Life Course tool: Mapping critical health transitions

Dec 2nd 2018

Core adapted the Life Course approach and developed a corresponding life course mapping tool to capture the connections and ruptures in women’s sexual and reproductive health journeys and grasp the contexts in which they unfold.

 

The life course approach proves ideal for Core’s work – it helps analytically bracket time into focal areas for research and directs our attention to the critical transitions that influence the identity, needs, rights, responsibilities, and status of women in their lifetimes – presenting a lens to examine how past experiences may influence future health outcomes. Explorations in India, Kenya, Nigeria and Tanzania saw this approach adapted as a tool, to prompt sensitive dialogue with women and gather and map women’s sexual and reproductive health experiences to uncover correlations, insights and patterns. The tool has been and can be used for one-on-one conversations as well as group discussions. 

You can use this tool in multiple ways. It allows you to map any journey that you would like to study. In the case of Core, we used this to map life courses of women but also to do deep dives into shorter journeys at specific life stages. For example, this tool would be useful if you would like to study shifts in financial planning across different life stages, or explore a key behaviour within a specific period such as mapping interactions with the opposite sex during pre-adolescence and adolescence.

Kenyan men participate in a group discussion guided by the life course tool

Objectives

The objective of the Life Course tool as used for Core is to understand:

  • To discover fundamental constructs that impact a woman’s health journey
  • To explore key moments of her life course through an intergenerational lens
  • To locate moments as brought up spontaneously and organically by participants or cued by us (informed by expert perspectives & desk research)

Components

  • Life Course map. The map is a long fabric numbered from 0-100 to signify age. In Core we customised the tool for different settings by using local fabrics and at times using pictures instead numbers for different stages of life.
  • Stickers
  • Paper or post-its
  • Pens
  • Pins
  • A facilitator

The life course journey tool used in Kenya, with a piece of local textile serving as base for the age line. Participants place colour coded stickers and notes along the different life course transitions

Goal

The goal of the tool in Core was to prompt sensitive conversations ensuring both, women and design researchers, are provided a guiding framework to exchange information on key moments of a woman’s sexual and reproductive health journey in a coherent way.

Setup

Participant profile
It is important to define your sample carefully, usually through a lead profile that is needing to be met as well as the goals of the session. The profile could be based on gender and/or age (for example adolescents), life stage (for example recently married) or SRH relevant phase (for example pregnancy).

Length of the session and size of the group
These will depend on the sessions’ goals and objectives. For our needs, we had participant group sizes ranging from three intergenerational participants to 6-8 women or men of the same age. An average length of session can be at least 2.5 hours, dependent on the number of questions posed to participants.

Flow

1. Warm up
Let participants know you have brought along a tool to share with them to make the interaction fun! Mention that you are here to learn from them, that you don’t wish to make assumptions about the experiences of the women in the community, and that you would like them to help you understand their lives better. Let them know from the outset the approximate time required for the full interaction. Start with general introductions and then ask the women to describe themselves – how they see themselves or how others might see them. If they hesitate, be patient and provide some additional prompts, such as asking them how their mother, sister or friend might describe them to someone else. Once participants share an initial set of thoughts, feel free to probe further to get a more rounded sense of who they are. This line of questioning can be used to probe more about them as individuals, their families, relationship/marital status, children, occupation, and social roles as well as responsibilities among others.

2. Life course map
Roll out the map with age numbers written on it; this is to be used for the entire duration of the interaction. Have the post-its, various stickers and pins at hand. Ask participants to think of their own lives or imagine the life of a woman like them. It is at times better to conduct this entire session in the third person, so the participant does not feel pressured to talk only about their own personal experiences. Request them to start by plotting simple things such as the points and periods they considered themselves a child, or when they considered themselves young, grown up, and old, by marking those ages with stickers. Explore their reason for plotting each of these points at the moments they do. It is this exploration that is the most important part of the exercise, not the exact spot where they have plotted a point in their lives. Use different kinds of stickers, post-its, images (for example depicting emotions) and symbols (for example referring to health related transition points) to populate the different moments and their meanings on the life course map together with the participants. 

Life course mapping tool in use in Tanzania

Life course mapping tool as used in Tanzania

Participants might tend to bring up other linked events when plotting the broad initial moments. Listen carefully to these, and cue them for the next line of questioning, which is to explore events and moments across a variety of dimensions. These should include but not be limited to social events such as marriage, health related moments such as giving birth, menarche etc., or even more psychosocial notions such as “I was free then” or “I don’t have time for myself” etc. The exercise should flow like a conversation, and it is better to explore ideas as they come up organically from the participants as opposed to sticking to a strict timeline or flow of activities. 

The facilitator could further engage and steer participants with questions such as:

  • What else happens here between being young and becoming an adult, for example?
  • What else happens here while one is an adult? How does one know one is an adult?
  • What else happens between being an adult and becoming old?
  • When does one become old? Are there also different levels of old? How does one know one is old?

Once the life course is broadly populated with her/their versions of key milestones, start with questions to further understand some more specific notions of a woman’s life. At this point, the focus starts to sharpen:

  • When along this journey is a woman usually the happiest? Mark more than one event if applicable.
  • When does a woman have the least amount of responsibilities? When does she have the most amount of responsibilities?
  • What are some of the big decisions made at which points during this life course? Who makes these decisions? How does she/they learn of these decisions?
  • What are some of the toughest moments on this life course? What makes it tough? What kinds of support help a woman get through these points?
  • When does a woman not have to worry about her health? When does she have to take extra care? Why? What kinds of support help a woman get through these points?

3. Mapping general health and wellness
At this point, the discussion progresses to notions of health and wellness. The facilitator probes the participants’ perceptions of health, asking what being healthy means to them, how they would describe being healthy and being unhealthy, and what would be the most relevant factors that influence their health in a positive and negative way. More broadly, encourage participants to organise responses along the following lines:

  • “Good for health, that I follow”
  • “Good for health, that I don’t follow”
  • “Bad for health, that I follow”
  • “Bad for health, and I stay away from”

For each of these it is important to always follow up with “why?” so as to explore for a deeper understanding of these reasons why this is so.

In addition to the categories the participants come up with, the facilitator cues general categories that women can organise across the life course, and describe further, using the tool. Some example categories include food, exercise and physical activity, sleep, medication, mood and mental state, weight, water intake, habits, and so on. If there is time available, ask participating women if this health mapping would be different for men, and how. It would be worthwhile to enquire along the lines of how it would differ and what they would add.

After exploring these dimensions you can shift the focus to asking what best describes her/their current moment:

  • Which of these would you say is your current life stage? Plot this now on the map as persona #2
  • What was the stage that you were in, just before the current stage? What has changed since then and now? Plot this on the map as persona # 1.
  • What would be the next stage you would enter? What would mark that? Plot this on the map as persona #3.

While building the persona, participants select images to  represent the different transition points and plot at which point the persona might experience it

4. Mapping personas
We then move into a persona building exercise, for each of these identified personas. This will help us understand in anecdotal terms how things are defined for different life-stages, and later in the conversation, will help us understand the shifts that take place between one life-stage and another.

Adopting a persona allows the participants to dissociate and share insights more freely. It is often helpful as you try to solicit more genuine and insightful responses, to take the pressure off of the girl/woman to expose herself. Hence, the facilitator is encouraged to change the pronoun from the first person to third person. This switch should be cued by the facilitator by asking participants to imagine a person like themselves, an exercise participants should be familiar with from earlier in the interaction.

As the conversation flows, be attentive to areas where you will be able to ask about specific people, the girl/woman knows, who represent the persona and how this fits or does not fit with her own life.

One by one build each persona with the participants. Start with theyoungest persona, and questions for each persona covered should cover:

  • Routine
    • What the average day is like for her?
    • What are the places she visits?
    • Who are the people she interacts with?
    • What do they do?
  • Social definitions & relationships
    • How would she describe herself? How would her best friend/ sister describe her?
    • How would her family members describe her or define what her role is? Would different members of the family have different definitions?
    • How would people outside of the home define her?
    • Who advises her on things? Who does she turn to for advice?
    • Who makes decisions for her?
  • Mind-state
    • What makes her happy? What brings her joy? What are the things she loves to do, but is unable to find time for?
    • What does she imagine for her life, or aspire to when she thinks of the future?
    • What brings her down? What worries her?
  • Health, health activities, behaviours, and risks including interactions with care providers and facilities.
    • What does being healthy mean for her, specifically?
    • What are the areas in her health she doesn’t have to worry about?
    • What are some areas of concern, what does she do about them?
    • Are there any aspects of her health she neglects?
    • Any risks posed specifically to her? How does she recognise these?
    • Who advises her the most on health?
    • Who influences her decision-making?
    • What are aspects of her health she wishes she knew more about?
    • What are her experiences of different SRH services or information for example family planning or ANC?

Continue building upon the life course journey map, appending any things the participants want to add or highlight on their map.

5. Findings links between the present, future, and the past
As the conversation continues, probe the shifts between moments in the past, present and future on the life course to get more stories and an understanding of the context, the woman/girl and the persona at different time points. This will help map nuanced changes and shifts between life stages. You can also try enquiring along the lines of inter-generational shifts, for instance, by asking how would this have been for her mother, or her grandmother? How she hopes this will be for her daughter?

Intergenerational life course mapping underway in Bihar, India

PAST: Start with the recent past. Try and understand what the participants’ previous life stage was like, using the term she used when plotting her life course. Spend less time on this than the next question.

PRESENT: Move onto the present. Request her to compare the past stage with what it is like right now for her. How is it different for her today? Spend more time on this stage and deep dive using the tool, especially on health.  

FUTURE: How do you think this will change in the future? And at what point? What specific aspects will change, do you think?

Repeat this exercise using the life course tool and persona mapping with different individuals and groups, including with other generations to gather substantive data, while locating shifts between generations, and learning about how knowledge and behaviour is passed on and shared.

In the end, thank and close the session. Collect the populated life course maps, take photos and/or videos of them before packing them away.

Read more about the use of the Life Course tool in Core here.

Tips and Notes

  • Remember to carry project consent forms translated to the local language if necessary, including photo consent and minor consent forms.
  • Carry all tools and materials to make the interaction seamless.
  • Bring an audio recorder, camera and notebook to capture interesting moments from the interaction.
  • As you get set to interact with participants, try setting a tone of humility as well as of inclusivity, flexibility and open-mindedness. Ensure they understand that in the interaction there are no right or wrong answers, and that everything they say is valuable!
  • Make participants aware that they will spend about 2.5-4 hours at the interaction and acquire their verbal or written consent. Ask them if they’re comfortable being photographed and recorded (audio and video) for parts of the interaction. Let them know that the interaction is intended to be fun for all involved, and maybe even a way to strike friendships in the process. Start with a round of introductions.
  • Please be mindful that you are entering someone’s private and personal space. Be respectful and seek verbal or non-verbal cues to venture into parts of their home.
  • Try and observe the spatial layout of the home, relevant objects such as medicines, thermometers, IEC posters, capturing artefacts that represent the lives and contexts of women.
  • Ensure there are silences and pauses in your conversation when required. Allow room to simply observe, be shown things and speak of the things they wish to discuss!
  • Make sure everyone understands the basics before starting.
  • Encourage participants to ask questions of the facilitator as well.