Calling all designers – help us out here!

Regular readers will know that our Kit Yamoyo anti-diarrhoea kit has design features that respond to the needs of the mothers we talked to as part of the design process. A technique we now know is calledΒ ‘Human Centred Design’.

Village mothers focus group (cropped)
Mothers helping with the design of the Kit Yamoyo

Two key features of Kit Yamoyo help mothers mix the ORS correctly:

  1. The inclusion of ORS sachets that make up 200 ml (the standard ones make up 1 litre and were designed for institutional use, not for use in the home)
  2. The fact that the Kit Yamoyo container also acts as a measuring device for the correct amount of water and is also a mixing device and cup

Early indications show that mothers using a Kit Yamoyo get the mixing right more than 90% of the time whereas those that are given 1 litre sachets get it wrong about half of the time.

This is an example of how product design can improve adherence to the correct use of the ORS.

But we remain with a challenge that we’d like your help with and here it is.

ADK IEC Insert Kit Yamoyo v5To get the full effect of the Zinc tablets included in the kit, children should be given them for 10 days. Half a tablet a day for children under 6 months and a whole tablet for children over 6 months. However, early results show that only around 25% of children are given the tablets for a full 10 days. When the diarrhoea stops, mothers tend to stop giving the Zinc. Although this does no harm, children will not get the full benefit of the kit if they do not complete the Zinc course. Zinc strengthens the immune system and so helps protect against future bouts of diarrhoea.

Is there a design adaptation we could make to increase adherence to Zinc in the same way as we have increased the correct use of ORS?

For your information, here is the Zinc panel of the instruction leaflet in English. The leaflet in the commercial kits is in 3 languages and can be viewed and downloaded here.

But note that only around half of our users consulted this leaflet!

Over to you . . .

 

 

 

 

 

 

 

A note on the data in this post
Cited data are interim results from the midline evaluation and do not reflect the final report.
Final calculations may vary.
Final results of the ColaLife trial will be published in due course by Ramchandani R, et al.

Comments

  1. When I took over supplies to Western Province I took vitamin gummy bears. I had to make sure I told Mom to only give one a day as they were like candy but if they took too many it could make them sick. What if you put the zinc in gummy bears ? It would be a reward for taking the initial ORS and the child would be asking for the gummy bear each day until finished? I don’t know if the zinc will go well in gummy bears but just a thought!

  2. Justis Saayman says:

    Simon, I really think to get the message across you need to look at creating a more graphic way of explaining the process. This could include something as simple as showing a sick face for a few days and showing what they get and then a happy face but the Zinc treatment continues on in the pictures. Infographic style instructions go far to get the point across. I stand corrected.

  3. Turn the instruction leaflet into a sticker chart with 10 stickers – one for each day. Kids love the chance to peel and stick and will remind their parents to continue with the course to the end. I suggest the instructions become a hang up sheet (incorporate a hanger), with space for the 10 stickers to be stuck round the outside of where the instructions are written. The back of the chart could contain the 10 stickers, with one to be peeled off and stuck on the front each day.

    Regarding the idea of zinc in gummy bears: I used to work for one of the large toothpaste manufacturers. Zinc is a common active in toothpaste. We looked at a similar idea for zinc in chewable sweets to get benefits for oral health. It should work from a technical point of view.

  4. Luke Berry says:

    I’m sure you’ve thought of this already, but how about printing something on the foil on the back of the packs that the pills come in. The contraceptive pill does this – it has dates or days of the week.

    All you’d need for the zinc pills is numbers – 1 to 10 – and 10 faces from. πŸ™ to πŸ™‚ or maybe something else …

    Obviously it’s got to be visual, and not just numbers. Somehow illustrating the value of completing the course and its connection with health and happiness. You want them to think:

    “There’s no way I’m going to stop on 😐 I want to get to πŸ™‚ ”

    YELS

    PS – I’m sure there was a TED talk where the guy was talking about getting people to complete a course of antibiotics. Instead of giving them 10 white pills, you give them 5 red ones and 4 blue ones and one yellow one. You tell them to take the red pills, then the blue pills, then the yellow pill. Something like that maybe.

  5. Maria Ana Neves says:

    What a nice design challenge.

    Two human centred design thoughts:

    Option 1 – adapt medication to human behaviour – don’t change the user, change the product performance.

    Design brief: how can the dosage/tablets be redesigned to provide full result by the time the symptom disappears?

    Option 2 – play with human curiosity and make it fun.

    Design brief – how redesign the consumption (most likely the packaging) to make something interesting happen only at the end of the full dosage, to keep user (mother and child) engaged until the end?

    Maybe a picture (remember children soup bowls that had a drawing at the bottom? ) maybe a story that is discovered step by step (Christmas calendars) maybe a little song or a funny sound at the end (birthday cards that have a song when we open). Maybe each pack has a 10 day calendar, and something interesting happens every time they take out a tablet? Or the whole pack glows when they remove the final tablet?

    Another strategy is to work with the mothers to find other ways (more embedded in their belief systems). I suspect this is happening due to a deep belief that when a symptom is gone the danger is gone, if that is correct it is much easier to adapt the product to the user!

    Hope this helps! Curious to hear about other possible solutions!

    Maria Ana

  6. Is it possible to create a plaster-like patch which provides the correct dose of medicine on a slow release basis over ten days? Perhaps the patch changes colour over time and Luke’s idea of a smiley face appears. Pharmaceutical companies providing insulin to diabetics might have some ideas to share.

  7. Sarah Lewis says:

    As suggested by Maria Ana, take the Advent-style calendar for daily pill release. Create two calendars; one for children under 6 months and one for children older than six months, and make them two very different colors so that they can be easily distinguished (blue for one, yellow for the other, for example).

    Children appreciate tangible items. For children older than six months: Each day that a child ‘opens an Advent (cardboard) door’ to take their Zinc supplement, they will open a door containing both the Zinc supplement and a collectible, mini toy — all ten toys/items will be related/coordinated, with a them containing a beginning, middle, and an end, perhaps. Each Zinc supplement and toy should be the same color as its corresponding calendar door so as to make it very easier to keep track of daily dosage — with each of the ten days being a different color. The mothers within each village would help designers cater the dosage rewards to what their children would most appreciate (instead of mini plastic toys, perhaps there are practical items that these mothers might know their children would appreciate more as dosage rewards — i.e. a collection of ten, nested drinking cups (made entirely of biodegradable material), each subsequent cup being larger than its previous cup).

    At the end of the ten day regimen, the child will have ten items they’ve ‘earned’ and can ‘show and tell’….

    For children under six months, isn’t it more about encouraging the overworked, overtaxed mother to follow this ten day regimen? If I am correct, make the dosage reward each day one that is appreciated by the mother, and perhaps something she can look forward to each day (but not money or something that could be traded for money, unfortunately, as this would defeat the purpose of spreading the dosage out over ten days).

  8. Mark Phillips says:

    Simon,

    I’ve seen the challenge and reviewed the comments received to date (see below). It’s a well known challenge for pharma companies too. Most of the technical solutions in pharma have failed to deliver as the problem is essential a motivational / psychological one. High tech solutions are clearly not an option, but there are a couple of ideas that come to mind:

    1 – use of simple graphics and interaction to promote compliance
    The idea is to provide a graphic / card where the mother or child (depending on age) add a sticker every time a zinc tablet is taken , more importantly the graphic is designed such that you are only considered successful if you get all ten – the graphic is designed to indicate that all ten must be completed. It’s cheap and simple. Education is also important, there may be an opportunity to make this a more community based event / activity – i.e. Cards and stickers are in a public place? Someone in each village supports education, displaying cards etc

    2 – integrate graphics with use of mobile phones
    A more sophisticated solution might be to incorporate a simple code / texting system, whereby the mother is required to send a simple code (which is revealed behind each tablet). If no code is received a prompt/reminder is sent. If all ten are completed then some incentive is provided (i.e. all texts are free/reimbursed). Relies on user having access to a phone and reading instructions (!!)

    3 – if there is a problem with the taking of tablets themselves consider alternative formulations
    Sometimes compliance can be reduced because the patient does not like taking (or cannot take) a whole tablet. Possible options include soft gel (see gummy bears below) or dispersible tablets, which dissolve in less than one minute on a spoonful of water, or a dispersible ‘straw’ (the zinc is formulated as a dispersible and packed into a straw)

    For comments on suggestions so far on website/blog: See below:
    1 – Joanne – formulation in gummy bears could be an option, can formulate zinc in a soft gel, so it should be technically viable. I’d also be concerned about ‘over dosing’ is giving all tablets in one or two days.

    2 – Justis – Graphic approach – agree, it’s cheap and should be designed so completing ALL TEN is the obvious and rewarded goal

    3 – Phil – Instruction leaflet with stickers – essentially the same as above

    4 – Luke Berry – essentially the same as 2 and 3 above.

    5 – Maria – both suggestions are a bit generic, but addressed by some of the earlier options.

    6 – Bob – a transdermal patch, could be another option. They were used for a bi polar disorder for sustained release. Only concern would be patch coming off after 1-2 days.

    7 – Sarah – similar to 2-4 above

    Regards

    Mark

    • Sarah Lewis says:

      Great points.

      Mr. Berry: What has your team learned thus far from focus groups (with mothers and guardians who would provide their children the Zinc supplements)?

      I love Bob Pulley’s ‘Zinc patch’ suggestion — this would be the absolute easiest adherence method. To take it a step further, perhaps the patch adhesive completely wears off after all Zinc has been absorbed by the body… (an energy exchange in the adhesive — from patch adhesive to body’s blood stream).

      Whatever the design, I’d more strongly support one that is graphic only, with tangible incentives. Would children in such areas appreciate a sweet-tasting reward each time they took their supplement? If so, might that encourage overdosing on any given day during the ten-day period (as some of you have suggested)?

  9. Perhaps something indicating improving vitality and strength over the 10 days would be better than smiley faces and appear to both mother and child.

    To support any other ideas how about something social such as a simple story to be told/song to be sung when administering the zinc which reinforces the timing. eg. #To ensure health stays take the zinc for all 10 days#

  10. Expanding on Joanne’s idea, how about having mini gummy bear packets?

    I agree, the liklihood of a child wanting more gummy bears, after having just one, is high. Therefore, providing a packet, with 5 or so in, may tackle this. The whole content of the packet could contain one dose.

    Nonetheless, there may still be problems with this plan – what about the varying dose for under 6months? And also, what about the providers of the Kit Yamoyo – how would they know?

    I believe that there are solutions to these ‘potential problems’ and still feel that it is a viable option.

    We could have some packs with a smaller dose for children <6 months?
    For the providers of the Kit, they could tell the difference by the packs having colour co-ordinated strips; Blue (6mths).