Field Visit and Insights Report
Feb 19-20, 2024.
Figure 1: Home visit for an interview at Naroli, Tharad
Background
GHBIL, in collaboration with UNICEF and research partners (Social Action and Policy Lab, IIT Gandhinagar), is committed to reducing the prevalence of anaemia among adolescents and pregnant women in Tharad Taluka through behaviourally-informed interventions. Following research conducted in seven villages in December 2023, which unveiled gaps and potential solutions, low-fidelity prototypes were developed. The subsequent phase involved a three-day workshop in Tharad led by the GHBIL team and research partners to ideate, prototype, and prioritise interventions. This paved the way for the handover to a dedicated team for the pilot testing and final implementation of these interventions. The team, comprising UNICEF Consultants and research associates from the Social Action and Policy Lab, IIT Gandhinagar, piloted the proposed interventions among adolescents and pregnant women. The team conducted field visits in two villages, Malupur and Naroli, located in the Banaskantha district of Tharad Taluka, on the 19th and 20th of February 2024.
Objectives
To understand current gaps in the interventions by showcasing low-fidelity prototypes to gather feedback from relevant stakeholders, including adolescents, pregnant women, family influencers, SHG groups, teachers, and health department representatives.
To gain feedback on viability, feasibility, efficiency, and impact for prioritising Interventions with the Health System.
Methodology
The methodology for the pilot survey employed a qualitative approach, chosen to meet the research objectives effectively. The methodology integrated ethnographic investigation, Focus Group Discussions (FGDs), and semi-structured interviews. This comprehensive approach facilitated a deep exploration of the community's attitudes, norms, and beliefs concerning pregnancy and delivery. The ethnographic investigation provided contextual
understanding by observing behaviours in natural settings. At the same time, FGDs allowed for exploring collective attitudes. Semi-structured interviews provided personal insights into individual experiences and perceptions, enriching the overall understanding of the topic. This multi-faceted approach was crucial in unravelling the complexities of social issues. Teams were divided into two groups, conducting 90-minute interviews in dyads and
triads, using low-fidelity concept prototypes in two villages. The feedback gathered from end users, and critical health department stakeholders will be instrumental in refining and prioritising interventions to address the identified issues effectively.
The sample groups include:
1. Pregnant women in the first and second trimesters of pregnancy
2. Mother-in-Law
3. Husband
4. Adolescent age group 12-15 M
5. Adolescent age group 12-15 F
6. Adolescent age group 16-19 M
7. Adolescent age group 16-19 F
8. Influencers of adolescents - Mothers
9. Influencers of adolescents - Teachers
10. Health system (ANM, ASHA, MO)
11. Representatives of SHG groups
12. Non- government medical practitioners
Figure 2: At Community Center, Malupur, Tharad
Figure 3: Home visit for interview at Naroli , Tharad.
Figure 4: Visit to an Anganwadi center at Naroli, Tharad.
Sample Groups
Sample group | Village 1 - Malupur 19th February 2024 | Village 2 - Naroli 20th February 2024 |
PW 1st trimester | 3 Pregnant women group | |
PW 2nd trimester | 3 Pregnant women group | |
PW MIL | 3 MIL of pregnant women | |
PW Husband | 3 husbands of pregnant women | |
ANM/MO | ANM/MO | |
ASHA | ASHA | ANM/MO |
Informal practitioners | 1 Informal practitioner | 1 Informal practitioner |
Adolescent (12-15 M) dyad | Two adolescents | |
Adolescent (12-15 F) dyad | Two adolescents | |
Adolescent (16-19 M) dyad | Two adolescents | |
Adolescent (16-19 M) dyad | Two adolescents | |
Parents | 3 mothers | |
SHG leader | 1-2 SHG leaders | |
Teachers | 1-2 teachers |
Insights
1. Visual Deficiency Scale:
Figure 5: Visual Deficiency Scale
No. of Participants | Response/ Reaction/Remark | |
Adolescent boys and girls (12-15 years and 16-19 years) | 4Response/ Reaction/Remark | They demonstrated a strong connection with the emotional aspects. When presented with an explanation of the visual scale depicting deficient colours and numbers, the adolescents quickly grasped the concept and responded positively. They associated red with ‘danger’ and green being ‘safe’ or ‘swasth.’ |
Adolescent mothers | 3 | The adolescent mothers could only relate to the scale to a certain extent; they would instead prefer a written explanation or conversation, for they understand it better and quicker. The mothers (of adolescent boys) believe that the colour red means ‘good’(maybe a cultural connotation) instead of ‘critical’ as presented by the visual scale. The mother of the adolescent girl could track the ‘parivartan’ or changing emotions on the scale. |
MO | 1 | Described it as a colourful pictorial description. Illiterate can also understand Red for danger and Green for safe mode. However, the scale could be better regarding peaking curiosity among the people who may come for testing/screening. |
Pregnant Women (1st & 2nd Pregnancy) | 3 | Colour recognition was unsuccessful. However, participants were aware of their haemoglobin levels, with two measuring 8 gm/dl and one measuring 12 gm/dl. Verbal communication was the primary mode of interaction, prioritised over reading or visualising information. |
Comments :
High Impact, low feasibility.
The younger generation exhibited better understanding and connection compared to the older demographic. It is essential to consider this age difference and relatability factor.
The characters depicting the changing state of emotions and health could be tweaked to make it more culturally specific. For example - the attire.
2. Checklist + Tracker :
Figure 6: Iron and Anaemia Symptom checklist + Tracker
Sample group | No. of Participants | Response/ Reaction/Remark |
MO | 1 | The checklist's utility would increase significantly if ASHA could administer face-to-face counselling sessions. |
Comments:
High Impact, High Feasibility
Positive responses all across. Respondents found it to be self-explanatory.
Another significant insight from the interviews is that these checklists could be utilised for rapid self-assessment and self-reporting of symptoms if restructured and developed.
3. Tracker (Mitra Mandal):
Figure 7: Tracker for Mitra Mandal Exercise
No. of Participants | Response/ Reaction/Remark | |
Adolescent Girls (12-15 years) | 2 | School dropouts. |
Adolescent Boys (16-19 years) | 2 | If such a tracker is circulated among the school's existing sports group of adolescent boys, it will be beneficial; it will help them become better sports persons. |
Mother of Adolescent Girl | 1 | She desires to closely monitor her children's health outcomes and finds motivation within the home environment. It would enhance the experience if the children actively engaged in games. As for her own intake of iron and folic acid (IFA) pills, she does not consume them and thus abstains from providing feedback on their tracking. |
Teachers | 2 | No tracker up until now. “I think we should we should implement the system now”. Personal health should be in the curriculum. |
ASHA | 1 | Many girls avoid taking iron and folic acid (IFA) pills because they experience nausea. There needs to be a system in place to track or maintain records of IFA pill consumption. It might be helpful to inquire with the 'shikshak' (teacher) if anyone was inadvertently overlooked. Initially, there was some confusion about the scenario, but once clarified, it was acknowledged that visual aids could facilitate better data tracking. |
MO | 1 | Consistency serves as the cornerstone. Introducing a reward system may introduce biases, thus opting for a half-hour discussion instead of rewards. A stringent follow-up mechanism is imperative for effective implementation at the grassroots level. Examples of effective monitoring mechanisms include conducting haemoglobin level scans in schools and utilising the Techo App. Utilising social media influence can stimulate discussions on health-related topics. |
Comments:
Low relevance or impact, insufficient feasibility
No conversation on health with parents or with teachers in school.
Response to ‘Anaemia’ or ‘Paandu rog’ - no idea.
The Adolescent boys know of ‘laal goli’ or IFA pills that are pinkish/reddish.
The girls are given ‘laal goli’ or IFA pills every Wednesday by the school warden or ‘guru mata’ after the school assembly.
There is no system of tracking; if any student is absent, they simply miss out on pills (High school students in Naroli village)
There is no mention or idea of Blue IFA pills or ‘neeli goli’ meant explicitly for adolescents.
4. Evening THR snack - Purnashakti Ladoo
Figure 8: Visuals for advertising Purnashakti Ladoos along with a Recipe Booklet
Sample group | No. of Participants | Response/ Reaction/Remark |
Adolescent girls (12-15 years and 16-19 years) | 4 | Anganwadi sends them and tries them at their homes. Make Sukhdi out of it. Vitamin Benefit (girls -12-15 years) Dont like it, and 15 diwas mai milta hai. (girls - 16-19 years) |
Adolescent Boys (12-15 years and 16-19 years) | 4 | Haven’t heard of Purnashakti, but I know sukhdi ladoo is made at their homes. |
Mothers of Adolescent Boys | 2 | Written text or conversation is better. They make sukhdi ladoo for their kids and elders at their homes quite often. |
Mother of Adolescent Girl | 1 | Is aware of Purnashakti packets but does not consume them. |
SHG Leader | 2 | The SHG leader grasped the visual aspect somewhat but found reading the text within visuals challenging. They expressed a preference for written explanations or conversations. During the interview, they showcased posters with more written content already created. An existing potluck system is in place, which overlaps with another scenario. In this system, they prepare Thepla using Take-Home Ration (THR) packets and share recipes with adolescents. While the adolescents consume the THR packets, their parents do not. Mothers are not actively involved in cooking for them, prompting the 'kishoris' to prepare meals themselves. Some girls dislike the taste of the prepared meals and suggest incorporating flour and spices for improvement. |
Comments:
Low impact, Low feasibility
Primarily, make Sukhdi Ladoo out of Purnashakti Packets at home.
The entire family shares it; some do not like the taste of it.
Receive the packets once in 15 days.
5. Food chart
Figure 9: Visual - Food Chart
Sample group | No. of Participants | Response/ Reaction/Remark |
Adolescent girls(16-19 years) | 2 | Will follow the food chart if they are going to follow. One of the respondents likes Khajur or dates, which are challenging to get and not available in a hostel mess, so they would appreciate it if it is included in the chart. |
Teachers | 2 | The high school, a Bhansali Trust initiative, provides nutritious food during the lunch break on Tuesdays and Fridays. They must get Chana, Fruits and Seengh. For example, the last Friday before the interview, they received Oranges. |
Comments:
High impact and relevance, high feasibility.
Most pointed out food they eat from the chart.
Some knew iron-rich foods and vitamins, and some didn't.
Most families interviewed come from farming backgrounds, so They eat veggies consumed on their farms.
Rotli (commonly bajra) and chai are their breakfasts or snacks.
Adolescents like biscuits (mostly PARLE G or 20-20) because they are readily available in shops near their homes and schools. Mostly consumed during the school recess.
At Naroli, there was no culture of tiffins in high school because ‘sharam aati hai’.
Primarily consume biscuits during the school recess.
6. Potluck (Moringa Thepla)
A recipe booklet for Moringa Thepla was shown highlighting the benefits of the vegetable.
Sample group | No. of Participants | Response/ Reaction/Remark |
SHG Leader | 2 | The SHG leader could relate only to the visual to a certain extent. Reading the text within visuals. Would instead prefer a written explanation or conversation. Already made posters with more written content, samples of which were shown during the interview. They do have a potluck system in place. This came across as an overlap with the previous scenario. They make Thepla from THR packets and create and show the adolescents recipes. The adolescents consume the THR packets, but their parents do not. Mothers do not involve themselves in cooking for them, so the ‘kishoris’ do make it themselves. Some girls do not like the taste; suggest adding flour and spices. |
Comments:
Low impact or relevance; insufficient feasibility.
Annexure
List of respondents interviewed on Day 1 (19th February 2024)
Village 1 - Malupur
Two pregnant women - 1st
Pregnancy
2 MIL of pregnant women
1 ASHA (for pregnant women)
2 Adolescent boys (12-15 years)
2 Adolescent girls (12-15 years)
1 ASHA (for adolescents)
Two mothers of Adolescent boys
One mother of an Adolescent girl
Respondents interviewed on Day 2 (20th February 2024)
Village 2 - Naroli
Three pregnant women - 2nd
pregnancy
2 Husbands of Pregnant women
1 SHG (pregnancy)
1 ANM (for pregnant women)
1 THO instead of MO (for
pregnant women)
Two adolescent males (16-19
years)
Two adolescent females (16-19
years)
Two teachers (on adolescent
anaemia)
1 SHG (on adolescent anaemia)
1 MO (on adolescent anaemia)
Note: *No informal practitioners were available for the interview.
*No ANM worker was available on Day 2 for the interview on Adolescent Anaemia
Field Plan
- Day 1 (19th February 2024):
● Location: Malupur
● Activity: Prototype testing with Sample Groups
- Day 2 (20th February 2024):
● Location: Naroli
● Activity: Prototype testing with Sample Groups
- Day 3 (21st February 2024):
● Activity: Presentation of Insights and synthesis.
- Day 4 (22nd February 2024):
● Activity: Prioritizing the proposed interventions' feasibility and impact.
Timeline
- Step 1: Field visit for prototype testing - 2 days.
- Step 2: Prioritizing ideas with the health
Comments