Deconstructing design thinking as a tool for the implementation of a population health initiative.

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.

Visual dream content, graphical representation and EEG alpha activity in congenitally blind subjects.

It is currently claimed that congenitally blind do not have visual imagery and are therefore unable to present visual contents in their dreams. The aim of our study was to quantitatively evaluate the existence of visual imagery in born-blind dreams and to correlate it with objective measures, such as sleep EEG frequency components, namely with alpha attenuation (regarded as an indicator of visual activity), and graphical analysis of dream pictorial representations. The investigation was carried out via simultaneous recordings of dream reports and polysomnography, during nocturnal sleep at volunteers' homes; scheduled regular awakenings during the night provided the data for dream and EEG analysis. In the morning, subjects were asked to make a drawing of their dream images. Congenitally blind (n=10) were comparable to normal sighted subjects (n=9): the two groups presented equivalent visual activity indices, and no differences in the analysis of graphical representation of dreaming imagery. However, blind subjects presented a lower rate of dream recall than sighted (27% versus 42%). Both groups had significant negative correlation between Visual Activity Index (VAI) and alpha power in the central and occipital O2 derivations (blind: C4: r=-0.615, P<0.005; O2: r=-0.608, P<0.006; sighted: C4: r=-0.633, P<0.01; O2: r=-0.506, P<0.05). This correlation was weaker for the blind in O1 (r=-0.573, P<0.05) and non-existent for the sighted. Blind individuals have significantly lower alpha activity in the central derivation. In conclusion, the congenitally blind have visual content in their dreams and are able to draw it and, as expected, their VAI is negatively correlated with EEG alpha power.