Community-centered approach to malaria programming through human-centered design (HCD).pdf

Despite promising progress, malaria transmission remains an issue in forest areas3where it predominantly impacts mobile migrant populations (MMPs) including forest workers, who frequently move between low-and high-transmission areas and are hard to reach to provide malaria services and information.
* Cambodia has a goal of eliminating all forms of malaria by 2025.
* Cases decreased from over 100,000 in (2010) to less than 32,000 in 2019.
* Deaths decreased from 151 in 2010 to zeroin 2018.

BEHAVIOUR CHANGE OBJECTIVE
* We wantall forest-goers [women and men, all ages] to visit V/MMW or PH facilities for malaria testing when they exit the forest -no matter if they have symptoms or not, so thatat every opportunity cases of malaria are identified, treated, and reported.

INTERMEDIATE OUTCOMES
* 89% of forest-goers recalled the main message through the loudspeaker
* 98% of forest-goers think that malaria is a serious illness
* 97% of forest-goers believe that one should get tested each time after returning from the forest, regardless of symptoms
* 96% of forest-goers think that other forest-goers (their peers) are getting tested every time they exit the forest regardless of their symptom (67% pre-test)

1. Malaria
SBC Activity
“Don’t Wait for Symptoms!”:
A Community-Centered Approach
to Malaria Programming through
Human-Centered Design (HCD).
A Presentation for RMB SBC TWG
Annual Meeting,
September 11-13, 2024, Nairobi, Kenya
USAID/CAMBODIA
PROMOTING HEALTHY
BEHAVIORS ACTIVITY
(PHB)

2. [The How]
●Intro to HCD approach
and methodologies
●Target persona
●Forest-goer journey
●ERP framework
●Behavioral determinants
[The Solution]
●Concept
●Key messages & channels
●Tools
●Implementation plan
●Theory of change
2
MALARIA SOCIAL AND BEHAVIOR CHANGE
(SBC) INTERVENTION (2021-2022)
[The What]
●Project problem
●Project goal and focus
[The Results]
●Data points on behavioral
outcomes

3. Credit / PHB
MALARIA SBC
INTERVENTION
[The What]

4. Cambodia has a goal of eliminating all forms of malaria
by 2025.
1
Cases decreased from over 100,000 in (2010) to less
than 32,000 in 2019.
2
Deaths decreased from 151 in 2010 to zeroin 2018.
2
Despite promising progress, malaria transmission remains an issue in forest areas
3
where it
predominantly impacts mobile migrant populations (MMPs) including forest workers, who frequently
move between low-and high-transmission areas and are hard to reach to provide malaria services and
information.
1. Malaria Elimination Framework 21-25
2. SovannartohS. 2020 Achievements and Plan for 2021 of the National Malaria Control Programs Paper presented at: The 38th Annual
Congress of the National Center for Parasitology, Entomology and Malaria Control 2021; Cambodia.
3. DurnezL, Mao S, Denis L, et la. Outdoor malaria transmissinein forested villages of Cambodia. Malar J. 2013;12(329).
PROJECT PROBLEM
4

5. GOAL PERSONA FOCUS
PROJECT GOAL & FOCUS
5

6. We wantall forest-goers [women and men, all ages]
tovisit V/MMW or PH facilities for malaria testing
when they exit the forest -no matter if they have
symptoms or not-
so thatat every opportunity cases of malaria are
identified, treated, and reported.
(according to national malaria case management and surveillance guidelines)
THE BEHAVIOUR CHANGE OBJECTIVE
6

7. Credit / PHB
MALARIA SBC
INTERVENTION
[The How]

8. PHB: Approach to design SBC interventions in
for Malaria programming
CO-DESIGN
User-centred
interventions
CO-DELIVER
Interventions to
address health
needs
CO-DIAGNOSE
Unmet health needs
in Cambodia
CO-ASSESS
Interventions to
monitor outcomes
and ensure learning
11 22 33 44 55
CO-DECIDE
Where to
intervene for
greatest impact &
Key Behaviors
Set your strategy Build your intervention
Learn and Share

9. HUMAN CENTERED DESIGN (HCD)

10. Empathy
“I feel fine when I get back
from the forest, so I don’t
think I need to get tested
for malaria.”
"I don't have time to
visit the clinic after a
long trip; I just want
take care of my
children”
I enjoy speaking to my
neighbour, I tell her what I
am worried aboutand she
tells me about her
experiences.
"I wish we had more
resources to provide
comprehensive care and
support to those affected
by malaria."
"Effective malaria
prevention starts with
education, but reaching
remote areas is often a
challenge."
Waiting at the clinic
keeps me from
important tasks at
home.
"I rely on home
remedies for any
illness; I don’t see the
need for testing unless
I’m really sick."
"People don’t always
understand the
importance of testing,
especially after
returning from the
forest."
"I just want myself to
be safe, but getting
people to test after
returning from the
forest is always a
challenge."

11. CO-DIAGNOSE/DECIDE: DATA COLLECTION METHODOLOGY
1. Diagnose Stage
(desk review)-Collecting existing
information
2. New data collection from users to fill in the gaps
●Methods: Interview, Observation, Card Sorting; Heat Map Voting; Persona Development;
Journey Mapping (FICM); Perception true/false game. etc.

12. WHO?
Audience persona summary [example]
MUNNY | 32 | MALE | FOREST GOER
Working as a forest-goer with his family
Forest-goer is the job available in the area as there are not a
lot of rice fields and less farming opportunities (i.e.collecting
certain species of wood, hunting animals, mushroom…)
Married with 2 children who live in the village.
His wife is often a forest-goer herself. She is involved at
several steps of the forest-goer work journey.
Primary income provider.
Works hard to look after his family.
Basic literacy.
Primary level education.
Has a smart phone with signal when back in the
village.
1212
Credit / URC Cambodia

13. WHO?
Audience persona summary [example]
MUNNY | 32 | MALE | FOREST GOER
1313
Credit / URC Cambodia
INFLUENCERS: Couple, Health service provider, VMW, Village chief
GOALS: Good health and wealthy for family, especially be happy with family
HOBBIES: Peer gathering (drinking), playing football
MOTIVATED BY:Being a good father, keeping his children and family healthy
Things to know about Munny:
●He has not been reached recently by malaria communications and doesn’t
know that VMW expect him to get tested when he gets back from the
forest
●He trusts his home-based treatment to cure him in case of symptoms
●He cares for his family and doesn’t want to risk them getting malaria
Munny’s Current Behaviour
●Avoids Testing: Munny frequently goes to the forest but doesn’t seek
malaria testing when he returns.
●Socializes Often: Munny enjoys peer gatherings with drinking, leading to
late nights outdoors and higher mosquito exposure.

14. Identifying the barriers-
USING A BEHAVIOR CHANGE FRAMEWORK (ERP)
The path
The environment
around us
The elephant
What we feel
The rider
What we know
14

15. INSIGHT 1:
LOW RISK
PERCEPTION
KEY INSIGHTS
AND STRATEGIC RECOMMENDATIONS
INSIGHT 2:
INFORMATION
GAP
INSIGHT 3:
COMMUNITY
INFLUENCE
INSIGHT 4:
WORK
FIRST
INSIGHT 5:
REMOTE
WORK
ENVIRONMENT
Munny thinks he is
already sufficiently
protected for his
perceived level of risk
Munny has some
information gaps
which do not
encourage proper
care seeking
behavior
Munny is connected
to his community,
and there is a sense
of mutual care
Work and earning an
income is a priority
and takes up most of
Munny’s time
Munny’s work
environment is
restrictive to facilitate
care seeking
behaviors
Increase a fair
risk perception
Bridge the
information gaps
through existing
touch points
Connect the behavior
of the forest-goers
with the well-being of
the whole community
Make the path to testing as easy as possible
by integrating it with the forest-goers’ existing
routine
INSIGHT
STRAT
REC.

16. Intermediate Outcomes
…
so that they
…
…
to
…
Behavioral Outcomes Impact
Forest Goers seek
RDT test every
timethey exit the
forest, it is part of
their routine
(individuals)
SELF EFFICACY
Forest goers are confident in their ability to seek an RDT after ALL forest visits-regardlesssymptoms.
KNOWLEDGE
Forest goers know that seeking a RDT after the forest will protect them from Malaria.
SOCIAL NORM
Care seeking post forest become a routine practice for the Forest Goer community.
Forest Goers
receive a RDT test
from VMW, or
public facility
providerfollowing
all visit to the
forest.(providers)
Perceived Severity:
Forest goers know that Malaria is a serious disease and what are the protocol to be protected.
Perceived social norm.
Forest goers believe seeking a RDT after all forest visits is a social norm among forest goers.
Behavior change theory was developed, based
on formative research
16

17. We wantall forest-goers [women and men, all ages]
tovisit V/MMW or PH facilities for malaria testing
when they exit the forest -no matter if they have
symptoms or not-
so thatat every opportunity cases of malaria are
identified, treated, and reported.
(according to national malaria case management and surveillance guidelines)
THE BEHAVIOUR CHANGE OBJECTIVE
17

18. Credit / PHB
MALARIA SBC
INTERVENTION
[The Solution]

19. PHB: Approach to design SBC interventions in
for Malaria programming
CO-DESIGN
User-centred
interventions
CO-DELIVER
Interventions to
address health
needs
CO-DIAGNOSE
Unmet health needs
in Cambodia
CO-ASSESS
Interventions to
monitor outcomes
and ensure learning
11 22 33 44 55
CO-DECIDE
Where to
intervene for
greatest impact &
Key Behaviors
Set your strategy Build your intervention
Learn and Share
●Ideation (Co-creation)
●Pitch Test

20. LET’S SEE HOW THE SBC SOLUTION IS
DEVELOPED!
20

21. CONCEPT DEVELOPMENT
1. Early jam with CNM
experts
2.Literature
review, key
findings and
insights from
FGs
3. Ideation
with PHB
team and
malaria
experts
4. Early
Concepts
5. Concept Testing with target audiences (Iteration with users in the field)

22. CO-CREATION SESSION WITH USERS

23. 4 EARLY CONCEPT SUMMARY
STOP!
LET’S GO TO TEST
CONCEPT 4
DON’T BRING
IT BACK
CONCEPT 3
WELCOME
HOME
CONCEPT 2
VILLAGE
PROTECTORS
CONCEPT 1
ឆ្មាំភូមិ សូមស្វមគមន៍ក ាំយកវមមកផ្ទះឈប់សិន!
ត មះត្វើតេសត

24. Being a forest-goer, you’re used to
working on the front lines in risky
forest environments. But the risks that
you face in the forest should not come
back to your community.
As a forest-goer, malaria testing is
part of your dutyand you do it with
pride in order tokeep you and your
village healthy.
KEYWORDS:Protector, duty, pride,
strength, individual
CONCEPT 1
VILLAGE PROTECTORS
ឆ្មាំ
ភូមិ

25. Working in the forest can be risky but
your community is here to help you
stay healthy. They can’t wait to
welcome you home and help you to
get tested.
Ending malaria is allour responsibility.
Together we can help each other to
keep our village malaria free.
KEYWORDS: Positive, helpful,
energetic, warm, togetherness,
community
WELCOME HOME
CONCEPT 2
សូមស្វមគមន៍

26. Malaria wants to come back home from
the forest with you. He’s so sneaky at
first you won’t even realise that he’s
there.
He’ll try to join you for you family dinner
and he’ll follow your children to school.
He’ll make you sick, he’ll stop you from
going to work.
Don’t be the one to bring malaria into
your community. Getting a test when you
leave the forest keeps you and your loved
ones safe.
KEYWORDS: Dark, ominous, fear,
personification
DON’T BRING IT
BACK HOME
CONCEPT 3
ក ាំយកវាមកផ្ទះ

27. When returning from the forest, take a
moment to stop at your nearest health
centre/ Village Malaria Worker for a free
malaria test.
Join your fellow forest-goers in getting a
simple prick on the finger. Immediate
results let you know that you are healthy
and that you can safely go home to your
family.
Stopping to get tested can stop malaria!
KEYWORDS: Simple, easy, direct,
practical, instructional
STOP ! Let’s go to test
CONCEPT 4
ឈប់សិន!
ត ះត្វើតេសត

28. 4 EARLY CONCEPT RECAP
Can you guest, which concept was the winner?
STOP!
LET’S GO TO TEST
CONCEPT 4
DON’T BRING
IT BACK
CONCEPT 3
WELCOME
HOME
CONCEPT 2
VILLAGE
PROTECTORS
CONCEPT 1
ឆ្មាំភូមិ សូមស្វមគមន៍ក ាំយកវមមកផ្ទះឈប់សិន!
ត មះត្វើតេសត

29. INSIGHT SUMMARY
INSIGHT 4INSIGHT 3INSIGHT 2INSIGHT 1
Fear for the
family
A reminder
from the wife
Forget or
delay testing
No symptoms,
no test
INSIGHT 5
The benefit of
testing before
symptoms
CONCLUSION
Insights captured while exploring these concepts become the building blocks
on which we develop our final concept. By better understanding the forest-
goersdrivers, we are able totrigger the right behavior in our communication
to forest-goers.

30. FINAL CONCEPT

31. Forest-goers
have a good basic
understanding
of malaria
Credit / WHO Cambodia

32. But there is a
lack of urgency
when it comes to
testing
Credit / trekearth.come

33. They don’t see the
need for testing if
they don’t show
symptoms
Credit / THE NEW YORK TIMES

34. Forest-goers must not wait
until they are sick to be tested.
They must get tested as soon they exit the forest.

35. Don’t wait for symptoms

36. FINAL CREATIVE CONCEPT
ក ុំចាុំមានរ ាគសញ្ញា
Don’t wait for symptoms
Exit forest, test for malaria immediately at HC/VMW
36
The [don’t wait] give a
“time” reference and
therefore create the sense
of urgency
[to have symptoms]
The travel history is a well
understood criteria for getting
tested, but people tend to delay the
testing moment until they
experience symptoms

37. KEY MESSAGES
37
Don’t allow yourself go get
severely ill from malaria.
Don’t lose time and money
because of malaria
Don’t bring malaria back
home​​
Don’t take the risk of
catching malaria or your
family will have to take
over your work
Don’t spread malaria to
others
Don’t make your village
sick with malaria​​
Don’t wait for symptoms
When you exit the forest, go to test for malaria at VMW/HC

38. Project SBC
materials executed
ordistributed
Forest-goers and
villagers exposed to
community activities
and media
Target audience
recall to project
message
…
leading to
…
OutputsInputs
…
which will contribute to
…
Intermediate Outcomes
…
so that they
…
…
to
…
Behavioral Outcomes Impact
Forest Goers seek
RDT test every
timethey exit the
forest, it is part of
their routine
(individuals)
SELF EFFICACY
Forest goers are confident in their
ability to seek an RDT after ALL forest
visits-regardlesssymptoms.
Calendar
Calendar
IPC at house-to-house visit
Tools for VMWs
Set up SBC tools (billboard,
banner, & posters) in village
Community activities and media
PHB
distribute and implement
…
Badges
Community mobilization
throughloudspeaker
KNOWLEDGE
Forest goers know that seeking a RDT
after the forest will protect them
from Malaria.
SOCIAL NORM
Care seeking post forest become a
routine practice for the Forest Goer
community.
Tools forest
-
goers
Flip-books
Stickers
Pen
Forest Goers
receive a RDT test
from VMW, or
public facility
providerfollowing
all visit to the
forest.(providers)
Perceived Severity:
Forest goers know that Malaria is a
serious disease and what are the
protocol to be protected.
Perceived social norm.
Forest goers believe seeking a RDT
after all forest visits is a social norm
among forest goers.
How to Monitor
Theory of Change
38

39. CHANNELS
Visual communication in
the village
Word of mouth, social
influence
!
VMW house
visit pitch
VMW speaker in the village
39
VMW/MMW channel

40. TOOLS SUMMARY
40

41. Credit / PHB
MALARIA SBC
INTERVENTION
[The Results]

42. KEY ACHIEVEMENTS
Summary Indicators of Success in 2022
42

43. INTERMEDIATE OUTCOMES
Knowledge Self Efficacy
89%
FGs recalled
the main message
through the
loudspeaker
98%
of FG think that
malaria is a serious
illness
97%
of FGsbelieve that
one should get
tested each time
after returning from
the forest,
regardless of
symptoms
92%
Believe that they
are at risk of
getting malaria
43
Social Norms
96%
of FGs think that other FGs (their peers) are
getting tested every time they exit the forest
regardless of their symptom
(67% pre-test)

44. BEHAVIORAL OUTCOMES
Self-reported Practice
90%
tested within 48 hours of exiting the forest
(27% in pre-test)
44

45. THANK YOU
45