Category: Healthcare, communication strategies for behaviour change
My Role: We were a team of 3, helping NIN conduct this research. I co-ran a Sprint, ideated communication design strategies, created research plan for testing in the field, prototyped visual content.
Client: National Institute of Nutrition. The project was done in my role as a Product Designer at Obvious Ventures, along with 2 other team members and NIN team.
Timeline: The project started and was completed in 2020.
What's the project about?
The National Institute of Nutrition in India commissioned this project and was a part of their "Strategies that primarily address salt added in the home" initiative.
The project was a small-scale experiment conducted in a remote village called Siddipet in Telangana, India. The NIN team later scaled the approach in other parts of India based on the results.
The National Institute of Nutrition in India commissioned this project and was a part of their "Strategies that primarily address salt added in the home" initiative.
Why salt reduction?
Salt reduction can save many lives at a low cost. Eating excess salt raises blood pressure and causes more than 3 million deaths each year. Reducing salt consumption is possible and can be done at scale cheaply.
The United Kingdom showed us that change is possible and faster than we could think.
Countries like Vietnam(5% reduction in 1 year) and Australia(10%reduction in 3 years) have also shown positive results.
Why did we choose this approach?
Increasing consumer knowledge and motivation to reduce sodium is one of the only interventions available when the primary source of salt is salt added in the home, as in many low and middle-income countries. This included both health education and media campaigns—mass media and social media both.
The campaign supports other interventions by increasing demand for lower sodium products, educating the population about changes in institutions, and providing broader support for environmental changes related to reducing sodium consumption.
Graphic ads with explicit warnings for other risk factors, such as smoking, have been shown to change knowledge, attitudes, and behaviors in both high and low-income countries.
Our approach was to help change the cultural norms and increase demand for healthier products by communicating a clear, simple, and compelling message across channels and over time.
The Sprint
Our first step was to get a cultural taste of the village and the people we would be testing with.
We started by identifying different actors who would help conduct the experiment, identifying subjects for the study and influencers who would help us create the impact we were targetting.
We laid out a schedule of one of our primary targets, the woman who cooks for the family, how and when she buys groceries, food-sharing practices, etc. We defined what factors might lead to the success and failures of the experiment.
Once we had got enough context of their lifestyle and culture, we formulated a long-term goal for the project.
To create awareness, acceptance, and behavior change at an individual as well as at the family level to have home-cooked food with 50% less salt.
With many ideas from the whole team, we had a plan we storyboarded. We prototyped three posters and two videos with available resources, and then it was time to go to the field.
What did we test?
We tested different messages in the form of 3 posters and two videos delivered by an ASHA worker to 5 different couples in their respective homes.
Who is an ASHA worker? ASHA is short for Accredited Social Health Activist. An ASHA will mobilize the community and facilitate them in accessing health and health-related services available at different levels of health centers, such as immunization, Ante Natal Check-up (ANC), Post Natal Check-up supplementary nutrition, sanitation, and other services provided by the government.
Who did we test with?
Young couples
between ages 20 to 40
from a mix of nuclear and joint families
residents of 2 neighboring villages in Siddipet, Telangana
What was the plan?
A coordinator shares the videos to the five couples a day in advance over WhatsApp.
ASHA visits the couples' home the next day and notes the recall from the videos sent the previous day.
ASHA also notes comprehension of the posters in the same visit and leaves copies of the posters for each family.
The team makes a short follow-up visit the next day.
Key Findings
Couples quickly understood 2/2 videos and 2/3 posters.
The "salt alternatives" poster wasn't understood well and needed additional explanation.
The concept of "gradual reduction of salt" was understood well and seen as doable.
There is good awareness about salt and blood pressure among the participants we spoke to
9/10 people were aware of the impact of high salt consumption
3/5 families were already practicing adding less salt to home-cooked food
3/5 participants made a change while cooking on that day
One did not add salt to the dough as she usually did
One used lesser than usual salt while cooking dinner and said the family still liked the food.
One added an extra tomato to the curry, even though she didn't reduce salt.
4/5 participants recalled the implications of consuming high salt and the gradual reduction concept from both videos the next day.
Themes that worked well
Woman's husband and family complimenting her cooking
Gradual reduction of salt so that the food still tastes good.
Health implications of consuming a high quantity of salt—like heart attack, stroke, etc.
The descriptions of the characters in the video being relatable—like the character not having bad habits like smoking, drinking, eating out, etc., and still having health problems.
Showing ASHA workers in the video—made it relatable.
Visual representation of the concept of gradual reduction
Mediums that worked well
All participants were comfortable watching videos.
Even in the one family that did not have a smartphone, the wife manages to watch recipe videos on a neighbor's smartphone.
The posters were a known medium too, and worked in this context.
3/5 participants stuck up the posters in their living room, kitchen, and shop as a reminder of healthy habits
Some participants who were already trying to cut their salt intake...
Because father-in-law has high BP and insisted food be cooked with less salt. "Health is more important than taste."
A child in another family has health issues and is advised to consume less salt by the family doctor.
The husband's family has been cooking with less salt for a long time, and the wife changed her habits to adapt.
What less salt looked like to some participants
Participants' kitchen
