School of Nursing, McMaster University, HSC 3N25,1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, Ontario, L8P 1H6, Canada.
BMC Fam Pract. 2019 Sep 4;20(1):122. doi: 10.1186/s12875-019-1013-9.
Working with patients and health care providers to co-design health interventions is gaining global prominence. While co-design of interventions is important for all patients, it is particularly important for older adults who often experience multiple and complex chronic conditions. Persona-scenarios have been used by designers of technology applications. The purpose of this paper is to explore how a modified approach to the persona-scenario method was used to co-design a complex primary health care intervention (Health TAPESTRY) by and for older adults and providers and the value added of this approach.
The persona-scenario method involved patient and clinician participants from two academically-linked primary care practices. Local prospective volunteers and community service providers (e.g., home care services, support services) were also recruited. Persona-scenario workshops were facilitated by researchers experienced in qualitative methods. Working mostly in homogenous pairs, participants created a fictitious but authentic persona that represented people like themselves. Core components of the Health TAPESTRY intervention were described. Then, participants created a story (scenario) involving their persona and an aspect of the proposed Health TAPESTRY program (e.g., volunteer roles). Two stages of analysis involved descriptive identification of themes, followed by an interpretive phase to extract possible actions and products related to ideas in each theme.
Fourteen persona-scenario workshops were held involving patients (n = 15), healthcare providers/community care providers (n = 29), community service providers (n = 12), and volunteers (n = 14). Fifty themes emerged under four Health TAPESTRY components and a fifth category - patient. Eight cross cutting themes highlighted areas integral to the intervention. In total, 414 actions were identified and 406 products were extracted under the themes, of which 44.8% of the products (n = 182) were novel. The remaining 224 had been considered by the research team.
The persona-scenario method drew out feasible novel ideas from stakeholders, which expanded on the research team's original ideas and highlighted interactions among components and stakeholder groups. Many ideas were integrated into the Health TAPESTRY program's design and implementation. Persona-scenario method added significant value worthy of the added time it required. This method presents a promising alternative to active engagement of multiple stakeholders in the co-design of complex interventions.
与患者和医疗保健提供者合作共同设计健康干预措施在全球范围内受到越来越多的关注。虽然干预措施的共同设计对所有患者都很重要，但对于经常患有多种复杂慢性疾病的老年人来说尤其重要。技术应用程序的设计师已经使用了角色-场景方法。本文旨在探讨如何通过一种经过修改的角色-场景方法共同设计一项针对老年人和提供者的复杂初级保健干预措施（Health TAPESTRY），以及这种方法的附加值。
该角色-场景方法涉及来自两个学术相关的初级保健实践的患者和临床医生参与者。还招募了当地的志愿人员和社区服务提供者（例如家庭护理服务、支持服务）。由经验丰富的定性方法研究人员主持角色-场景研讨会。参与者大多以同质的两人一组的形式，创建一个虚构但真实的角色，代表与自己相似的人。描述了 Health TAPESTRY 干预措施的核心组成部分。然后，参与者创建了一个涉及他们的角色和拟议的 Health TAPESTRY 计划的某个方面的故事（场景）（例如，志愿者角色）。分析包括两个阶段：描述性地确定主题，然后进行解释性阶段，以提取与每个主题中的想法相关的可能行动和产品。
共举办了 14 次角色-场景研讨会，涉及患者（n=15）、医疗保健提供者/社区护理提供者（n=29）、社区服务提供者（n=12）和志愿者（n=14）。四个 Health TAPESTRY 组件和一个第五个患者类别下出现了 50 个主题。8 个跨主题突出了干预措施不可或缺的领域。总共确定了 414 个行动，并在主题下提取了 406 个产品，其中 44.8%（n=182）的产品是新颖的。其余 224 个产品已被研究团队考虑过。
角色-场景方法从利益相关者那里引出了可行的新颖想法，这些想法扩展了研究团队的原始想法，并突出了组件和利益相关者群体之间的相互作用。许多想法已被纳入 Health TAPESTRY 计划的设计和实施中。角色-场景方法具有很高的价值，值得花费额外的时间。这种方法为复杂干预措施的多方共同设计提供了一种有前途的替代方案。
