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Table 3 Exploration phase—activities and domains for the development of the Better Hearts Better Cities initiative in São Paulo, Brazil

From: Deconstructing design thinking as a tool for the implementation of a population health initiative

Process phase

No.

Activity

When

Main actors

Dose/input

(time required to develop/implement or activity frequency)

Target (of action; unit of analysis)

Actions (brief)

Purpose (brief)

Expectation/outcome (brief)

Exploration

14

Observational research: A day in the life of CHAs

Mar 2018

Tellus team

100 visits were shadowed

– CHAs (from two pilot sites)

Observational research

Build empathy with key stakeholders

To extend user-focused research and insights generation

Direct engagement with stakeholders to build empathy and promote trust

15

Field research and interviews

Mar–Apr 2018

Tellus team

6 days in total—1 day per pilot health unit

– Itaquera community

– HTN patients

– Pilot health units and staff

Field research—system structure and dynamics

Build a dynamic picture of the structural environment influencing the aetiology of HTN

To understand HTN links between establishments within the Itaquera territory and community behaviour

16

Observational participation in activity groups at primary care clinics

Apr 2018

Tellus team

One activity group observed for 10 hours

HTN patients attending activity

Primary care workers (health technicians, CHA, managers)

Observational research—HTN services in primary care

Understanding current patient services and engagement

To understand patient services and health behaviours

To build relationships with pilot sites and patient communities

17

Co-creative meetings with managing councils of each clinic

Apr 2018

Tellus team

6 meetings with co-creation session; 1 hour per meeting

Managing councils (healthcare professionals, health system managers and community representatives/clinic users from each UBS)

Co-creation sessions

Check learnings about system and processes; deeper examination of needs and ideas; promote interest for sustainability

To understand system processes and develop and enhance relationships

18

Establishing baselines: questionnaires and desk research

Apr 2018

Tellus team

6 days; 8 hours a day

– Primary care workers

– Clinic managers

Hard and comparative data at different levels of the health system

Establish baseline for evaluation; extend evidence base to direct action; build relationships

To establish a set of indicators for subsequent evaluation

To characterize HTN care and treatment

To strengthen relationships

19

Evidence review, co-creative sessions—patient adherence and health information

Apr 2018

Tellus team

Desk research (10 days)

6 interviews (pharmacists)

6 co-creation sessions (five patients per session)

HTN patients

Local population

Health information system (secretary, coordination, supervisors, UBS, patient)

Review of evidence on patient adherence, local experiences, health information system

Identify system levers to support patient adherence

To promote evidence-informed (global–local) thinking to support the design of desirable, feasible and acceptable innovations

20

Clinical guideline review and curriculum review

Apr 2018

Tellus team

10 meetings with co-creation sessions

18 questionnaires

18 interviews

NF

Medical Society

Itaquera and Santa Marcelina supervision

Assess clinical guidelines use, professional training and user journeys

To develop guidelines based on understanding of system functioning and system actor perspectives; augment designer–stakeholder relationships

To reach an informed position to redesign guidelines to promote improved execution

To show a deep appreciation for user experiences

To better understand key challenges and needs

21

Checkpoints

Mar–Apr 2018

Tellus team

2 meetings each month (with 1 week of preparation for each meeting)

Itaquera supervisor and supervision managers

Recurring face-to-face meetings with Itaquera technical supervisory team

United project management and team-building

To clarify specific doubts about management and accelerate the exploration process

22

User journey formulation

Apr 2018

Tellus team

80 hours

Itaquera HTN ecosystem—people: healthcare workers, doctors, CHAs, pharmacists, patients and managers

Assemble data into visual summary—user journeys

Visual depictions of user experiences as evidence summaries (convergence) and workshop tool to guide co-creation phase (divergence)

To create journey maps for each target actor to inform design thinking

23

Itaquera map

Apr 2018

Tellus team

40 hours

Itaquera HTN ecosystem—structure: demographic profile, location of UBS and coverage area, public and private leisure and consumer facilities

Assemble data into visual summary—territorial map

A visual guide to the structural layout of the health ecosystem to identify key targets and change opportunities

To understand the behavioural profile of users based on what services (consumer, health and leisure) are available in the territory

24

Personas

Apr 2018

Tellus team

40 hours

Itaquera community members at risk of, or already living with, HTN

Evidence-based creation of target “personas” for HTN

User-friendly evidence summary, educational and co-creation tool

To identify target groups with challenges and behaviours as a tool for informed action in workshops

25

Stakeholder map

Apr 2018

Tellus team

80 hours

Itaquera HTN ecosystem (people and environment)

Visualization of spheres of influence across health ecosystem

User-friendly visual summary and co-creation tool

To present the whole health ecosystem in terms of influential actors to be used as a tool for informed action in workshops

26

Characterization of health system and living environment

Apr 2018

Tellus team

80 hours

Itaquera HTN ecosystem (infrastructure and services)

Visual profiles of pilot health units for intervention

User-friendly educational and co-creation tool

To create a setting-sensitive tool to guide and validate innovation ideas, and inform resource planning and evaluation

27

Development of design principles for the design strategy

Apr 18

Tellus team

40 hours

Tellus team

Empathy, engagement and training as basics for the co-creation strategy

To place empathy and community engagement at the heart of design strategy

To define a set of design principles with the necessary qualities to promote the innovation and implementation process

28

Development of guidelines for co-creation workshops

Mar 2018

Tellus team

40 hours

Future co-creation workshop participants

Guidelines for co-creation workshops based on design principles

To bring all learnings into a concrete form to educate, co-create and reference

To consolidate evidence for reference and educational materials to enable engagement and shift thinking paradigms

29

Phase presentation to steering committee and broader group

Apr 2018

Tellus team

1 workshop split into two parts

Part 1: Steering committee

Part 2: Meeting with broader group

End-of-phase presentation of project findings for validation and next steps

To complete validation rituals as necessary for the design process

To validate process and target challenges to be taken forward to co-creation workshops

  1. CHA community health agent, HTN hypertension/hypertensive, NF Novartis Foundation, UBS Unidade Básica de Saúde