded wards. Instead they resorted to clinical methods causing uncertainty and discussions. I concluded our solution should present a streamlined process providing quick and accurate results. My next visit to a regional hospital on the countryside challenged this perception though. Getting to know the health workers and the shortcomings of rural health services, called for a solution focusing on educating and guiding the entire process of diagnosing and treating jaundice. A lower standard of medical training amongst the health workers, in addition to little experience with smartphones, required a tool providing assistance rather than one that saves time.
Engaging with the health workers through interviews and observation, allowed for a deeper understanding of the problem and richer insights of user needs. On another level, user engagements presented me with personal relations and experiences to relate to when facing design decisions, as well as an increased personal motivation to succeed.
- Get physical – bring a prototype
When addressing a problem in a foreign culture, obtaining user empathy can be a challenge in itself. Language barriers can complicate and mislead when interacting with end users. A tool to better initiate and steer a conversation is to bring a physical representation of the concept at hand. A prototype is not only valuable in terms of usability investigations, but also as a means to carry out an explorative conversation. Whether you bring a prototype of a new concept or a product of an existing solution – a physical item to revolve the conversation around will help the interview objects in remembering and relating your questions to relevant experiences. In addition, it enables for interaction with the product which can substitute insufficient oral communication. It is easier to discuss something that is tangible, than a situation or concept that is not present. In Uganda this proved to be valuable when health workers had trouble understanding the concept I was developing, until they could experience a prototype of it themselves. Then they quickly got more talkative and started comparing my prototype to existing solutions and practices at their workplace, sharing interesting stories and opinions I wouldn’t have gotten from a prepared question set.
- Being a white researcher
Together with language, cultural differences and practices can also complicate user engagement. Preparation and research can get you a long way, but being a foreigner can in itself be a challenging role to inhabit and can affect the research. The Hawthorne effect, when research participants or interview objects modify their behavior in response to their awareness of being observed, is a common challenge in design research. When striving for genuine insights, it is key to establish a trusting relationship where the participant feel safe and reassured so that they want to share their thoughts and experiences with you. Entering a foreign culture adds complexity to the researcher or designer role, and in my experience it was unavoidable to reflect on my identity as a young white female from a rich country. Mostly I experienced a curiosity which lead to people being helpful and interested in me and my project. In those cases the Hawthorne effect would be reinforced due to people having a lot of respect for foreigners and wanted to please me with nice answers, or they believed they could get something in return if I was happy with their responses. Such instances called for increased observation rather than conversation, and follow-up questions on how they for example interacted with a tool or the prototype, to ensure a certain rootedness in authenticity. On the other hand, I also experienced difficulties in gaining trust either due to my young age and sex, or related to their mistrust to foreigners in general. Being white reinforced the fact that you are a stranger – many have never personally engaged with white people before, and a natural reaction for many is to feel insecure and unwilling to share their thoughts with me. This was easier to handle if I brought a long my contact person of the premises I visited, who always was a respected and familiar person to the health workers I wanted to engage with. Then again, this could make it difficult to obtain genuine answers as the health workers did not want to upset their manager.
Despite the many challenges of doing field work in a foreign culture, the project I worked with gained crucial insights by making use of design thinking principles. The insights from Uganda on user needs and context constraints, are used to ensure a useful tool that creates value for its end users.