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Give me a Sign

How wayfinding can help the vaccine opportunistic

By UNICEF Ghana and Common Thread

KUMASI, GHANA — With COVID-19 vaccine becoming increasingly available, Ghana has shifted its focus from vaccine procurement to vaccine uptake. As of February 25, 2022, less than 16% of Ghana’s population was fully vaccinated against COVID-19. Despite having enough vaccines to inoculate 88% of the population with at least one dose, only about half of the country’s available vaccines have been administered.

How might we explain this gap between supply and vaccine coverage? Are people in Ghana hesitant to get vaccinated? Do people have difficulties accessing vaccination services? Or, is it something else?

Kumasi is Ghana’s second-largest city and historic capital of the Ashanti Empire. It’s here where we discovered one possible explanation. Many people that we spoke to were not vaccine hesitant but rather, vaccine opportunistic. If vaccination services were clearly visible, available and easy to access, people had no objections to vaccinating.

Like all of us, we found that many people we talked to were generally willing to get the COVID-19 vaccine, but they often had multiple competing priorities and were therefore unlikely to go out of their way to find a vaccination site. It was a question of prioritization, convenience and perceived cost.

In other words, if someone was at a market and happened to hear an announcement giving the location of a nearby vaccination site, that might be enough to get them to get the vaccine then and there. Someone who is vaccine opportunistic would therefore be unlikely to actively search for a vaccination site without being prompted or shown the way.

UNICEF Ghana and Common Thread collaborated with local civil society organisations (CSOs), and the Ghana Health Services (GHS) to help make vaccination as salient and easy as possible. Our 2-month project included a rapid assessment to help us develop a solution that prioritised vaccine opportunists. Our prototyping efforts focused on prompts for vaccination, support for finding such services, and information to help prime people for what to expect. The goal was to reduce friction so that individuals would need to exert as little effort as possible to get vaccinated.

One way to help people find and access certain locations and services is through an approach called wayfinding.

Wayfinding

Wayfinding is more than just signs. When done well, it’s an information system that enables people to move through their environment to a desired destination with ease. The best airports help us all make sure we know where we are, where we’re going, and what to expect when we get there. Wayfinding can be used to:

An arrow with a caption that reads "direct people towards a location," a location pin with a caption that reads "indicate/signal a location, a document with a caption that reads "provide information about a location/process."

Effective wayfinding is logical, consistent, and considerate of its environment. Tools that are often used to create effective wayfinding systems include:

  • Colours
  • Symbols and icons
  • Effective language
  • Sound
  • Light
  • A designed environment (e.g. paths and rails)

The best wayfinding systems should be able to effectively guide people through their physical environment and enhance their understanding and experiences within these spaces. In doing so, they can both increase the efficiency of a process and improve the overall experience of users. Beyond providing direction, when wayfinding is used to guide a user to a particular public service, it can, at the very least, inform people of the existence of the service and may therefore act as a visual prompt for people to access it.

Informal paper and cardboard signage at vaccination points and a queue of people sitting outside a vaccination point.
Existing wayfinding in Kumasi, Ghana

Existing wayfinding at vaccination points was inconsistent, lacking information and did not engender trust or confidence in the service being provided.

Although a wayfinding system alone may not increase COVID-19 vaccination rates, a consistent visual marker for a service may help establish familiarity and confidence in the service. By being located at strategic points of a person’s daily routine and eventually their journey towards receiving a COVID-19 vaccine, wayfinding could prompt a person to decide to get vaccinated, to direct people to convenient vaccination sites, and to inform people of what they can expect before and throughout the vaccination process. Setting expectations of the requirements and steps of the vaccination process can reduce any potential friction that might cause a person to abandon ship before getting vaccinated. Such communications should include information about requirements (paperwork, age), cost and expected wait times.

What we did

Before designing a wayfinding system, we needed a better understanding of COVID-19 vaccination in Ghana, particularly in the Ashanti Region. Our background desk research and multiple consultations with key stakeholders led us to Kumasi, an urban area with a high population density and unvaccinated population.

In order to get a more complete picture of the journey to vaccination — and all the potential barriers along the way, we spoke to vaccinators and people receiving their COVID-19 vaccines at static and mobile vaccination sites. We visited three different vaccination sites: a workplace booster campaign at the Bank of Ghana, a static vaccination site at a Kumasi Municipal Authority (KMA) clinic, and a mobile vaccination site at Kumasi City Market. Interviews revealed little resistance to vaccination, and we saw that periodic market announcements drove more people to the vaccine site.


Armed with our insights from the field, we brought people together to learn more. We held a day-long co-design workshop with regional level stakeholders from Ghana Health Services, UNICEF, implementing partners, and civil society organisations in Kumasi. Our goal was to collaboratively brainstorm and iterate on potential wayfinding solutions to help the vaccine opportunistic get fully vaccinated. We collaborated on our mission to reduce uncertainty towards the vaccination process, cue people to get vaccinated, and instill trust and confidence in the vaccine and the vaccination process.

Our team returned with key insights and ideas for effective wayfinding systems. Our design team went to work leveraging recognisable colour schemes that built upon the national vaccination card and the green and gold of Ghana Health Service’s ‘Good Life’ brand. They created mock-ups with critical messaging around how to prepare for the vaccination process.

Mockup of a green and yellow sandwich board sign with text that reads "COVID-19 Vaccine Here" with an arrow pointing inside Kumasi City Market.
Mockup of sandwich board directing to a vaccination site
Mockup of a green and yellow banner hanging above the vaccination pop-up in Kumasi City Market that reads "COVID-19 Vaccination" in big text with opening hours and "Please have your ID with you. Vaccines are available to everyone over 18" in smaller text.
Mockup of banner above pop up vaccination site

Once the prototypes were developed, we moved on to testing. We built a rapid field testing kit and engaged our in-country partners, The Light Foundation, Theatre for Social Change, and RISE Ghana to get feedback from vaccinated and unvaccinated adults in Kumasi on the messaging, look and feel of our prototypes. While the people we spoke to were generally receptive to the ideas, we gained valuable insights on how to ensure the messaging and imagery were culturally relevant and impactful for Ghanaians.

A digital mockup of a mural on the side of a wall, depicting a woman wearing a mask and pointing to a band-aid on her upper arm. There is text that reads "Free COVID-19 Vaccination! Available to anyone 15 years and above, including pregnant women. Walk into any clinic or hospital between 8:00 AM and 5:00 PM. Don't forget to bring your ID card!" on a green background. A yellow line across the mural has text that reads, "Protect yourself and your community. Get your COVID-19 vaccine today."
Mockup of mural tested by partners in Kumasi

Our findings revealed that messaging was helpful and understandable. Feedback underscored the need to translate the messaging into Twi (or other local languages, as appropriate) and adapt the hairstyle and clothing of the woman illustrated to resonate with the community in which the sign is placed. Wherever possible, information on wayfinding materials should be adapted to include the particulars of the vaccination site, especially their hours of operation.

The UNICEF team will take this feedback forward by working with health authorities in Kumasi to invest further in learning how renewed wayfinding and investment in reducing friction for opportunistic vaccinators will impact vaccination rates at these sites. This rapid and practical process has piqued the interest of partners in Ghana, who have become curious about how community-driven solutions and behavioural design can support improved health services for the people of Ashanti.


This article was originally published on our Medium.

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