All illustrations by Ibrahim Osman
Somali Health Board
Research & Design/ 2020
Summary
Challenge
How might we create culturally appropriate support that de-stigmatizes mental health for the Somali Community?
Context
Our presentation starts at 1:04:45.
Somali Health Board, a public, non-profit 501(c)3 grassroots organization, was formed in 2012 by Somali health professionals and volunteers concerned about the health disparities that disproportionately affect new immigrants and refugees within King County. The community had seen increasing rates of suicides, opioid abuse, and emergency interventions needed for people struggling with mental health issues.
SHB knew they needed help figuring out how to reduce stigma around and educate people about mental health, which is why they came to us for help. We were paired through the AIGA Changemakers program.
Outcome
A new understanding of unique Somali mental health needs and an intervention that could reach people of all generations.
My Role
I developed the research plan and interview guide, conducted interviews, planned our analysis & co-design workshops, created content, and helped develop a roadmap to bring interventions to the community.
Process
Methods & Tools
Research: Interviews with community members and health experts, secondary research, community sessions, collaborative analysis sessions
Design: Co-design sessions with their mental health group and community members, journey maps and prototypes
Research Approach
We worked closely with SHB's mental health team to identify people to speak with, in addition to conducting our own desk research around mental health, Somali health mindsets & behaviors, and successful past programs SHB had run.
Expert Interviews: We interviewed Somali mental health professionals, imams (religious leaders in the Muslim faith), graduate students studying mental health and the Somali community, and school counselors. They provided insight into how mental health intersected with a wide variety of age groups in the Somali community and how different interventions worked - or didn't.
Community Interviews: One of our biggest challenges was navigating remote research, since large parts of the community weren't well connected to technology. Ideally, we would have been able to visit Somali gathering spaces and events. We supplemented part of this by attending virtual community conversations on Facebook and conducting interviews with family members.
Community conversations around mental health are hosted by SHB once a month to educate and engage the community around health topics.
Social Media: We examined social media channels to understand how mental health organizations and accounts were connecting to the Somali experience and reached out to speak with group leaders across the world. Groups such as Xiishod shared their experiences with Somalis in their own cities like London and Minneapolis, so we could learn from and lean on their success.
Analysis workshop with SHB
Co-Design Sessions: We prioritized working closely with the SHB mental health committee, holding an analysis and ideation workshop together and meeting biweekly. This helped us keep the committee actively involved and centered the lived experiences of the Somali community, as most of us were coming in as outsiders.
Synthesis & Analysis
Key Takeaways
Currently, there is only one word for mental health struggles: ‘waali’, or'crazy.' Mental health is generally understood through binary states, without nuance for different conditions. This created stigma and barriers around seeking help and being shamed forever.
Western healthcare doesn’t recognize Somali culture, especially the role of religion, in treatment. Resources must put treatment in the context of the Somali experience.
Family is the core support network. But generations struggle to understand each other’s unique mental health experiences. Family members need help bridging the gap so they can better support and understand each other.
Fear of judgment and lack of a shared language present obstacles for people seeking help for—or talking about—mental health. People need a shared language and a safe space for seeking help and talking about mental health.
Defining Experience Principles
We developed experience principles to help inform our ideation sessions and provide a common set of guidelines and inspiration which kept our research insights top of mind.
We arrived at several high-level themes to group principles around:
Religion + healthcare resources working together
Safe space, non-judgemental, trusting, confidential
Awareness/openness to the topic of MH
Education + access to resources
Family support & collaboration
Different cultures within Somali community (kids and parents)
We refined the draft principles after our workshop into final principles:
Provide a safe space to land. Take time to build spaces that see, love, and recognize everyone. Listen first, practice empathy and compassion, and meet people where they are.
Sharing shows strength. Vulnerability builds resilience. Take care of yourself and your body to take care of your community. Be brave, share yourself; there’s power in your story.
Bridge the two systems. Approach mental health from a holistic lens that draws tools and treatment approaches from religion and Western medicine together.
Center Somali stories. Sharing our lived experiences shows they are not alone and starts to create a shared language around mental health.
Supporting a Multigenerational Range of People
Through our research, we identified several distinct people we'd need to consider:
Younger Somalis
Deal with a different set of struggles than their elders, with the challenge of navigating two cultures (Somali and Western)
Greater literacy around and exposure to mental health concepts
Their challenge lies in getting the help they need when they struggle without bringing shame on their family
Influences include trusted figures like a soccer coach, people on social media, and their friends
Older Somalis
Hold lower literacy around mental health and technology (generally)
Are resistant to talking about it and would speak about their experiences in the third person
Dealt with the challenge of intergenerational trauma and firsthand experience war and hardships in Somalia
With beliefs rooted in religion, their key influences are religious and community leaders like imams and family
Mapping Support Ecosystems
We needed to consider how we could reach each audience, with distinctly different influences and behaviors. We created ecosystem maps to show the strengths and weaknesses of various ties.
A general ecosystem map shows potential influences on behavior and receiving information
An individual map for Aaden shows his individual influences
Ideation
For our ideation workshop, we used two methods to spark creativity: a mash-up exercise, where we combined community activities with the best things about the internet to center our ideas around community activities and our current online-first reality; and Creative 8s, where we each sketched or jotted down 8 ideas in 8 minutes to generate lots of ideas.
The team came up with tons of great ideas (a variety show acting out mental health scenarios, a mentorship program pairing people across generations, a community garden), but two stood out most: the idea of Guided Question cards which could spark conversation and educate people about mental health, and Asariyo (tea time), which leveraged a community tradition of gathering over tea and paired it with relaxed conversations focused on mental health.
The winning “guided questions” concept
Given the current COVID climate, we moved forward with Guided Questions, since the content developed could provide a base to support future ideas and test communication approaches. The card content could be used immediately across social channels, developed into physical cards later, and appear throughout other ideas like Asariyo (an intentional gathering concept based on a coffee and tea ritual familiar in Somalia) and a community garden.
Solution
Providing Pathways for Connection: Conversation Cards and Content Design Templates
We worked with the mental health team to develop five categories for cards:
Wellness Warm-Up: Indirect questions around mental health and wellness to create space for conversation. Examples: “What brought you joy today?”; Listening strategies and techniques
Awareness: help people determine the appropriate resources for someone, provide perspectives on mental health, and understand symptoms. Examples: Symptoms like trouble sleeping or appetite changes which indication mental health struggles; Learn about which words are harmful
Know Yourself: provide space for self-awareness and reflection on thoughts, feelings, emotions, which could be paired with religious passages, and allow people who feel alone in their mental health journeys to take the first steps towards understanding themselves. Examples: “When you're having a bad or off day, what makes you feel better?”; “What does it feel like when things are in balance?”
Dictionary: define and translate mental health terms into Somali language. Examples: Wallaaca = Anxiety; Ladnaan = Well-being
Empowerment & Action: teach people how to advocate for themselves, be there for someone who is struggling, and learn how to find the help they need. Examples: “How does your faith support your mental health?”; Strategies to help someone who is down
Understanding Different Touchpoints: Multipersona Journey Maps
We created a connected journey map to understand how different people might be reached throughout the stages of their mental health journey with the card content.
Impact
The mental health committee team has been incredibly excited about the potential for this project and we're in the process of developing and rolling out the content in different formats, including a website.
Part of our team from the initial project has joined the SHB Mental Health Committee going forward so we can continue to support and work with them.
One of the long-term goals mentioned by SHB is to have more Somali health practitioners, especially in mental health, who look like the community. We hope that by making mental health easier to talk about, more Somali youth may be inspired to become mental health practitioners and build a health system that looks like and can better serve the Somali community.
Key Learnings
Working with a culture so different from our own required a lot of learning and challenging assumptions. We were fortunate to get training from Creative Reaction Lab on equity-centered design to help us learn how make the process more community-led, rather than centering ourselves as researchers and designers.
Being able to meet in person with the community would have been an excellent opportunity to put more of CRX's principles into practice, but we're looking forward to piloting our mental health initiatives to find people in the community who are interested in taking the lead.
I read a couple of books to help me better understand designing with other cultures and the Somali experience: Call Me American by Abdi Nor Iftan, to understand the historical context of civil war, immigration, and intergenerational trauma. Cross-Cultural Design helped me understand Hofstede's cultural dimension theory, which measures where different countries & cultures sit on dimensions such as uncertainty avoidance and long-term vs. short-term orientations. This helped us contextualize and compare cultural differences on a greater scale.