Methods

UX Research
Service Design
Content Strategy
Workshops
Co-Design
Equity-Centered Design

Challenge

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.

We were paired through the AIGA Changemakers program, which creates multi-disciplinary teams to help non-profits develop interventions to challenges.

Outcome

A new understanding of unique Somali mental health needs and an intervention that could reach people of all generations.

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.

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.

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.

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.

Given the COVID climate at the time, 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.

Interventions

Providing Pathways for Connection: Conversation Cards and Content Design Templates

We developed five categories of cards with the mental health team, each serving a unique purpose in facilitating mental health discussions:

1. Wellness Warm-Up: Indirect questions to initiate conversations, like "What brought you joy today?" Also included listening strategies to encourage open dialogue.

2. Awareness: Resources for identifying mental health issues, including common symptoms like sleep or appetite changes. Aimed to guide people to appropriate resources and address harmful language.

3. Know Yourself: Self-reflection prompts such as "What makes you feel better on a bad day?" Some cards paired with religious passages to resonate with the community's values.

4. Dictionary: Mental health terms translated into Somali, bridging language gaps. Examples include "Wallaaca" for anxiety and "Ladnaan" for well-being.

5. Empowerment & Action: Strategies for self-advocacy and supporting others, including faith-based approaches like "How does your faith support your mental health?"

These cards were designed to facilitate discussions, increase understanding, and provide actionable steps for mental health support, all while respecting cultural nuances within the Somali community.

Multi-Persona 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.