The analysis of the focus group discussion generated four themes or key issues: 1) aspects of the game that aided men’s understanding on topics discussed (learning aids and messages); 2) benefits of the game (empathy and change in perspective); 3) general attitudes about the game; and 4) recommendations for the game (context specific messages and should be used in the rural setting).
Aspects of the game that aided men’s understanding
Learning aids used
Participants spoke about the symbols that were visual such as dice, little croc shoes, and pathways clearly marked on the board game.
The shoe is a core point, it has ignited my thoughts to stand in the shoes of women, to walk in her shoes. P4
The significance of the shoe as my colleague has emphasised is that for many of us here even in daily life situations, we do not place ourselves in the shoes of others…P1
Using the symbol of a shoe enabled participants to reflect on women’s experiences in pregnancy and roles at home. Participants appeared fascinated by the concept of the little shoes and throwing the dice on the board. This captured men’s attention and inspired them to pause and examine their actions through a woman’s lens.
Some of the participants were motivated through the choice of words used to relay messages to men in form of poems, questions and statements.
When we were playing the game, the dice I threw, took me to the poet’s corner and the poem I ended up picking said let us work together, they used the phrase of real people and not roles. P2
It has opened my understanding in that, although we talk about it, we sometimes overlook it but the way the questions were phrased…P4
Messages reinforced a collective effort in addressing women’s health concerns. It reinforced the need for men to view themselves as part of the facilitaters of change.
Use of real life events & experiences
All participants appreciated the use of real life situations on topics discussed which inspired them to share their own experiences whilst engaging with health professionals and family life.
We are here talking about real life scenarios happening in Kitgum, Soroti, Masaka [districts in Uganda]. It is real scenarios, no doctor, no medicine, a woman is pregnant, vulnerable, she has to give birth. I look at the fact that all this is true. P2
The messages on the cards talked about experiences women go through such as dignity in care, nutrition, birth preparedness, male involvement among others. These were experiences the men in the group could relate to being fathers in stable relationships.
Benefits of the game
Participants placed emphasis on the concept of ‘little shoe’ which draws men’s attention to think about women’s experiences during pregnancy and child birth
This particular game brings men’s attention to not just overlook women’s issues especially pregnant women but to go deeper to think about it as several men father children, take them to school but in his thoughts, he has never really stepped into the shoes of women. P3
Enhances change in perspective
Reflection appears to act as a mirror where men view their actions through a woman’s lens and are able to weigh in on their actions.
I think for me what I have picked from this game which is most important is about perspective and mind set. P1
The game provided a platform to discuss women’s experiences with fellow men. Such opportunities for self-examination and critical thinking enhances a change in mind set about cultural roles accrued to men and women by society.
General attitudes about the game
All men in this study were receptive towards the use of board games to engage with men in maternity services.
Yes, you chose the best [game], I think we need to encourage all men everywhere especially in Uganda or Africa to stand in the shoes of women. P2
Participants were keen on the concept of Whose Shoes, drawing on empathy to reflect on experiences women face during pregnancy and child birth. This was also reflected in the roles women perform in the home beyond child bearing such as care giving and house work.
Despite the fact that the men in this study generally liked the concept of Whose Shoes? game, there appeared mixed reactions with regards to the relevancy of the game to men living in the UK.
let us say that almost you are preaching to the converted, since we have lived in this country and also been here for long, we already got a perspective irrespective of what we had that a man does not do this and that, now we all do things differently. P1
…even us here, it has helped us except that most of us here can relate on the same level because we know, we’ve been there, we do it and the environment we live in, is normal [for men to be involved]. P2
Some of the participants were inspired to reflect on their involvement in maternity services, whilst others were already actively involved in offering support including chores around the home.
Participants highlighted different perspectives between men who are exposed and unexposed to male involvement due to contextual factors such as environment.
You will find that generally we who are here [UK], the perspective we have will be different from the everyday Ugandan man because of the different experiences and environment. P4
Men in this study appeared to have adopted a new perspective of being involved in women’s health as a result of living in the UK. Exposure to a way of life that is different from the Ugandan context had influenced men’s decision to be involved.
Easy to understand and use
In this study, men found the components of the game and messages easy to understand and could easily relate with the content of the game since they were parents.
This shoe whether you went to school or not, whether whoever assisted with the delivery did that in a health facility or not, I want a man to wear the shoes of this woman… P2
The use of symbols like little shoes and footprints on the board are visual tools that drew men’s attention to reflect on women’s experiences. The simplicity of the game implies that it can be used with men across different socio-economic status and education levels.
Recommendations for the game
Participants emphasised the need for the game to be applied to the Ugandan context to make it is more relevant so that it has the potential to make a unique contribution
If you shift it to Uganda, for so many men, it would be something new. Pregnancy is hers to deal with and as a man, I come in to boast about being a father to the child and that is it. There is a great need for change to come to our communities. P3
If you went deep in the villages like in Mukono [district], all your trying to aim for is a change in perspective and mind set… it would be more eye opening to them because you will find that for them when a woman gives birth, I know about it when she comes back with a baby or when am picking her up from the hospital. That is where his role starts as a man. P1
Considerable importance was placed on engaging men in the rural setting especially the villages where cultural values are dominant and social norms dictate men and women’s roles.
Participants proposed the need to design messages that are not only context specific but compelling messages that could provide men with opportunities for self-reflection.
The messages must be hard hitting and relevant in that it has to give people food for thought like when a man says traditionally, we have always done things this way, the questions become tailored to that. P3
As a concept [game] it is very good but then it has to be more hard hitting that if I place someone in that position, it gives them a chance to think. A woman does not complain but she suffers in silence but it does not remove the fact that a man needs to change. P1
Participants highlighted the need for messages addressing socio cultural norms that hinder male participation in maternity services and women’s access to health services.
In addition, messages could reinforce men’s active involvement during pregnancy and support each other as a team
If we work on changing our mind sets as men especially in Uganda that when a woman is pregnant, from that day we wear the same shoe and it becomes my responsibility as well to put on a woman’s shoes, know her experiences and support one another as we are in this together. P2
Participants suggested the inclusion of messages with an emphasis on pregnancy and child birth viewed as shared responsibility amongst couples.