Feedback: the Ultimate Frenemy

Imagine a working environment where your most critical project stakeholders are unpaid, undereducated and don’t speak your language. These are the challenges I love about public health and about working abroad.

We’re hosting another community volunteer meeting during my visit, and I’ve been playing around with different ideas on how to get the most valuable feedback from each of them.

Letting people speak up and having open dialogue during my last visit was insightful, and it lets people ‘piggy back’ off of one another’s thoughts, which is great. But I’m not confident enough that it can represent each volunteer’s experience. To do an evaluation I really need all of them to provide feedback.

So I’m trying to design a survey they can all take at once, which would be really simple if everyone was literate.

Traditional Likert Scale

To make sure everyone can complete the survey successfully I want to make a ‘visual’ likert scale. The challenge here is how to illustrate the values on the scale without assigning other implied values, impacting how the volunteers respond to the questions.

one example of a visual scale, esp valuable when you need to communicate with someone who speaks another language

I thought about using thumbs up and thumbs down icons–but then what goes in the middle? I spent more time studying ‘thumbs sideways’ graphics than I’d like to admit. Will the volunteers avoiding giving us a thumbs down if they think it’s not what we want to hear? Same goes for smileys vs frowns or red, yellow, green bubbles. I’m thinking the latter might be the best option.

I did some research and there are some other thoughtful ways to get this kind of information from people who can’t read a written survey, but they are time intensive.

In one study I found, the survey respondents were given ten beans, and split them into two areas based on the likelihood they thought they were HIV+. So someone who knew they had HIV would put all 10 beans in the designated ‘affirmative’ spot, zero beans (all in the other area) if they were 100% sure they did not, and any split in between to establish different levels of uncertainty.

One big constraint here is time. We know this is the best opportunity to get ahold of the most respondents, and we don’t have all day to sit down with them individually to get this kind of information.

The more I learn about public health projects and research, the more I start to understand where compromise is necessary and where to push the envelope. New needs arise while executing one project, and these ideas and opportunities sprout up constantly. One could design (and probably fund) an entirely separate project just for designing a graphical likert scale, and it could have a big impact if it were a good replacement for the written one. We’ve all seen those pain scales–a heavily adopted measurement and communication tool that someone saw the need for and made it happen.

I believe the positive psychology description of this project would be “opportunity rich.” Having the space to explore where our resources are invested, with so many opportunities available, is exciting and scary, but mostly the former.

Zikomo as always, for following along!

Picking Up Momentum

My return to Malawi is approaching quickly! I’ll set off on my 24-hour journey to the heart of Africa in less than two weeks.

IMG_0719With timeliness on my side, I’m starting to make more progress with the team. I’ve had more time over the summer to dive deep into the Ministry of Health’s maternal death surveillance guidelines, and had juuust a few thoughts and questions in response.


When I shared some of these considerations with the team at CLI, they scheduled a meeting and hosted representatives from the District Health Office for the first time since the maternity ward opened. They asked for what the published guidelines promised–communications from the top down, and coordination across facilities.

Another big win came out of this meeting: vouchers for visitors who can’t afford a hospital visit but are transferred from CLI to St Gabriel’s, the nearest full hospital which can perform more complex operations that we aren’t equipped to handle at the clinic.

St Gabriel's Missionary Hospital in Namitete
St Gabriel’s Missionary Hospital in Namitete

The sense from CLI was that patients weren’t coming to deliver at the clinic, for fear of being transferred to a hospital which they couldn’t afford. So this solution removes a significant barrier to entry and I’m excited to see how the word spreads and, hopefully, increases deliveries at the facility.

My second visit to the site will focus on two efforts:

  1. Evaluate the project we implemented about 18 months ago, with a final product being a publication that might provide insights for other clinics or organizations hoping to collect data on maternal and neonatal deaths in their catchment areas.
  2. Develop a needs assessment, based on the data collected during the surveillance, and input from stakeholders across the catchment area. This will be a proposal of sorts, for initiatives that might address the barriers we are finding to safe pregnancies, deliveries and postpartum care.

I’ll only be in Malawi for half the time I spent during my first visit, so the pressure is on to complete a lot of pre-work in order to make the most of my face-to-face time in August. I’ve reflected on ways I can improve my communications skills and be a more effective collaborator on site to make it all work. Send me prayers, luck, good vibes, whatever you have to send my way!