Module 1: Using an Ethnographic Approach

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In this section, Professor Anirudha Joshi presents some of his work in which he has used
ethnography approach to design products and services for a varied set of contexts.
(Refer Slide Time: 0:17)

Professor Joshi teaches interaction design at the IDC School of Design, IIT Bombay. He has
been involved in designing interactive products for emergent users in developing economies with
a particular focus on Indian users.

(Refer Slide Time: 0:33)

Among his many projects is Swarachakra a free soft keyboard for Indic scripts on Android
devices. Some of his recent research looks at the acceptance of information and communication
technology amongst pregnant women and new mothers in urban slums. Let us hear from him.

Hi, I must first say that I am not an ethnographer I am a designer, so I make things. But in order
to make things, I need to understand people.

(Refer Slide Time: 1:03)

And I use contextual inquiry as my main method to understand people. And contextual inquiry,
as it happens, borrows a lot from ethnography. It uses an ethnographic approach. But
ethnographic approach is not ethnography, per say.

(Refer Slide Time: 1:19)

Contextual inquiry shorter in time ethnography is typically has long involvement with users.
Contextuall inquiry, usually maybe 30 minutes, 40 minutes. That kind of short involvement
produces. Ethnography has goals of description, contextual inquiry derives methods from

ethnography but not the goals. Ethnographers are very, very careful, in fact, not to change things
that they are observing. They are very, very careful.

They do not want to disturb anything, what they are trying to understand. In contrast, designers
are constantly trying to change things.

(Refer Slide Time: 2:01)

So, this overall scope of things, contextual inquiry and ethnography broadly is trying to answer
the question what matters, what matters in society? The case study that I wanted to talk about
was a project that I worked with a large number of people.

(Refer Slide Time: 2:10)

A quick background about HIV in developing countries. So, even as recently as in 2017, about
37 million, 3.7 crore people in the world are living with HIV AIDS, and majority of them are in
developing countries. In fact, 69 percent are in Africa alone. And one of the challenge with HIV
is that you cannot remove HIV from the body.
Once a body is infected with the HIV virus, it just stays in your body more or less forever. So,
you have keep taking your medication all your life. And one of the challenges is that a lot of this
medication is fairly expensive. And so financial status is one of the common reasons why people
stop taking medication. However, governments have responded, already now more than 10, 15
years now ago by providing free medication through government hospitals. In India, for
example, a lot of medication is available for free for treatment of HIV.

However, in spite of this a people who are in fact receiving free medications were also found to
be having lower adherence.

(Refer Slide Time: 3:28)

So, other than financial status, other reasons were, you know, people were just depressed or just
were not educated enough to understand that you know you have to keep taking your medicines
throughout. They were unemployed or strangely because they felt healthy. So, they felt that they
had overcome the disease. So, they do not need to take the medication anymore.
Like most of the medication, once you once you become healthy, you stop taking the medication.
But that does not happen with HIV. So, as a result of all of this, in 2009, when we started the
project, every year, about 170,000 people in India die related to HIV. And this was in spite of the
fact that antiretroviral therapy, which is the medication used for treatment of HIV, was available,
affordable and even free in the government hospitals.
So, one of the things that we learned very early in this project is that there is a large information
component in the treatment of HIV. And so the objective of our project was to see what can we
do about that. And opportunity that was growing at that time was all over the world. Mobile
phone penetration was improving.
(Refer Slide Time: 4:38)

So, the question that we were asking was that can we use the mobile phones in some way to help
support HIV treatment in developing countries?
(Refer Slide Time: 4:47)

So, we went and looked at operations of clinics, how clinics work, what are the information
needs of people, how people take pills? What are the social-cultural issues? What are the
financial issues? So, we went and looked at the whole ecosystem of people living with HIV
AIDS in India.
(Refer Slide Time: 5:01)

So, what we found is that large number of people know fact. Are no procedures, so facts would
be what is CD4 counts or what is your HIV law and so on? So, these will be facts. Procedures
will be things like you should take your pills on time, you should not miss taking pills, you
should have high adherence, you should eat healthy food and so on.
But very few people actually understood concepts. You know how HIV works. Why should I
take my pills on time? What happens if I miss my pills and so on? So, HIV was this disease,
which everybody knew about but nobody understood. So, of course, in HIV treatment is always
associated with counselling.

(Refer Slide Time 5:50)

And counselling is provided by professional counsellors. But counselling is insufficient and it is
always under time pressure. So, there is a long queue waiting outside of the counsellors' room
and it tends to get repetitive and difficult to retain. Also during counselling, the purely the person
living with HIV AIDS gets too much information and gets it all in one go. Sometimes some of
that information is relevant, but not all of it is relevant.
And then the information that they get outside the counsellors' room is not very trustable. So, we
found a lot of opportunities to provide information.

(Refer Slide Time: 6:31)

So, we used to call this drinking from the waterfall. So, like you can only drink so much from the
waterfall. So, you needed smaller chunks of information. One of our interesting findings was that
this was a study done in 2009-2010. So, by this time already mobile phone penetration was very
high, but SMS use was very little in India almost, almost half the people that we interviewed and
had mobile phones did not use the SMS had never read the SMS in their life.

So, SMS use was not very nice or what not very extensive, but one of the things that we did was
that we sent SMS to people at their pill times and those SMS reminders, helped people with their
pill adherence. We also investigated a lot of social and cultural factors. So, we found that there
are different kinds of people living with HIV AIDS. Some people had extensive family support,
so people in their family were taking extensive care of some of them.

On the other hand, some people had kept their HIV status as a secret from their family members,
and they had not disclosed. In fact, they did not care about disclosing to all unknown people, all
and sundry people that they met.
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But they were very particular that they did not want to disclose their HIV status to their family
members. And this was a very important aspect to them. In fact, this is something that we learned
because of our relationships that we could develop with the people that we were interviewing
that for them retaining their relationship with their family, as it was originally, was very
important, and they did not want to disclose to their family members. We also investigated
(Refer Slide Time: 8:27)

So, one of the things that came out very strongly was that people, the people living with HIV
AIDS had to spend a lot of time in the HIV clinic waiting for the doctor and so sometimes you
wait for a long time with the doctor, the doctor said, you come after six months, so you should do
better to do some tests and then do this test and meet me so that you have to do those tests and
wait for the report and bring those reports and give it to the doctor and then see the doctor again.

And this used to take a lot of time, but people had a lot of respect the HIV patients who got
cured, had a lot of respect for the treating doctors. In fact, this respect and trust also created a lot
of fear about the doctors, like they did not willingly want to share many of their mistakes or like
they missed their pills. They would not tell the doctor that I missed this pills or so there was this
sort of this very high powered distance relationship with the doctors.

There were some gender issues with the in the clinics, like female patients did not want to talk to
the male doctors. There were a majority of doctors that we interacted with were males. There
were few female doctors. And the female patients did not like to talk about some of their issues
with their doctors. Many of the counsellors that we talked to were female, and many of these

counsellors were also very young girls, maybe just out of college kind of people with relatively
less experience about the world, as you might say.

So, the male patients, some of them in their 40s and 50s found it very odd to discuss their very
personal intimate sexual lives with these very young girls, in a closed room, so it was a very odd
situation for many of them. So, many of these sort of gender issues were coming up. We also
found that clinics struggled because of poorly maintained health records. Health records the
treatment history particularly made a big impact on future HIV treatment, even now it makes.

(Refer Slide Time: 10:31)

But because of the stigma associated with HIV, a lot of patients either do not maintain their
health records or do not maintain the complete health records they keep minimum. The most
recent prescriptions or something like that. One of the challenge was that many of these health
records were in English, and people could not read English for them. These health records were
meaningless information.

So, they did not know which of this is important and which is not. So, as a result, many of the
clinics maintain their own health records for the patient. Now, this reduced patient mobility. So,
if there is a migrant worker, and if it goes from here to his hometown for a few days, he cannot
access a clinic there. He cannot carries his health records with them. And so there are lots of
issues about maintenance and updation of health records.

So, socialisation is the primary method by which information spreads in society. So, most of the
information that we learn, we do not necessarily learn by reading about it. We learn from friends
or from family members or from somebody else. So, socialisation is therefore very important.

(Refer Slide Time: 11:34)

But HIV, people living with HIV and AIDS tend to socialise less, partly because they are already
under financial pressure and partly because they are depressed. So, they do not want to really talk
to people. They do not really enjoy socialisation. And then even if they do socialise, they really
do not end up talking about HIV because firstly, most people havn't disclosed their family and
friends about their HIV status. And even if they did, this is not a topic of conversation for most

So, information about HIV then did not spread easily within the society. And so maybe
technology can help with that. One of the things, though, that we came up with and we
understood really I mean, we knew this, but we understood from the inside, richly, as you might
say in ethnography is that solutions need to operate under very tight financial constraints. So,
you cannot expect people to buy gadgets or equipment only for the treatment we need to develop
solutions which will work on existing equipment or existing platforms.

(Refer Slide Time: 12:35)

So, based on our findings, we came up with some solutions. So, we mainly came up with, as I
said, a interactive voice response to support people living with HIV AIDS we evaluated this. We
came up with several prototypes. Some of our early prototypes did not work with people who are
new to technology. So, we redesigned it. We went through several iterations and then once we,
we were confident, we came up with our final system. So, the system had some interesting
(Refer Slide Time: 13:12)

Firstly, it provided post-pill time reminders to patients. So, just after it was time for people to
take their medication and why just after, well, what we found out is that sometimes people get

over-reliant on technology. And one of the things that we wanted people to do was be less reliant
on technology. So, say if my phone gets discharged, I might not get a call if I do not get a call, I
do not want to be in a condition that I forget to take my medicine.
So, every time we gave a call to the person, we said, by now you should have taken your
medicine. If you are taking your medicine press 1 else, press 3.
(Refer Slide Time: 13:46)

So, we used to always assume that you are independent and then we are just checking if you
have done that. So, all the dialogues and the way we had written up the IVR system was like that.
Then when they said, yes, I have taken my medicine, then the system would give them adherence
feedback. Or if they said, I am going I am not going to take my medicine today, it will give them
adherence feedback or sometimes there was also an option to say that I am going to take my
medicine later after some time.
Then if they did that and you say, okay, you should not delay it too much, take it as soon as you
can because it is important that you take your medicine, so appropriate feedback was given based
on that.

(Refer Slide Time: 14:26)

We also provided what we called as personalised health tips. So, all the counselling information
we can of broke it down into small 30-second nugget's, which were easy to absorb for people.
One of the things that we found was that a lot of people had not disclosed their HIV status to
their family members and partners.
(Refer Slide Time: 14:47)

So, we protected this system with a pin, with a number. So, when the system calls you music
plays and people are just keep listening to the music. So, if somebody else picks up your phone
and phone sharing is very common in our society also. So, if somebody else picks up the phone,

they will hear the music, and they will not understand what it is and they might disconnect the
call. But every patient that we deployed the system with we use to train them that this is your
pin, this is your number you have to keen, the number, it will not prompt you to do that.
(Refer Slide Time: 15:19)

So, it is protected with a PIN, and it is localised to a clinic. So, although it was a single system
that was deployed across 20 clinics for each clinic, it would say, hello, I am TAMA calling from
this particular local clinic. It was localised to the clinic. And so we were here trying to leverage
the respect and the relationship to the doctor, the treating doctor has with that particular patient.
So, what we did was this is a second ethnographic study of sorts, not really ethnographic field

(Refer Slide Time: 15:51)

Where we went and looked at how these 54 people who had tried TAMA for 12 weeks, how they
actually have been using one of the things that we found was that the pill reminders was used
extensively and especially that snooze like feature. So, in fact, every patient on an average for
every pill time snoozed twice. So, it was consistently being used so it was extensively and
everybody was surprised with that.
People used to complain about things like, you know, when I miss one pill, you know, I used to
be take for 10 days, I take a pill my adherence shows up 100 percent eleventh day I miss a pill it
becomes suddenly 90 percent. In the twelfth day, it becomes 91 percent. So, when I lose lose a
lot and when I gain, again, very slowly. So, people have started understanding that this is how it
works. The health tips, the information that we are providing was a great hit.
In fact, originally when we had talked to the doctors, the doctors are really not very convinced
that we needed to provide information because they said that we provide all the information that
they need. They do not need to get additional information. We should not provide them any
additional information because this might confuse people. However, what the doctors did not
realise was that although they were providing the information, they were all providing the
information in one go.

And that is just too much of information and people did not retain a lot of it. So, in this round,
when doctors came back, and they said they were very happy that actually, we were providing all
this information, the system was then subsequently developed more and currently it is being used
as of December, about 800 people were using it in Mumbai district. And hopefully this will get
scale up to other HIV patients and for other conditions beyond HIV also. Okay. so, that it. So, I
wanted to close by saying that contextual inquiry is a method that uses ethnographic approaches
for the needs of the design process.

As we saw from Professor Joshi's presentation, the ethnographic approach can help us gain a
nuanced understanding of everyday phenomena. There are layers of complexity in the most
common of tasks. It is by understanding these layers that we are able to design products and
services that fit into the context and the needs of the participants.
Professor Joshi made an interesting point while he was talking about his project that provided
medical information to AIDS infected persons. The project team made a conscious decision not
to remind participants to take their medicines. Instead, the program was designed to check if the
participants had taken the medicines. The team felt it was important that people do not become
dependent on the service; instead, the service was designed to empower people to be responsible
for their own care.
In some way, what this signifies is that the researchers and designers working on this project did
not think of the participants as perpetual users dependent on the services given to them. They
believed in and decided to enhance the agency of the patients by providing information and
timely checks. We could say this is a manifestation of empathy and respect among the
researchers for their participants.
Professor Joshi's, work gives us an opportunity to see how these qualities filter into the products
and services we design for the other. In our next section, we will meet Professor Athwanker, who

also uses the ethnographic approach in design. He brings an element of play and interactivity into
it. Let us see how he does this.As promised, we have a presentation by Professor Uday Athavankar, a senior member of the
faculty in IDC School of Design, IIT Bombay, Professor Athavankar teaches courses in game
design, product design and user studies, among others. And much of his work has been around
designing products of everyday use for homes, offices and industries. He has designed 0 cost
games for children, through which he has explored games as a way of learning.

(Refer Slide Time: 0:36)

And he has designed low-cost housing for urban populations with two of his colleagues, Ameya
Athavankar and Prasad Anaokar many of his projects; professor Athavankar has used an
ethnographic approach to learn about his participants, their needs and their context. In this
section, he, along with Ameya and Prasad, will share with us some of the insights that this
approach has brought to their work. Let us listen to what they have to share.

Professor Uday Athavankar: We study people to make them a source of innovation for us. Iin
conventional design language. This part of designing is called as user studies. We still not use the
word ethnography right now. We will come to that as we go along. It is relevant because it
overlaps with many other professions we study people and study cultures.

It has some overlap with visual ethnography, and we will actually discuss this overlap as the case
study unfolds. At this point, I would like to introduce you to two of my colleagues, Ameya and
(Refer Slide Time: 1:57)

We were involved in the Project for Affordable Housing, which was funded by Housing and
Urban Development Corporation and partly Tata funds in IIT to investigate how we could cater
to a slum rehabilitation scheme.
(Refer Slide Time: 2:12)

This project started around 2013. We have a team of architects and researchers with us, two of
them are with me now Ameya and Prasad.
Amaya Athavankar: In 2014, we began working on a project on affordable housing, which is
housing for urban low-income groups. After the economic downturn of 2009, there had been a
new interest in this area, but most of the work that was being done in the area was still quite
narrowly focused on the idea of achieving affordability through cost reduction.
Naturally, the approach tended towards taking middle or high-income housing solutions and
adapting them to the affordability constraints of low-income groups. Our project was looking to
take a different approach to this. Being initiated at IDC, the idea was to look at this the entire
problem of affordable, delivering affordable housing solutions through a design thinking lens.
So, it was very natural for us to begin by understanding the needs and aspirations of the people
that we were designing for.

(Refer Slide Time: 3:32)

In this project we were looking to develop radically innovative solutions. So, we needed to look
beyond what people in the target segment wanted to see in their house and really look for
insights into what housing meant to them and what role it played in their lives. So, we felt that
new design opportunities could emerge only if the problem was expanded, and a wider
understanding of the problem was created.

So, we began our research with a broad question. We framed it as we wanted to know how
people in their target group currently live, why they live the way they do, and how they aspire to
live, as you may imagine. This included probing a very large set of past, present as well as future
choices and behaviours. Lot of topics require the use of different ethnographic methods.
For example, the house, the dwelling that household currently occupies tells a lot about their
lifestyle choices and behaviour and identifying these and probing these, these choices can
provide valuable insights into the household's current struggles for self-betterment.
For example, the house, the dwelling that household currently occupies tells a lot about their
lifestyle choices and behaviour and identifying these and probing these; these choices can
provide valuable insights into the household's current struggles for self-betterment.
(Refer Slide Time: 4:55)

We asked household members to give us a guided tour of their houses. We also captured
photographs and drawings to understand how households inhabited their current spaces, if and
how they modified them and what they chose to populate them with.

(Refer Slide Time: 5:12)

But housing in living patterns also change and evolve over time, and we used a bunch of visual
methods to capture this temporal dimension.
(Refer Slide Time: 5:22)

To give you an example, we created a deck of cards with household products and furniture, some
home improvements etc.
(Refer Slide Time: 5:33)

Using these, the participants were asked to create a timeline of changes to their household, to
their house, rathe. As they build the sequence, the researcher will encourage them to share the
stories behind these decisions. This exercise revealed to us a lot of rich and detailed stories about
the decisions and events like say weddings or childbirth or educational milestones, employment
changes that shaped the house as well as the household.

Prasad Anaokar: Interesting thing that we saw was how they would sequence their belongings in
the household.
(Refer Slide Time: 6:06)

Prasad Anaokar: And the sequence would go one after another, and suddenly there were like 3 or
4 items in a straight line and horizontal line, and we realised that most lot of households had that.
And when we asked them what that was, they said was this is what they got in a dowry.
Ameya Athavankar: If we had to really come up with radical solutions based on powerful
insights, what we needed to understand was not only the pushes or the current struggles of the
household with their housing but also the pools or their desire for progress that would drive
change towards betterment.
Prasad Anaoakar: What we realised we were looking for a more deeper engagement with them
so that they could reveal a lot more than what they have currently experience and to an extent
that they would reveal something that they would have not experienced before and what they
would like to experience, which is a very difficult thing to do.
Professor Uday Athavankar: We feel that people are willing to tell you the truth. And my
experience of doing this for several years is that lot of people try to study you and give you
responses that you want to hear rather than what the actual truth is
Ameya Athavankar: We developed an elaborate set of visual props the bunch of activity cards,
furniture's, products, building elements and a set of combinable frames that represented rooms.
Households had to sit together, and they had to work together to use these to create or represent a
house that they would love to live in.

Prasad Anaokar: Like for example, most of them in tier two cities, the first thing that they did
was put a TV in the centre of the room, and then they would arrange everything, all the furniture
around the TV. So, we figured out that TV was an important member of their household as much
as a family person because that is what they put it centre of the house.
Professor. Uday Athavankar: Any specific instance where this came out very strongly?
Ameya Athavankar: I think most cases the TV was, almost plays, one of the first items to be
located in the house and also very highly contested among different family members was the
location on the TV, whether it should be in the living room.
(Refer Slide Time: 8:18)

Whether it should be in one of the most private or secluded rooms and so on. But most often they
would agree upon keeping their TV as a centre in the living room where everybody could watch
it. So, here it was almost like the TV was like the centre of the, you know, the whole house kind
of revolved around that particular item.
Prasad Anaokar: There was an incidence when we were mapping a person's behaviour within the
house where he perform different activities, literally all the activities were performed in front of
the TV, literally including studying. So, that was how much TV was important to them.

Now, if this exercise was to work, it would have to be very open-ended and, you know,
encourage a lot of playful exploration. So, the household was asked to think as if they had won a
lottery, and there was no budgetary constraint on their actions.
Prasad Anaokar: All of them wanted to have a grand entrance experience because the entry to the
house somehow was very important for everybody.
(Refer Slide Time: 9:22)

I mean, they put the jhula, the flowers, the very decorative doors. They would want to have
parking for their cars or bikes right in front of the house. So, all of it sort of created an aura of
opulence that they wanted to show to people.
Uday Athavankar: You had that experience of somebody describing the requirement for a
bathroom. Maybe we should discuss that.
Prasad Anaokar: It was interesting it is probably another example how the natural language takes
over when things are more playful, so we had asked them to arrange a house which included you
know putting room around and including the bathrooms and all that. So, our initial thought was
that maybe, perhaps because they were this semi tier two cities, they would sort of put the
bathroom a little bit outside because we had earlier seen a pattern of that happening.

But this lady actually made the bathroom the centre of attraction, so to speak. And what she said
was interesting that she said "ek bathroom chahiye bada chahiye, magar bathroom dhinchak wala
chahiye". That sort of language I do not think you would see in a regular interviews or things.
But it was interesting the way she described the bathroom, and we asked her where she got the
idea of this dhinchak bathroom.
And what she said was also interesting that she said that she was a tailor and she basically
stitched wedding dresses so she would go to these rich people's houses and get their
measurements and, you know, stitch dresses and sell it to them. So, she said she actually saw one
of these bathrooms in one of her client's house, and that is what she wanted to sort of replicate
Ameya Athavankar: I think what was unexpected for us was that we never expected the
bathroom to be like a symbol of luxury and such as such a delightful experience for people. I
think it was partly that and partly I think she was also reacting to the fact that most bathrooms in
their current situation are extremely tight spaces. And I think you have to probably imagine the
challenge of dressing up in a sari, let say in like a 3 by 3 kind of a bathroom, which is essentially
a wet space after this, the first step where the ideal situation had been imagined.

We started introducing constraints. We told the household that they had exceeded their current
budget and they needed to give up some of their some of their houses as well as their positions.
This started a bunch of negotiations. It turned out to be an extremely engaging experience for
(Refer Slide Time: 12:15)

Prasad Anaokar: That had helped us understand how they what they prioritise and why they
prioritise and what are the reasons behind their choices.
Ameya Athavankar: What