Refine, Evaluate & Adapt Solutions to Different Contexts
Learning Objectives
After completing this session, you will be able to:
Where are we in the process?
Refine, Evaluate & Adapt
In the spirit of continuous improvement, the process of refining and evaluating can continue indefinitely as innovations scale across different contexts. Whether testing, piloting, or evaluating a solution in a new context or setting, some degree of adaptation is usually necessary – this holds true regardless of whether the solution was originally generated using HCD or not.
Who is involved?
Key local stakeholders and potential users of the adapted solution in the new context – similar to who would be involved in co-design (see Session 5).
Starting the Adaptation Process
Step 1. Decide as a team
Whether you are bringing the new HCD-generated solution or a pre-existing solution to your context, the starting point is the same:
- You must have a thorough and shared understanding of the problem you are trying to solve.
- You must work as a team with key stakeholders and potential users to adapt the solution.
Nigeria Case Study
In Nigeria our adaptation was adjacent, since we intended to adapt the chosen solution to a different health area, in a different country, and we understood that there was a need for a change of format.
Inovation
Although modifying something that already exists may not seem innovative or exciting, these types of adaptations are precisely what drive innovation! Innovation is often thought of as being entirely brand new and disruptive, or what is known as transformational innovation. However, there are multiple forms of innovation:
Incremental innovation
- Typically involves bringing a solution to a broader audience, often with little adaptation. For example, expanding a tool that was designed to achieve a specific purpose among a specific audience to reach more of that same intended audience
Adjacent innovation
- Typically involves adapting an existing solution to a new audience or for a slightly different purpose. For example, Empathways, which was originally designed for providers and young people to build empathy during family planning consultations, was adapted for use in Nigeria between CHWs and caregivers to build empathy around complementary feeding. The goal and mechanism to build empathy is the same, but the audience and content are different. Adjacent innovation is a great starting point, especially for teams that are time constrained. Later in this session we will explore quick ways to innovate using the Adaptation Canvas. In this lesson we will explore this type of innovation through the Adaptation Canvas.
Step 2. Scan for solutions that solve a similar problem
When the time came for the Breakthrough ACTION Nigeria team to ideate, the team decided that in addition to ideating afresh, they would also consider existing solutions to see if anything could be adapted. Given this decision, the team looked within the Breakthrough ACTION portfolio of solutions and found inspiration in Empathways, a tool designed to build empathy between two groups of people in a 1:1 setting.
Empathways in Nigeria
Empathways Challenge
The challenge
Lack of empathetic care from health providers is a well-known issue. Empathways was an innovation created by Breakthrough ACTION, to address this problem.
What is it?
Empathways is a card activity designed to take youth clientele and their family planning service providers on a dynamic, engaging journey from awareness, to empathy, to action. The objective is to forge greater empathy between these groups, and then for providers to apply this empathy to improve youth family planning service delivery (Breakthrough ACTION, n.d.).
Nigeria Challenge
The challenge
The research revealed that there is a lack of compassion and empathy when CHWs provide counseling sessions and in-home consultations. Therefore, the team decided to focus on innovating to elicit more empathetic behaviors from CHWs and more cooperative behaviors from caregivers.
What is it?
Empathways was identified as a possible solution because it addresses the same core challenge: lack of empathy. Once this decision was made and an existing solution was identified for adaptation, the team worked through a series of questions, which have been consolidated and refined in the form of the Adaptation Canvas.
Step 3. Complete the Adaptation Canvas
Adaption Canvas
Inspired by the Business Model Canvas, the Adaptation Canvas is a one-page framework intended to help nutrition and SBC practitioners think through what changes might need to be made when adapting a solution.
1. Key Actors
Who are the key actors (target audience, influencers, systems, organizations, institutions, etc.) in the original concept? Are they the same or different in the new context? Do they play similar or different roles? (e.g., grandmothers existing in both settings but play different roles).
Tip: Map out the key actors and their relationships across the socio-ecological model.
2. Setting & Environment
Review existing data or evidence from the country or context you are adapting to. What stands out? Consider changes in setting in the new context. Is it urban or rural? What is the socioeconomic profile of the target population?
3. Key Resources & Costs
What are the key resources needed for the original concept? Are they also needed in the new context?
Tip: Consider the five S’s: “staff, stuff,
space. systems, and social support” (Zhang, 2021). Are the following resources the same or different in this new context? What are the associated costs?
- Human resources
- Materials and supplies
- Physical space needs
- System(s) access, integration or
institutional buy-in - Social supports (i.e., transportation and meal vouchers)
4. Value Proposition & TOC
What change are you trying to make by
adapting this concept? Does the Theory of
Change (TOC) still hold true?
Tip: Conduct this fill in the blank exercise:
“If we [NAME OF ACTIVITY] with [TARGET AUDIENCE] then [DESIRED RESULT].
5. Constraints
What constraints are present in the new
context that may need to be factored
into the adaptation?
Tip: Consider these factors but do not
limit yourself to them.
6. Proposed Changes
Given the previous steps, what key
changes do you propose making to the
concept?
Tip: List the changes and prioritize them
using an importance/ difficulty matrix or
another matrix of your choosing. For
example, translation would be “important” and “not difficult”, whereas adapting a digital video so that the characters more closely resemble the local population would be “difficult.” The importance may be unknown but can potentially be validated during testing!“
7. Validation & Refinement
Which of the changes need to be validated? How will you know if the
changes are “successful?” With whom do you need to validate and how will you do that?
Tip: Focus on assessing desirability and
feasibility.
Each component of the canvas includes probing questions and tips to help think through possible adaptations. You may find that you do not need to fill out each component, and that is ok. Each solution, adaptation and context is unique.
Aim to complete the first draft of the canvas relatively quickly (within an hour). If you complete it alone, share it with other key stakeholders to get their input. Or if you have the opportunity to fill this out as a team, then conduct individual brainstorming for each section, share back, and build off of each person’s input.
Here is an example of how the Nourishing Connections Team utilized the Adaptation Canvas.
Step 4. Build your adapted prototype
Now that the specific changes have been identified, it is time to turn them into a prototype. Refer to Session 5, Prototype & Test for specific guidance about building a prototype.
Component | Original Empathways | Adapted Empathways for Nourishing Connections in Nigeria |
Topic | Original Empathways | Adapted Empathways |
Rounds or categories of cards | – Open up – Awareness – Understand – Empathy – Compassion – Action | – Awareness – Understand – Empathy – Compassion The other categories were left out because Nourishing Connections have other activities that are responsible for building this piece of the relationship. |
Audience | Family planning providers and young people | CHWs and caregivers of 6-24 month-old children |
Format | Card deck | One page handout with 5 questions |
Method | One-on-one interaction | One-on-one interaction |
How to use it | To be used in training sessions | To be used during counseling sessions |
Uniqueness | First application in a safe space/training setting. | “Share Just Enough” concept: CHWs should share with caregivers just enough and not expose themselves. |
Download the Empathways for Nutrition prototype (PDF) that was tested in Nigeria. See Session 5 for more details on testing the prototype in Nigeria.
Key Tips for Adaptation
Step 5. Finalize the concept
Once the testing concluded and the results were synthesized, a version of Empathways for Nutrition was finalized for the Nigerian context, which includes a one-page tool composed of five questions divided into sections between relationship building and emotional state of the mother. The final Empathways for Nutrition tool was integrated with other activities of the Nourishing Connections package, thus making the tool an element of something bigger. You can find Empathways for Nutrition on pages 3 and 4 of the CHW Job Aid.
Why the final version was consolidated
- Due to the intended group (CHW) strengths and weaknesses – Most CHW in Nigeria have a low level of literacy, so they usually memorize content. Therefore, memorizing 50 cards wouldn’t work. For this reason, we need to work with what is essential to make it possible for them.
- The original Empathway was made for a training context while the Nigeria version for a counseling session. It was necessary to concise it to the reality of a 30min counseling session.
- In Nigeria culture people are talkative, for this reason they just needed a starting point to set up an empathetic conversation and space to make the magic happen.
- Since many CHWs in the target group are not literate, they needed to be able to memorize the questions and reading cards would not have worked.
- Nigeria is a very open country, so participants just needed something to start the conversation.
- Feasibility – printing thousands of card decks was not financially feasible, the single-page layout enabled the implementing partners to make the objective feasible.