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How Can Whatsapp Aid At-Risk Patients' Recovery in Rural India?

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Hospitalized patients and their families receive limited knowledge on how to manage their medical event or chronic condition outside of an inpatient setting and lack quality post-discharge education and support systems.

Even in high-literacy patient populations, only 20% of medical professionals' advice is remembered after leaving the hospital, leading to poor care at home and preventable hospital readmissions, which drives up costs (for both the patient and the hospital) and reduces patient satisfaction.

Noora Health collaborates with health systems and governments in implementing the Care Companion Program to provide high-impact medical skills training, positioning family members as the cornerstone of recovery in facilities and at home. The Care Companion Program (CCP) educates the patient's family on healthy behaviours and ensures they're practiced at home after discharge from a public hospital. It's mission is to improve outcomes and save lives of at-risk patients by training families of patients with high-impact medical skills, making them an integral part of healthcare delivery.

With over 400 million users in India, Whatsapp has penetrated India reaffirming its reach in its biggest market. Noora Health leveraged Whatsapp's influence to engage with patients & families in rural and semi-urban India in order to extend it's support during the post-discharge period.

Care Companion Program Session, Ramanagara District Hospital

Photographed by Rachana Deshpande

Families and their patients often leave healthcare facilities anxious, confused, and ill-equipped to care for their loved ones, leading to preventable complications which could be fatal.

Families that have attended the Care Companion Program (CCP), sign up to receive extended medical guidance throughout the recovery time.

Noora Health then sends them personalised content based on their condition (Oncology Care, Mother and Newborn Care, Cardiac Care) in their native tongue through the medium of messages and videos. This service is also paired with Noora's in-house medical team that responds to emergency queries which are then sent after being translated.

I worked with Noora Health in the summer of 2019 to redesign this post-discharge service to make communication interactive and effective. I conducted workshops, research and experiments to identify the stumbling blocks in the service.

After noting the gaps in the technical and scalability aspects of the service, I knuckled down on the interaction and communication strategy of the content. I conducted research in the Mother and Newborn Care (MNC) department of Vani Vilas Hospital, Bengaluru and District Hospital, Ramanagara and after observation and interviews with new mothers, fathers and mother-in-laws (who are an integral part of formative care in Indian households), we identified areas of intervention in tone of voice, message delivery timing and the structure of these messages.

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Antenatal Care, Vani Vilas Hospital, Bengaluru

We incorporated smartphone usage patterns of semi-urban, low income households in our messaging. This would directly affect who we address in the content (the male head of the family owns a mobile in 48% of all cases). This also helped evaluate the role of fathers in facilitating healthy behaviour in new mothers and newborns.

We chose ten families at random that signed up for the service, and experimented with message format, tone of voice and time of sending and collected feedback at the end of their two weeks subscription.

Nurses trained by Noora to conduct the CCP sessions were actively involved in advising the construction of these message modules. Their experience in interacting with over 50 mothers each day with varying levels of knowledge and discomfort aided the design process.

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Further, using Louis and Sutton’s Model of “Switching Cognitive Gears” relevant emojis were used to present information in novel ways to grab attention and engage.

Building upon insights from the field and feedback from families, I created guidelines on message design in order to make this a sustainable process. The message content was created based on temporal needs of the patient anticipating their complications.

We found out that the largest issues in households is the propagation of unscientific beliefs by heads of families (in-laws) that can deter improvement, hence, providing a sense of authority gave these messages the power to be heard. The shift in mobile health communication made approaching the healthcare system instead of ignoring complications easier and accessible. Improving translation through thorough testing improved responses and interaction from these families.

THE OUTCOME

Message Design Guidelines↗︎

Research Presentation↗︎

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Mentored by 

Anjali Gupta

Shout out to

Shanti, Nurse, Vani Vilas Hospital

Victoria and Sudhanshu, Research and Survey

Neelima and Anindita, Medical Assistance

Noora Health Translators

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