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Shortly after the CGI Annual Meeting, the Literacy Bridge team met in Ghana to kick off the integrated health and agriculture program Health & Agriculture Communication for Women & Children. Literacy Bridge Maternal/Child Health program manager Ayva Larson chronicles her experience in Ghana in the following blog.

The community of Gozu is home to approximately 500 individuals, most of whom are subsistence farmers. The community has no electricity, no running water and almost no access to medical care. The nearest hospital is an hour down a bumpy, dirt road in the town of Jirapa. The community has no cars or trucks, and motorcycles are a rarity. It is in this community that Literacy Bridge launched the beginning of the Health & Agriculture Communication for Women & Children Program, a program designed to help reduce maternal and child mortality rates.

The program focuses on five key health messages identified by UNICEF and Ghana Health Services as having the greatest impact on reducing mortality rates in pregnant women and children under the age of five. These key health messages are:

• Hand washing with soap.
• Proper use of insecticide treated bed nets for pregnant women and small children.
• Use of oral rehydration therapy for children with diarrhea.
• Delivery with a skilled birth attendant.
• Exclusive breastfeeding for the first six months of a child’s life.

Literacy Bridge added one additional message:

• The best food combinations to create the most nutritious food for small children and pregnant women.

During our time in Ghana, Literacy Bridge staff met with health officials, agriculture ministers and other development agencies to determine how to best create content around these key subjects. The result was interviews, songs and simple messages created to engage community members in low-literate, rural communities in the Upper West of Ghana.

Gozu was the first community Literacy Bridge approached, and the first community to provide essential feedback to our staff. When we first visited the community the sun was beginning to set, and a small group of men were sitting on wooden benches by the road. We first approached the group to ask for an audience with the Chief. When he arrived, we described the program to the Chief, demonstrated a Talking Book and asked if he felt this information was useful to his community. He felt it was very useful and agreed to hold a community meeting the next morning to introduce our staff and allow community members to ask questions.

The community of Gozu.

The following morning we returned to Gozu with Talking Books and all four members of our team: Andy Azaabanye Bayor, Fidelis Da-Uri Awonodomo, Cliff Schmidt and myself. We were greeted at the road by a group of women who sang, clapped and danced for our arrival. Their laughter and singing escorted us to the main ‘square,’ a central clearing in the community with a large tree for shade. There we were greeted by nearly 200 members of community, a very large turn-out for a market day. We were told many of the women would have to leave by mid-day to go to the market, but that all present were eager to hear about the Talking Book and the Child and Maternal Health Program.

What followed was an engaging speech and demonstration by Andy, Literacy Bridge’s Country Director. He described the program and demonstrated the recordings on the Talking Books. He answered questions, received feedback and made certain to engage all members of the community present. Andy and Fidelis took turns interpreting for Cliff and I as we described our roles in the project and how the program would unfold in the coming months. The community members were excited and honored that two people from so far away would care about their community and take the time to come all the way there to provide them with this information.

Community gathering

The meeting ended with more song and dance by the women, which in turn meant I had to dance in thanks. A good laugh was had by all at my terrible mimic of their joyous movements and we left Gozu for the second time, leaving behind instructions and Talking Books, and curious to gain feedback the next day.

The feedback we received in the following two days would help us to rethink some of our ideas and force us to address issues surrounding access. The Talking Books were listened to extensively and community members created their own recordings in response to our content. The final program will be more comprehensive as a result of this trip, and our understanding of the challenges facing these communities has continued to grow.

Interacting with the Talking Book

Access to knowledge is one of the most powerful tools anyone can provide. In communities like Gozu, a Talking Book can provide life saving information to the mother of a small child. The power of this kind of information cannot be underestimated. If you have extremely limited access to a medical facility, are illiterate and live in a remote community with no electricity your access to medical information is extremely limited. Literacy Bridge is trying to increase this access by bringing information from medical and agriculture experts directly to the communities.

For me, this trip informed how I think about the program I am helping to create and the potential impact it will have. I feel extremely privileged to have met the community members of Gozu and to have experienced our time in Ghana. The impact Talking Books can make in a community is incredible and I am humbled and proud to be a part of the Literacy Bridge Team.

Monday and Tuesday, we worked with Ghana Health Service officials to create child and maternal health messages for the launch of our behavior change program.

The photos show Fidelis conducting an interview with Madame Theresa, the public health official for the Wa Municipal district of Ghana Health Service. She is discussing what pregnant women can do to have a safe delivery.

Literacy Bridge has learned a lot since we began in 2007 about how to create audio recordings that help people with the least formal education adopt new practices and behaviors to improve their family’s health and income.  We have learned by studying academic research, by reading reports from other successful projects, and by doing a lot of first-hand learning with the people we are dedicated to serving.

With this knowledge, we have begun training our partners and documenting best practices for creating the most effective content.  We’ll soon blog more about this important aspect of our work; but today I would like to focus on how we help our partners learn to improve upon their content by using technology easily collect and analyze the feedback from the communities they serve.

In an earlier post announcing the new Talking Book operating system (version 1.50), I mentioned that we delivered a set of feedback features requested by our partners.  By co-releasing the Talking Book upgrade with a new version of our Audio Content Manger, we have offered organizations a way to easily organize their recorded Talking Book messages and to track how community members are responding to those messages.

ACM Beta 4

The Audio Content Manager (ACM) is like a digital music manager (e.g. the iTunes app); but instead of searching, sorting, and filtering music by artist and genre, it searches, sorts, and filters messages by language and category.  For example, with a single click, you hear all messages about maize farming, child/maternal health, or adult literacy; with another click; you can hear only the ones in the Twi language. For an overview of the ACM, see the first blog written about the ACM by its lead developer,  Michael Busch, or go to our website.

With this latest release, the Talking Book and the ACM work together, not only to organize content, but also to help our partners learn how to improve the content they offer to local communities.

Recorded User Feedback

From the beginning, Literacy Bridge designed the Talking Book to encourage user comments and original recordings to share with their peers. Over the years, we’ve found that many people will record feedback intended for the author of other recordings, such as the health and agriculture messages.  We also heard from our partners that they were very interested in feedback. Some feedback messages ask for clarification, some explain that a particular message is not applicable in their community, and some feedback messages ask for information about a new issue.

In this new release, we now prompt users to leave feedback about the message they have just listened to, and we link the original recording with the feedback.  This encourages user feedback and will soon allow feedback recordings to be grouped with the original message, both on a Talking Book and in the next release of the ACM. This will make it easier for our partners to quickly review their own recordings and comments about each recording (just as I can review this blog post to hear what text comments readers have made – we’re just doing the same with audio for users who live on less than $1 per day).

Monitoring Usage

While recorded user feedback offers a chance for an individual to give detailed opinions about an original recording, these recorded messages may or may not represent what the rest of the community thinks.  To give content authors a sense of whether their recorded audio message is popular and frequently referred to, we monitor what users are doing with the recording.  For instance, the new Talking Book tracks every time a message is started and every time it is listened to in full; it also tracks each time one listener decides to give a copy of the recording to another user.

With the latest release of the ACM, these statistics are automatically imported from a Talking Book whenever it is connected to it.  In fact, the ACM not only reflects the usage of that Talking Book, but also the usage of every Talking Book that was at one time connected to that one.  Every time a user gives a copy of any message to another Talking Book, the two devices exchange usage statistics so that any one of them offers a glimpse into what is popular throughout the community.

Built-In Surveys

While usage statistics can give the content author a sense of what is popular, it doesn’t necessarily indicate that people are learning and applying what they have learned.  To answer these questions, we added a survey feature to the Talking Book.  Just as a user is prompted to leave their recorded feedback, the user is also offered the option to answer a survey question.  The question we ask users in this release is “Do you plan to apply what you have learned from this message?” or “Do you think this message was not helpful to you?”  Their response is recorded along with the usage statistics and all survey responses are exchanged when two Talking Books connect to each other to copy a message.

This allows the ACM to reflect the number of times that a user (of the Talking Book connected to the ACM or of any Talking Book that was connected to it) indicated they would apply what they learned and the number of times that a user thought the message was not helpful.

Combined with the recorded user feedback and the usage statistics, this gives content authors a comprehensive picture of which of their recorded messages are successful and which may need to be revised.

by Cliff Schmidt

In an earlier post, I announced our latest Talking Book operating system, version 1.50. One of the two main goals of this release was to significantly improve the usability by people with little or no formal education. I mentioned there that we did this by focusing on consistency, conversational instructions, and concealing complex operations.

Consistency

In April of 2009, I pondered a potential problem with our user interface: the Left/Right buttons change categories (e.g. “health” or “agriculture”); the Up/Down buttons change messages within the selected category and immediately begin playing each message.  Once a message is played, the Left/Right buttons would suddenly control jumping backward/forward within the recording — they would no longer change categories. To change categories, the user would have to press the Home button to return to the Welcome message and then use the Left/Right buttons to change categories.

Over the last two years, we have reluctantly lived with this inconsistency because users wanted to rewind or jump forward when necessary and they eventually learned to understand this system, although it might take an hour of training for some of them. With this latest release, we decided that we want people who need Talking Books the most (those who are least educated) to be comfortable with the most essential operations as quickly as possible, even if some other useful features are not as obvious.

With the new Talking Book version 1.50, the Left and Right buttons consistently change the subject/category, whether the user has just found a new category or a message is being played.  But this means that rewinding or jumping forward within a message now requires holding down the Left or Right buttons – not just tapping them.  Users will only know to do this if they listen to the built-in user manual or if they are trained or taught by a peer. However, we think it’s more important that they can easily find a message on a subject they’re interested in with this simple instruction: “press the Right arrow to change subjects and then press the Up arrow to listen to messages”. No further training should be required to get started.

Another example of our “consistency theme” is what we did with audio user manual. Previously, when a Talking Book was turned on, it would offer two options: press the Right arrow to choose a category, or press the Home button to learn how to use the Talking Book (the audio user manual). But the Home button was also a way to return to the Welcome message at any time…unless you’re already at the Welcome message, and then you go to the user manual. Here again, we were assigning two functions to a tap of the Home button: returning to the Welcome message and getting help.

With this new version, the Home button will do one thing: return the user to the Welcome message. The user manual is now just another category on the device like “Health” or “Agriculture”.  The user just presses the Right arrow to find the “Talking Book” category and then the Up arrow to listen to messages about the Talking Book.

Finally, we are applying consistency to the location for newly recorded messages.  We used to allow users to insert their own message between any two existing messages in a category. They would simply find the message they wanted their message to be next to, and then press the record button (the asterisk “*”).  But we found that many users didn’t intend to do this and had trouble finding where their recording went.

With this new release, a new recording is always the first message in its category. Some users may still want to control the order of new messages; we have a solution for them that won’t confuse the other users – more about that in a future post on configuration options.

Conversational Instructions

In earlier Talking Book operating systems, when a user would browse through each subject, the device would say something like, “Health.  To listen to messages in this category, press the Up arrow.  To try a different category, press the Right arrow.” We found that many users didn’t understand what “in this category” means. Sentences like this are not part of everyday conversation. For instance, if I wanted to invite you to my group discussion on politics, I wouldn’t say “Politics. To participate in a discussion in this category, join my group.” Instead, I might say something like “If you are interested in discussing politics, join my group.”  When we changed Talking Books to speak this way, users who had trouble understanding the old instructions understood this new version perfectly.

Concealing Complex Operations

In every community, there are people who are less comfortable with technology and people who want to learn and use the most powerful features. For the former group, the essential operations need to be simple and obvious, without any unnecessary distractions. For the latter group, the advanced operations need to be possible. Every technology team designing a mass-market product has to find a way to serve both needs.  (Recall Microsoft Office’s early attempt to solve this problem by showing an abbreviated list of only the most common options in each drop-down menu until the user explicitly requested to see more options.)

Impoverished rural villages are no different in this respect than any other community: some users need simplicity and some want power. To impact the most people, we need every Talking Book to offer both simplicity and power. Our approach to this problem is to hide the powerful but non-essential operations by requiring a button to be held down for 1-2 seconds to activate the feature.

I gave one example of this above when I explained that rewinding or jumping ahead during playback requires holding down the Left or Right arrow, respectively. This allows a simple tap of those buttons to consistently change the subject.

Here’s another example: a user increases or decreases the volume by pressing the + and – buttons.  This is an essential feature that every user needs to be comfortable with.  However, our technology also allows playing a message back slower or faster than normal. This can be very powerful for people who need a slower playback to understand a different accent or for those who want to scan ahead to find something they have already hear — but these aren’t essential features. Therefore, we require users to hold down the + or – button to access them, as explained if you take the time to listen to the audio user manual (which the power users do).

Each Talking Book can include audio instructions in multiple languages. Users can change languages by pressing the black circle button during the Welcome message; each press would rotate to the next language. But accidentally pressing this button caused more than one user to suddenly find their familiar language replaced by a language they didn’t understand at all. Therefore, we’ve changed this feature to require a holding down the black circle to prevent this sort of problem.

Finally, we’ve been asked by our partners to include a number of configuration and convenience features, which will be described in a future post. These features are not useful to the majority of users, but they need to be available on every device and in every system language. There are far too many of them to assign a “button hold” to each one. Therefore, we created an “expert mode” that allows experts (or “power users”) to be able to browse lots of powerful features with a single button tap.  To access the expert mode, a user must hold down the Up arrow for 1-2 seconds during the Welcome message.

We have already received early positive feedback about these changes, and we look forward to evaluating whether Talking Books are impacting more people through this focus on consistency, conversational instructions, and concealed complex operations.

by Cliff Schmidt

Hi Everyone! 

I’m excited to announce a major update to our Talking Book operating system (version 1.50) and our Audio Content Manager (beta 4). These updates coincide with the launch of our partnership with the (ECHOES program). These updates had two major goals: 1) improve usability for people with little or no formal education, and 2) provide our partners with features that improve the efficiency and effectiveness of their programs. These goals responded to feedback that we’ve received over the previous two years from communities and organizations, respectively.

I’ll give a brief overview of why this release is so important, but I’ll leave the details to a series of future posts that will be linked from this one as they are published.

If you’re not familiar with the Talking Book, you may want to visit our website summarizing the Talking Book and describing its features, such as the ability for users to:

 - find local language audio recordings by selecting a category like “health”, “agriculture”, “education”, “business”, or “stories”

 - record their own messages

 - send a digital copy of any message to another Talking Book (no need for a computer)

 - playback messages faster or slower, while keeping a normal pitch

 - use local language audio instructions to guide illiterate users through the Talking Book’s features

 - easily switch the audio instructions to a different language

 - learn from multiple-choice quizzes and audio hyperlinks to related messages

 - use the Talking Books in hot, humid, and dusty environments and not to worry about dropping it on hard surfaces.

Ease of Use

Since the first version of the Talking Book, children in even the most deprived communities have had no  problem operating it. Adults with a few years of formal education and those who live near cities with exposure to other technology also rarely have any trouble. But until this latest Talking Book version, women and men with no formal education living in remote communities required 45-60 minutes of training to become comfortable with the Talking Book’s basic operation.

With this new version 1.50, the device has become simpler to operate than ever. We did this by focusing on consistency, conversational instructions, and concealing complex operations. Non-essential features are now just a little less obvious so that the essential ones are more consistent. Read more about this change and several others.

Improving the Efficiency and Effectiveness of Our Partners’ Programs

Our partners, who are NGOs (nonprofits) and government agencies with expertise in local challenges related to health, agriculture, education, and business, have been telling us that they want feedback from the communities they serve. They want to know whether the expertise that they record on Talking Books is really making a difference. They want to know whether the solutions they propose are viewed as practical, and they want to be aware of what other needs a community has.

With this version of the Talking Book operating system and our Audio Content Manager, we provide partners an easy way to listen to recorded feedback from these communities and to view statistics on the relative popularity of their recordings.  They can find out whether listeners intend to apply what they have learned.

We also make it easy for anyone to translate the Talking Book’s operating system into any language they choose. This can be done in a few hours without needing a computer or anything more than a Talking Book.

Finally, we’ve worked hard on a lot of features that make practical steps in a Talking Book program much easier and faster. For instance, selecting a particular set of messages to copy to each of many Talking Books scattered throughout a community is now easier than ever. It was always possible and easy for our staff; but we have observed how our partners will need to do this and have adapted the device accordingly.

Thanks to seed funding from an anonymous donor, Literacy Bridge is launching a pilot program to help reduce the maternal and under-five mortality rates in Ghana.  The Health Behavior Change Program seeks to demonstrate how the Talking Book can dramatically decrease the number of preventable deaths through actionable recordings on safe birthing practices and steps to avert illnesses, like diarrhea, malaria and malnutrition. The seed grant will allow us to evaluate the Talking Book’s impact on behavioral changes of mothers on five key health and hygiene practices, including hand washing with soap, usage of the bed nets and the use of oral rehydration therapy, to prevent maternal and under-five mortality.

The goal of the Health Behavior Change pilot program is to reach 1,000 at-risk families in ten Ghanaian communities. To achieve this, we are now actively seeking the balance of the required funding from a variety of sources, including our own Literacy Bridge community. Please join us in putting Talking Books into the hands of those who need it the most. The cost of the program is only $25 per family.  With your gift of $25 or more, you will ensure that families without any other resources or means are able to receive life-saving and life-changing health information.  Join the Literacy Bridge community in supporting this much-needed demonstration project of how the Talking Book can be integrated into Ghana’s efforts to reduce maternal and under-five mortality.  Please make your gift today.

by Cliff Schmidt

I was hosted in Washington, D.C. last month by the Agricultural Technology Adoption Initiative (ATAI) so I could participate in a workshop that brought together development practitioners and academic researchers to share ideas, identify new joint projects, and learn about funding opportunities.

Other invited participants include economists from MIT, UC Berkeley, Yale and a handful of other U.S. universities, plus senior staff from governments, NGOs, multi-laterals, the CGs, foundations, and other agencies with agriculture-for-development programs.

ATAI is a research program to improve appropriate adoption of proven agricultural technology—specifically for technologies that promise to dramatically improve the welfare of small-scale farmers in Sub-Saharan Africa. The program is jointly managed by the Jameel Poverty Action Lab at the Massachusetts Institute of Technology, the Center of Evaluation for Global Action at the University of California, and the Bill & Melinda Gates Foundation.