Adapting Design Thinking Methods and Best Practices to a Virtual Environment: Lessons Learned and Future Considerations

Prepared by: Jared Bishop; Claire Sadeghzadeh, MPH; Eduardo Hernandez, Liz Chen, PhD; Alice Ammerman, PhD; Tracy Dearth- Wesley, PhD, MPH; and Molly De Marco, PhD, MPH

Project Overview

UNC’s Center for Health Promotion and Disease Prevention’s Food, Fitness, and Opportunity Research Collaborative (FFORC) is leading the development of an innovative intervention model for the Supplemental Nutrition Assistance Program — Education (SNAP-Ed) to improve its impact and reach at the Sectors of Influence level. Specifically, this intervention model will be used by SNAP-Ed Implementing Agencies to engage eligible caregivers of children under six years old. SNAP-Ed programming at the Sectors of Influence level involves partnering with a variety of stakeholders across sectors (e.g. Education, Food Industry) to collectively impact healthy eating and active living in low-income communities.

To inform the intervention model, FFORC engaged 14 caregivers in a series of virtual design thinking workshops. Initially, FFORC planned to conduct in-person workshops with caregivers across five priority states to identify preferences, challenges, and opportunities for accessing SNAP-Ed programming; however, COVID-19’s emergence forced us to reimagine the methods to achieve project goals in the dedicated timeline. This article describes lessons learned, best practices for engaging people virtually to conduct design thinking activities, and implications for research and practice.

Project Adaptation

When the COVID-19 pandemic started, we turned to experts in design thinking and public health to explore key methodological and programmatic questions concerning how to adapt our protocol for virtual delivery: What will we gain or lose by transitioning design thinking sessions to a virtual platform? How appropriate is it to engage people with limited income, and possibly limited connectivity, in these sessions during the pandemic? If we conduct these sessions now, how relevant will the developed intervention model be beyond the pandemic (i.e. will the pandemic radically change systems and sectors that they engage with on a regular basis)?

We conducted key informant interviews with five design thinking experts to discuss these questions and learn about their strategies to sample across multiple sites. The main takeaways from these conversations that informed our project were:

• We should not assume that people with limited income cannot or do not want to participate in virtual design thinking sessions.

• Convening virtually may reduce logistical barriers (scheduling, transportation, childcare) for people with limited incomes.

• There are online platforms to facilitate design thinking activities, including Zoom, Miro, and Google Slides.

• We should offer a variety of ways for people to engage in the activities to account for differences in computer literacy and technological access. For example, always offer the opportunity to draw or sketch ideas on paper to support virtual interaction.

After these interviews, we decided to recruit a small cohort of caregivers (up to three caregivers from each state) who would be able to attend four virtual design thinking workshops. This model would allow us to dive deeper into how the pandemic is impacting caregivers’ lives as well as learn about routines and experiences before the pandemic.

Virtual Recruitment

We partnered with SNAP-Ed Implementing Agencies in each priority state to disseminate virtual recruitment materials (flyers, sample emails) in Spanish and English. People who were interested in learning more completed a short screener survey via Qualtrics, and if they were eligible, completed a brief survey of characteristics to help our team select personas, archetypes created to represent the different types of users for a possible product or service. The survey intertwined traditional demographic questions with those related to experience with food skills education and personal motivation to adopt healthy eating behaviors. As the design question asked where caregivers currently spend time outside the home, we asked, “In the past month, which places have you visited?” to help our team start brainstorming different ways to assess unused time and potential opportunities for the delivery of food skills education in those locations.

Session Design

The table below provides a brief overview of the session goals, what we learned from each session, and how each session led us to our next session and ultimate goal.

Session Content

The table below provides a brief overview of the design activities we implemented virtually, what worked well for our team and the caregivers, and potential improvements. We also highlighted the online platform(s) we utilized during each session.

Session Best Practices

After analyzing our collective reflections and discussing what worked, what didn’t work, and what we would do differently, our team created this list of best practices in the table below.

What We Learned:

As design thinking is an iterative process, we integrated several methods to facilitate on-going convergence of information and reflection on the form and content of the workshops. We scheduled one week between sessions to synthesize what we learned and adapt the content and technical components of workshop activities. This amount of time was sufficient; however, if time allows, up to two weeks may be necessary to engage all key stakeholders.

Immediately after each workshop, facilitators completed a brief reflection survey to capture interesting or surprising conversations, emerging ideas or questions, facilitation challenges, and questions for the rest of the design team. These reflections facilitated our convergent thinking and helped us continuously improve the experience for caregivers. Centering the reflections during team meetings provided key insights for us, especially on facilitator experiences and group dynamics, what questions or activities worked, and what modifications we needed to make.

We also learned that developing a set workshop structure can help caregivers anticipate what to expect and create a welcoming, safe virtual space to share. Our workshops started with a check-in (internal (moods and feelings) and external weather) and ice breaker to build trust between caregivers, a review of the group norms, and a review of the workshop’s goal and activities. We ended the session with a reflection on what went well and how we could improve the next session. We remained committed to integrating caregiver feedback since this was our first time hosting virtual design thinking workshops, and this was a key part of how we gathered and acted on caregiver feedback throughout the process. For example, caregivers shared Miro.com was challenging, so we responded by exploring other platforms in subsequent sessions.

People communicate and process information differently, and we learned that providing multiple ways to communicate can deepen engagement and participation. Verbal communication via Zoom can be daunting for some; therefore, we emphasized other features in Zoom to share, specifically the chat feature and smaller breakout rooms. We also integrated individual, quiet time for reflection and brainstorming before each activity to give all caregivers (especially internal processors) ample time to gather their thoughts and to avoid a few caregivers from dominating the group discussion.

Lastly, we learned that caregivers were craving this type of engagement with others, especially during the pandemic. During the reflection at the end of the first workshop, one caregiver shared, “I have not an opportunity to sit down and talk with five other mothers in like eight months. So this is a cool way to talk to other people who are doing the exact same stuff I am, and a lesson I have learned over and over again in my life is when things are stressful, it is so helpful to find common ground and relatability.” This affirmed our decision to move ahead with this project virtually and led to interesting, fruitful conversations with caregivers and the design team about the importance of connections between caregivers.

Implications for Research and Practice

This project illuminated several important implications for future design thinking projects. First, users with lived experience should be compensated as experts and projects should plan for this expense by incorporating a budget line item. We compensated caregivers at $50/hour for their time in and out of sessions. This rate reflected their status as experts and ensured they could cover costs for services that we would have provided during in-person sessions, like meals and childcare. Since the caregivers who participated also receive support from federal nutrition programs, we acknowledged that this level of compensation could potentially change their eligibility for benefits and/or the benefit amount. Be transparent with caregivers about this possibility so they can plan and/or provide feedback on how they would like to be compensated. Be prepared to adapt compensation based on caregiver feedback.

Second, as design thinking has the potential to reinforce and/or maintain existing systems of power and oppression, a design justice approach should be considered. Design justice is “a growing social movement that aims to ensure a more equitable distribution of design’s benefits and burdens, fair and meaningful participation in design decisions, and recognition of community-based design traditions, knowledge, and practices.” We applied several design justice principles in these sessions. First, we selected caregivers with diverse ages, backgrounds, races, levels of education, and experience with food skills education and provided English and Spanish sessions. Second, we established norms that honored their multiple roles; for example, normalizing turning off their camera and/or microphone if they needed to step away. This norm centered their experience as caregivers during the COVID-19 pandemic and acknowledged that they are simultaneously tending to their family while participating in the session. This norm made caregivers feel understood and supported by the group and may have contributed to 100% participation across all four sessions.

Lastly, our team reflected on our own positionally, experience, voice, and power within the group and frequently inquired about who was holding power to ensure we were sharing it with caregivers whenever possible. Future design thinking research must continue to center design justice at the forefront of project inspiration, ideation, and implementation. We must continue to prioritize the experience of users with lived experience, shift decision making power to them when possible, and ground every decision we make in a vision for equity and justice.

Citations

• 1. U.S. Department of Agriculture, Food and Nutrition Service. (2016)The Supplemental Nutrition Assistance Program Education (SNAP-Ed) Evaluation Framework: Nutrition, Physical Activity, and Obesity Prevention Indicators: Interpretive Guide to the SNAP-Ed Evaluation Framework. Arlington, VA: USDA; 2016. Interactive version: https://snapedtoolkit.org/framework/index/
• 2. IDEO.org. (2015)The field guide to human-centered design: Design kit. IDEO.org. Interactive version: https://www.designkit.org/
• 3 Brown, A. M. (2017) Emergent strategy: Shaping Change, Changing Worlds. Chico, California: AK Press.
• 4 Costanza-Chock, S. (2020) Design justice: Community-led Practices to Build the Worlds We Need. Cambridge, MA: MIT Press.