Public Health Framework and Tools.
Project Overview
Specs.
February - May 2024
4 month project
Master’s degree capstone project
Group project
Service design
UX/UI design
Problem Statement
The National Public Health Service (NPHS) identified the need for a comprehensive public health equity framework. This framework is intended for internal kaimahi and staff, aiming to provide clear direction and support. To achieve this, it is essential that the framework be fully implemented through the effective use of designated tools.
The Challenge
Working within the current health system, we recognised that our own identities and political ideologies could introduce bias. We understood that achieving health equity is a long-term process and placed a strong emphasis on the well-being of whānau and communities. Furthermore, we identified significant societal barriers that fell outside the scope of this framework.
Bearing these challenges in mind, we aimed to develop a framework and tools for implementation to build and strengthen the internal capability of NPHS kaimahi. Our goal was to advance equity in health outcomes for priority groups by fostering a shared understanding of equity. This shared understanding would guide decisions on planning, service delivery, commissioning, and review activities.
The Team
Kristen Boraca
Christine Cho
Maisie O’Donnell
Tomasin Patrick
Taylor Pule
Danielle Wilson
My Role
Background research (support)
Scoping review and analysis (co-lead)
Workshop facilitation, analysis, and design (support)
Framework principle design (support)
Framework design concepting (support)
Tool #2 design (lead)
Our Toolkit
Figma
Miro
InDesign
Procreate
Teams
The Design Outcome
The design outcome of the public health equity framework for NPHS incorporates five key principles symbolised by seeds in a kauri cone, which are to be embedded into the NPHS culture. The supporting tools will ensure the practical application of this framework, guiding NPHS kaimahi during implementation.
Key Learnings
Confronting Bias.
We learned to manage bias by acknowledging and challenging our assumptions through milestone reflections and positionality statements.
Critical Tiriti Analysis (CTA).
This project provided us with the opportunity to learn about upholding Te Tiriti principles. We applied CTA to guide us on how to uphold Te Tiriti in our mahi.
Upholding Tikanga Māori.
Upholding and respecting tikanga values throughout our process through uplifting Māori voices and highlighting the importance of rich kōrero.
Limitations in Methods.
The limited numbers of participants and mixed results from our design workshops meant we needed to adapt our analysis approach. We learned to work with what felt important to inform our next steps.
Advocating for What is Important.
Honouring our stakeholders and rigorous design processes to be worthy advocates of our mahi.
How We Got There…
Research
When conducting background research on existing frameworks and tools in the healthcare sector related to health equity and best practices for addressing racism, our initial step was to investigate previous policy-making efforts. By examining the existing landscape, we aimed to understand the complexities of health equity beyond just health issues, focusing on how various approaches have been implemented to tackle racism effectively. This foundational research phase provided insights that shaped a more holistic understanding of the challenges and opportunities within the healthcare domain, guiding us toward more informed and impactful design strategies.
Useful Findings From Our Research:
Te Tiriti o Waitangi sets foundational principles including effective stewardship, Māori self-determination, achieving health equity, and respecting Māori customs and knowledge. These principles intertwine with health equity in New Zealand and were vital for the framework's success.
The Pae Ora Act (2022) outlines its aim to safeguard, advance, and enhance the health of all New Zealanders, striving for equity in health outcomes, particularly for Māori, and promoting healthy futures for New Zealanders. It emphasises the inclusion of iwi-Māori partnership boards in local service planning to ensure Māori participation and priorities in health.
Takoha (2022) acts as a tool to gauge progress in improving Māori and overall New Zealanders' health, aligning with Te Tiriti o Waitangi principles and community-centred approaches towards healthy futures.
Te Ara (2019) explores how Māori and Pacific weaving practices can influence Public Health Data Systems towards equity, guided by Te Tiriti principles of equity, anti-racism, and accountability.
HEAT (2008) underscores its utility in Ministry of Health workshops to enhance health sector contributions to equity, identifying policy gaps and evidence for development and evaluation, informing the framework's development.
Core Design Values
After conducting background research and grounding our mahi, we set out to define our core design values. These values focused on skills that would enhance collaboration between our team, our project leads and the kaimahi we worked with.
Scoping Literature Review
Once our core design values were established, we collaborated with kaimahi to assess both academic and grey literature. Due to my background in anthropology and research, I played a significant role in this part of the design process. Given the project's time constraints, we needed to analyse a large volume of material quickly. We adapted the affinity mapping process to align with the objectives of the scoping review, focusing on generating themes from secondary research. We conducted the analysis on Miro.
Stakeholder Engagement
The Project team conducted eleven internal stakeholder engagements, crucial for ensuring the framework would meet NPHS kaimahi needs. These engagements sourced information to develop principles, a framework, and tools in an informed manner. A communication and engagement plan was executed by the team, focusing on equity definitions, existing tools addressing inequity, current inequities, and ideas for the new framework. Notes from the interviews were analysed to expand on themes identified in the scoping review.
Design Workshop Series
Our participatory design workshops focused on our key deliverables: the principles, the framework, and the tools.
We invited 11 stakeholders with expertise in our priority populations to attend the workshop series, ensuring their unique perspectives and expertise were integrated into the framework development.
This collaborative process aimed to ensure the most robust outcomes and foster greater ownership of the framework. I took part in the facilitation of workshop one and the design of workshop three.
Workshop One: The Principles
Intended Outcomes:
Identify important themes missing from the initial research and stakeholder engagement.
Determine any themes that should be excluded from the framework.
Identify priority themes for the framework.
Findings:
All themes identified in the scoping review and stakeholder engagement were deemed important and relevant, and should be included in the framework and principle development.
Workshop Two: The Framework
Intended Outcomes:
Identify the relationships and dependencies within the identified themes and categorise them into key principles.
Establish a framework structure by determining if there are priorities or hierarchies within the set of principles.
Findings:
The themes are interdependent and should have equal weighting in the equity framework. Te Tiriti o Waitangi should underpin all themes within the framework. The context of the framework is crucial as it is situated within the current public health system.
Workshop Three: The Tools
Intended Outcomes:
Identify existing successful tools to evaluate how similar methods can be adapted for the framework.
Discover and explore ways to develop tools that support the implementation of the framework and principles.
Findings:
Improved methods are required for sharing resources, data, and tools across directorates and regions. Face-to-face interactions are vital for strengthening relationship-building and learning practices. Lastly, data collection methods need enhancement, and data should be shared with communities to improve health literacy.
Framework Concepts
Our team began brainstorming the visual representation of the framework, aiming to convey the concept of five interdependent and equally important principles working together towards equity in public health. I contributed the ideas of using a waka and native flora and fauna. The waka, symbolising a shared destination, had oars representing the five principles working cooperatively. Another proposed concept was a forest, intended to introduce a watercolour illustration style, contrasting with the hard-edged vector illustrations of other concepts. Additionally, we suggested a kauri cone cross-section, displaying five inner pods representing the five principles. I played a significant role in brainstorming these designs, which allowed our team members with strong graphic design backgrounds to develop fleshed-out concepts. A major influence in the brainstorming process was ensuring the design was inclusive of all priority populations without being tokenistic or appropriating Te Ao Māori.
Under the guidance of our NPHS project team, we proceeded to refine the kauri cone concept. The team expressed interest in drawing inspiration from the natural world for this framework, and the kauri tree, revered as taonga and a symbol of forest and community health, resonated as a fitting metaphor.
Building on the positive reception of the watercolour illustration in our forest concept for its unique and emotive visual style, we aimed to integrate this aesthetic into the development of the kauri cone concept. Using Procreate, a digital illustration application, we experimented with various watercolour styles and effects, iterating to refine the wording, appearance, and placement of text elements.
The Final Framework Concept
The final framework integrates both textual principles and visual elements.
The outer layer of the cone symbolises whānau, communities, and kaimahi across all levels of NPHS. At its inner core lies the directorate's mission of "promotion, protection, prevention, and intelligence." Each of the five seeds or pods within the kauri cone represents one of the principles aimed to be embedded into the culture at NPHS.
The principles have evolved significantly through review and guidance from our collaborating public health experts at NPHS, forming part of an ongoing development process. There is potential for a sixth principle to be added in the future.
Tools to Support the Framework
Our four tools came about from a need to innovate work processes at NPHS to give direction on how to practically implement our framework.
Tool One:
The first tool, a Design Workshop Guide, enables kaimahi from various directorates, with diverse expertise and perspectives, to come together and foster creativity and collaboration in achieving health equity.
Tool Two:
I designed this tool. Our second tool is a research and tools library for internal kaimahi to share their knowledge and research, aligning work processes and strengthening approaches.
Each feature is utilised to streamline the workflow of kaimahi, avoiding redundant and repetitive tasks.
Tool Three:
The third tool allows consumers to access their health data.
By prioritising community health alongside individual health through the My Health Record online service, this tool empowers communities by giving them control over their data and ensuring accountability for its availability and usage.
Tool Four:
The fourth tool educates kaimahi through educational modules, supplemented by face-to-face interactions.
These modules teach kaimahi to reflect on their work from the perspectives of different priority populations, fostering shared knowledge on equity and collective goals.
Creating a safe space for questions will help to address and shift personal biases.
Reflection
What’s Next?
Our involvement in this project was brief and concluded before the framework's completion and publication. Consequently, we developed ideas on the next steps needed to fully develop the framework and its tools to their full potential.
Tool Development:
Our tool concepts are in the early stages and need to be tested to ensure they meet the expectations of kaimahi. Usability testing will
allow us to refine them to better implement the framework.
Framework Refinement:
While a range of voices were invited to our workshops, not all were able to attend so our framework is only as equitable
as the voices in the room. It is therefore vital to test the principles and visual concept to ensure they are fit for purpose.
How to Improve
This project was an invaluable experience. Being my first major UX design project in a professional group setting, it presented numerous challenges and obstacles, highlighting areas where I can improve my practice as a UX designer.
What I Would Do Differently:
Spend less time on background research – given the extensive volume of scoping reviews to analyse, it would be beneficial to keep initial research brief, allowing more time for scoping review analysis.
Maintain more flexible workshop plans – our workshop plans were very thorough and unintentionally based on many assumptions about the outcomes. In the future, it would be better to design a basic foundation for workshops that can be adaptable and open to change.
Utilise CTA more strictly – although we aimed to use CTA to guide our mahi effectively, there were not enough Māori voices present throughout the design process. Next time, I would advocate much more strongly for this inclusion.
Takeaway Skills:
Workshop design and facilitation – this was something I had never done before and is likely the most prominent skill I gained from this project.
Applying design processes to non-design environments – this was a significant challenge that required immense adaptability. Finding ways to use design processes, such as affinity mapping, in a project that typically doesn't require them was an obstacle. Once overcome, it proved to be a valuable skill to add to my toolkit.
Adapting to a client’s communication style in design – at the start of this project, the language used in the healthcare sector was completely unfamiliar to me. However, through scoping review analysis, stakeholder engagement, and workshops, I learned the importance of adapting language and communication to suit the needs of those we were designing for.