This piece originally ran on usaidmomentum.org
By Rida Nadeem, Marketing Officer, Population Services International (PSI) Pakistan
Responding to a need: engaging men as informed partners for Family Planning and Reproductive Health (FP/RH)
In 2020, with funding from UNFPA, PSI Pakistan conducted a study to identify gaps around engaging Pakistani men in FP conversations. The study found that men have a higher degree of decision-making authority than women regarding number of children and contraceptive practices within their families. However, they were reluctant to use modern FP due to stigma and shame they may face from family members and their religious community. Negative perceptions about infertility and the association of masculinity with the ability to procreate also discouraged men from considering family planning and contraception.1
Building on this evidence, and on the data that approximately 51% of men in Pakistan had not been exposed to messages on FP,2 MOMENTUM took a holistic approach to engage men to become more informed partners, spouses, and users of FP. The project aims to influence uptake of FP and improve the enabling environment around FP/RH by increasing awareness of this information through community meetings, digital interventions, and marketing campaigns.
Digital health for personalized, accessible information
Digital Health for Social and Behavior Change is a high impact practice and highlights evidence of how digital technologies and tools can foster male engagement in family planning.3 MOMENTUM looked to digital tools that could meet the needs around FP socialization and use, engage men, and personalize the delivery of quality reproductive health information, products, and services. Since men and women in Pakistan receive much of their FP and sexual and reproductive health (SRH) information through the internet and social media platforms,4 a digital medium could enable MOMENTUM to develop messaging specific to the local culture and language. It could also engage men, women, girls, and boys to initiate conversations and feel more comfortable asking questions about taboo topics, since the way the messages were crafted would enable users to feel like they were speaking with a trusted friend.
Introducing VIYA Pakistan
In identifying digital tools to share information directly with men, boys, and women and with readily accessible and available SRH and wellness information, MOMENTUM created VIYA. VIYA, a sexual and reproductive health chatbot serves as a one-stop personalized solution for all SRH concerns. The chatbot primarily covers information about FP methods, alongside an overview of different topics such as puberty and sexually transmitted infections (STIs). The chatbot includes eight different ‘personas’ (Figure 1) that embody many of the same characteristics and lifestyles of the chatbot’s main users. Some of these personas and target audiences include married and unmarried men, newly married couples, unmarried youth, and couples or individuals who feel their family is complete.
How it Works
VIYA is a decision-tree5 based chatbot initially created to be used through WhatsApp and is designed on sophisticated logic programming, which identifies different profiles of the user based on age, gender, marital status, family size, and their topic of interest to allow them to converse with more than 500 chat dialogues6 on different SRH topics.
VIYA is also an omni channel7 chatbot, accessible through WhatsApp, Facebook, Instagram, and a website landing page. Once the user initiates a quick chat by sending any message, the bot gets activated and starts responding to the user in a series of messages, stickers, pictures, and videos. Users can also press buttons to select their topic of interest. Currently, the chatbot does not enable access to a live person on chat. However, the bot is accessible 24/7 and all the activity is monitored in real time with the help of dashboards to access user satisfaction and client feedback, which provides substantial data and learnings to make adaptations to the design or content.
Who is engaging with VIYA?
Accompanying VIYA’s launch in 2022, MOMENTUM implemented a robust behavior change communication strategy aimed at various target personas and disseminated through social media posts, a digital video commercial jingle, and short videos that resonate with young men and give an impression of VIYA as a friend in times of need. Since its launch, VIYA has reached 20,000+ new users, of which 88% are men. VIYA’s average user profile is a married male, approximately 29 years of age, with two children, who has accessed the chatbot due to his concerns about financial stability and the impact of having more children on his family’s well-being and his wife’s health. VIYA’s messaging and marketing continues to target men and youth and has reached more than 8 million people on social media and attained 27,000+ social media followers and 935,000+ engagement through its Facebook and Instagram pages.
MOMENTUM also made available, through the VIYA platform, animated videos in Urdu and Sindhi. These were not only culturally sensitive, focusing on a couple working together, but also incorporated an unconventional and innovative approach in Pakistan by providing animated demonstrations of how to use condoms and other forms of contraceptive methods.
What has MOMENTUM learned so far?
Through VIYA’s implementation, MOMENTUM has gained insights on how to develop and adapt a digital tool that considers local context, language, literacy levels, and cultural norms to make the information more effective and user-friendly for different target groups, including both men and women of reproductive age. Additionally, incorporating scalability and flexibility into the design can help ensure that the information can reach and be understood by a wider range of individuals in similar contexts. The project shares below a few more insights since the chatbot’s launch:
Retain users by building adaptability within the digital platform
A key learning from MOMENTUM’s process of developing and launching the chatbot was that the decision-tree based design strengthens the go-to-market strategy,8 enabling MOMENTUM to effectively bring the chatbot to the market and establish it as a valuable user-driven platform. The decision-tree design served as a form of cost-effective test marketing through which the team developed a chatbot that was intuitive, personalized, and easy for clients to use, while also ensuring that it provides the necessary information and support. The approach allowed MOMENTUM to gather valuable feedback and insights from users, which helped them to make further adaptations and improvements to the product. This user-driven approach enabled the team to refine and enhance the chatbot based on real-time feedback and valuable user insights, ensuring that it met the needs and expectations of the target audience.
User insights are key to generating contextually appropriate content and targeted information
During the chatbot’s development, user insights were generated from multiple focus groups and in-depth interviews conducted with men, women, and youth from different socioeconomic backgrounds, to create user profiles and select relevant and sought-after topics. While there is a vast amount of FP and SRH content that could be integrated into the chatbot, it was important to include evidence-based information that was relatable to the chatbot’s primary audiences. Moreover, it was also important to realize that the chatbot development could not have a one-size-fits-all approach. Rather, it was imperative to create a bot that resonates with every target persona in a culturally sensitive manner and that supports behavior change.
Once the chatbot content was ready, MOMENTUM conducted additional focus groups to beta test the content. Based on feedback from beta-testing, the digital team made adaptations to bulk up content for female users, such as content about menstruation and contraceptive methods, and include supportive messaging to emphasize that the eventual FP method taken up should reflect the woman’s decision, with support from her well-informed partner. Per the feedback, MOMENTUM launched an Urdu version of the chatbot simultaneously with an English version.
Refine the content to keep messages evidence-based, but easily understood
Ensuring the chatbot was available in different languages was integral to its reach and use. Equally as important was ensuring the chatbot conveyed reliability, trust, and friendliness as a digital source for SRH. It was crucial to include information that was most relatable to the users and aligned with their preferences. This task proved particularly difficult in attempting to ensure medical and evidence-based FP and SRH was simple, concise, and easily understood by users of the chatbot.
Insights from some of the focus group discussions noted that the chatbot messages lacked empathy. Efforts were made to improve its conversational and empathetic tone so users felt they were conversing with a friend for advice and information. To enhance the user experience and create a sense of trustworthiness, various stickers and illustrations were also incorporated alongside the text. These additions not only made users feel more comfortable but also ensured the provision of reliable, medically backed information in a friendly and conversational tone.
To ensure messaging remained accurate and led users towards behavior change through a digital journey, the chatbot’s design made use of a Behavior Change Stairway Model9 that:
- Raises awareness about FP;
- Gives users a chance to consider and make informed decisions;
- Allows users to explore options and take up FP methods of their choice; and finally
- Provides clear next steps to allow users to engage, understand, and eventually advocate for the methods they have chosen.
What’s Next?
Moving forward, MOMENTUM is partnering with private telehealth consultation firms and e-pharmacies to solidify its “one-stop-shop offering” and include features such as online consultation, e-commerce, geolocation, and signposting in the chatbot that will show nearby doctors and pharmacies. These telehealth, e-locator, and e-commerce features cater to women and men who have an unmet need for FP methods but are too shy or afraid to buy over-the-counter contraceptive pills and/or condoms, or individuals who cannot commute to pharmacies due to work schedules and dependency on partners and family members. With this intention, VIYA aims to provide further convenience to users and emphasize a shift to self-care and access to a broader range of modern contraceptive methods such as Long-Acting Reversible Contraceptives (LARCs).
For the next phases, there will be an increase in the depth of conversations that exist on the chatbot, along with an expansion in the number of topics covered, based on the clients’ feedback received through the bot. Through this feedback, VIYA aims to deliver customized resources and information to address the unique needs of each user.
Want to learn more about VIYA?
Learn more about our initiative at: www.viya.pk
Talk to VIYA ici.
- PSI Pakistan and UNFPA, Family Planning in Sindh & Male Engagement: Views on Unlocking The Power of Partnership (2020).
- National Institute of Population Studies (NIPS) [Pakistan] and ICF. 2019. 2017-18 Pakistan Demographic and Health Survey Key Findings. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF.
- High-Impact Practices in Family Planning (HIPs). Engaging Men and Boys in Family Planning: A Strategic Planning Guide. Washington, DC: USAID; 2018 Jan. Available from: https://www.fphighimpactpractices.org/guides/engaging-men-and-boys-in-family-planning/
- PSI Pakistan and UNFPA, Family Planning in Sindh & Male Engagement: Views on Unlocking The Power of Partnership (2020).
- Decision tree based chatbot particularly uses a series of pre-defined rules to drive visitors’ conversation offering them a conditional if/then at each step of the chatbot interaction.
- Chatbot dialogs are the questions, answers, buttons, content, pictures, videos etc. that are shown in the front end of the chatbot.
- It is a multichannel approach to connect with users on different channels (WhatsApp, Facebook, Instagram, website) to provide a seamless experience, whether they are online from a desktop or mobile device.
- The ‘go-to-market strategy’ refers to the plan and approach adopted to introduce the chatbot to the target market. It encompasses various elements such as market research, chatbot development, channels, and marketing communications.
- The Behavior Change Stairway Model, developed by BJ Fogg, a behavioral scientist at Stanford University, explains how people can achieve behavior change through five steps: Awareness/Understanding; Interest; Motivation/Desire; Ability; and Maintenance/ Reinforcement. https://behaviordesign.stanford.edu/resources/fogg-behavior-model
