May's force was with Nivi!

The monthly newsletter from Nivi bringing updates from journeys on askNivi, product and marketplace corner. Bonus: our CTO David wrote about Nivi's plans to use LLMs.

Bonus first : A note from our CTO David Tresner-Kirsch

The World Health Organization recently published a call for safe and ethical AI for health, emphasizing “the importance of applying ethical principles … when designing, developing, and deploying AI for health.” That publication is a reaction to recent rapid (and at times reckless) adoption of Large Language Model LLM technologies (which include ChatGPT, BERT, RoBERTa, Google Lambda, and others) in many industries, including healthcare.

At Nivi, we’ve always been committed to equity, accessibility, and safety in our use of AI, which is why our project titled “Gender Accessibility in Health Chatbots” (in collaboration with University of Lagos) was one of three awardees in the Equitable AI Challenge: Sourcing Approaches to Prevent and Respond to Gender Inequity in AI (funded by Digital Frontiers, from USAID’s ITR in partnership with DAI). In that work, we are implementing and evaluating AI development workflows which explicitly emphasize models that achieve gender equity in accessibility and are attuned to the needs of local populations. We have leveraged LLMs (specifically, XLM-RoBERTa, a multilingual LLM) strategically in that work.

WHO’s message specifically cites risks that “LLMs generate responses that can appear authoritative and plausible to an end user; however, these responses may be completely incorrect or contain serious errors, especially for health-related responses.” We have seen this sort of outcome first-hand in our internal testing of state of the art chat-based LLM tools (for example, fabricating completely plausible but completely incorrect addresses and phone numbers for local healthcare providers).

For these reasons, we are not including generative, open-ended question answering in our near-to-medium term roadmap for leveraging LLMs to better support our individual end users and customers. Instead, we are applying state-of-the-art LLMs to make the askNivi chatbot more accessible and effective, leveraging them as feature encodings for improved user intent recognition and as paraphrasers to adapt content to appropriate literacy levels for Nivi’s end users.

Pregnant women in Assam join askNivi’s Maternal Health Journey!

In the April newsletter, we wrote about how askNivi is helping pregnant women in Assam find quality healthcare during their pregnancy with the goal of reducing maternal mortality. We’ve since been working tirelessly along with our consortium partners to onboard clinical facilities on the askNivi and we’re happy to report that the pre-pilot of the MH journey is now successfully integrated with five clinical facilities in and around Guwahati and we’ve trained 60 healthcare providers at these facilities. These facilities are Marwari Maternity Hospital, KGMT Multispecialty Hospital, Dr. B.A. Saikia Memorial Nursing Home, Dr. Kalicharan Das Nursing Home and Polyclinic and Satribari Christian Hospital.

Through these facilities, 390 pregnant women scanned our QR codes and 309 women onboarded to the longitudinal chat journey that will support them throughout the duration of their pregnancies. 54% of the onboarded women showed substantial engagement by interacting with conversations on askNivi as the chatbot reached out to recommend check up visits according to the WHO guidelines. Furthermore, they provided feedback about their experience at scheduled visits at a rate of 21%, providing rapid and valuable insight into patient impressions of the local healthcare system.

As we move into June, we’re excited to expand our coverage and onboard other facilities to the MH journey as well as ramp up the efforts to reach more pregnant women in the state of Assam. We’re also working with the partners to update the content on the MH journey to enhance user experience and improve engagement metrics but more on this in the upcoming newsletters!   

How Nivi’s driving equitable access to Family Planning services in Kenya

Earlier this week on the Nivi blog, we published an analysis of referral seeking and redemption behaviour amongst Kenyans towards family planning services. We studied how certain demographic factors of the users on askNivi FP Journey, like gender, age and location within the country, take up a family planning service. We observed higher engagement amongst women which we attribute to commonly used contraceptives being women-specific methods, e.g., injectables, implants and oral contraceptives. While the conventional wisdom is that adolescents face significant barriers in accessing SRH services, in our experience, adolescent females reported visiting Nivi’s recommended providers at much higher rates than older segments of women suggesting that the digital experience is particularly useful for that demographic segment. There’s more such insights waiting for you, simply click the button below to read it on our blog!

We continue to refine our ability to segment and serve the fast growing user base in Kenya to meet their health aspirations by helping address their specific reproductive health needs. Organizations looking to tap into the power of digital technologies and behavioral sciences to advance public health causes have been partnering with Nivi to leverage its expertise and distribution. For organizations keen to support equitable SRH access, working with Nivi can empower access to services that reach otherwise underserved communities. If you’d like to explore how we can help further your cause and drive better public health outcomes on therapies and topics of interest to you, reach out!

News from the Reproductive Health Journey on askNivi Kenya

Nivi, since January 2023, has been working with Ipas to launch a suite of content offerings related to Post Abortion Family Planning (PAFP). This reproductive health journey features a 4 minute quiz designed to assess current knowledge, attitudes, and beliefs around medication abortion (MA), followed by a targeted learning experience that provides the key information they need to decide their next step. 

User onboarding and engagement

• Healthcare providers/pharmacies are key entry points to the PAFP journey and this month, we’ve refined the content experience for women who have self-managed their MA to encourage uptake of contraception. When a customer scans an askNivi QR code at one of our trusted pharmacies, they are invited to answer a few questions about their shopping experience. 

• askNivi users who report purchasing a Reproductive Health product receive a custom follow up with informational support on next steps. In the case of MA pills, askNivi will help female users make a plan for contraception and provide her with emotional and informational support – including how to prepare and when to see a doctor. 

• At key parts of the health journey, askNivi invites her to learn more about post-MA family planning methods. If she’s interested in taking up a family planning method, askNivi refers her to providers in her area, which can initiate a return visit to the pharmacy where she previously scanned any Nivi QR code.

• This month, we collaborated with Ipas to distribute QR codes to community mobilisers, so that they can share askNivi with their networks. With this new entry point to askNivi, we look forward to connecting new users to reproductive health topics that are relevant to them at every step of their health journey.

Updates from the askNivi Nigeria Malaria Journey

In the April version of the Nivi newsletter, on World Malaria Day, we wrote about the Malaria Journey that’s live on askNivi Nigeria. We also covered the malaria quiz embedded within the journey which is an interactive way of engaging users, testing their knowledge and also spreading awareness and education about causes, prevention and treatment. In the quiz, we ask users questions like ‘how long does it take for someone bitten by an infected mosquito to feel sick?’, ‘how can malaria be treated?’, ‘are all fevers malaria?’ etc. and give them multiple options to choose from. 

Well, we’re back with the quiz results!

200 people took the malaria quiz and the group collectively answered 70% of the questions correctly showing general awareness about malaria.

• When the group was asked about how someone gets malaria, 93% of these users gave the right answer with women being right at a rate of 92% and men at a rate of 95% - higher than the average.

• When the group was asked how long it takes for the person bitten to start showing symptoms, only 40% of the users answered correctly. While only 56% of the women on the quiz got this one wrong, men answered incorrectly at a higher rate of 67%!

• We also asked the users if they thought all fevers are indicative of the person having malaria and 53% of the users chose No to answer correctly. Both men and women answered this question correctly at a comparative rate. 

It is important to mention that the purpose of the malaria conversation on askNivi was to spread awareness and drive uptake of WHO recommended Rapid Diagnostic Tests. The success of malaria control depends heavily on effective diagnosis and then the treatment strategies that follow. We’re now in the process of updating this quiz further to improve user learning outcomes that support a broader Malaria journey aimed towards better diagnosis and treatment awareness. 

In this initial phase, more than 1,300 users have now interacted with the Malaria journey on askNivi Nigeria. Almost 13% of the users ended up seeking a referral from us for a provider facility and 7% of those users who sought a malaria related referral reported redeeming it. We believe in collaborative efforts to combat malaria and are actively seeking like-minded organizational partners who share our vision. If you are interested in harnessing Nivi's proven expertise in segmented engagement and referral capabilities, we invite you to connect with us!

The HPV Journey in Kenya is now 600+ respondents old

In the last newsletter, we wrote about the new HPV journey that’s live in Kenya and how we’re working with Ninety Insurance to identify leading health concerns among Kenyans and to assess the need for affordable health coverage. Through a set of Facebook ads aimed towards the target population for this survey, we recruited 600 respondents in the first week alone! 

A good majority of the respondents were English speaking Kenyans who reported that access to insurance products tailored to their scenarios needed to be improved. We’ve also learned how affordability and coverage benefits continue to be a significant barrier in insurance uptake amongst the target population. We’re continuing to gather these insights and working with our partner, Ninety, to inform the design of a women’s cancer insurance product that provides financial coverage for preventive services and treatment of HPV and HPV-related cancers. 

In November 2022, we wrote about how Nivi’s marketplace model is pivotal in furthering our mission and helping break barriers to healthcare access for askNivi users. Since then, we’ve expanded the providers network to facilitate more referrals and improve redemptions through our platform in our operational geographies - India, Kenya, and Nigeria. Our partners in these geographies too have joined the ship and are contributing to the mission of enabling individuals achieve their health aspirations.    

The latest news on this front is from Kenya, where Nivi is partnering with 51 pharmacies to help users get access to healthcare and to support the pharmacies with counseling. These partnerships are useful for a variety of reasons. First, and the most obvious, our provider network expands and we’re able to offer multiple options to the users to go for a referral based on their convenience. Second, these partnerships also become a source of user acquisition as the pharmacists guide customers to scan the QR code and experience the askNivi chatbot to access information on health topics. Another goldmine in these partnerships is the ability to check-in with the user and take feedback on their experience at the provider and confirm if they got the help they needed. This enables us to capture insights around user experience in our provider networks and for our partners, these feedbacks become a source of action towards improving the quality of services offered by the facilities. 

Since February, when the partnerships with the 51 pharmacies started going live in Kenya, we’ve had close to 400 users scan the askNivi QR code. Interestingly, we’re now seeing many of these users return to the same pharmacies they onboarded from - indicating the high quality of experience they’ve had in the first visit.  

Our partners asked us to introduce A/V capabilities on askNivi and we delivered! 

With the rise of social media platforms, there’s a shift happening in how individuals learn and consume content. This is also evident from research that points out how the systemic coordination between the audio-visual (AV) industry and healthcare is leading to convergence in form of increased user-engagement and experience as well as emotional connection. 

The askNivi chatbot now allows its users to engage with audio and video files. The chatbot can embed Youtube videos, and send audio and video files in native WhatsApp format. Embedding Youtube videos provides a player-in-player experience, which doesn’t interrupt the chat. 

Video and audio can significantly enhance chatbot engagement for several reasons. Firstly, they provide a more immersive and dynamic experience compared to text-based interactions, capturing users' attention and holding it for longer periods. Non-verbal cues such as facial expressions, gestures, and tone of voice help convey emotions, build rapport and empathy, and establish trust with users, resulting in more engaging conversations.

Moreover, video and audio can enhance the clarity and efficiency of communication. Visual demonstrations or explanations can quickly convey complex information, eliminating potential confusion or misinterpretation that may occur in text-based conversations. Similarly, audio cues can enhance the comprehension of instructions or guidance, ensuring users understand and follow them accurately. Eliciting emotional responses from the audience can help enhance their overall experience.  

A study by TechSmith indicates that 83% of people prefer watching videos to accessing instructional or informational content via text or audio. Over the coming months, you will hear more about how we’re deploying AV content on the askNivi chatbot in collaboration with our partners and what we’re seeing.  

Padmapriya Sastry, Nivi’s Senior Growth & Partnerships Lead for Nivi Insights in India, wrote a Mother’s Day special article for the May edition of Learning4Impact blog. Learning4impact is a knowledge partnership between USAID/India and Swasti. L4i provides technical support to USAID India Health Office to review current programs, track trends in the health landscape and plan future investments for positive health impact.

That’s all from our side for this newsletter edition. Use the button below to leave a comment for us, we’d love to hear from you on how you found this edition!