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BACKGROUND: Government-led, population-wide initiatives are crucial for advancing the management of hypertension - a leading cause of cardiovascular disease (CVD) morbidity and mortality. An urban population health initiative was conducted against this backdrop, focussing on hypertension in the primary health system in São Paulo, Brazil. Within the frame of the initiative and under the supervision and leadership of the municipal health authorities, a situational analysis was conducted on the needs in hypertension management, marking the first phase of a Design Thinking process. This article describes the situational analysis process and presents the identified elements to be strengthened considering hypertension diagnosis, treatment and control. METHODS: First, a mixed-methods approach was used, starting with a literature review of municipal hypertension data followed by meetings (N = 20) with the local public health administration to assess health system level components. To investigate activities on hypertension diagnosis, treatment and control, nine primary healthcare units were selected from two districts of São Paulo city- Itaquera and Penha- which received an online form addressed to managers, participated in conversation circles of staff and patients, and underwent shadowing of community health agents. RESULTS: Data gave rise to two main outputs: (i) a patient care journey map; and (ii) a matrix summarizing the identified needs at patient, healthcare professional and health system level for diagnosis, treatment and control of hypertension. Patient awareness and knowledge of hypertension was found to be insufficient and its management needs to be improved. For health professionals, disease awareness, technical training, more time dedicated to patients, and simplified guidelines and clinical decision-making tools for hypertension management were identified as principal needs. The situational analysis found that the healthcare systems efficiency might be improved by establishing defined treatment and care delivery goals with a focus on outcomes and implemented through action plans. CONCLUSIONS: This situational analysis identified several needs related to hypertension control in São Paulo that are in line with global challenges to improve the control of CVD risk factors. Findings were also confirmed locally in an expansion phase of this situational analysis to additional primary care facilities. As a consequence, solutions were designed, promptly taken up and implemented by the municipal health secretariat.

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BACKGROUND: Hypertension is the leading risk factor for cardiovascular diseases (CVDs) and a major public health issue worldwide. In Brazil, it affects approximately 52.5% of the adult population. We describe the solutions package and the impact of a population health initiative in São Paulo city, following the CARDIO4Cities approach for the management of cardiovascular risk. METHODS: Using a design thinking approach, interventions were developed with a coalition of local and international stakeholders to address needs of patients, healthcare professionals, and the health system. The resulting solution package was checked to comply with guidelines for non-communicable disease and hypertension management. Clinical impact was measured by extracting the hypertension cascade of care-monitored, diagnosis, treatment, and control-from medical records. RESULTS: Under the leadership of the municipal health authorities, nine solutions were piloted and scaled across the city. Solutions conform with local and international best-practices. Between October 2017 and December 2021, 11,406 patient records were analyzed. Results showed a 40% increase in monitored patients (patients with at least one blood pressure, BP, measurement); reduced proportions of patients diagnosed among those with available BP measurements (72%-53%) and treated among diagnosed (93%-85%); and an improvement in controlled patients among those receiving treatment (16%-27%). CONCLUSIONS: The solution package described in this study was correlated with increased BP control. The implementation methodology and results add to the body of real-world evidence supporting population health implementation science in Brazil and beyond.

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Resumo Introdução: A matriz curricular do curso de Medicina pode variar de acordo com o projeto pedagógico de curso (PPC) de cada instituição de ensino superior (IES). Nem sempre a visão da coordenação e do corpo docente do curso de Medicina está alinhada às opiniões dos alunos. Assim, a utilização de uma metodologia para identificar a visão do corpo discente seria fundamental. O design thinking (DT) é um processo que propõe a busca, de forma empática, colaborativa e criativa, de soluções para problemas complexos. Objetivo: Este estudo apresenta o DT como uma metodologia para identificar como os alunos do internato acreditam que deva ser a matriz curricular do primeiro ao quarto ano de um curso de Medicina no estado de São Paulo, e, para tanto, coletaram-se sugestões e pontos que exigiram a reavaliação na matriz original. Método: Realizou-se uma avaliação qualitativa com base no modelo do DT. Os alunos foram divididos em três grupos de cinco alunos, e cada grupo dedicou-se a discutir livremente sobre suas ideias acerca da matriz curricular. Posteriormente, apresentou-se um painel para cada grupo com a separação dos semestres correspondentes - do primeiro ao quarto ano - com post-it representando a matriz curricular vigente do curso de Medicina, e cada grupo teve uma hora para remontar a matriz curricular da maneira que julgasse mais adequado. Resultado: Após a fase de discussão, cada grupo montou sua matriz curricular, e propuseram-se algumas mudanças do ano em que a disciplina era ministrada e a inclusão de algumas matérias. A maioria das sugestões foi julgada procedente e incorporada na matriz curricular. Conclusão: A metodologia do DT contribuiu para a identificação de várias demandas acerca da matriz curricular de uma forma ordenada, empática e colaborativa, levando em consideração a opinião do estudante, sendo, portanto, uma estratégia de planejamento capaz de evidenciar fragilidades e fortalezas do currículo que talvez não fossem percebidas por outras estratégias.

Abstract Introduction: The medical school curricular structure may vary according to the educational planning of each higher education institution (HEI). The viewpoint of the coordination and the medical school faculty is not always aligned with the students' opinions. Thus, using a methodology to identify the students' point of view would be essential. Design thinking (DT) is a process that proposes a search, in an empathetic, collaborative, and creative way, for solutions to complex problems. Objectives: To present DT as a methodology to identify how clinical internship students believe the curricular structure from the 1st to the 4th year of a São Paulo state medical school should be, by collecting suggestions and points that require a re-evaluation process of the current curricular structure. Methods: This is a qualitative assessment, which will use the DT model. Students were divided into three groups of five, and each group was committed to having a free discussion on its ideas concerning the curricular structure. Then, a panel was presented to each group, dividing the semesters from the 1st to the 4th year with post-it notes representing the current curricular structure of the medical school, and each group had one hour to reassemble the curricular structure as they deemed appropriate. Results: After the discussion stage, each group assembled its curricular structure. Some changes concerning the year in which the discipline was provided were proposed, and the inclusion of others. Most of the suggestions were considered valid and were incorporated into the curriculum. Conclusions: The DT methodology contributed to the identification of several demands regarding the curricular structure in an orderly, empathetic, and collaborative way, taking into account the students' opinions. It is, therefore, a planning strategy able to evidence weaknesses and strengths of the curriculum that might not have been noticed by the use of other strategies.

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Aim: This study was designed to recommend strategies to improve prostate patients' access to radiotherapy treatment in the Brazilian Unified Health System, along with a cost-tool to support radiotherapy care pathways' lead times and costs. Methods: Data was collected prospectively from patients with prostate cancer receiving radiotherapy in two Brazilian centers to provide data to apply design thinking and process reengineering techniques. The current status of the radiotherapy pathway was determined and the length of time taken for in-hospital activities was measured using data exported from ARIA®. Interviews with patients were used to estimate their waiting periods. This provided the data used to provide recommended strategies and the cost tool based on time-driven activity-based costing. The strategies were classified according to priority. Results: Data from 47 patients were analyzed. The mean interval from diagnosis to start of radiotherapy was 349 days (SD581), and the mean interval from seeking medical attention to starting treatment was 635 days (SD629). Twelve strategies affecting in-hospital processes and 11 impacting patients' care pathways and experiences are recommended, mostly focused on system improvement opportunities. A time-driven activity-based costing monitoring using data extracted from ARIA was coded and can be used by centers as a cost assessment guide. Conclusion: This study uses reengineering and design techniques to introduce priority strategies to allow more efficient and patient-centered radiotherapy.

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Abstract How might we define local innovation challenges that are user-centered but also address strategic goals, such as the Sustainable Development Goals (SDGs)? We propose a design process that introduces a relevant contribution to the practices of the Mission-oriented Innovation Policies (MIPs) field as it goes from Grand Societal Challenges (GSCs) to local innovation challenges, which are more relevant to local needs and capabilities of solution. The main goal of the design process is to go from a GSC, such as "access to health" and one of its missions, like "reducing chronic Non-Communicable Diseases (NCD)," to a more able-to-solve innovation challenge, passing by its mission, and different problems and aspects. Snowball sampling methods allow us to find and mobilize electable subjects and design thinking techniques to process problem mapping, election, and clustering, as well as create challenge statements. It was possible to translate GSC to the local reality while reducing contestation and complexity and producing a problem-grouped map with prioritization and three problem statements (challenges) with open phrasing and solution criteria to foster the users' desired outcomes.

Resumen ¿Cómo podemos definir desafíos locales de innovación local que estén centrados en el usuario pero que también aborden objetivos estratégicos, como los Objetivos de Desarrollo Sostenible (ODS)? Proponemos un proceso de diseño que introduce una contribución relevante a las prácticas en el campo de las políticas de innovación orientadas por misión (en inglés, Mission-oriented Innovation Policies - MIPs), ya que va desde los grandes desafíos sociales (en inglés, Grand Societal Challenges - GSCs), comenzando con los ODS, hasta los desafíos locales de innovación, que son más relevantes para necesidades locales y capacidades de solución. El objetivo principal del proceso de diseño es ir desde un GSC, como "acceso a la salud" y una de sus misiones, como "reducir las Enfermedades Crónicas No Transmisibles (ECNT)", a un desafío de innovación más concreto, pasando por la misión, y por diferentes problemas y aspectos. Los métodos de muestreo de bola de nieve nos permiten encontrar y movilizar sujetos elegibles, y técnicas de design thinking, procesar el mapeo, la elección y la agrupación de problemas; y crear declaraciones de desafío. Fue posible traducir GSC a la realidad local, al mismo tiempo que se reducía la contestación y la complejidad, y se producía un plano agrupado de problemas con priorización, y tres declaraciones de problemas (desafíos) con redacción abierta y criterios de solución para promover los resultados deseados por los usuarios.

Resumo Como podemos definir os desafios locais de inovação que são centrados no usuário, mas também abordam objetivos estratégicos, como os Objetivos de Desenvolvimento Sustentável (ODS)? Propomos um processo de design que apresenta uma contribuição relevante para as práticas no campo das políticas de inovação orientadas para a missão (em inglês, Mission-oriented Innovation Policies - MIPs), uma vez que vai dos grandes desafios societais (em inglês, Grand Societal Challenges - GSCs) aos desafios locais de inovação, que são mais relevantes para as necessidades locais e capacidades de solução. O principal objetivo do processo de desenho é passar de um GSC, como o "acesso à saúde" e uma de suas missões, como "reduzir as Doenças Crônicas Não Transmissíveis (DCNT)", para um desafio de inovação mais capaz de resolver, passando pela sua missão, diferentes problemas e aspectos. Os métodos de amostragem bola de neve nos permitem encontrar e mobilizar assuntos elegíveis e técnicas de design thinking para processar o mapeamento de problemas, eleição e agrupamento; e criar declarações de desafio. Foi possível traduzir o GSC para a realidade local, reduzindo a contestação e a complexidade, e produzindo um mapa agrupado de problemas com priorização e três declarações de problemas (desafios) com formulação aberta e critérios de solução para promover os resultados desejados pelos usuários.

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BACKGROUND: The translation of evidence-based practices and rapid uptake of innovations into global health practice is challenging. Design thinking is a consultative process involving multiple stakeholders and has been identified as a promising solution to create and apply implementation strategies in complex environments like health systems. METHODS: We conducted a process evaluation of a real-world example, namely an initiative to innovate hypertension screening, diagnosis and care in São Paulo, Brazil. The parameters of the evaluation were informed by a specification rubric and categorization system, recommended for the investigation of implementation strategies, and the double-diamond conceptual framework to describe and examine the strategic architecture and nature of the design thinking approach, with particular emphasis on identifying potential areas of "value-add" particular to the approach. The retrospective evaluation was performed by an independent partner who had not been involved in the setting up and implementation of the design thinking process. RESULTS: The evaluation unveiled a dense catalogue of strategically driven, mostly theoretically based, activities involving all identified health system stakeholders including patients. Narrative reconstruction illuminated the systematic and coherent nature of this approach, with different resulting actions progressively accounting for all relevant layers of the health system to engineer a broad selection of specific implementation solutions. The relevance of the identified features and the mechanics used to promote more successful implementation practices was manifested in several distinct ways: design thinking offered a clear direction on which innovations really mattered and when, as well as several new dimensions for consideration in the development of an innovation mindset amongst stakeholders. It thereby promoted relationship quality in terms of familiarity and trust, and commitment to evidence-based enquiry and action. Design thinking was also able to navigate the territory between the need for intervention "fidelity" versus "adaptation" and provide the operational know-how to face familiar implementation hurdles. Lastly, it brought a new kind of skill set to the public health stakeholders that incorporated diplomacy, multidisciplinary approaches and management sciences-skills that are considered necessary but not yet widely taught as part of public health training. CONCLUSIONS: Design thinking is a sound and viable tool to use as part of an implementation strategy for engaging with health system stakeholders and successfully translating evidence-based practices and new innovations into routine practice, thereby addressing an important knowledge-practice gap and, more broadly, contributing to the strategic repertoire available to implementation science.

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PURPOSE OF REVIEW: This narrative will focus on the adoption of design thinking to improve patient-centered care innovation in Orthopedics. RECENT FINDINGS: The literature reveals a complete set of applications of the design thinking approach in the different stages of the patient experience throughout the health context; however, the papers identified focus on specific parts of the process, and there is no systemic analysis about the different aspects involved in each stage of the complete experience. This review presents a holistic analysis concerning the application of design thinking to the distinct phases of innovation development in orthopedics, from the identification of the specific initial challenges up to the introduction of technology-based artifacts, such as innovations in the musculoskeletal health market. Systematic description of design thinking application to orthopedics, including concepts, methods, tools, and implementation examples in the most relevant phases of the patient experience-clinical treatment, perioperative care, and rehabilitation.

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PURPOSE OF REVIEW: This paper presents some approaches and techniques for translating an idea or research into clinical practice, considering the innovation development process. RECENT FINDINGS: Innovative tools have been a key solution for healthcare problems, such as musculoskeletal disorders, which represent a great economic burden and are among the leading causes of disability. There has been an increase in publications on this topic, but there has been no analysis of the process of innovation development. This review describes the innovation phases for translating an idea or research into clinical practice, considering the stages of discovering the opportunity, innovation creation, project specification, technology development, and innovation launch. An analysis of the innovation development process to translate an idea or research into clinical practice, including concepts, approaches, and techniques that shows the "why", "how", and "what" of innovation.

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BACKGROUND: Cancer care can negatively impact children's subjective well-being. In this research, well-being refers to patients' self-perception and encompasses their hospital and care delivery assessment. Playful strategies can stimulate treatment compliance and have been used to provide psychosocial support and health education; they can involve gamification, virtual reality, robotics, and healthcare environments. This study aims to identify how playfulness, whenever applicable, can be used as a strategy to improve the subjective well-being of pediatric cancer patients in the Brazilian Unified Health System. METHODS: Sixteen volunteers with experience in pediatric oncology participated in the study. They were physicians, psychologists, child life specialists, and design thinking professionals. They engaged in design thinking workshops to propose playful strategies to improve the well-being of pediatric cancer patients in the Brazilian Unified Health System. Data collection consisted of participatory observations. All activities were video recorded and analyzed through Thematic Analysis. The content generated by the volunteers was classified into two categories: impact of cancer care on children's self-perception and children's perceptions of the hospital and the care delivery. RESULTS: Volunteers developed strategies to help children deal with time at the hospital, hospital structure, and care delivery. Such strategies are not limited to using playfulness as a way of "having fun"; they privilege ludic interfaces, such as toys, to support psychosocial care and health education. They aim to address cancer and develop communication across families and staff in a humanized manner, educate families about the disease, and design children-friendly environments. Volunteers also generated strategies to help children cope with perceptions of death, pain, and their bodies. Such strategies aim to support understanding the meaning of life and death, comprehend pain beyond physicality, help re-signify cancer and children's changing bodies, and give patients active voices during the treatment. CONCLUSIONS: The paper proposes strategies that can improve the well-being of pediatric cancer patients in the Brazilian Unified Health System. Such strategies connect children's experiences as inpatients and outpatients and may inform the implementation of similar projects in other developing countries.

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Introdução: Segundo a Organização Mundial de Saúde, 35% da população brasileira possui algum tipo de alergia, e os principais tipos de alergia são as alergias alimentares. Estudos da Associação Brasileira de Alergia e Imunologia afirmam que entre 6% e 8% das crianças e entre 2 e 3% dos adultos têm alergias alimentares (AA) e dentre todas, a alergia à proteína do leite de vaca é a causa mais comum de alergia alimentar em crianças e adolescentes. Objetivo geral: Desenvolver tecnologias educacionais, com ênfase na produção de um E-book como ferramenta pedagógica para embasar o ensino à distância do cuidado seguro da criança com alergia à proteína do leite de vaca e demais alergias, para a formação profissional dos enfermeiros e profissionais de educação. Objetivos específicos: 1- Analisar as publicações nacionais e internacionais existentes sobre a gestão do cuidado seguro da criança alérgica à proteína do leite de vaca com risco de anafilaxia no ambiente extra-hospitalar. 2- Identificar o conhecimento dos graduandos de enfermagem sobre a gestão do cuidado seguro da criança com alergia. 3-Apresentar a elaboração e a aplicação de uma oficina para o ensino de acadêmicos de enfermagem, com a construção de um Plano de Ação. 4- Estruturar um curso na modalidade à distância para o ensino de todos os profissionais que atuam nas escolas. 5- Produzir e validar um E-book como material didático para o embasamento do curso na modalidade à distância. 6- Propor um Plano de Intervenção para o Cuidado Seguro na formação profissional dos enfermeiros e para os profissionais de educação. Método: Trata-se de uma pesquisa do tipo aplicada de natureza interventiva com desenvolvimento de tecnologias educacionais baseadas no método Design Thinking, ou seja, centradas no ser humano. A coleta de dados se deu durante uma oficina pedagógica, que foi estruturada com base na Metodologia da Problematização, onde foi aplicado um Pré e Pós-teste, utilizando um questionário semiestruturado, autoaplicável, composto por questões fechadas. Também foi elaborado pelos participantes um Plano de Ação abordando a temática referente à segurança da criança alérgica à proteína do leite no ambiente escolar. A partir desta oficina e de uma revisão prévia, estruturou-se um E-book como material didático do curso na modalidade à distância, que se pretende aplicar posteriormente a este estudo. O E-book foi validado por juízes especialistas através de um instrumento composto por vinte e dois itens, divididos em três blocos para avaliação da tecnologia educacional, adaptado da ferramenta proposta por TEIXEIRA (2011). Resultados: Participaram da oficina pedagógica 16 acadêmicos de enfermagem. Observou-se que 75% (12) referiram ter tido a escola como campo de estágio e 25,0% (4) disseram não ter passado ainda por uma escola no estágio curricular. Dentre os estudantes, 56,25% (9) disseram conhecer o Programa Saúde na Escola e 43,75% (7) não conhecem esta Política Pública. Quando indagados sobre se conseguiam correlacionar os conteúdos de segurança do paciente com o ambiente escolar, 62,5% (10) disseram que sim e 37,5% (6) afirmaram não conseguir. Entretanto, 100% (16) deles reconheceram que a criança com alergia ao leite de vaca está sujeita a riscos na escola. Conclusões: Constatou-se que o objetivo da oficina pedagógica foi cumprido. Foram construídos conhecimentos de forma coletiva, os participantes puderam sentir e visualizar a situação-problema apresentada, entendendo o papel e a importância de cada ator neste cenário. Discutiu-se como o enfermeiro pode atuar e ser o profissional de saúde responsável pelo planejamento das ações de gestão do cuidado da criança com alergia à proteína do leite de vaca e demais alergias, e agir na elaboração e na implementação de estratégias que possam propiciar um ambiente escolar com um mínimo aceitável de riscos às crianças. O uso da metodologia da Problematização em combinação com ferramentas de gestão se mostrou satisfatório e pode ser aplicado em diferentes contextos de cuidado em enfermagem. Sugere-se ampliar a oportunidade de se trabalhar conteúdos de segurança do paciente, em todas as disciplinas assistenciais do Currículo de Enfermagem, para que se aprenda a identificar os riscos, medir o dano, compreender as causas, identificar as soluções, avaliar o impacto e transpor a evidência em cuidados mais seguros. Como proposta de continuidade deste projeto, almeja-se a implementação de um curso na modalidade de ensino a distância com suporte do E-book Cuidado Seguro da criança com alergia alimentar no ambiente escolar, já validado por juízes especialistas.

Introduction: According to the World Health Organization, 35% of the Brazilian population has some type of allergy, and the main types of allergy are food allergies. Studies by the Brazilian Allergy and Immunology Association state that between 6% and 8% of children and between 2 and 3% of adults have food allergies (AA). And among all, cow's milk protein allergy is the most common cause of food allergy in children and adolescents. General objective: To develop educational technologies, with emphasis on the production of an Ebook as a pedagogical tool to support the distance education of the safe care of children with allergies to cow's milk protein and other allergies, for the professional training of nurses and education professionals. Specific objectives: 1- To analyze existing national and international publications on the management of safe care for children allergic to cow's milk protein at risk of anaphylaxis in the out-of-hospital environment. 2- Identify the knowledge of nursing students on the safe care management of children with allergies. 3-To present the elaboration and application of a workshop for teaching nursing students, with the construction of an Action Plan. 4- Structuring a distance learning course for the teaching of all professionals working in schools. 5- Produce and validate an Ebook as teaching material to support the distance learning course. 6- Propose an Intervention Plan for Safe Care in the professional training of nurses and for education professionals. Method: This is an applied research of an interventional nature with the development of educational technologies based on the Design Thinking method, that is, centered on the human being. Data collection took place during a pedagogical workshop, which was structured based on the Problematization Methodology, where a Pre and Post-test was applied, using a semi-structured, self-administered questionnaire, consisting of closed questions. Participants also drew up an Action Plan addressing the issue related to the safety of children allergic to milk protein in the school environment. From this workshop and from a previous review, an Ebook was structured as didactic material for the course in the distance mode, which is intended to be applied later to this study. The Ebook was validated by expert judges through an instrument composed of twenty-two items, divided into three blocks for the assessment of educational technology, adapted from the tool proposed by TEIXEIRA (2011).Results: 16 nursing students participated in the pedagogical workshop. It was observed that 75% (12) reported having had the school as an internship field and 25.0% (4) said they had not yet gone through a school in the curricular internship. Among the students, 56.25% (9) said they knew the PSE and 43.75% (7) did not know this Public Policy. When asked if they could correlate patient safety content with the school environment, 62.5% (10) said yes and 37.5% (6) said they could not. However, 100% (16) of them recognized that the child with a cow's milk allergy is subject to risks at school. Conclusions: It was found that the objective of the pedagogical workshop was fulfilled. Knowledge was built collectively, participants could feel and visualize the problem situation presented, understanding the role and importance of each actor in this scenario. It was discussed how the nurse can act and be the health professional responsible for planning the management actions of child care with allergies to cow's milk protein and other allergies, and act in the design and implementation of strategies that can provide a school environment with an acceptable minimum risks to children. The use of the problematization methodology in combination with management tools, proved to be satisfactory, and can be applied in different contexts of nursing care. It is suggested to expand the opportunity to work on patient safety content, in all the care disciplines of the Nursing Curriculum, so that one learns to identify the risks, measure the damage, understand the causes, identify the solutions, evaluate the impact and transpose the evidence into safer care. As a proposal for the continuity of this project, the aim is to implement a distance learning course supported by the Ebook Safe Care of children with food allergy in the school environment, already validated by expert judges.

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Se han utilizado aplicaciones móviles para promover el uso del condón que carecen de fundamento teórico y no consideran la opinión de los usuarios en su desarrollo por lo que han sido evaluadas negativamente. El objetivo fue desarrollar y evaluar una aplicación móvil para promover el uso correcto y consistente del condón en jóvenes mexicanos con riesgo de VIH, basado en enfoque de pensamiento de diseño centrado en el usuario. Utilizando metodología cualitativa se realizaron tres fases. En la primera fase, inspiración, se identificaron las necesidades de 9 jóvenes con respecto al uso del prototipo. En la segunda fase, ideación, se transformaron estas necesidades en soluciones y se validaron en 15 jóvenes. En la tercera fase, implementación, se realizó una prueba de usabilidad en otros 15 jóvenes. En conclusión, este enfoque ofreció una solución práctica para el desarrollo de un prototipo móvil para fomentar el uso de condón en jóvenes(AU)

Mobile applications have been used to promote the use of condoms, but those have no theoretical basis and do not consider the opinion of users in their development, which is why they have been evaluated negatively. The objective was to develop and evaluate a mobile application to promote the correct and consistent use of the condom in youth at risk of HIV, based on a user-centered design thinking approach. Using qualitative methodology, three phases were carried out. In the first phase, inspiration, the needs of 9 young people were identified with respect to the use of the prototype. In the second phase, ideation, these needs were transformed into solutions and validated in 15 youths. In the third phase, implementation, a usability test was conducted on other 15 youths. In conclusion, this approach offered a practical solution for the development of a mobile prototype to encourage the use of condoms in young people(AU)

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BACKGROUND: While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery. METHODS: The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management "toolkit" to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency-inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental "difference-in-differences" (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be "differenced out" when measuring the effect. DISCUSSION: This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response.Trial registration This trial has been registered in Clinical Trials (NCT03371914). Registered 13 December 2018.

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Introdução: A adoção de metodologias inovadoras para a formação docente em enfermagem é desafiadora, porém necessária. As estratégias pedagógicas utilizadas para a formação do enfermeiro docente devem ir ao encontro das demandas de saúde, as quais se encontram em constante transformação, constituindo-se esta uma tarefa complexa. Nesse sentido, o Design Thinking se apresenta como uma metodologia ativa inovadora a qual agrega na formação docente do enfermeiro, despertando-o para a empatia, trabalho colaborativo, criatividade e resolução de problemas inerentes a prática pedagógica. Objetivo: Analisar as contribuições do Design Thinking como metodologia ativa inovadora na formação docente em enfermagem. Método: Estudo de caso qualitativo, fundamentado na teoria sócio-interacionista de Lev Semionovich Vygotsky. Para a produção de dados optou-se pela condução de uma oficina pedagógica pautada nas fases do Design Thinking para Educadores. Participaram 15 docentes em formação, mestrandos e doutorandos de um Programa de Pós-Graduação em Enfermagem, de uma Universidade Pública situada em Curitiba Paraná. A oficina pedagógica foi estruturada em três etapas e sete atividades, com duração total de oito horas. Os dados foram áudio e vídeo gravados, respeitando-se os aspectos éticos. O projeto foi aprovado pelo Comitê de Ética em Pesquisa com seres humanos, sob o Parecer n°2.607.086. Introdução: A adoção de metodologias inovadoras para a formação docente em enfermagem é desafiadora, porém necessária. As estratégias pedagógicas utilizadas para a formação do enfermeiro docente devem ir ao encontro das demandas de saúde, as quais se encontram em constante transformação, constituindo-se esta uma tarefa complexa. Nesse sentido, o Design Thinking se apresenta como uma metodologia ativa inovadora a qual agrega na formação docente do enfermeiro, despertando-o para a empatia, trabalho colaborativo, criatividade e resolução de problemas inerentes a prática pedagógica. Objetivo: Analisar as contribuições do Design Thinking como metodologia ativa inovadora na formação docente em enfermagem. Método: Estudo de caso qualitativo, fundamentado na teoria sócio-interacionista de Lev Semionovich Vygotsky. Para a produção de dados optou-se pela condução de uma oficina pedagógica pautada nas fases do Design Thinking para Educadores. Participaram 15 docentes em formação, mestrandos e doutorandos de um Programa de Pós-Graduação em Enfermagem, de uma Universidade Pública situada em Curitiba Paraná. A oficina pedagógica foi estruturada em três etapas e sete atividades, com duração total de oito horas. Os dados foram áudio e vídeo gravados, respeitando-se os aspectos éticos. O projeto foi aprovado pelo Comitê de Ética em Pesquisa com seres humanos, sob o Parecer n°2.607.086. Resultados: A fim de atender aos preceitos do Design Thinking, a pesquisadora assumiu o papel de mediadora e designer thinker líder do projeto, ao passo que os participantes de designers thinkers. Na primeira etapa da oficina duas dinâmicas foram aplicadas com o intuito de aproximar os participantes aos conceitos de empatia e trabalho colaborativo; após, estabelecerem-se três grupos e o desafio estratégico Como podemos avaliar o aprendizado do aluno? foi exposto, o qual serviu como fio condutor para todas as etapas e atividades subseqüentes. Além disso, foram executadas estratégias de resgate a conhecimentos prévios, pesquisa exploratória e elaboração de mapas da empatia e personas. Na segunda etapa, as ideias mais viáveis, desejáveis e praticáveis foram delimitadas para que, então, fossem prototipadas. Na terceira etapa, os protótipos apresentados foram nomeados como Avaliação de Múltiplos Casos, Trajeção da Aprendizagem e Instrumento de Avaliação. Complementar ao processo, um instrumento de avaliação com perguntas abertas e fechadas foi aplicado a fim de se obter feedback acerca das estratégias e recursos utilizados. Conclusões: Sob a perspectiva do referencial teórico, o Design Thinking mostrou-se como uma metodologia ativa a qual se vale de diversos elementos mediadores que atuam na Zona de Desenvolvimento Proximal dos participantes, a exemplo o mapa da empatia e a persona. Por meio do trabalho colaborativo e interação social, propiciou a formação docente, bem como instigou a criatividade ao prever a elaboração de protótipos. O Design Thinking contribuiu para a formação docente dos participantes à medida que o tema avaliação da aprendizagem foi problematizado, houve partilha de conhecimentos, experiências e busca coletiva para a resolução de um problema de forma inovadora e criativa.

Introduction: The adoption of innovative methodologies for teacher training in nursing is a challenge and also a necessity. Pedagogical strategies used for the formation of the nurse faculty must meet the demands of health, which are in constant transformation, being this a complex task. In this sense, the Design Thinking is an active innovative methodology which aggregates on teacher training of nurses, awakening empathy, collaborative work, creativity and solving problems inherent in pedagogical practice. Goal: Analyze the contributions of Design Thinking as active innovative methodology in teacher education in nursing. Method: Qualitative, case study, based on the theory of interactionist partner Lev Semionovich Vygotsky. For the production of data, we opted for conducting an educational workshop based on the stages of Design Thinking for educators. 15 teachers participated in training, Master students and doctoral candidates of a graduate degree program in nursing, a Public University located in Curitiba Paraná. The pedagogical workshop was structured in three phases and seven activities, with total duration of 8 hours. The data were recorded audio and video, in conformity with the ethical aspects. The project was approved by the Committee of ethics in research with human beings, under the opinion n°2.607.086. Results: In order to meet the requirements of the Design Thinking, the researcher assumed the role of mediator and designer thinker project leader, whereas participants of designers thinkers. In the first step of two dynamic workshop were applied with the aim of bringing the participants to the concepts of empathy and collaborative work; After setting three groups and the strategic challenge "How do we assess student learning?" Was exposed, which served as the guiding principle for all the steps and subsequent activities. In addition, rescue strategies have been implemented to previous knowledge, exploratory research and elaboration of maps of empathy and personas. In the second step, the most viable, desirable and feasible were defined for that, so they were prototype. In the third step, the prototypes presented were named as "Multiple assessment Cases", "Trajeção" and "learning assessment tool". Complementary to the process, an assessment tool with open and closed questions was applied in order to obtain feedback about strategies and resources used. Conclusions: From the perspective of the theoretical, Design Thinking showed up as an active methodology which is worth of various elements mediators working in the zone of Proximal Development of participants, for example the map of empathy and persona. Through the collaborative work and social interaction, provides teacher training, as well as encourages creativity by providing for the development of prototypes. The Design Thinking contributed to the teacher training of the participants as the theme "assessment of learning" was problematic, there was sharing of knowledge, experiences and collective search for solving a problem in a creative and innovative way.

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O Design Thinking tem sido aplicado como uma nova abordagem de resolução de problemas adequada aos desafios das organizações, ao incentivo à inovação e ao crescimento, pois os seus mecanismos específicos melhoram o resultado organizacional. O objetivo geral do artigo é apresentar as ferramentas do Design Thinking para a inovação em modelo de negócio. Para tanto, metodologicamente, a pesquisa caracteriza-se como qualitativa, exploratória, descritiva e bibliográfica. O artigo está estruturado da seguinte maneira: primeiramente são abordados os temas Criatividade, Inovação, Design Thinking e Modelo de Negócio. No quarto item é descrita a metodologia utilizada na pesquisa seguido da análise dos dados e, finalmente, as considerações finais do estudo. Pode-se concluir que a maior recompensa em adotar uma abordagem de Design Thinking não é somente identificar uma solução,mas no caso da inovação prever e implementar as novas possibilidades descobertas

The Design Thinking has been applied as a new methodology for solving problems appropriate to the challenges of organizations, encouraging innovation and growth, as their specific organizational mechanisms improve the results. The overall objective of this article is to present the tools of design thinking for innovation in the business model. For that, methodologically, the research is characterized as qualitative, exploratory, descriptive and bibliographical. The paper is structured as follows: first examines the Creativity, Innovation, Design Thinking and Business Model themes. In the fourth item is described the methodology used in the survey followed by data analysis and finally the concluding remarks of the study. It can be concluded that the greatest reward in adopting an approach Design Thinking is not only to identify a solution, but in the case of innovation to provide and implement new discoveries possibilities

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O Design Thinking tem sido aplicado como uma nova abordagem de resolução de problemas adequada aos desafios das organizações, ao incentivo à inovação e ao crescimento, pois os seus mecanismos específicos melhoram o resultado organizacional. O objetivo geral do artigo é apresentar as ferramentas do Design Thinking para a inovação em modelo de negócio. Para tanto, metodologicamente, a pesquisa caracteriza-se como qualitativa, exploratória, descritiva e bibliográfica. O artigo está estruturado da seguinte maneira: primeiramente são abordados os temas Criatividade, Inovação, Design Thinking e Modelo de Negócio. No quarto item é descrita a metodologia utilizada na pesquisa seguido da análise dos dados e, finalmente, as considerações finais do estudo. Pode-se concluir que a maior recompensa em adotar uma abordagem de Design Thinking não é somente identificar uma solução,mas no caso da inovação prever e implementar as novas possibilidades descobertas (AU)

The Design Thinking has been applied as a new methodology for solving problems appropriate to the challenges of organizations, encouraging innovation and growth, as their specific organizational mechanisms improve the results. The overall objective of this article is to present the tools of design thinking for innovation in the business model. For that, methodologically, the research is characterized as qualitative, exploratory, descriptive and bibliographical. The paper is structured as follows: first examines the Creativity, Innovation, Design Thinking and Business Model themes. In the fourth item is described the methodology used in the survey followed by data analysis and finally the concluding remarks of the study. It can be concluded that the greatest reward in adopting an approach Design Thinking is not only to identify a solution, but in the case of innovation to provide and implement new discoveries possibilities (AU)

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Atopic dermatitis (AD) is the most prevalent dermatological disease in the pediatric population. It is a chronic, pruritic, and inflammatory skin disorder, with a complex etiology involving genetic predisposition, skin barrier defects, and immune dysfunction. AD can be a challenge for patients, physicians, and caregivers and has a clear impact in patients' quality of life (QoL). Educational programs for patients with AD and their caregivers are effective in improving adherence, QoL, and clinical outcomes. Different models of educational programs exist and their structures depend on cultural, social, and economic factors. To improve existing programs, the educational team should go beyond the disease and have a broader view of the many aspects involved in the pathological process. These include psychological, environmental, social, financial, and cultural aspects. Patients and their caregivers should have a more realistic expectation about the treatment. Innovative methods and approaches like design thinking can create new and effective solutions for patients with AD and their caregivers.