Earlier this year, the GSMA mHealth programme published the mHealth Design Toolkit, a collection of 10 principles on how to design and launch a mobile health service. The toolkit was primarily informed by our experiences and learnings from conducting user research across eight African countries, together with partners from the GSMA mHealth programme. Instead of simply giving a list of design tools, the toolkit offers strategies to put the end-user at the core of the design process. Since publishing the toolkit, we have spent most of our time in the field with users and keep on learning important lessons for mHealth services.
This blog post is the first of a series where we share stories about how user centricity research has informed service design for supported mHealth services. Here, we are looking at on-boarding new users. Our key message to mobile operators and other mHealth service providers is that in order to succeed, they should always have on-boarding mechanisms that teach new users how to use the service – even for basic voice and messaging services. This means that, for example, Interactive Voice Response (IVR) services could use simple IVR games to teach new users how to use the service, while Unstructured Supplementary Service Data (USSD) services could lead new users through fun USSD exercises that teach and explain how to navigate through the menus.
What digital literacy means for Africa
We often assume that most users in developing countries will know the basics of how to use a mobile phone, particularly when it comes to feature phones and basic technologies such as USSD and IVR. In urban areas, it is common to see the more privileged members of society typing away on WhatsApp, downloading the latest ring tones via value added services and topping up their airtime via mobile phones. From a young age, these users will have learned how to operate calculators, televisions and ATMs – all of which teach the principles of interacting with digital devices, such as the mobile phone.
However, this is not true for the average mobile user in Sub-Saharan Africa. For most rural populations, which make up over 60 per cent of the population in the region, and over 80 per cent of the population in countries such as Uganda and Ethiopia, the mobile phone will be the first digital device that they have ever used. These users simply will not fully understand how to operate a mobile phone.
Using the mobile phone is like learning a new language
There is an important difference between knowing how to successfully complete a certain task on a mobile phone and knowing how to operate the system as a whole. Think of it as learning a language. We could relatively easily teach someone how to say a sentence in Spanish. The person could say this sentence with great confidence and a perfect accent. However, this does not mean that the person knows how to speak Spanish. When a native Spanish speaker would ask a question, the person would not understand what was asked or how to respond.
The same is true for many mobile users across Africa. People know how to top up airtime via a USSD menu because they have learned a sequence of buttons to press. They can press this sequence of buttons with great confidence and very fast. However, as soon as they face a different menu, they do not know what to do, because they have never learned how to operate the system as a whole.
Tasks that may appear very simple to service designers can feel dauntingly difficult to end-users. For example, we often think of IVR services as the least complex. Users just have to listen to a voice message and then make a choice by pressing a button. However, many users have never before encountered such a system that asks them to make this choice on their own. They have never learned that pressing buttons means making choices. They will have learned that pressing ‘4’ followed by ‘1’ allows them to top up airtime. But they have never learned that pressing different buttons in a menu allows them to control the device as they wish. As a result, we often observe first-time IVR users that listen to IVR menus without making any choices at all.
The same is true for SMS services. Many users in rural Africa will have never subscribed to an SMS service before. Hence, they simply do not know what to do when their phone suddenly asks them to enter the birth date of their child. Even more confusing, we are observing the same patterns with smartphone users. People know how to make calls, chat via WhatsApp, even browse Facebook, because someone has showed them how to complete these tasks. However, all the other icons and buttons of the interface are nothing but a mystery – better not to be touched, since one can never know what might happen.
Let’s take a step back though and reconsider IVR and SMS. We should not assume that someone who has never used an IVR or SMS service would know how to do so. Most smartphone apps use on-boarding mechanisms that teach new users how to use the software. App developers realise that most users would not know how to use their software without a little bit of training. By showing an illustration here and highlighting a button there, clever on-boarding mechanisms teach complex operations without users even realising that they are learning something new.
The key is to teach how to use a service while using it
If mobile operators and other service providers offering mHealth services want to succeed, it is important that they consider designing on-boarding mechanisms that teach new users how to use the service – even for basic IVR and SMS services. This comes with an obvious challenge: How do you teach someone how to use a service, through this service? One of our mHealth partners, Human Network International, started experimenting with simple games that introduce users to IVR – pressing buttons to make choices – before letting them access the actual service. While the pilot is still running, first results have been encouraging. Users that completed the on-boarding game, before using the main service, were significantly more likely to make a choice from the main menu. We are currently experimenting with similar approaches for SMS services, and encourage all mHealth service providers to do the same.
While there is a wealth of resources on how to design on-boarding mechanisms for rather complex smartphone apps, there are currently no best practices available on how to do the same for IVR and SMS services. Our GSMA mHealth programme hopes to fill this gap in the coming months. If you are working with on-boarding mechanisms for your IVR and SMS services , we would love to hear from you!
This project was funded with UK aid from the British people.