Aarogya Seva: Developing a whatsapp-based health behavior change messaging platform to encourage healthy behaviors
Summary:
Increasingly, global health organizations have leveraged and used digital health platforms in behavior change programs and interventions, especially messaging platforms that enable users to access health information on their mobile devices or engage with medical professional. Aarogya Seva (AS) is one such service, which caters to health populations across 6 Indian states, 5 languages, and 3 health areas. AS sends daily push messages and relevant health behaviors to families, and allows them to ask specific questions as they arise. Overall, AS aims to promote healthy practices and health seeking behaviors by providing continued care when families leave the healthcare facility and return to their communities. In October 2019, AS sent almost 30,000 individuals messages to people who opted to use the service and received 1216 health questions from individuals. Building a service which delivers behavior changed informed health messages across messaging platforms, both on the back end and front end, is difficult when working across language, health topics, and cultures. Key lessons learned center on the best practices of developing health messages across culture context and health areas; frameworks to consider user and families experience while using the services; and technical back end requirements to support the delivery of these health messages.
Background/Objectives:
In the Indian context, patients only get 2.5 minutes on average for discharge, which comes with a rushed flurry of information on what to do, what to avoid, what steps to follow, and medications to take. Support structures that remind, inform, and encourage key evidence-based healthy behaviors are required to help patients, families, and caregivers ensure that patients recover and stay healthy from their hospital visits. Given the increasing digital health landscape, there are opportunities to use platforms such as Whatsapp, which can provide information, when families need it the most for greater impact at scale, sustained behaviour change.
Description of Intervention and/or Methods/Design:
Aarogya Seva (AS), translates to Healthy Service in Hindi. AS is Noora Health's Whatsapp based patient communication service that sends customized key social behavior change messages and videos for specific health condition areas targeting health behavior change at home for patients recently discharged from a hospital stay. Designed with the Principles for Digital Development in mind, AS aims to improve outcomes (reduction in readmissions to hospitals, increase in key health indicators) for patients across urban and rural settings, who seek care from 100+ public sector secondary care hospitals spread across India. Noora Health's clinicians, health behavior change specialists, and user experience designers create culturally appropriate message content, flows, and overall experience to deliver health messages when families need them the most. AS is interactive, providing a novel avenue for patients with otherwise poor access to care, to ask qualified providers pressing clinical questions particularly in the post-discharge period.
Results/Lessons Learned:
Throughout the last 2 years of AS' development, there have been several key lessons learned. First, given the diverse user population AS serves, we develop messages that address a core, common practice; acknowledge existing, undesirable, cultural practices; and use of multimedia. We have an in-house medical team which responds timely to queries received from users, and a FAQ database when appropriate. Second, there have been evolving approaches for AS to engage with patients and families. Families often share mobile devices, which demands that designed health messages not only need to be clinically appropriate, but also be designed to motivate the receiver to relay it to beneficiaries. Other important considerations for messages are acknowledging diverse health practices, tone of voice, character limit, frequency, and timing of messages. Finally, the tech backend required to support AS must be resilient and robust to allow for smooth message delivery and user experience.
Discussion/Implications for the Field:
Given that WhatsApp is the most-used messaging platform, it offers a unique opportunity to promote health messages and support families when they are discharged from the hospital. Whatsapp offers advantages that other digital technologies like short message services and interactive voice response systems do not. AS is one such application for the Indian healthcare context, which delivers social behavior change communication to families and allow them to ask questions. The learnings demonstrate that developing a digital health service to promote health behaviors and care seeking behavior is possible for populations who otherwise would have limited access to healthcare information.
Abstract submitted by:
Shirley Yan - Noora Health
Sudhanshu Gautam - Noora Health
Arjun Rangarajan - Noora Health
Anindita Bhowmik - Noora Health
Victoria G - Noora Health
Anjali Gupta - Noora Health
Increasingly, global health organizations have leveraged and used digital health platforms in behavior change programs and interventions, especially messaging platforms that enable users to access health information on their mobile devices or engage with medical professional. Aarogya Seva (AS) is one such service, which caters to health populations across 6 Indian states, 5 languages, and 3 health areas. AS sends daily push messages and relevant health behaviors to families, and allows them to ask specific questions as they arise. Overall, AS aims to promote healthy practices and health seeking behaviors by providing continued care when families leave the healthcare facility and return to their communities. In October 2019, AS sent almost 30,000 individuals messages to people who opted to use the service and received 1216 health questions from individuals. Building a service which delivers behavior changed informed health messages across messaging platforms, both on the back end and front end, is difficult when working across language, health topics, and cultures. Key lessons learned center on the best practices of developing health messages across culture context and health areas; frameworks to consider user and families experience while using the services; and technical back end requirements to support the delivery of these health messages.
Background/Objectives:
In the Indian context, patients only get 2.5 minutes on average for discharge, which comes with a rushed flurry of information on what to do, what to avoid, what steps to follow, and medications to take. Support structures that remind, inform, and encourage key evidence-based healthy behaviors are required to help patients, families, and caregivers ensure that patients recover and stay healthy from their hospital visits. Given the increasing digital health landscape, there are opportunities to use platforms such as Whatsapp, which can provide information, when families need it the most for greater impact at scale, sustained behaviour change.
Description of Intervention and/or Methods/Design:
Aarogya Seva (AS), translates to Healthy Service in Hindi. AS is Noora Health's Whatsapp based patient communication service that sends customized key social behavior change messages and videos for specific health condition areas targeting health behavior change at home for patients recently discharged from a hospital stay. Designed with the Principles for Digital Development in mind, AS aims to improve outcomes (reduction in readmissions to hospitals, increase in key health indicators) for patients across urban and rural settings, who seek care from 100+ public sector secondary care hospitals spread across India. Noora Health's clinicians, health behavior change specialists, and user experience designers create culturally appropriate message content, flows, and overall experience to deliver health messages when families need them the most. AS is interactive, providing a novel avenue for patients with otherwise poor access to care, to ask qualified providers pressing clinical questions particularly in the post-discharge period.
Results/Lessons Learned:
Throughout the last 2 years of AS' development, there have been several key lessons learned. First, given the diverse user population AS serves, we develop messages that address a core, common practice; acknowledge existing, undesirable, cultural practices; and use of multimedia. We have an in-house medical team which responds timely to queries received from users, and a FAQ database when appropriate. Second, there have been evolving approaches for AS to engage with patients and families. Families often share mobile devices, which demands that designed health messages not only need to be clinically appropriate, but also be designed to motivate the receiver to relay it to beneficiaries. Other important considerations for messages are acknowledging diverse health practices, tone of voice, character limit, frequency, and timing of messages. Finally, the tech backend required to support AS must be resilient and robust to allow for smooth message delivery and user experience.
Discussion/Implications for the Field:
Given that WhatsApp is the most-used messaging platform, it offers a unique opportunity to promote health messages and support families when they are discharged from the hospital. Whatsapp offers advantages that other digital technologies like short message services and interactive voice response systems do not. AS is one such application for the Indian healthcare context, which delivers social behavior change communication to families and allow them to ask questions. The learnings demonstrate that developing a digital health service to promote health behaviors and care seeking behavior is possible for populations who otherwise would have limited access to healthcare information.
Abstract submitted by:
Shirley Yan - Noora Health
Sudhanshu Gautam - Noora Health
Arjun Rangarajan - Noora Health
Anindita Bhowmik - Noora Health
Victoria G - Noora Health
Anjali Gupta - Noora Health
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Turn.io