Agnessa Spanellisa, Paula A. Zapata- Ramírezb, Polina Golovátina-Morab, Anna Borzenkovaa and José M. Hernández-Sarmientob a Heriot-Watt University, Mary Burton bl, Edinburgh, EH14 4AS, UK b Universidad Pontificia Bolivariana, Circular 1 # 70-1, Cede Central, Medellín, 050031, Colombia Effective communication with local communities is a critical factor in containing an outbreak. H particularly in indigenous communities that traditionally rely on ancestral knowledge. This paper presents an investigation into developing a shared understanding of COVID-19 in indigenous communities of Choco, Colombia, that could help them develop effective mitigating practices, while being respectful of their believes. Unstructured interviews and observations were used to explore how indigenous communities perceive and respond to COVID-19. Based on these, a communicative strategy was developed using participatory design and gamification approach, that aimed at bridging their beliefs and traditional ancestral medicine with the official medical recommendations for prevention of the virus transmission. The findings revealed that the intervention became a trigger for mindful discussion within indigenous communities about the preventive measures from the virus, while gamification elements acted as an enabler of such discussion and created more trusting attitude towards the recommendations. Based on the initial findings, we discuss challenges of conducting indigenous research, including the role of trust between researchers and the communities, gamification as an enabler of shared knowing of a problem matter, and the importance of flexible participatory research methods whereby indigenous people are treated not as mere researched, but as full participants of the study. Gamification, Communicative strategy, COVID-19, Indigenous communities, Narrative, Infodemic, Choco during the most recent and still ongoing COVID-19 pandemic. It can lead to the spread of misinformation [2] and the phenomenon Communication with local communities is called infodemic, defined as over-abundance of crucial during an outbreak or a pandemic in an information, some accurate and some not effort to control the spread of a virus [1]. Failure making it hard to find trustworthy sources and to do so (effectively) was particularly evident 5th International GamiFIN Conference 2021 (GamiFIN 2021), April 7-10, 2021, Finland EMAIL: a.spanellis@hw.ac.uk (A. Spanellis); paula.zapataramirez@upb.edu.co (P. Zapata-Ramirez); polina.golovatina@upb.edu.co (P. Golovátina-Mora); g.borzenkova@hw.ac.uk (A. Borzenkova); josem.hernandez@upb.edu.co (J. Hernández-Sarmiento ) ORCID: 0000-0001-7379-3775 (A. Spanellis); 0000-0001-8461- 6328 (P. Zapata-Ramirez); 0000-0002-7686-9699 (P. Golovátina- Mora); 0000-0001-5576-0275 (A. Borzenkova); (J. Hernández- Sarmiento ) 2021 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0). CEUR Workshop Proceedings (CEUR-WS.org) reliable guidance when needed [3], [4], or create an information vacuum, if the [8], whereby indigenous peoples are the ones communities cannot understand or do not trust researched and used to advance selected the information provided [5]. In such instances, research objectives [9]. In response to the the communities create their own interpretation dominating paradigm and attempts to of the new situation and develop coping decolonize indigenous research, indigenous strategies. research methodologies emerged combining This paper presents the first results of the research practices that give indigenous research project conducted in the Choco region communities a voice [7] and project indigenous of Colombia. The aim of the project was to epistemologies [8]. conduct a seroprevalence survey in the region Indigenous research methodologies are to estimate the spread of the virus in the participatory, flexible and respectful of the indigenous territories and to design a language, culture and worldview of the communicative strategy that includes the World indigenous communities [10], [11], striving to Health Organization (WHO) recommendations develop shared ways of knowing and bridge of the preventive measures during the two worlds [7]. When engaging with pandemic, which would be respectful of indigenous communities, researchers have to be traditional beliefs of the indigenous peoples. accountable to the communities, and thus We used gamification techniques to engage the research methods cannot be reigned supreme by communities in the discussion of the the Western notion of the scientific method. recommendations, while being respectful of These considerations shaped our choices of their traditional beliefs, and to facilitate methods for data collection, design of the acceptance of and trust in the provided intervention and data analysis. recommendations. We then combined these insights with the results of the seroprevalence survey to observe the differences in perceptions and behaviors of the infected and other community members. The preliminary results The Choco region in Colombia is located in showed that the use of Easter Eggs technique the remote areas on the Pacific coast and has an approximate population of 65,000, living in combined with the visual representation of the about 120 native territories and speaking six imaginary world engaged all groups within the communities and made them more trusting of different languages (Table 1). The indigenous the recommendations. When the settlements live inland between the coast and communication was combined with the results the Andes with almost no road infrastructure. of the tests, the community members were more The main means of transportation is the canoe. inclined to follow the recommendations, e.g. They do not have access to digital self-isolation. communication technology, have low levels of In the next section we discuss the research literacy and are partially surrounded by context and design, followed by the criminal gangs (paramilitary, guerrillas and development of the communicative strategy. drug cartels). All these factors make access to Then the paper presents preliminary results, the national healthcare system problematic. followed by the discussion of gamification as Thus, when the pandemic started, there was an effective technique for communication and almost no engagement and support provided from the healthcare and government officials. the challenges of conducting research in indigenous communities. The lack of engagement meant the communities were left on their own to face the unknown. Together with the national lockdown this also led to the intensification of criminal activities [12]. The above description of the Indigenous communities have traditionally context outlines the challenges of conducting been subject to colonization and imperial research in remote indigenous communities. At practices, and marginalization by Eurocentric the same time, they dignify the importance of values [6]. This created a sense of distrust to the and the need for such engagement. dominant culture and its histories [7]. Such mindset implicitly favors conventional research To align with the principles of the chosen The initial findings were analyzed using research methodology and maintain trusting thematic analysis [18] and provided the basis relations with the indigenous communities, the for communicative materials. The materials research team chose unstructured interviews for were designed in the form of a poster, which data collection. The field investigator is a met the constraints of the local environment, i.e. medical expert and has had a continuous a low-tech solution for the communities with research program in the region over the past 10 limited access to information and years, and therefore has already gained their communication technologies. Local artists and trust. According to the researcher, unstructured translators were involved in all stages of the interviews in the form of discussion are the design to ensure participatory approach of the most acceptable form of engagement for these poster development. communities. The field material was captured We considered gamification to be an in field notes and through subsequent appropriate approach, because playing is interviews of the field investigator by the rest of essential to any human culture [19], including the research team, as the indigenous indigenous peoples, who have been using communities did not want to be recorded. games to share their knowledge and traditions The research team was interested in [20]. With the rise of video games, these games understanding the emergent behavior [13] gave rise to the movement of indigenous game during the pandemic and the indigenous design and development [21], which among knowledge that the communities were using to other are used for learning [22] and as a source build resilience against the current vulnerability of self-exploration [20]. We considered a poster [14]. This includes exploring how they perceive to be a suitable medium of representation due current risk [15], what coping strategies, to the local constraints, i.e. lack of access to the experimental practices and associated digital communication technology. responses they have developed so far [14], how Then the posters were delivered to the they assign trust to information [16], and communities and placed in the communal areas, historic memories they have of similar and their effectiveness as well as the results of emergencies, e.g. epidemics and outbreaks of the project were evaluated using unstructured other viruses present in the region [17]. interviews and observations. Other methods, The initial interviews were conducted in the such as surveys, were not considered as they town of Quibdó, one of the two regional created a risk of losing fragile trust of the centers, where the field investigator had communities to the lead investigator. From discussions with the leaders of indigenous previous experience, even recording interviews communities, who came there to trade with and group discussions posed a problem. each other and procure additional supplies for their communities. Adult men and women from six communities participated in this study. Details of the interviewed population are presented in Table 1. The interviews were The development of the communicative complemented with observation notes and strategy followed a cycle of three phases. In the photographic materials. For instance, the field first phase, we analyzed the perception of the investigator saw a mural in a community center, pandemic and identified the insights that were and took photos of it that provided ideas for the critical to being incorporated in the design. This phase was followed by the design of the poster aesthetics of the communication materials. and incorporation of the gamification elements in it. The initial designs were then tested with the communities and their recommendations were incorporated in the design. This cycle Indigenous N of Share of people Interviewees population formed the basis for several iterations. Embera Chami 74 12 % Embera Katio 51 8% Embera Dobida 395 66 % Wounann 25 4% Kuna Tule 19 3% Others 64 7% Although some of the interviewees expressed fear of the uncertainty that came with the pandemic, many questioned why so much attention and resources are dedicated to this and bathing with gliricidia (mata raton). They disease, noting that we do not have a cure for it, have also developed ritual ceremonies to while other diseases spread in the region are protect from the virus, whereby the spiritual more dangerous and can be treated. This remark leaders spit on those participating. showed that indigenous communities distrust the system rather than modern medicine. So far there has been little engagement from the government healthcare authorities with the indigenous communities, e.g. medics came once to test some communities, but never The design process started with analyzing shared the results of the tests. This added to the the official WHO recommendations that should a be included or omitted from the posters, and . At the time of the first which would be respectful of the traditional interviews, there have been no confirmed knowledge and beliefs of the communities that deaths from COVID-19 within the were identified during the background research. communities. The only two confirmed deaths Then the team selected an overall theme for the were local leaders who went to the local poster and made nuanced design choices that hospital. Their bodies were not returned to the also incorporated some of the gamification communities, and this is considered for them principles. Finally, the team incorporated worse than death, as they could not organize a additional gamification elements to further proper burial ceremony. This incident further strengthen the persuasive design of the poster. undermined trust in the recommendations on how to protect the communities from the To counteract the perception about the man- pandemic. For instance, the communities made origins of the virus, the researchers refused to wear masks. included a message about animal origins; However, this distrust was not projected on however, the message also emphasized that it the field investigator who has been engaged came from animals that were kept in captivity with the community for over 10 years. During and treated with disrespect. This way, the the initial interviews, the field investigator message was not confronting the indigenous discussed the official recommendations, in and particular the importance of self-isolating at the resonating with the appreciation of the nature. community level. As a result, the community Then the team included the message leaders stopped travelling to the towns, explaining why the virus is so dangerous (long including Quibdó, and so the team had to adjust incubation period), and why social distancing the background research process. (of 2 meters) might help to reduce the spread. The communities were quite observant of However, the recommendation was made for any changes and were able to trace the spread social distancing at a community level, because of the disease to an individual who brought it to maintaining social distancing within small and the village. They observed that the virus affects dense communities might not be feasible. elderly more. They do not believe that it The team included the message about originated from the animals, because they washing hands, but not wearing masks or going would have known about it, as they live among to the hospital for those in critical conditions. animals. They concluded that it was a man- These messages were omitted partially because made virus designed to eradicate indigenous the communities were particularly negative knowledge and wisdom held by the elders. about these recommendations, and therefore the They emphasized that everyone is affected research team faced the risk of undermining yed the balance trust in all the other recommendations. In any between nature and men, and criticized case, local health centres are ill-equipped to capitalism as it disregards many forms of life. provide help to critically ill patients. They have developed their own ways of Furthermore, the communities live in open and protecting themselves. Local spiritual leaders very well ventilated huts with no walls, which Jaibanas and herbal healers Hierbateros reduces the risk of airborne transmission and believe that the virus will not stick to bitter the need for masks [23]. blood. Thus, they recommended drinking The team included a message explaining the herbal tea with lemon, ginger, and elderflower symptoms and recommending to self-isolate at home for those who exhibit the symptoms. considered different approaches, e.g. comic- Finally, the team recommended to drink herbal based storytelling [24] or completing mini- drinks to bridge indigenous traditions with quests for readers to solve [25]. Eventually, the modern medicine, but emphasised the use of team created a metaphoric [26], personal plates and cups, explaining that the [27] that mimicked the real world, and yet virus might be transmitted through the saliva. represented its idealistic version with beautiful environment and in bright colors. Although the After several discussions and design iterations, the team decided to use an environment, it was considered appropriate in indigenous village as an overall theme of the this study as the graphic representation of the poster. a world served the same purpose. valley This world depicted how traditional houses by a mountain range. The messages associated look like, although the photographic evidence with the origins of the virus and its impact on showed that some families deviate from this the world were placed in that spot. All the other structure. Men and women were dressed up in recommendations were placed in different parts traditional clothes, wearing colorful bead of the village. Different elements of the village (chaquira) necklaces, embroidered pieces resembled that of real villages, e.g. the shape of (molas of the Kuna Tule culture), and covering the huts, people and their clothes, or various their bodies with traditional ornaments made objects, such as dishes and stairs. Clothes were with genip (jagua) and achiote (Bixa Orellana) adjusted for different indigenous groups. plants, while attending to their everyday chores. With regards to the specific elements, However, indigenous people wear these several design choices were made to further attributes mainly during festivals and spiritual reinforce the ceremonies, although some elements are also the two worlds. In the outside world, the used in day-to-day practices and this is reflected animals linked to the origins of the virus were in the choice of ornaments. Such an amplified depicted in cages to further emphasize the virtual world provided an environment for them disrespectful treatment of nature and the to celebrate their identity [26]. unbalance between people and nature. In order Within this world, the recommendations and to show that the whole world is affected, the other relevant information were narrated team depicted people of different races and age through mini-storytelling [28], [29]. It was used groups. People depicted in the village were to contextualize impersonal recommendations adults, but not elderly. This choice was made to [30] and further strengthen the link with the de-emphasize the perception that the virus identity of indigenous communities. Thus, the mainly targets the elderly. verbal messages were informative rather than Different everyday life attributes were affirmative in nature, engaging the participants depicted faithful to the real environment. For in a dialogue with the poster. instance, when recommending washing hands, The mini-stories were narrated by an avatar the poster shows a plastic water tank rather than that impersonated a community leader. The a tap, since most of the villages do not have status of the avatar was visualised through plumbing, and people bring water in plastic circular body tattoo patterns, which are only containers from the nearest river. used by spiritual leaders [31]. This element Finally, the team used a distinctive icon aimed to further the impression that the throughout the poster to symbolise the virus. recommendations came from within, rather the avatar engaged with each of them the chest). Thus, the team reinforced the individually [32]. message about the nature of the disease. Additionally, the team hid the animals inhabiting Choco region in different parts of the poster close to the most important messages From the beginning, the research team was concerning mitigating recommendations, and planning to use gamification techniques as a medium for narrating the recommendations and community members were invited to find all of them. For instance, a hummingbird was flying helping the community to develop a shared understanding of the new emergency. The team near a flower on the hair of the lady with a water tank, drawing attention to the message about washing hands. This technique resembles puzzles in hidden object games, a typical books, and is also sometimes referred to Easter Eggs technique as a form of variable rewards The poster was printed in 140x100 cm size [33]. This technique allowed us to draw and the field researchers completed several attention to specific recommendations and field trips to deliver them to different engage them in exploration of the poster [34]. communities and continue conducting Figure 1 shows the final design of the poster. seroprevalence survey. At the time of writing this paper, the team still had several trips planned to visit the remaining villages and continue monitoring changes in behavior of the indigenous communities. The poster was placed in community areas where people normally gather to discuss community matters. Figure 2 shows the poster displayed in a common area of one of the communities. The researchers would place the poster in the morning and explain to the community what the main recommendations were, then they would conduct tests and attend to other medical matters, and finally they would informally interview different members about their impressions of the posters. They would then complement these reports with their own observations and photos of people interacting Throughout the design phase, individual with the poster. visual artworks and and prototypes of the poster were continuously shared with the local artists and community leaders to ask for their feedback and suggestions. For instance, the first sketches of houses and stairs were modelled based on the photos from the field trips, but the community leaders and the local artists noted that they did not look traditional enough, so they were changed to more traditional looking huts. This change improved the visual aesthetics of the poster significantly. Among other changes, the community leaders commented that the first versions of the women on the poster were too skinny and light in complexion, which might have reflected the implicit perception of our western standards of beauty. They also commented on the colours of the clothes and representation of body tattoos. The community leaders suggested numbering all the messages, as it made it easier for them to follow. Furthermore, there were suggestions of moving different parts of the message to improve clarity of the poster, and comments on some attributes, and the clothes and appearance of indigenous men. From the first impression, the communities When the design was finalized, the poster liked the virtual world, because they could was translated into six language (Spanish and identify with it and recognize themselves with five indigenous languages) by local teachers. it. They liked the bright colors of the poster that were more representative of their local and mothers asked if the team could share A4 domestic life attributes and artefacts, e.g. printouts with them to take home, so that they female skirts (parunas), tableware (totumos) or can use it as an education material to teach their colorful clothes in the huts, than standardized kids their language in writing, as there almost oking infographics. In one village, no materials available. In another village, they were amazed by how accurate the people did not recognize their own language at representation of the people on the poster was, first, because they are used to receiving written reflecting their own identity. Men liked women materials in Spanish, but once they learnt about characters in particular and found them very it, they became more attentive. beautiful. The impact of the findings is two-fold. First, Kids were the first to engage with animals it provides a basis for discussing whether and and were spending a long time in front of the how gamification can be used in indigenous poster together trying to find different animals. research. Second, the findings are illustrative of After some time, adults would join them and the challenges of conducting indigenous engage with them in the discussion of what was research that might inform future similar written on the poster. Thus, the Ester Eggs studies. Furthermore, they challenge the technique served as a tool to indirectly engage prevailing perception of what constitutes a adults through the initial excitement of kids, rigorous research and call for a more nuanced whereby both groups paid greater attention to attention to a study context. the recommendation through mutual engagement. The researchers did not observe the same attention being paid to the avatar, although on one of the photos a community leader points distinctively on the avatar, when explaining to The pandemic is an emergency event that the community what was written on the poster. disrupted lives of indigenous peoples [13]. In In contrast, a black man with grey hair wearing this study, gamification was used to develop a a white shirt representing part of the rest of the common understanding of the disease, the world attracted a lot of attention. They pandemic, its effects and mitigating practices. perceived him as a man of importance and Although the developed poster did not convince asked who he was. It is important to note that the communities of the official view of the indigenous peoples do not distinguish between origins of the virus, as we have not found different races; instead, they divide the world evidence that they stopped believing that the into indigenous population and the rest of the virus is man-made, the intervention became a people catalyst of the discussion about the preventive Regarding the changes in behavior, in some measures. Some of these measures (e.g. villages the researchers observed that at the washing hands) might help to protect the beginning teenagers behaved carelessly, but communities against other disease beyond the once they learnt that their test results were pandemic. positive, they started self-isolating, following We have observed that the virtual world was the recommendations on the poster. In other the first aspect of the poster that attracted and villages, such behavior was observed among engaged the users. Virtual worlds are an older people. In some villages, people even essential component of a game, creating a started wearing masks. This might indicate that fantasy, which however resembles elements of although they had been aware of the WHO the real world [35]. Virtual worlds enable an recommendations, they have become more immersion with the gamified environment [26], perceptive to them. However, a longitudinal but this only happens if they identify with the study would need to be conducted to estimate world at a level sufficient to consider whether the implemented intervention brought themselves representative and a good fit in the about long-term behavioral changes, e.g. if world. This might partially explain why people started washing hands more regularly. standardized infographics with pandemic In many villages, people showed recommendations, which the indigenous appreciation of the messages written in their communities have seen before, did not persuade own indigenous language, which made them them to listen to the recommendations. This more attentive to the poster. In one village, also points in the direction of identity and the important of this concept, which the research problem area and co-development of the team initially attempted to project through the response. This is particularly visible in how the avatar. discussions during unstructured interviews The initial observations showed that the unfolded. The indigenous leaders were avatar representing a spiritual leader went questioning the questions of the field researcher unnoticed. However, the communities were and challenging the status quo, the very essence drawn to all the indigenous characters of the problem area, i.e. why this virus is presented on the poster, because the considered more important than other disease communities could identify with the characters. that claim lives of hundreds of thousands of Personal avatars are often used to represent people every year. When such dynamic occurs, oneself [32] and become the means of co- an investigator cannot remain a mere observer, [36]. Although as their biases are entwined in their personal understanding and experiences, as well as mutual experiences of both parties, and which liking, some community members were provide the basis for interpretation of the stunned by how realistic and look-alike they empirical materials [39]. Thus, traditional were, and many showed appreciation for notions of methodological rigor is difficult to manifesting their own identity in the poster. apply in such context. These findings highlight the importance of One of the key success criteria of this project identity, and we suggest that its role should be was the trust that indigenous communities explored further in gamification research. developed with the field researcher, ensuring Additionally, Easter Eggs technique proved that the communities would engage with the to be particularly effective in engaging the kids research team. Trust is a social construct that is in the poster. Easter Eggs technique is much highly fragile [40]. An investigator has to less frequently discussed in the literature [34] respect the boundaries of what is considered than more commonly used elements, such as acceptable by the community. If the points, badges and leaderboards [37]. In this investigator were to attempt conducting a study, we have observed that it is not just a form survey to ensure rigorous evaluation of the of reward that an individual receives for impact of the intervention, the trust would have exploring an environment. For the communities been undermined. Alternatively, the impact it provided a sustained engagement, whereby could have been evaluated by means of the adults were drawn to the poster by their longitudinal observations, traditionally used in kids, after all the animals were found. In these ethnographic studies, particularly in indigenous moments of meaningful engagement, they research [7]. However, this approach is not became more attentive to the poster, while feasible in times of a pandemic, especially explaining to the kids what the poster said, and when the participants are located in remote and thus more perceptive to the recommendations difficult to access areas such as a rainforest. provided. Therefore, the hidden animals These considerations further question the became a catalyst of a new social practice. uncompromising nature of definition of methodological rigor and its applicability in different contexts. This study is representative of the dilemma of methodological rigor and relevance in This paper presents the results of the study gamification research [38], whereby the design of developing a gamified communicative of the study can satisfy the requirements of strategy for mitigating the impact of the internal and external validity, and at the same pandemic in indigenous communities of the time stay relevant to the non-academic users. In Choco region, Colombia. The present study line with the indigenous research methodology goes beyond communication with indigenous and supported by our observations, engagement communities and its findings expand our with indigenous people requires highly understanding of the community-based and participative approach, involving co- needs-centered communication strategies construction of mutual understanding of the overall. The positive impact of gamification complemented and amplified the role of care [7] K. C. Snow et al. and sincere interest in the needs of the Action communities in question. That altogether Res., vol. 14, no. 4, pp. 357 375, 2016, contributed to overcoming centuries long doi: 10.1177/1476750315622542. distrust and barriers or gaps in apprehension [8] and perception of the communities constructed Research Methodologies: Critical by it, which in its own right made the Reflections by an Indigenous communicative strategies more successful. Qual. 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