Digital Gamified Trainings

Maternal Depression (MD) which includes both, prenatal and postpartum depression, has a prevalence in Pakistan which is under-estimated to be at 40%. As screening and mental health services are limited, it adversely impacts the health of pregnant women and mothers. By training community-based lady health workers (LHW), which are the first point of contact for maternal and child health services for over 60% of the population, we can treat such women living in these underserved regions of Pakistan.

 We propose leveraging the LHW network and training them via digital training modules delivered through smart phones to identify, counsel, treat and refer women with MD. Our solution will ensure scalability and global replication by utilizing prevalent technology, reducing prohibitive training costs and maximizing engagement and retention via its gamified approach, while also empower workers coming in contact with women suffering from MD to support their mental and emotional well-being.

Maternal Depression (MD) adversely affects the mental and emotional health of women throughout pregnancy and after child birth. Women with MD often feel overwhelmed, have difficulty bonding with their children and struggle with negative thoughts. In low and middle income (LMIC) countries, on average MD is prevalent among 18.7-19.8% of the population. In Pakistan, the situation is even more dire with an estimated prevalence of 40%. The situation is further exacerbated due limited and expensive treatment options and poor identification and referral of patients. Moreover, a large proportion of the population lives in slums with limited infrastructure and poor access to the healthcare facilities. Although there is a great reliance on community-based workers, such as the lady health workers, mental health training is sparse and neglected leading to an inability to identify, support/counsel or refer MD patients in time. Successful management of MD should ideally begin before gestation, requires planning, counselling and community support, and should be sustainable and scalable in a resource-constrained setting. No such system currently exists in Pakistan. There is thus a need to develop an innovative solution to improve maternal health outcomes while leveraging existing resources.

Our idea is to introduce an interactive digital module that will train and provide on-going support to build capacity of LHWs to identify, counsel, treat and refer women suffering from MD. We will leverage the ability of technological platforms to easily display and share audio-visual material while allowing interaction between multiple, geographically dispersed users in one digitally shared space to allow instructional as well as peer to peer learning. To ensure effectiveness of our developed module we will utilize attractive training videos with in-built gaming elements such as quizzes, activities, badges, leaderboards, competitions, and rewards to engage and motivate trainees. While the use of gamification is increasingly popular for training programs to drive behavioral change, it is a relatively novel concept in mobile health, with significant potential for success. We would make this module accessible via relevant play stores allowing download and use over personal devices. We will capture the baseline knowledge level of LHWs via a questionnaire before the release of the module and will continue to capture user metrics and end-user feedback to improve engagement on the module. After successful completion of module coursework, we will re-administer the knowledge questionnaire to evaluate impact and inform future interventions.  

Our solution aims to improve the lives of pregnant women and mothers suffering from MD. Our solution particularly targets vulnerable women living in underserved areas such as slums who have limited access to care by building capacity in the LHWs that visit them often to cater to their MD needs. In order to ensure that our solution meets the needs of our target population we will develop the digital training module via a user and recipient centered process. We will also engage LHWs and mental-health professionals at this stage to identify gaps in the knowledge, shortcomings of the current curriculum and LHW needs for refresher and on-job training. The project team will then work with a team of technology, education, and behavioral experts to design the digital training content. In the short term, our proposed activity would lead to the development of an innovative digital learning module for LHWs that will help enhance their knowledge of MD and equip them to provide required care. The increase in LHWs skills, productivity, and knowledge as a result of engaging with the training module, will translate to improved care and psychological support for those struggling with MD in unreached rural and remote areas.

Women suffering through Maternal Depression (MD) often feel overwhelmed, demonstrate poor fetal attachment, suffer from headaches and chest pains, develop insomnia and in some cases are plagued by thoughts of death and suicide. Our solution caters to these women by leveraging an existing workforce of community workers and trains them via innovative digital training modules, to build their capacity to identify, support/counsel and refer women suffering from MD. Our solution aims to provide a low cost, accessible community support solution to these vulnerable women, via the provision of psychological care/counselling and connecting patients to relevant medical care.

With the fast moving world, technological advances are becoming more accessible and affordable. Even in LMIC’s like Pakistan, mobile applications for online gaming are becoming an increasing source of entertainment with a surprisingly large percent of the population online in some form or the other. These gaming platforms are an untapped source of technology that can not only help train health staff in a fun and interactive way, but also allow low cost update of programmes to ensure continued up to date evidence based practices. In its interactive form we will also be able to evaluate strengths and weaknesses through quizzes and feedbacks. Till date no platform has been created regarding training of lady health workers (LHW) on maternal mental health in Pakistan. Furthermore, gamified videos will allow inclusion of LHWs working in hard to reach areas, enabling them to keep themselves abreast of the latest mental health diagnostic tools. Due to taboos attached to mental health, addressing maternal mental health in countries like Pakistan with high rates of maternal depression is imperative. This is especially important of times like today where the COVID19 pandemic requires social distancing. 

We are currently building gamified videos using Adobe Captivate to create and educate health workers on immunization, specifically on standard operating procedure regarding immunization during COVID19. The COVID19 pandemic has driven innovation to support new ways of teaching not requiring in person attendance. 

This technology is currently used throughout the world for distance learning, allowing information and education to reach every household. We will be taking what has already been tried and tested, and developing affordable training for every health worker. Training will also be created in local language. 

Mental health is considered taboo in Pakistan and is frequently under reported in vulnerable populations. Lady health workers are trusted members of the community and were therefore created to help educate and mobilise hard to reach communities. They are frequently the first and often the only access to primary health care for expectant mothers. It is therefore imperative that their training regarding maternal depression is also maintained. Through gamified videos we hope to improve awareness and screening of maternal depression trough lady health workers in the community. We hope to see better screening and more accurate measure of incidence of maternal depression in the community.  

Currently we would start as a pilot in a high risk union council (UC) in Karachi, defined as areas where immunization rates are low and is polio endemic; estimated population of 2.4 million for the first year. Karachi itself has an estimated population of 16million and growing, our aim would be to eventually implement digital gamified training LHW throughout the city. Sindh, one of the largest populate province of Pakistan has an estimated population of 44 million are final goal at the five year mark would be to launch digital gamified training across the province.

Over the next one year we aim to construct, implement and evaluated digital gamified training on maternal depression for lady health workers. We would use this time to adapt and update any issues that arise, to ensure uptake and maximum affect. Within the next five years we hope to see the use of digital gamified training being implemented across the province, allowing better evaluation, support and referral of expectant mothers across Sindh. This would also allow better measure of true prevalence of disease. 

As we are a not for profit organisation, our work is supported through grants.

The IRD works closely with the local government and has a long standing relationship with the expanded program for immunization. We have developed the electronic immunization registry, zindagi mefooz that is currently in use through out the province of Sindh. This EIR has been invaluable in evaluating real time immunization rates, specially during the COVID19 pandemic.