WhatsApp poetry and the power of digital health promotion
Culturally and contextually appropriate online communication about health-related topics requires a deep understanding of local health information flows. Over the last year, our innovation colleagues in the UK-based MSF Manson Unit have carried out a series of Digital Health Promotion pilots in Bangladesh, Malaysia and Tajikistan to evaluate a five-step process for developing context-specific digital campaigns in MSF operations.
A 5-step process for engaging with patients and communities online
In a recent article, we looked closer at the MSF Manson Unit's Information Ecosystem Mapping initiative in Bangladesh, Malaysia and Tajikistan. This work aimed at providing MSF staff with insights into how health information flows in different contexts and how different groups engage with health information.
Building on the Patient Multimedia Engagement Toolkit, the Information Ecosystem Mapping is the first phase in a five-step process for developing digital patient and community engagement campaigns as part of MSF operations.
Following the Information Ecosystem Mapping, the MSF Manson Unit team supported the design and launch of digital health promotion pilots in four contexts in Bangladesh and Tajikistan, and an additional one in Malaysia which is underway.
Nuance and context in health communication
Through their Information Ecosystem Mapping work, the Manson Unit team gained insightful information about what health themes different groups engage with online, what devices they use, when and where they are online, what content formats (video, GIFs, text, etc.) they prefer, demographic biases, safety concerns, and much more. All this information was synthesised and documented into Campaign Protocols, one for each context or community. The next phase, Content Production, was informed both by MSF's activities in the respective areas and feedback received from the community as part of a broader co-creation process.
"In Kamrangirchar in Dhaka, Bangladesh, MSF provides support to survivors of sexual and gender-based violence (SGBV). Our initial plan was to carry out an education-based digital health promotion campaign focused on SGBV. However, input from the community during the information ecosystem mapping revealed SGBV educational content to be too sensitive for online dissemination. Instead, we had to adjust our approach and deliver content to increase awareness of MSF’s services regarding both sexual and reproductive health and SGBV, basically sharing information about how MSF can support women and girls more generally, The process really showed the importance of understanding information flow dynamics within the community to give us the best chance of positive engagement" explains Dasha Reddy, who leads the Manson Unit’s Digital Health Promotion pilots.
Based on insights from the Information Ecosystem Mapping and the goals of the different campaigns, different platforms were used during the Content Dissemination phase. Digital communication has been used as a targeted approach for SGBV support and case identification, but also for conferring adequate healthcare information and continued training to our outreach staff, and for wider reach to inform communities of the availability of our services.
"In Kulob, Tajikistan, one goal of the campaign was to develop a stronger network among outreach healthcare workers since many had expressed a need for more in-depth information about tuberculosis (TB). To provide a space where we could share information and others could discuss and ask relevant questions, we decided the best strategy would be to create a WhatsApp group for local healthcare providers. In other contexts, we used Facebook campaigns to reach a larger audience and WhatsApp Broadcast to ensure targeting and the anonymity of users," says Dasha Reddy.
Case: WhatsApp poetry in Dushanbe, Tajikistan
The MSF team in Dushanbe, Tajikistan, saw the need for a campaign focused on paediatric tuberculosis (TB) and the Information Ecosystem Mapping focused on the information needs and interests of young TB patients and their caregivers. The mapping showed that members of this audience had a strong preference for storytelling and poetry, an important aspect of Tajik culture, and that they are especially active on WhatsApp.
Building on insights from the Information Ecosystem Mapping, the Manson Unit team supported the Tajikistan HP team in setting up a WhatsApp Broadcast channel for family members of young TB patients in Dushanbe. For this channel, they created a five-episode animated short story about a boy, Behruz, who is a superhero who contracts TB and loses his powers. Throughout the series, viewers follow Behruz to different medical appointments and learn about the disease alongside him. He is also exposed to stigma by his friends who have many misconceptions about TB, all based on real misconceptions that surfaced during the Information Ecosystem Mapping.
As part of the campaign, the project team also worked with a well-known local TB activist who recorded a short video message for the WhatsApp broadcast channel. Adding an interactive element to the campaign, the team also launched a poetry competition, where people could submit and vote on each other’s poems.
"The interest in the poem competition was huge, all members of the MSF HPO team in Dushanbe submitted a poem. The Dushanbe team said the poem contest went so well that it was hard to choose a winner. In the end, it came down to two poems and we managed to find a way to integrate both into the campaign,"
What now?
The project team is currently evaluating the digital campaigns carried out in Bangladesh and Tajikistan. One goal of this pilot is to assess the feasibility of a context-specific approach to Digital Health Promotion in humanitarian settings by profiling the context in which the campaigns have been deployed.
"In addition to evaluating how people interact with and perceive the campaigns, we do an internal MSF management assessment. We want to understand what type of support MSF staff require to carry out digital health campaigns and if they feel that they have sufficient resources to manage these types of campaigns," says Dasha Reddy.
“We hope that by identifying internal capacity gaps, we will be able to develop adequate delivery models for a more context-specific operationalisation of DHP, which would ultimately help complement ongoing efforts within the organisation” adds Francesc Galban Horcajo, Medical Innovation Lead for the Manson Unit.
While the team is still processing quantitative and qualitative data about the campaigns in different contexts, the initial results look promising.
"In Cox's Bazaar, Bangladesh, we did pre- and post-campaign surveys with participants in the WhatsApp Broadcast channel where we shared information about MSF's services for survivors of SGBV. In this case, we targeted local women’s support groups as well as pre-existing school-based networks, identified during a community-based stakeholder assessment. The responses show that people's understanding of this topic has increased post-campaign and almost all (95 per cent) of the 52 participants in the group stated that they had referred someone to MSF's SGBV services after seeing our campaigns, while less than 10 per cent said that they had made a referral prior to the campaign. Many participants also gave feedback asking for further content on this and many other health topics. While this is a small group of people and we cannot draw any generalized conclusions based on only this data, the results indicate that there is potential for digital campaigns to promote an increase in discussions about important health topics” says Dasha Reddy.
“We know from the literature that more targeted approaches, leveraging on pre-existing local networks of support, have proven successful in case identification and referral. We now start to see growing evidence of how these approaches can also be effective in the contexts where MSF works” adds Francesc Galban Horcajo.
While most of the campaigns included in this pilot will wrap up this year, “resources exist within the organisation to take the learnings from this work forward, turning these approaches to part of our day-to-day operations, and ensuring that our staff are properly upskilled and supported to safely deploy it” says Francesc Galban Horcajo.