I love my smartphone. Prior to arriving in India last month I had never had a smartphone.  My previous India life consisted to a large extent of trying to find the next Internet café so that I could stay connected or print out a crucial document. Now if I need to look something up or do a quick email check, I just reach into my pocket. This past week I made it through a flight and a train ride without printing anything out myself—I just brought my phone and the tickets that I had downloaded.  It may sound trivial, but it felt like a victory in this country that loves it forms and stamps and seals and paper copies.  I used the map feature to navigate an awesome two hour walk home last night, something that would have been very challenging just asking people and try to think of landmarks that people might be familiar with.  I can see how it could be a quick slide into email/phone/connectivity obsession, but so far so good.  And now here I am getting to work on one of Dimagi’s first smartphone app deployments.

Over the past several weeks in India I’ve gotten a massive dump of Dimagi’s last year or two of cumulative experience in India developing apps and carrying out trainings.  But now that I’m on my own, I have found myself getting to think about how to train healthcare workers on a very different phone and new operating system.  I know that smartphones present a unique set of challenges and opportunities.  In my previous job in the military I participated in a number of meetings where we discussed how tablets and smart devices can themselves be used as training devices for a lot of “real world” activities because the interface can be so straightforward, flexible, and intuitive. I often find that to be the case — I think to myself, I should be able to change the title of this or the order of that clicking here — and when I try, it usually works! The intersection of clever software designers and solid hardware helps make this so. Yet I’m still not quite sure if the massive flexibility and slick interface of smart phones is going to make smart-phone CommCare deployments and trainings more challenging, less challenging, or just an entirely different game.

These musings made me realize that the last couple of weeks have gotten me thinking about how much I’m learning about learning.  I was privileged to participate in a training session with a couple other Dimagi field fellows, representatives from a local NGO, and about 20 community healthcare workers.  Watching the training and working with the healthcare workers it was interesting to observe what different approaches make things click for people. The tools employed include lectures, skits, analogies, group/team exercises, and one-on-one work.  There were also some cool approaches to explaining complex topics. For example, navigation in a phone can be challenging to explain to a new user.  While concepts like “forward” and “back” may seem simple to experienced users of computerized media, when you are starting from scratch it can seem rather abstract.  So one of the field fellows spent some time using good old fashioned paper charts to explain how you could move back and forth between different screens and menus.  When the more complex topic of skip logic came up one of the local NGO workers stepped up with an extended metaphor about how you choose your path home from the field means you will encounter a unique set of obstacles and situations. Employing such a mixture of techniques and explanations hopefully enables reaching a broader audience and at the very least makes things more entertaining and engaging.

As I was trying to think of different techniques and approaches to training on smartphones I realized I was just trying to follow the same model I had learned that Dimagi had used over the past years and substituting smartphones for the simpler handsets.  That certainly seems like a good start—after all there is extensive experience in those approaches that is now well documented.  But relying entirely on training plans, guidelines, and rules of thumb may get you locked into a particular way of doing things, when there could be entirely different approaches out there that would work even better.  Usually training means someone something fairly specific — one or two people stand up and talk while everyone else listens. Then there are some practice and group exercises to make sure everything actually makes sense.  Finally there’s the classic one-on-one walking through it all.  But it does make me wonder if we’re missing out on other structures or tools of training and learning.  I’m not even sure what that might look like, but perhaps it could be a “training program” that walks the user through the app, or employs other apps/phone features as steps up to using the our more complex apps.  Even though we as Dimagi are not necessarily determining how training is done, it’s definitely something I want to learn about in the coming months as many projects scale up, the sheer volume of training increases, and the smartphone app becomes more widely used.  Our accumulated experience can continue to be a resource to our partners and the broader ICT4CHW community.

And thinking about how to learn hasn’t stopped at work!  It’s always been interesting to me to explore alternative teaching/learning methods.  Last time I was in India I spent some time with an NGO that encouraged people to drop out of school.  While I was pretty confused by this at first, I came to understand that they were promoting an alternative model of education.  Instead of the didactic Indian system they proposed experiential learning and knowledge transfer among people. Know how to fold bags out of newspaper? Good, show your neighbors how to do it. Know how to market artisan crafts?  Pair up with these soap makers. Did you write a song about how to use a cell phone? Let’s see how useful it is!  The main idea was that in a world where often having a hard skill could be more financially viable than being able to pass the eighth standard, maybe forcing children down a traditional education/training path won’t necessarily equip them well with a livelihood.  It’s a big world of techniques, approaches, and ideas out there.

While I’m not sure how this all translates into apps and public health, I think the main takeaway is that as apps and phones evolve there will be cool new ways to learn how to use them and to get feedback about how to improve the technology.  It will remain critical to keep in mind linguistic, regional, and individual variation in knowledge acquisition.  Hopefully we’ll be on the way forward with increasing input from local partners (who are best placed to be effective communicators and teachers) as well as by keeping an open mind to novel techniques and approaches that may come at us from outside of the public health and NGO worlds.


Jeremy Wacksman lives and works in Mumbai, India as a Dimagi Field fellow. His work includes design, development, testing, training, and evaluation of CommCare mobile applications for use by community health workers in rural India. To learn more about CommCare, please visit www.commcarehq.org