Persona-scenario exercise for codesigning primary care interventions

Group facilitation

The persona-scenario exercise was conducted with patients, health care providers, volunteers, and community service agency staff. Sessions were conducted with participants of a single stakeholder group. Each group received a tailored discussion guide and an introduction to the program components (volunteers, electronic health records, community services, interdisciplinary teams). Participants were told that the goal of the exercise was to create a detailed and realistic character that represented their stakeholder group (ie, the persona) and to have that persona experience all aspects of TAPESTRY (ie, the scenario), stressing that they had the freedom to be creative beyond the health care system as they knew it.

Participants were divided into pairs. Each pair of participants typically created one persona and one scenario; however, if time allowed, they could create another scenario with their personas. Pairs described their personas and scenarios to the group, and this summary was audiorecorded—unlike in focus groups, in which the entire discussion is recorded. After using various combinations of working group sizes, we found that paired participants worked best. Ideally, having no more than 4 pairs allowed for enough time for each pair to present their personas and scenarios to the group, and also resulted in a manageable participant-to-facilitator ratio. We recommend that pairs share similar backgrounds, such as age or experience level, so that personas represent more authentic characters. For example, less experienced volunteers should not be paired with more experienced volunteers because they are unable to create personas as realistic as those of the more experienced volunteers. Having tested several configurations, we found that, ideally, each pair should have a note-taker who is not participating in the discussion to write down key points using a laptop or pen and paper. This helped participants to speak freely and work through ideas without losing time to write their answers, and allowed note-takers to facilitate conversation. Using research staff as note-takers to clearly write out participants’ answers to each question enhanced the sharing of information with the larger group and improved the quality of audiorecordings. Note-takers must feel comfortable in clarifying questions and giving directions regarding pacing, staying on topic, and fully completing the exercise. Ideally, the exercise should last no more than 2 hours (10 minutes for instruction and consent; 10 minutes per persona; 25 to 30 minutes per scenario; and 8 to 10 minutes for each pair to report back to the group).

Analysis

Summaries of the persona-scenario exercises that were presented by participants or note-takers were transcribed verbatim and coded in NVivo, version 10.⁷ Three researchers (R.V., K.N., and J.L.) coded a transcript together to create the coding structure. Two authors (K.N., J.L.) independently completed the open coding⁸ process; few new ideas emerged after 13 sessions, indicating data saturation. A list of highly descriptive and self-explanatory nodes was generated. These were organized by program components under broad headings, exported to Excel, and formatted into a table with columns for nodes, actions, and items. Each node was assigned specifications (ie, actions that were required to actualize the ideas and items that were required to execute the actions) to be implemented (Table 1). Two research team members (K.N., J.L.) independently reviewed each node (investigator triangulation) to ensure that multiple perspectives were incorporated during analysis, increasing rigour.⁹ Once the table with actions and items was generated, it was reviewed to determine what already existed in the program, what was unfeasible, and what needed to be developed. Finally, a program to-do list was created (Figure 1). The action and item specifications that were generated from the nodes formed the basis of program development.

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Figure 1.

Analysis process to reveal specifications for actions and items: Specifications were generated from the nodes that formed the basis of program development.