14. Dr. Alice Ladur - Using Whose Shoes in PhD work with men in Uganda to improve maternity outcomes

This is a very special podcast for me - a story I was really keen to capture as it deserves a large audience.

Today I am speaking to Dr Alice Ladur, who has used my Whose Shoes board game in her PhD project in Uganda, working with men to bring about culture change and improve maternal and the enable outcomes.

It is a very powerful story and the immediate changes and outcomes are extraordinary. There is so much scope to build on this project and save lives.

I am delighted that Alice won the  Vice Chancellor's Postgraduate Research Prize, Bournemouth University. Very well deserved!

Lemon lightbulbs with Alice 🍋 💡🍋

• Alice had the vision to target men in Uganda in order to bring about culture change and improve maternity outcomes
• It is vital to ensure that pregnant/ birthing women have choice, so involvement of the partners had to be on their terms
• Careful research and planning essential in adapting the Whose Shoes approach for a new audience 
•   It was vital to run the pilot study to ensure that the Whose Shoes game was acceptable and accessible to Ugandan men.
• Make sure the messaging is appropriate and translate into the local language
• Experiencing what it is like as a participant helps in designing and facilitating a Whose Shoes session
• It is useful to record ‘before and after’ impressions, to help evidence the impact of the approach. Quotes are brilliant!
• By building trust, the men talked about their experiences in childbirth and realised the impact of their attitude and behaviour on their spouses. They became more concerned and caring
• Essential to understand the reality of working in a difficult political context; overcoming the political divide through coproduction
• “Maternal death knows no colour divide and has no political affiliation”
• In Uganda, it was in is essential to engage a male facilitator. 
• Choosing the right male facilitator added so much- a father himself, who succeeded in breaking down stereotypes and getting the men to share experiences openly and learn from each other
• Humour helps to break down barriers! Complete strangers bonding over a board game!
• Essential to identify and dispel the misconceptions men had about maternity services. Allaying the fears!
• Better nutrition! Increasing the uptake of leafy vegetables and animal products
• Seeing real behavioural change. More understanding, more caring!
• The women felt more supported to attend antenatal care
• The board game – wise, educational and fun!
• This was highly innovative. Board games have not been used in this way in Uganda before.
• Coproduction rather than competition.
• Whose Shoes is creating safe spaces for people to reflect and share experiences and think through individual and community actions
• An article in the BMC about Whose Shoes as an educational board game to engage Ugandan men in pregnancy and childbirth
• We have only really scratched the surface here. Who can help with funding for a longer term study?

Read the early research findings here:

`Whose Shoes?` Can an educational board game engage Ugandan men in pregnancy and childbirth? | BMC Pregnancy and Childbirth | Full Text 

We LOVE it when you leave a review!
If you enjoy my podcast and find these conversations useful
please share your thoughts by leaving a review (Spotify or Apple are easiest to leave a review - navigate via 3 dots) and comment on your favourite episodes.

I tweet as @WhoseShoes and @WildCardWS and am on Instagram as @WildCardWS.

Please recommend 'Wild Card - Whose Shoes' to others who enjoy hearing passionate people talk about their experiences of improving health care.

Chapters

• 1:54 Alice sets the scene talking about the context for her PhD project around improving maternity care in Uganda
• 5:30 Alice talks about how she became specifically interested in male involvement in maternity
• 6:56 Early impact from focusing on men and culture change, including reducing domestic violence
• 7:30 Ensuring women have choice
• 8:27 How the story began – sowing the seeds for using Whose Shoes in Uganda
• 9:39 Alice attends a #MatExp #WhoseShoes workshop at UHCL and starts to plan the pilot study with Uganda men in London.
• 11:46 The early response – they loved the game!
• 12:27 It was interesting to see the men come alive, talking about their experiences in childbirth and realising the impact their attitude had on their spouses
• 13:05 Some immediate outcomes – becoming more concerned and caring
• 14:14 Thinking through the logistics of making this work in Uganda, including adapting the Whose Shoes board game for the new context
• 15:52 Getting ethics approval in Uganda and the political backdrop to the field work in Uganda
• 16:31 Careful planning paid off in terms of making the project appropriate for this rural area of the Uganda – more about how Alice made this work
• 16:55 “Maternal death knows no colour divide and has no political affiliation”
• 17:30 Recruitment to the study
• 19:04 Making participation easy and accessible for the women and their partners
• 20:00 The need to engage a male facilitator - a father himself, who succeeded in breaking down stereotypes and getting the men to share experiences
• 21:45 Opening up and learning from each other
• 22:43 A bit of humour always helps! Complete strangers bonding over a board game!
• 23:42 The women felt more supported to attend antenatal care
• 24:30 Finding out about the misconceptions men had about maternity services. Allaying the fears!
• 27:00 Better nutrition! Increasing the uptake of leafy vegetables and animal products
• 30:11 Seeing real behavioural change. More understanding, more caring!
• 30:44 Appropriate messaging, translated into the local language: Luganda. And other ways of breaking down barriers.
• 32:07 Overcoming politics and learning together.
• 32:49 Some quotes giving the men’s reaction to the board game – wise, educational and fun!
• 35:11 This was highly innovative. Board games have not been used in this way in Uganda before.
• 35:34 Coproduction rather than competition.
• 36:21 Whose Shoes creating safe spaces for people to reflect and share experiences and think through individual and community actions
• 37:31 Writing up this Ugandan study – an article in the BMC about Whose Shoes as an educational board game to engage Ugandan men in pregnancy and childbirth
• 38:21 Next steps – writing up in more detail. Who can fund an extension of this project to build on the impact and potential unearthed here?
• 40:12 Congratulations! Alice won the Vice Chancellor’s Research Prize for her excellent PhD project.

Transcript

Gill Phillips  00:10

My name is Gill and I'm the creator of Whose Shoes, a popular approach to coproduction. I was named as an HSJ 100 Wild Card, and one to help give a voice to others talking about their ideas and experiences. I'll be chatting with people from all sorts of different perspectives, walking in their shoes. If you are interested in the future of healthcare, and like to hear what other people think, or perhaps even contribute at some point, Whose Shoes Wild Card is for you

Gill Phillips  00:45

I'm very proud of my Wild Card Whose Shoes podcast guest today. That is the word that I want to use. I first heard about Alice Ladur when I met some of the research team at Bournemouth University back in 2016. Alice was just beginning her PhD, and they connected us. And then Alice came to our Whose Shoes maternity workshop at UCLH in London. Alice loved Whose Shoes and we started to hatch a plan as to how she could use it in her PhD work in Uganda. Today's story is about what happened. I'm so impressed with Alice's quiet, gentle perseverance in making extraordinary things happen without a big fanfare. This is a podcast we've been waiting a long time to record, delayed by tickly coughs, first mine and then Alice's, which are not very conducive to making podcasts. So a huge welcome Dr. Alice Ladur. I'm so proud of you. Congratulations on winning the Vice Chancellor's Postgraduate Research Prize. Can you tell us a bit more about that?

Alice Ladur  01:54

Thank you very much for having me. Excited as well to finally get to have this discussion that we've planned for a long time. I would like to start by saying thank you, to you for graciously allowing me to use and adapt the board game 'Whose Shoes' to the Ugandan context and I'll be talking later on in our discussion about how it all went and the exciting parts that we had during the fieldwork session in Uganda. I would like to say thank you to Bournemouth University for the Vice Chancellor Scholarship, which opened an opportunity for me to leave and study a doctorate in the United Kingdom, I'm forever grateful for this award. And also, I'd like to say thank you to the British Federation of women graduates for the grant that was accorded to me during the write-up phase of my dissertation. I n a special way, I'd like to thank my PhD supervisors, Professor Vanora Hundley and Professor Edwin Van Teijlingen, who supervised me throughout my research at Bournemouth University. My PhD focused on improving access to maternity care services in Uganda to help reduce maternal mortality. Uganda is grappling with a high maternal mortality ratio, despite a steady decline over the years. And research evidence shows that most maternal deaths occur during or immediately after delivery. Antenatal care presents a very unique opportunity for women and their families to learn about risks associated with pregnancy and also to plan and to have the options ready in terms of when the delivery time comes. I want us to briefly understand the narratives around maternal deaths in Uganda. And when we are looking at maternal deaths in Uganda or for most of Sub-Saharan Africa, one needs to draw on these social cultural meanings that society places on childbirth and women. You see pregnancy and childbirth hold very significant meanings, one in which women find their identity and social status in the Ugandan setting.  And there is a lot of pressure that is placed on women to produce children to extend the family lineage with a special preference for the male child. The pressure to give birth is often exerted by the woman's in-laws, husband and the community and it is important for us who are interested in maternal health or safe motherhood, to think of ways how we can integrate the family structures, especially the immediate family, when we are looking at safe motherhood interventions, or generally looking at improvement of maternal health outcomes for women in Uganda and beyond. Uganda is a patriarchal society with men having considerable control over resources and decision making. And as such, they need to work with both men and women to improve maternal health. As a public health specialist who has worked in the field of maternal health in Uganda, and in parts of southern Africa, my heart goes out not only to the rural woman but also to all women on the African continent. You see, although Africa consists of several countries and diverse cultures, these differences tend to disappear when it comes to the way women are treated and their social status. And this is largely fuelled by gender roles and communalism and you find that an individual is subordinated to a group, which has direct impact on health-seeking behaviour. My interests in male involvement in maternal health started way back in 2006, right after my first degree, and working in the community, looking at provision of HIV AIDS prevention services to post-conflict communities in northern Uganda. So through the health education sessions, that were targeting men using community dialogues, role plays and drama series, there was an observed decrease in domestic violence. I was able to see first-hand the importance of involving a woman's immediate family in the pursuit of improving women's health. Villages that were known for domestic violence, were now champions working alongside health workers, to denounce violence against women and promote uptake of health services. This in a way motivated me to carry on looking at aspects around working with families, working with the immediate family that surrounds a woman in terms of improving general health outcomes, whether it was in the field of HIV or directly looking at pregnancy and childbirth. I would like to emphasise that when we are discussing male involvement does not take away the woman's choice. And male involvement is encouraged, and dependent on whether the woman wants to involve her partner and her immediate family or not. And it may not be applicable for all women, as the needs and context of individual women may be different.

Gill Phillips  08:27 

Oh, that's, that's just such a powerful explanation, Alice and I learn more every time I talk to you. And obviously, it's just so different to what we're familiar with in the UK. And for us to manage to use Whose Shoes, and it's a board game, to make any kind of difference at all in this world that obviously I'm not familiar with, but I've been fascinated with.  I don't know ... just the whole story really, obviously, the involvement of men, and for me to learn about the culture and what it must be like to be a woman in Africa with that pressure to produce children. And then you say, the preference for the boy child. And I'm just so looking forward to you telling our listeners the story of how this evolved, because it's quite a striking idea really, isn't it to use a board game in this sort of situation, a bright, colourful board game with little shoes with men in Uganda who aren't used to talking about maternity care is such a story. And I want to somehow do justice to it really and to what you've achieved.

Alice Ladur  09:39

After I attended the workshop in London, which was really an eye opener for me, because I was a participant, it gave me many ideas. We were looking at a number of aspects around improvement of health services within the UK. And we were all seated at the table, not knowing, there are different professions, but through the engagements we had, I learned so much from my colleagues on that day, because there were several moments to pause and reflect and think in our different capacities, how we've interacted with health services and how the outcome has been or has looked like. And through that reflection, what I was quite intrigued and thought perhaps if men had an opportunity to come together in a safe space to reflect on their own individual actions, and also on the community expectations or the broader structures that fuel or that facilitate some of the inequities within the Ugandan community. So through that process of reflection, and then obviously coming back to Bournemouth and designing a pilot study, which was very interesting, as it gave us pointers because at the very beginning, I was grappling with the question around would it be acceptable? How would I introduce an educational game for the first time to talk about maternal health or talk about pregnancy and childbirth, within a different setting, from the UK system. So from the pilot study that targeted Ugandan men, that were living in London, it was interesting that once the table was set, with the board game, and the little shoes, that was the first captivating moment for them, everyone wanted to look at the shoe. So they held the shoe, the literal shoe, and we then looked at the game, and they looked at the dice and immediately started throwing the dice and picking up cards, and without any formal introductions, and I let them carry on playing the game. 

Gill Phillips  12:26

That's amazing!

Alice Ladur  12:27

It was really interesting to see that come alive. And after, when we started the discussions around the different experiences in childbirth, or that women go through during pregnancy, it gave the different participants an opportunity to reflect as fathers, how their own actions, or their indifference impacted on their spouses when they were pregnant. And during the process of delivery. And through that, I was able to see changes as well, immediate changes, because after the session, immediately, one of the participants went to check on the wife, was somewhere else, and finding out she was okay. And I thought that was very, it was so real, that indeed, this is something that will work within the Ugandan setting. And also receiving feedback, valuable feedback from them on how the messaging should be adapted, was very helpful to prepare for fieldwork in Uganda.

Gill Phillips  13:47

So that's fascinating. Alice. Now I'm delighted to hear in particular, the men living in London, were influenced by a board game. And that's a pretty special outcome already. So how did you move on from that to think about your field work, and as I understand it, government ethics and ... the whole process just felt difficult. And I was hoping that you'd manage to actually push through and make this thing happen.

Alice Ladur  14:14

So the findings from the pilot study were really helpful, gave me areas to think about that I hadn't considered and how the messages needed to be a bit more specific and more hard hitting in terms of addressing some of the cultural aspects that have impacted on women during pregnancy or those that are creating barriers in terms of access to health services. So coming back from the London pilot, I had to think through some of the card messages to be more specific in terms of addressing the cultural aspects, so I included messaging around nutrition, I included case scenarios of women that had barriers or had challenges accessing health services, and the outcomes. And some of them were tragic. So including some of those very surreal case scenarios made the communities the men during fieldwork actually, each drove the message home. So I was very grateful for the London study that it brought out... it helped me design very specific and very had hitting messages that were relevant within the Ugandan setting. The fieldwork was an interesting time because after obtaining ethics for the study, the different approvals within the community structures, there was a bit of political unrest around the country generally. And this unrest later came out in terms of looking at the colours on the board game. The country then was divided into colour lines, you had yellow, and then you had red. And both colours tended to have a dislike for the other. So if you found those that loved red, were leaning towards everything red and detesting everything yellow, and vice versa. I had to spend some time introducing the colours on the game and the purpose why the study was being held. And also reinforcing the fact that maternal deaths knows no colour divide, and knows no political affiliation. The choices we make, ultimately will improve the lives of women, and also improve the lives of our community in general, make the communities a lot better and a lot happier, for all. So after the ethics applications and approvals, we went down to the community structures, and we also got approvals. And then we started recruitment in the communities. Again, recruitment was through the women, the pregnant women at the health facility. We were careful to promote the woman's choice in accepting the partner to be part of the educational intervention to play the Whose Shoes game. So for all the women that consented for the study, and we asked them further if they were happy for us to contact their spouses to participate in this educational game. And for those that accepted, we contacted their partners, and those were the ones that we used in the study.

Gill Phillips  18:20

There was so much for you to think through though, wasn't there in terms of getting it right, politically, and in terms of ethics approval, and then with consent, I think you've done so well to navigate this path, because it's very, very innovative, what you're doing Alice.

Alice Ladur  18:36

Thank you. It was important for us to get it right, in terms of the community structures and all the different approvals, because in the end, it paid off. The communities were accepting. Despite a climate of political unrest and tension, the fieldwork went on really well.

Gill Phillips  18:59

And as I understand in a really rural area.

Alice Ladur  19:04

Yeah, the study was in rural Uganda, a bit far off from the capital city. And it was within the primary health care facilities, which are in the communities and more accessible for the women and their partners as well. So through having this study, nearer to the households, made it a lot easier for them to participate and also to access health care when they needed to during this period. And we were introduced to the women by the midwives at the health facility during the antenatal care sessions. So it was really interesting to attend the antenatal care sessions. So once the fieldwork started, the recruitment of the couples, the pregnant woman and the husband, I interacted more with the women and then I had to engage a male facilitator for the Whose Shoes board game, due to the cultural dynamics within this setting. But I had observations of what was taking place during the board game sessions as well.

Gill Phillips  20:21

And it sounded as if you recruited a very special person there. And that role was key really wasn't it in terms of who that male facilitator was and how they would facilitate the sessions, I guess.

Alice Ladur  20:34

It was very interesting and a beautiful coincidence to have a male facilitator, who was a father of two children, and having interacted with maternity services, he literally was in the labour suite, when both his babies were born. And he had first hand experience of the importance really of involving husbands and also the immediate family. So having him as a facilitator, was helpful in motivating the participants, the male participants. And really reinforcing the fact that it is possible to be part of the process, and also addressing some of the cultural stereotypes in the communities around having men in the labour suite. So him having been in the labour suite, and also, having been actively involved during the process of the wife's pregnancy, was very helpful. As when he started talking about his experiences, men listened. And they were able to open up and share some of their fears as well. And this really became a learning point for all of them. They were learning from each other.


Gill Phillips  22:03

I think there was something that struck me how, as I understand unusual it was to get men actually talking and sharing about personal issues and feelings and women's business in terms of childbirth and pregnancy. That was quite a big cultural shift.


Alice Ladur  22:24

Yeah, the cultural dynamics are largely pregnancy and childbirth is a woman's business. So having men interact and talk about pregnancy and childbirth, in a way was breaking barriers. And having the male facilitator to facilitate sessions around that was key in giving men opportunities to open up and share the experiences. And their challenges alike, and I also want to point out that this male facilitator was very experienced and humorous in how he facilitated the sessions, because there was a lot of laughter. But yes, so complete strangers bonded over a board game, and shared so much with each other. And some of the content was beyond the scope of the study. But most importantly, they sought medical advice, and they were signposted to the health facilities where they would get medical support, which was a highlight from the discussions as well.

Gill Phillips  23:42

I think, for me, in terms of an outcome, learning that women were actually more supported to go to a health facility ... I think you'd said to me that beginning of the study, men hadn't understood perhaps why women needed to go to antenatal care, why they needed to go to the kind of hospital facilities because they weren't ill. I remember you saying they didn't have malaria! So to accept and to learn about antenatal care, and to learn that some of the logistics of antenatal care, that it takes time. And if the women were there, and they were delayed, that it wasn't because... tell us about that. What the men might have thought was happening when the women were delayed at the hospital and how that developed.

Alice Ladur  24:30

An interesting or rather a surprise moment for me during the study was learning about some of the misperceptions that men had around maternity services, because a number of men mentioned that they thought antenatal care clinics were spaces where women went to report them and that's why they took so long within the health care setting, so addressing some of those during the discussions, helps in allaying some of the fears. We had specific messages around what happens in antenatal clinics, the services that are offered the importance of antenatal care both to the woman and to the family, and how importantly men can play a role within the whole process. So this gave opportunity for men to reflect on their own actions and also to address some of the misperceptions they had around antenatal care services. The maternity clinics or generally the health services tend to have long queues because they are experiencing structural challenges around staffing. So there are significantly long waiting times in accessing health care in parts of rural Uganda. And this delay at the health facility has been misinterpreted on a number of occasions. So the board game created an opportunity to allay some of those fears by explaining the health services and some of the challenges. And through explaining the services and what takes place during antenatal care settings, men appreciated more the reasons why women may take significantly longer once they've gone to access care, and also why they need to go for antenatal care in the very first place. Because the perception again, is around seeking health care when you're physically sick, and having symptoms like malaria, fever, feverish or headache, and other complications, which can be clearly seen. But pregnancy is not a complication. And explaining the importance of healthcare during pregnancy helped a lot during this period.

Gill Phillips  27:17 

And that extended to nutrition specifically as well. I remember you telling me the story about the market across the road and the shift in attitudes of the couples ... tell us about the market and the healthy eating.

Alice Ladur  27:30

So the study was held across the road from the health facility. And from across the road, it was next to a trading centre or next to an economic hub within the village. So I took some time to observe the environment, looking at behavioural aspects of the participants and generally the community. So during the antenatal care sessions, women are encouraged to mind about nutrition, due to challenges around anaemia, which is largely due to poor nutrition. So women are encouraged to increase the uptake of green leafy vegetables and also animal products. But during the antenatal care sessions that were led by the midwife, I also observed that women tended to grumble or whisper to each other. And during those whispers, they were complaining to each other and saying that it's interesting to hear all this talk around nutrition, but when we get home, we cannot implement it. Because of the dynamics at home. Our husbands may not be very keen on having these changes made at home. So during those, and again, I need to emphasise that within the Ugandan system, or within this part of Uganda, men tend to make decisions around nutrition in the home, in terms of buying the food at home and also deciding what comes on the table eventually. So it was important for us to integrate nutritional messages during the board game sessions about healthy eating and the different kinds of foods. So after the board game, and one of the vivid behavioural aspects that I found very interesting, was that men were going to the market which was not far away from where we were during the sessions. So men went to the market, they were buying the animal products and also buying the duck leaf leafy vegetables and going with it home, or giving it to the wife as they were heading home, which to me was a very special moment and indicated that the messages were being taken seriously, that they are reflected on during the board game sessions.

Gill Phillips  30:11

And that's starting to be real outcomes, isn't it? You know, you could see that behavioural change, which is fantastic. One thing Alice, I've realised that we've not mentioned, which I found fascinating at the time was experimenting at the beginning. Obviously, you've talked about choosing which scenarios would work best, recognising gaps and developing new scenarios, particularly with the pilot group in London. At what point did you find it necessary? We actually translated the scenarios into Luganda, the local language didn't we?

Alice Ladur  30:44 

Yes. So at the very start during their ethics application, the games were translated into the local language, not just the games but all the study materials were translated into the local language. And using the local language, removed the barriers between us, the researchers, and also the community because we interacted and spoke the local language. And we were able to interact freely with both the women and the men as well in the communities. And speaking about, and relating to the cultural and community contexts within this setting, I think also served to reinforce the messaging that we had served to reinforce or rather to promote the uptake of the messaging that we had around nutrition and also generally uptake of health services within the setting.

Gill Phillips  31:45

And I think anything that reduces barriers, and I think you found various ways, and from some of the things that you've told me in terms of, if the men couldn't read the cards, then one of them could, and everybody can move the little shoes, and they started to appreciate that it was a coproduction tool rather than a competition.

Alice Ladur  32:07

It was nice to see the men ... the game itself in its design promotes teamwork. So you have your teams, so you have the different colours. And through those different colours, you get to form a group or a team. So you had red, yellow, blue, and green. And it was nobody wanted the yellow colour, again due to the tensions during the study period whereas everyone was fighting over the red colour within the board game. But in the end, moving the shoes around, they forgot about the different colours. And I'd like to share one of the quotations, or rather an extract from the participants around the game and also a bit about their views or perceptions they had when they initially walked into the room where they were meant to play the board game. It says that "When I came here, I saw this board game, I felt it was a children's puzzle. But when we started playing the game, reading the cards, it's really wonderful. And the people who thought about this really thought so well".

Gill Phillips  33:31

So lovely. So lovely to hear people's actual words, isn't it? I love it!

Alice Ladur  33:37 

So in a way, the display of the little shoes, the cards and the board game draped in bright colours, yellow, red, green, and blue, contributed two aspects - one that in the beginning, they thought it was perhaps a children's game. But then once they sat down to play the game, they found the game very educative, and also a fun, a fun game to play and to learn at the same time, which was something that they really appreciated during this session.

Gill Phillips  34:12

Do these men normally play games? Would they play card games? Or how would it compare with that?

Alice Ladur  34:19

They had a game that is commonly played in the villages or generally within the Ugandan setting, Ludo. And that's a fun game just to pass time, more of a pleasure game. But this was a very fast, educative game they had within this context. So it was also interesting to hear their feedback of what they thought at the beginning. And then after they had engaged with the game.

Gill Phillips  34:49 

It's fascinating. It is.

Alice Ladur  34:51

Yeah, and one of them says that "I like the way the game was designed, and how it communicates the message. It's not just a mere game for keeping people busy. This one keeps you busy, but you learn something".

Gill Phillips  35:06

So, educational. 

Alice Ladur  35:07

Yeah.

Gill Phillips  35:08 

Very interesting and very rewarding feedback, I think.

Alice Ladur  35:11

We were keen to hear their feedback given that this was the very first time we had this game in the community, and specifically looking at maternal health, pregnancy and childbirth. So we wanted to hear their perceptions, and also to observe some of the immediate behavioural aspects after engaging with the game.

Gill Phillips  35:34

And I think you'd said as well that they were expecting more of an element of competition. And then they learnt that actually, if they all work together, then it was about improving the maternal outcomes. And that was what the real win in the situation was?

Alice Ladur  35:49

You know, why this game was different from the games that are usually played, was because the games that have fondly played in the communities are competition based. So again, being the very first of its kind, they thought it would end in one team winning, while the other team losing. But within this context, we were careful to reinforce that we all win when we promote safe motherhood for all. 

Gill Phillips  36:19  

That's what matters. 

Alice Ladur  36:21

That's what matters, yeah. Another thought ... when they were reinforcing the aspects around education, one of them mentioned that "the game gives room for everyone to share their mind and encourages participation, you think better as one is talking. And I think I learned more from my colleagues here". So it really reinforces the aspect around Whose Shoes creating safe spaces to reflect and share experiences and learn from each other, which was one of the main highlights for me that during the fieldwork was that it gave opportunities for men, or for the participants to think individually about their own actions in terms of maternal health, or pregnancy and childbirth, and also collectively around the inequities and social structures, fuelling some of the poor maternal health outcomes. So having this safe space to think through individual actions and community actions, going forward is a good opportunity to break down some of the barriers, and also to demand for change.

Gill Phillips  37:38

Demand for change, yeah. So I'm personally thrilled with how far this got in such a short time and what a positive response there was. And I think Twitter and people like Edwin, in particular, such a supporter in terms of keeping me in the picture with what was happening. And then I was thrilled to see your article published in the BMC. So "Whose Shoes - can an educational board game engage Ugandan men in pregnancy and childbirth?" Well, clearly yes, it can. And I can attach that into the programme notes for our episode. But have you got any more plans to write up about the research that you've done Alice, or what might be the next steps as well?

Alice Ladur  38:21

So the next steps is to complete the write up of the Ugandan study. And also to share the results widely. I believe that our discussion today has been a snapshot of the entire interviews and experiences, exciting experiences I had in Uganda, while implementing the Whose Shoes board game as a health promotional tool. So I believe that there is a lot more to share, and also to learn through the entire process and experience.

Gill Phillips  38:56

And that's fantastic. I'm so thrilled to be able to capture, you know, as you say, a snapshot of where we've got to at the moment. And actually, I think for people to be able to hear your voice, you know, in talking passionately about your project and your work and so on. I suppose with the podcast series, generally, I'm really trying to make things happen for people, for the outcomes that we're all hoping to achieve, for the kind of understanding of people, in humanity and how it's not that different in different topics or different parts of the world. We're all united by this humanity. So if somebody somewhere magically could come up with some funding for a longer-term study or to take some of these outcomes forward, it seems that there's just so much scope there if a few short sessions as part of a research topic could shift attitudes to that extent.

Alice Ladur  39:45

Yeah, this study was a great eye opener, because it was a feasibility study so you were testing out a number of aspects around the Whose Shoes board game and I believe that there is opportunity to expand this a bit more and to explore or to look at long term behavioural aspects of the Whose Shoes board game in maternity care.

Gill Phillips  40:12

And you went on to win the Vice Chancellors award. That was fantastic and very recent. So I think if if we hadn't had our tickly coughs, and we've recorded this a few months ago, then perhaps we wouldn't know about that and be able to talk about that and congratulate you here on the podcast.

Alice Ladur  40:29

Thank you.

Alice Ladur  40:30

The highlight of the PhD… the whole fieldwork process in Uganda was seeing women, pregnant women coming back to access antenatal care services a lot happier and a lot relaxed. And I had opportunity to ask them some of these experiences during the focus group discussions, and they attributed this to the men knowing about the importance of antenatal care. And they didn't have to explain in greater depth, why they needed to seek care when they were not physically sick or presenting any symptoms. So to me, that was really special. And it summed up the whole field work. And the whole use of adapting Whose Shoes board game to the Ugandan context that yes, this is an opportunity for us to explore in terms of the use of educational board games in health promotion, and specifically in maternity services.

Gill Phillips  41:44

That is a tremendous result! And I'd like to say that I'd like to support you in going forward in whatever way there might be, an opportunity for you to extend this work and to continue this impact. 

Alice Ladur  41:56

Thank you. 

Gill Phillips  41:57

So thank you, Dr. Alice Ladur. I'm so proud of you. And thank you for joining me on this podcast. I'm glad your tickly cough's better and let's keep in touch and see where you go from here. You're amazing.

Alice Ladur  42:09

Thank you for this opportunity. I've enjoyed having this discussion.

Gill Phillips  42:14

I hope you have enjoyed this episode. If so, please subscribe now to hear more of these fascinating conversations on your favourite podcast platform. And please leave a review. I tweet as @WhoseShoes. Thank you for being on this journey with me. And let's hope that together, we can make a difference.