Essential Care for Every Baby
Clinical Decision Support Tool to help new-born babies get the first 24 hour essential care after birth.
‘Every year, 2.7 million babies die due to lack of the right essential care after birth.’ -UNICEF, 2017
The Essential Care for Every Baby, Helping Babies Breathe etc. are training programs (prescribed by the World Health Organisation) to help health workers perform the first 24 hour care on newborn babies as the first 24 hours after birth can determine long-term health outcomes for at-risk babies.
When there are multiple births in a low- resource environment, it becomes difficult to keep track of which baby to tend for, what was the last care given, what is the health status of the baby etc. We try to solve this problem through a Clinical decision Support Tool (CDST) design incorporating the ECEB guidelines.
So, we have a set of theories, guidelines and training programs such as ECEB, HBB etc prescribed by the WHO.
But are they followed internationally?
If yes, how are they implemented?
Why is the neonatal death rate still high?
Dealing with several deliveries simultaneously can tremendously increase the cognitive load of the health workers, which makes them vulnerable to mistakes. My team and I initiated user research with a how might we statement:
How might we tackle the challenge of cognitive load of understaffed health workers to provide the first 24 hour essential care for newborn babies in low- resource environments?
Understanding
Observed Pain Points:
Initial Ideation
The discussion of the present user flow showed an ideal path that could be used in the application:
- The baby is registered using a paper form
2. Baby’s papers goes into a dedicated file
3. The files are stacked in the store room near the nurses’ desk
4. The files are accessed based on manual monitoring
5. Each care given to the baby is entered in the file- one by one
6. The file goes back into the store room with more stamps
7. The information is input into the computer at some time later (usually before discharge)
8. The baby’s paper forms are changed according to the health status (normal/ at-risk)
After discussing the user flow for 2 scrum meetings, I gained clear insights of the flow from my team mates. Here, the baby database connected with the application would be difficult to access and manage every single time. This made us limit the scope of documentation of the baby to 24 hours post-birth and assessments within this time period. The record will be sent to the database automatically as the baby is discharged.
Information Architecture (after 2 iterations)
Initial Prototype
Our team was privileged to have an eminent set of evaluators involved in the participatory design and also the funding that allowed our team to visit Kenya for live user testing.
We started critical examination of the target audience by doing heuristic evaluations and system usability tests in 40 participatory design sessions at 3 different facility sites in Kenya. The initial app designed was user-tested and the findings are as shown:
Some of the problems we found are:
- Conflicting Terminologies
2. Lacking Iconography
3. Missing Steps
4. Lack of effective Feedback
5. Singular Flow- User had to finish a task without going back
6. Ability to logoff amidst action/ task
7. Less Feedback loops
8. Lack of quality checks
9. Display titles misinterpreted as buttons
10. Most importantly, manual Classification- The app wasn’t classifying babies by itself
First iteration
- The purple color is taking away attention. As this is an app for classification through color coding, it is better to choose a pale color for the main interface
2. Registration has to be given priority on the Home-Page
3. Danger should be replaced with ‘High Risk’
4. List should be included in the main Navigation Bar
5. Questions & options have to be displayed bigger which require them to be spread through the screen
6. Sliders can be made more efficient with values displayed at the bottom
Final Solution
Process Book ⏫
Challenges & Reflections
We wanted to design a supporting tool to assist health-workers working in labor wards and aid them to give newborn babies the first 24 hour care.
In engaging ourselves with an in-depth and well fleshed out process, Anushri, Kevin and I created a seamless, simplified and supporting decision support experience while providing an organised, color coded system. The inputs were simplified into single taps as to save time for the health workers in taking care of multiple babies simultaneously. Not only were we able to touch upon some basic user research, we were also able to take the project to an early prototyping stage, giving us a chance to not only work in a group setting, but also across a large span of the design process.
Approaching medical field was new as well as intimidating at the beginning, but having an amazing team from Health-Informatics made it possible for me to identify the minute details of the problem space and thus take the project into live adaptation.
The problem space was vast and it was difficult to find where to start and where to stop. Clinical terms were difficult to read and comprehend and moreover, they were tedious to remember. Having two eminent experts- Dr. Saptarshi Purkayastha and Dr. Sherri Bucher and my wonderful teammates with me throughout the process enabled us to prepare the prototype and user test it twice at the health centers in Kenya.
My take away from this endeavor is to work closely with people from versatile fields to understand versatile problems and to attend to them with the minute detail possible. Design for difference were something I keep close to my heart and with a phenomenal team, perseverance, doing tons of iterations enabled me realize this through this project.
