A Picture is Worth a Thousand Words...
Location
Our project aims to improve female health literacy in rural India through a pictographic approach. The innovation has two parts. The first is a product the size of a band-aid, but will actually help solve the problem of health illiteracy instead of just cover it up. Our pictorial dosage tabs are simple. On one side: pictograms of morning, afternoon, and night, with space beside each to draw the appropriate number of tablets, tickmarks, spoonfuls, etc. On the other side: an image of a person suffering from the same illness or symptom for which the patient is taking the given medicine.
This small tab will allow the patient to answer the following 3 questions: When do I take my medicine? How much do I take at one time? Why am I taking this medicine? Many literate and health literate people take for granted knowing these seemingly simple but crucial pieces of information. An understanding of our medicines’ dosage and usage empowers us to become agents in our own recovery and our own health. Take that away, and we are left to depend on physicians, literate/health literate family members or neighbors, pharmacists, traditional healers, parents. Everyone but ourselves. And until we can start to put people’s health back into their own hands, the foundations of awareness and ownership will not be built in our communities.
The second part is a preventative health card that each patient will be given after each visit to the clinic. In this card will come, in addition to valuable follow-up details, important health advice (i.e. eat more green leafy vegetables, elevate your feet, eat less salt, etc). These recommendations will come in the form of visual images, and the doctor will simply check those that are appropriate for each individual patient. We believe this will serve to both improve recall of preventative and nutritional health advice as well as legitimize preventative health in the eyes of the community as a critical component of health care.
About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Focus of activity
Product/procedure
Year the initiative began (yyyy)
2007
Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?
Patients not empowered
Which of the principles is the primary focus of your work?
Simplify through technology
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:
"Health care not consumer friendly" also applies since we're addressing our current inability to provide proper medical care to the health illiterate
Name Your Project
A Picture is Worth a Thousand Words...
Describe Your Idea
Our project aims to improve female health literacy in rural India through a pictographic approach. The innovation has two parts. The first is a product the size of a band-aid, but will actually help solve the problem of health illiteracy instead of just cover it up. Our pictorial dosage tabs are simple. On one side: pictograms of morning, afternoon, and night, with space beside each to draw the appropriate number of tablets, tickmarks, spoonfuls, etc. On the other side: an image of a person suffering from the same illness or symptom for which the patient is taking the given medicine.
This small tab will allow the patient to answer the following 3 questions: When do I take my medicine? How much do I take at one time? Why am I taking this medicine? Many literate and health literate people take for granted knowing these seemingly simple but crucial pieces of information. An understanding of our medicines’ dosage and usage empowers us to become agents in our own recovery and our own health. Take that away, and we are left to depend on physicians, literate/health literate family members or neighbors, pharmacists, traditional healers, parents. Everyone but ourselves. And until we can start to put people’s health back into their own hands, the foundations of awareness and ownership will not be built in our communities.
The second part is a preventative health card that each patient will be given after each visit to the clinic. In this card will come, in addition to valuable follow-up details, important health advice (i.e. eat more green leafy vegetables, elevate your feet, eat less salt, etc). These recommendations will come in the form of visual images, and the doctor will simply check those that are appropriate for each individual patient. We believe this will serve to both improve recall of preventative and nutritional health advice as well as legitimize preventative health in the eyes of the community as a critical component of health care.
Innovation
Define the innovation
Our project aims to improve female health literacy in rural India through a pictographic approach. The innovation has two parts. The first is a product the size of a band-aid, but will actually help solve the problem of health illiteracy instead of just cover it up. Our pictorial dosage tabs are simple. On one side: pictograms of morning, afternoon, and night, with space beside each to draw the appropriate number of tablets, tickmarks, spoonfuls, etc. On the other side: an image of a person suffering from the same illness or symptom for which the patient is taking the given medicine.
This small tab will allow the patient to answer the following 3 questions: When do I take my medicine? How much do I take at one time? Why am I taking this medicine? Many literate and health literate people take for granted knowing these seemingly simple but crucial pieces of information. An understanding of our medicines’ dosage and usage empowers us to become agents in our own recovery and our own health. Take that away, and we are left to depend on physicians, literate/health literate family members or neighbors, pharmacists, traditional healers, parents. Everyone but ourselves. And until we can start to put people’s health back into their own hands, the foundations of awareness and ownership will not be built in our communities.
The second part is a preventative health card that each patient will be given after each visit to the clinic. In this card will come, in addition to valuable follow-up details, important health advice (i.e. eat more green leafy vegetables, elevate your feet, eat less salt, etc). These recommendations will come in the form of visual images, and the doctor will simply check those that are appropriate for each individual patient. We believe this will serve to both improve recall of preventative and nutritional health advice as well as legitimize preventative health in the eyes of the community as a critical component of health care.
Context for Disruption:
What would you do if you found out your brother took only one day’s worth of his 8-day antibiotic because he had started feeling better? Or if your friend got confused and gave her bedridden mother one Tylenol and 5 tablets of ampicillin instead of the other way around? Dangerous consequences await both scenarios. And certainly even more dangerous scenarios are transpiring all over the world b/c we haven’t yet developed an effective and reproducible method for ensuring health literacy for all.
In the short term, our innovation will improve health outcomes by improving recall and understanding of medical instructions. In addition, it will encourage individuals to start asking questions about their own well-being and empower them to become agents of their own health. Our hope is that this new perspective will question the meaning and origin of the term “health literacy.” Arguably the impact of illiteracy in this vein is just as debilitating as receiving a medical explanation in a foreign language.
If someone is trying to get from Point A to Point B but doesn’t know how to drive a car, does that mean they can’t get there? Maybe nobody asked them if they knew how to ride a bicycle, and maybe nobody offered them one for the trip. This innovation attempts to facilitate access to health information by providing individuals and communities with the resources and appropriate media necessary to achieve health literacy. However, we hope that these materials serve as only an introduction to the use of visual images to facilitate health literacy. There are innumerable opportunities to expand both the depth and breadth of this innovation within the curative and preventative health circles active in both our local and global communities.
We believe that this innovation will transform community health by bringing the millions of “health illiterate” people back into focus under the lens of the global health care sector.
Delivery Model
The pictorial materials that have been developed will be distributed from within our maternal and reproductive health clinic based in the center of the remote region it services. Our doctors, health education counselor, and clinic staff will be working together to ensure the most effective implementation of these materials. If the initial phase of implementation in the clinic proves successful, we will begin scaling up by collaborating with local government health workers and local healers. Eventually, our innovation will be available through several channels of distribution, thereby increasing the base of users as well as our collaboration with other health initiatives in the region.
While our innovation aims to introduce visual images into the verbal system of medical explanations, we envision it as just one artery from which to supply fresh blood to the movement against health illiteracy. We plan to engage several arteries at once to improve health care in our remote region of Gujarat, India. For example, our organization has trained two local health cadres: a group of traditional midwives who receive professional and up-to-date training on safe maternal and child care, and a group of male and female health workers focused on issues of reproductive health in our communities. Through these eager and knowledgeable members of the local community, as well as through local government health workers such as ANMs (Auxiliary Nurse Midwives) we will be able to not only reach more women with this pictorial system, but we will also be able to follow-up more regularly, and provide the necessary supplemental information for ensuring recall and comprehension of medical information.
We will measure “market penetration” in the initial stages, as the number of women who are visiting the clinic and correctly administering their medications and other preventative health advice as a result of the supplemental visual images that are provided.
Key Operational Partnerships
We are working in collaboration with local non-profit organizations, government health workers, and motivated members of the local community to make this initiative possible. Drawing on each other’s strengths (e.g. trust within the community, access to outside resources and funding, knowledge of regional culture and customs, and health and medical expertise) we will be able to develop the most effective system.
Within the local community, we are working primarily with village leaders, midwives, and local health workers to ensure all villages receive the services and resources available. Midwives and local health workers will be instrumental in the field component of our initiative since they will be best equipped to bridge the potential gap between our goals and the current state of health and health literacy in their own villages.
The government MO (Medical Officer) and ANMs (Auxiliary Nurse Midwives) are eager to combine efforts on health initiatives, especially those focused on reproductive and child health since the maternal and infant mortality rates in our region are so high. We have collaborated with their team on many occasions (polio vaccination drives, community health meetings, health worker trainings, medical camps, etc) and we are confident their expertise in community health will add much value to the development and implementation of our pictorial system.
Impact
Financial Model
The major cost of this initiative lies in the development of our pictographic materials: the medicine labels and preventative health cards. As the daily stream of clinic patients (and their prescriptions) will require these materials, the need to replenish the stock will be recurring as will the expense. In addition, our model also requires finances for human resources at the start-up to form a field team that will pretest and pilot the project. However, aside from these costs, the initiative falls under the auspices of our rural health clinic and thus the financial and technical infrastructure to conduct and sustain such a project already exists. Within the clinic’s model, the main/only source of “earned income” comes in the form of patient examination, treatment, and delivery fees, which covers only a slight margin of the operating costs.
What is your annual operating budget?
$3000
What are your current sources of revenue? (please list any sources that are foundation grants)
Current sources of revenue come from patient fees (a marginal source) and two external funding partners: SDTT (a local funding source) and KOJAINA (a North American-based organization of Kutchi non-resident Indians).
Effectiveness
The project is in the initial phase, therefore it is not possible to predict the impact it will have. However, we have had positive responses from the approximately 50 local women with whom we have discussed the initiative. Almost all agreed that some form of visual supplement would improve their recall and understanding of medical instructions received from our clinic. In addition, there has been a very enthusiastic response from other health-related non-profit organizations operating in rural Gujarat who currently have no such system for ensuring illiterate patients have the resources necessary to adhere to medical instructions. In fact, one organization in particular, SEWA Rural, located in Jhagadia, Gujarat, has expressed interest in collaborating to develop a system which can be used in their rural hospital as well. Certainly, the potential impact of this initiative is great, especially in rural India, where both literacy and health services are often difficult to access.
Which element of the program proved itself most effective?
The program is still in its start-up phase and has yet to be implemented. While we are certain its impact will be far-reaching (as discussed above), we cannot—at this juncture—measure effectiveness empirically.
Number of clients in the last year?
As the project implementation phase has not yet begun, we have not had any clients. However, approximately one to three thousand women and children from Khavda and the surrounding villages visit our maternal and reproductive clinic each year. In addition, we estimate eleven thousand women in this region are of reproductive age, illustrating the vast potential of this initiative.
What is the potential demand?
Quite simply, the potential demand is any of the millions of people who are currently receiving medical information in any medium/”language” other than one in which they are “fluent.” While the current innovation is socially and culturally specific to the region we are working in, the concept and design of this program have alarming potential to improve the lives of those who are affected by low levels of health literacy.
Scaling up Strategy
We intend, first, to pilot the program with 100 pregnant patients of our maternal and reproductive health clinic. If the initiative proves effective in improving recall of medical instructions, we intend to scale up, first, on a local level. To this end, within the first three years of the initiative, we plan to supplement every patient’s clinic visit with a preventative health card and medicine labels. On a national level, we have begun discussing the concept and design of this project with like-minded Indian health organizations so that slowly health care and its language can become more accessible to patients across the country. In this way, our clinic can serve as a model for other health literacy programs. We also envision collaborating internationally and scaling up to the same so that health literacy becomes an actively tackled issue within the global health community. However, for the latter we may need a wider timeframe to adequately network and research culturally-appropriate designs.
Stage of the initiative:
0
Expansion plan:
We are in the initial stages of our project. To date, we have succeeded in networking with several health literacy experts to design a research action study that will effectively evaluate the use of pictograms in medical explanations among illiterate populations. We are now in the process of material development, which will involve two rounds of pre-testing with over 50 healthy illiterate women in our target community. Based on their responses and degree of comprehension, the pictograms themselves as well as their presentation will be revised by our research team, comprised of local health workers, government workers, members of our NGO, and partner NGO’s). One hundred pregnant patients will be recruited from our clinic, of which 50 will receive the supplemental pictorial materials during their check-up. Each study subject will be visited at home 2-4 days following her visit to the clinic. Recall and understanding of medicines’ dosage and usage as well as preventative health advice will be evaluated. Collected data will be analyzed and used to determine how to most effectively implement this system in our clinic.
We envision these materials being used for all clinic patients, and we plan to conduct regular evaluations of their effect on recall as well as patients’ overall reaction to the materials. It is likely that both the style and presentation will be slowly adapted to meet the current needs and learning styles of the local community.
Origin of the Initiative
One day I was sitting in the doctor’s room in our rural maternal and reproductive health clinic, as our visiting gynaecologist prescribed a patient 7 medicines. I watched quietly as he and our head midwife explained the proper dosage, times, and duration of all these pills, syrups, and powders.
She pulled out a strip pack of yellow pills and showed me the “1-0-1” written on the foil (many doctors use this formula to denote number of pills to be taken morning-afternoon-night). Then she asked, “This circle is a tablet, yes? that means I should take one in the afternoon?”
So we conducted a small study, questioning about 40 patients (almost all illiterate women) about their medicines. About 35% of their responses were incorrect. Many also had no idea for what illness or symptom their meds were being prescribed. We wanted to do something about this.
This Entry is about (Issues)
Sustainability
What are your two main challenges to finance the growth of your initiative
Our main challenge is to find funding that will cover the cost of material development. We can provide health education and information within the clinic, but once a patient leaves for her home, her source of recall and information will be the medicine labels and preventative health advice cards. Without the pictographic supplements to the verbal medical instructions, the program has little meaning. Additionally, we need funds to cover the salaries and training of a field team that will be responsible for piloting and evaluating the project.
How did you hear about this contest and what is your main incentive to participate?
We heard about this competition through Indicorps, a service-based organization in Ahmedabad, Gujarat, India. We were drawn to participate because of the interactive nature of the competition.
The Story
Do you have an annual financial statement?
Yes
Do you currently have an annual financial statement that tracks profit/loss?
No
Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.
As stated above.
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