Table 3 Co-design Process

Initial scoping of project

1–6/2016

Held several meetings to build a relationship between the university team and Poutiri. We also identified shared goals and what work had been done in the community previously and needs for further information. Poutiri identified the importance of sustainability for any new intervention.

Developed HPW Implementation Framework [28]

2–9/2016

Reviewed the international literature and shared framework with stakeholders for feedback.

Created causal loop model

6–12/2016

Created a causal loop model of factors for prediabetes and diabetes following soft systems logic using stakeholder interviews; Prediabetes was the primary disease of interest initially.

Conducted patient interviews

6–12/2016

Poutiri conducted interviews of their own patients with pre-diabetes and diabetes to better understand facilitators and barriers to care [46].

Meetings with key Poutiri stakeholders

3–6/2017

Met with Poutiri Board of Trustees, Poutiri’s network or providers and the District Health Board to share findings from the previous year’s work and to further scope intervention and identify additional stakeholders.

Initial co-design meetings

7–8/2017

Held several co-design meetings following a design thinking framework to determine target audience, craft potential interventions and identify partners. Information from systems map and patient interviews was shared and integrated into interventions ideas. Stakeholders including representatives from two primary health organisations (PHO), a public health organisation, and Poutiri’s network of providers.

Advanced co-design meetings

8/2017–3/2018

Determined the key target population for these stakeholders should be Māori men because there were no existing contracts that targeted men; focus on pre-diabetes and related conditions particularly related to weight. We honed in on gang members and their whānau because they represented a group underutilising health services and were a group several stakeholder organisations wanted to reach. We held co-design meetings with men and their whānau led by Poutiri. Other key stakeholders were a social service organisation for gang members, a PHO, and a provider in Poutiri’s network.

Launch intervention

5/2018

Held a health fair and began recruitment for a lifestyle intervention with integrated care (i.e., nurse to triage health issues and refer to needed services; community health worker to provide lifestyle intervention and be a navigator; social services; activities for community health improvement all through a single place of contact). Unfortunately, it never gained traction. The PHO had originally committed 1 day a week of nurse’s time along with co-delivering the lifestyle intervention and collecting data from a different community as a comparison group. Unfortunately, they had to withdraw their full support, and re-commit their resources to more pressing priorities due to losing a significant proportion of their primary health practices and patients to another PHO. Additionally, the social service provider had internal governance challenges that required immediate attention, which meant they could no longer support the intervention in terms of co-delivery and access to the target population.

Re-design intervention for 1st cohort

8–9/2018

With an emphasis on research team flexibility to address changing conditions, we focussed on re-designing the intervention with Poutiri as the only community stakeholder. Community members had some input into a lifestyle intervention for men and their whānau. The focus became solely on the lifestyle intervention rather than integrated care due to time constraints. The cohort focused on physical activity with some nutritional information.

Implement intervention

9–12/2018

Intervention was implemented with the first cohort.

Re-design intervention for 2nd cohort

1–3/2019

The first cohort had a limited number of men so we redesigned the intervention with direct input from the target audience. The result was an individually-tailored intervention to allow for flexibility for full-time working men.

Implement intervention

3–6/2019

Intervention was implemented with the second cohort.