In alignment with Dimagi’s 5 year strategy of ’Improving Outcomes by Improving Jobs’ of frontline workers,Dimagi is developing a Resilience Application to support resilience skill-building in frontline health workforces. The thinking is centered on the idea that improved resilience will help health workers “achieve a state of mental wellbeing” by reducing burnout and stressthat can act as a “buffer” during times of high workload and stress.
As part of Dimagi’s Resilience Application, the Resilience Message Program– published by our partner the Johnson & Johnson Center For Health Worker Innovation’s Resilience Collaborative– health workers will have access to a set of 82 evidence-based, free, and adaptable messages proven to boost health worker resilience & wellbeing.
In order for the application to add value, we believe that careful adaptation of the resilience content and messaging is required. The purpose of this blog is to share key learnings from a working group that Dimagi hosted earlier this year, to develop a process for adapting, translating, and testing the Resilience Message Program, for health workers living in LMICs around the world.
Working Group: A Collaborative Space For Organizations To Create Adaptive Content
Dimagi hosted a Working Group from March to May 2022 with support from the Johnson & Johnson Foundation Center for Health Worker Innovation. Over the course of three months, six organizations from different geographies such as Brazil, Rwanda, Nigeria, Uganda, Mexico participated in a series of 6 sessions. The 6 organizations included Dimagi, along with…
The purpose of the working group was to develop and test a roadmap for adapting the Resilience Message Program, to ensure that it resonates with health workers from diverse geographical and linguistic settings.
What did we learn from the Working Group?
High degree of interest in Resilience Programs
Feedback from health workers throughout the Working Group sessions showed us that interest in the Resilience Message Program is high. During user testing activities, health workers and their supervisors reinforced the need for implementing a resilience intervention. Health workers were eager to know more about the program and how these messages can support them to manage their stress & burnout levels. For example; one partner intended to conduct user testing with a small group of health workers, but ended up including other staff at the hospital– including managers– as they were interested to learn about the program. This is a testimony to the fact that additional efforts are necessary to reduce health worker’s exposure to stress & burnout.
Learnings from the Content Adaptation process
The Working Group sessions provided the participants with a roadmap to adapt content based Resilience programs, to suit the needs of health workers they work with.
After working through the roadmap together, we arrived at 3 core components of content adaptation for resilience and wellbeing:
Adapt: This includes contextualizing the content to ensure that it reflects the reality in which the target audience i.e health workers operate in. It includes thinking about:
Who will the audience think that the messages are coming from?
How will the audience feel based on the way the messages are communicated?
Translate: Once adapted, it is critical to translate the messages in a language that is easily understood by the target audience.
Test: User testing of the adapted content with health workers is a pivotal step that helps gather continuous feedback. This feedback can support the organizations to make small, incremental changes to the content before disseminating them at scale.
Each session of the Working Group took the participants through the key considerations that should be addressed at each step of the process. Now let’s take a closer look at the reflections shared by the participants
Adapting messages to suit the socio-economic & cultural context the Health workers operate in
The adaptation process starts with thinking about giving the messages a characteristic tone & voice pertaining to a specific persona. In any form of communication, the tone of voice influences the way in which the workers will perceive the messages, and their willingness to follow what is being communicated.
Here is an example of the different personas (and the associated tone of voice) that are relatively common at the field level in India: government officials, supervisors, and co-workers.
Uncovering ‘Complex topics’
Complex topics are terminologies that can impact the relevance or understanding of the messages, due to a lack of adaptation to a local context. These are terms, concepts, or references in the messages that are new, not commonly used, culturally sensitive, or difficult to translate directly.
Case Study from User Testing Conducted in India
As part of Dimagi’s field testing of the message program with community health workers in Katni district in Madhya Pradesh, ‘stress’ was identified as a complex topic. Here is an example of how a ‘complex’ topic was broken down into simpler ideas to make it more comprehensible for the audiences as part of Dimagi’s field visit.
Translating the messages to local language
The messages should be translated into the language that is easily understood by the health workers. Participants shared that the messages should be communicated in a succinct language and should avoid the use of jargon.
Conducting iterative user testing
Participants shared that multiple rounds of user testing supports strengthening the adaptation process, by identifying issues early, getting actionable insights that help make small incremental improvements to the messages, to make them more effective.
To know more about the learnings from the Working Group, we recommend reviewing the Guidebook on Content Adaptation that Dimagi has published. This Guidebook provides a roadmap for adapting and testing the Resilience Message Program.
If you are interested in learning more about the key takeaways from the Working Group sessions, here is a recording of the webinar where three of our partner organizations shared their learnings.
To sum it up, the Working Group sessions provided us with the opportunity to conduct mini pilots of the Resilience Message Program, with the health workers in specific geographic locations. This proved to be a litmus test for organizations by providing them with insights into things they may wish to change or adapt, before scaling up the intervention to more health workers.
The Future Roadmap
The Working Group sessions provided us with insights on how we can continue to design & implement resilience building programs for health workers. One of the ways in which Dimagi is envisioning the distribution of these adapted messages, is through a digital delivery platform built using Dimagi’s flagship technology, CommCare . Through this digital platform, we hope to deliver resilience tools to health workers at scale that can be used as a self-directed tool, that will guide health workers through the adapted Resilience Message Program and help them develop their resilience skills.
Kelly F, Uys M, Bezuidenhout D, Mullane SL, Bristol C. Improving Healthcare Worker Resilience and Well-Being During COVID-19 Using a Self-Directed E-Learning Intervention. Front Psychol. 2021 Dec 2;12:748133. doi: 10.3389/fpsyg.2021.748133. PMID: 34925152; PMCID: PMC8675897.