Mobile persuasive technologies for rural health

Mortality rates due to preventable tragedies in the developing world are devastatingly high. For example, 99% of maternal deaths due to complications in pregnancy and childbirth—which number nearly half a million each year—occur in developing regions. Enabling health information access is often seen as key to promoting preventive health measures. Yet, deep-rooted traditional values and beliefs often pose barriers to the acceptance of more modern maternal health behaviors, like delivering in clinics, or taking prenatal vitamins. This thesis looks at how technologies can leverage psychological theories of motivation and persuasion and be designed specifically to empower agents of change, in this case rural health workers, to address these barriers and promote maternal health practices in developing communities. This thesis describes three years of field research studying the maternal health care system in rural India, where gaps in training, accountability and credibility of community health workers limit their effectiveness in convincing pregnant women to utilize free medical services. It presents the iterative design and deployment of persuasive mobile videos to motivate and build the persuasive power of rural health workers. These include testimonials by influential persons in the villages, and dialogic, persuasive videos which directly target clients. The thesis includes findings from two experiments that compare the persuasive power of audio information when presented in a lecture style vs. a dialogic, interactive mode. The results show improvement in health workers’ self-efficacy (an important precursor to motivation), knowledge, and ability to provide high-quality counseling about important health information to clients. The contributions of this thesis are, (1) evidence that dialogic speech-based information presentation is more persuasive than traditional lecture styles, (2) a detailed ethnography of maternal health in India, and a sketch and exploration of the persuasive technology design space in this context, (3) an architecture for designing persuasive messages that improve the quality of health worker-client consultations, and (4) reflections on achieving ICTD research goals amidst challenging, developing world realities.