Developing a user-centred approach to improving community health and wellbeing
Working with the Lambeth Portuguese Health and Wellbeing Partnership, Unboxed supported 15 organisations to scope a new model for reducing health inequalities in the Portuguese-speaking community in Lambeth.
What we did
User research
Workshops
Community engagement
Discovery
Stakeholder engagement
Coaching and upskilling
6
week discovery phase
15
individual user interviews
The Challenge
The London Borough of Lambeth is a very diverse community, with an estimated 1 in 6 residents speaking Portuguese as their native language. A report from healthcare leaders in Lambeth identified the Portuguese-speaking community as being at risk of health and social inequalities.
Through targeted community engagement and coaching, Unboxed supported local organisations to develop their vision for a ‘Household Model’ of care, understand the needs of the target population and identify key themes for potential interventions.
Background
Since 2015, a small project team of healthcare professionals, education experts and Portuguese charities, led by Lambeth GP Dr. Vikesh Sharma, has been developing a Household Model of care to reduce healthcare inequalities across the borough.
Made up of 40+ individuals, local groups and community-led organisations, the Lambeth Portuguese Wellbeing Partnership (LPWP) combines knowledge, passion, resources and skills for improving the health and wellbeing of the Portuguese-speaking community across Lambeth.
The Household Model is a multi-perspective model of support for both individuals and families. Community engagement is central to this work, both in terms of understanding household and individual needs, and of strengthening the capacity of the LPWP to deliver support at scale.
“The household model starts with a referral from a GP or other service. We then visit that person and engage with their household. We start with casual conversations to help people think about what might work for them, and help us learn about their needs. Everything starts with this conversation. It allows us to brainstorm ideas as a team and come up with creative but structured ways to meet needs. For example, if there are language needs, we might create a talent show where we support people to participate in English. It’s fun and it’s social - this aspect of ‘convĩvio’ or coming together is central to the model.” - Nadia Antonio, Project Manager
25,000+
Portuguese-speaking people in Lambeth
19
household interviews
Our approach
Unboxed took a community-based approach to developing the vision for the Household Model. We started by engaging with the community organisations involved in LPWP to understand their needs, strengths and relationships, then moved into primary research with individuals and households in the Portuguese-speaking community (a ‘household’ might not be people living under the same roof, but they are people within a connected, co-dependent group). Finally, we came together as a group to synthesise what we’d learnt.
We were lucky to be working with an established collective of individuals and organisations with a passion for improving health outcomes for their community. Part of our task was to help equip them with the user-centred tools and methodology that would enable them to deliver change. Through a series of workshops and pair-working with our researchers, we supported LPWP to develop skills in communication, user research, storytelling and needs-based planning for community action.
“We’re taking a first step in tackling healthcare inequalities within Lambeth’s Portuguese-speaking community. We’re engaging those families who really need support from the community, but don’t know where to currently find it.” – Dawn Turner, User Researcher, Unboxed
Shared communication
As an agency, we often need local partners who can help us build trust and establish the relationships that enable people to fully engage in research and codesign. We already had the advantage of working with the organisations involved in LPWP. But many were volunteers with other jobs, working in evenings and weekends. We needed to establish clear communication channels for our team (the 15+ organisations of LPWP and the Unboxed design and research team).
We set up a WhatsApp group for the whole team to enable flexible and open communication. We organised ourselves into 3 smaller research teams, each with a researcher, an observer and a notetaker. This allowed members who were less confident in user research to pair with someone more experienced and ‘learn by doing’ (one of our Unboxed core values).
These teams carried out interviews with individuals and households to understand their needs in terms of accessing care for their physical and mental health. Many of these interviews were conducted in Portuguese, with information sheets and consent forms translated for participants.
Building skills in user research
The LPWP network brought a huge range of skills, perspectives and crucial relationships within the community. Yet some were less confident in user research and were new to user-centred design. It was important to develop a collective and consistent approach to research so that we could build a coherent picture of the needs of the community.
Through a series of collaborative workshops, we trained the research teams in interview techniques and agreed approaches to safety and risk management. For example, we agreed that a minimum of two people would attend research interviews. If one person couldn’t attend, the remaining researcher would reschedule the interview. This was not just to protect the researcher but to ensure the participant (an individual or household) felt safe and comfortable.
We used exercises to trial interview techniques like asking open questions, active listening and observing non-verbal cues.
From past experience in healthcare, we’ve learnt that people in frontline services can find user research quite challenging. Someone has come to them for help and the care provider usually wants to solve the problem as it is presented to them - indeed, it may be their job to do so. We needed to get them to stay in the problem space for a bit longer - asking questions to uncover insights ‘around’ the problem and get deeper into the underlying needs, rather than offering help as a first response.
One way to manage this was to have members of the partnership introduce their ‘clients’ (individuals who were already known to them) as research participants, but ask another member of the team to carry out the interview. This also helped mitigate the risk of members leaving out certain research questions because they had discussed them in past interactions with the individual.
Using the experience of the LPWP partners, we established processes around recruitment, information and engagement of participants. We agreed that we would start by engaging individuals within a household rather than approaching a whole household directly. This would allow us to start with people who were already known to members of the LPWP, understand their needs and then identify households that we could learn the most from. The individuals we’d already engaged with could support us to recruit households in a more organic way (coming from the community rather than from an outside agency).
Participants were able to choose an interview location. It was vital that participants felt safe and able to speak freely. Some preferred that we held interviews in a public space, like a cafe, rather than in their home.
Storytelling
It was important to the whole team that the voices of the community were central to the vision for the Household Model. We encouraged openness and transparency throughout the project, creating opportunities for everyone to share updates through our WhatsApp groups and collaborative sessions to share what we’d learnt and plan next steps.
We used project ‘retros’ (retrospective sessions) to discuss what was working well and not so well. This was new to some members of the team but provided a safe space for reflection and collectively discussing how to move forward.
We encouraged the team to tell stories of their own experience of the project as well as those of research participants. For example, we set up an ‘insights gallery’, inviting each team to present their insights to the group. This was a hugely valuable opportunity for the team to share their passion for their community. They had so much empathy for the families they worked with and this came across in their storytelling.
This kind of reflection is an important part of community codesign - enabling the team to bring their skills and experiences to the work in a way that feels comfortable and that enables us all to learn from each other.
Needs based planning
Our research approach was designed to be iterative. We started by understanding individual needs and the needs of the team, before moving into the second phase. As well as user interviews, we carried out desk research into existing community-based models of care.
This meant we could ‘validate’ the problem - checking that we were solving the right problem by researching with the people who are most affected by it - before scaling up engagement to households and family groups.
This adaptive approach is important to user-centred, community codesign. We need to understand what the team can bring to the process as well as understanding the needs we want to address. Throughout the whole process we were supporting the members of LPWP to learn new skills that would grow their capacity to deliver change.
Synthesis is one example. This is a process of bringing all of our insights together and deciding, collectively, what actions to take as a result of what we’ve learnt. Synthesis can be done in many ways. We used personas and journey mapping as part of our process - representations of participant experiences that would prompt discussion and help align our thinking. We also used community team meetings to review insights as a team and set out 13 key themes that we wanted to address through the Household Model.
Early identified themes included domestic violence, social housing, long-term illness and alcohol addiction. From these, we identified ‘positive opportunities’. These were opportunities where households were taking some positive actions, for example, towards engaging in healthcare services.
What we learnt
In just 6 weeks, we learnt a great deal from working alongside the people involved in LPWP.
We can learn more by empowering others
Being able to trust the wider team to go out and gather insights was very important. We’re used to doing the research so it can feel a bit uncomfortable to hand it over. But we know discomfort is a route to learning! We already had the advantage of some existing relationships with many of the families, but by speaking in Portuguese they were more able to express their feelings about their situations. This meant other members of the team needed to lead the interviews.
Preparation makes for better research
We prepared discussion guides and took part in some interviews, but when they were conducted entirely in Portuguese we had to support the team to go out and learn on the job. Having an agreed research process and trialling out interview skills in advance help build their confidence.
The translation and interpretation of research took longer but it meant we captured much deeper insights and gave ownership of the process to the wider team. The experience opened us up to new and different perspectives on how to research with different communities.
The outcome
Through this process of community engagement, we were able to validate the ‘Household Model’ concept of holistic care with the community, with a shared vision and alignment around prioritised opportunities. This allowed LPWP to further explore and test the model. Working with households, they were able to prototype early intervention concepts and run pilot experiments. The results of these would inform further development of this innovative model of community-based care.
An important secondary outcome is that the people and organisations involved in the LPWP have the skills and confidence to use user-centred approaches to turn their passion into action to reduce health inequalities in the community they care so much about.
“Our aim is always to work with the household, not just an individual. It’s not a static process, we’re always led by what the household needs.” - Felicia Luvumba, Wellbeing Team Member
Beyond the project
The team at LPWP moved into a design phase and then prototyped the model across 3 areas: household, community and partnerships. They found that the household element worked very well with the majority of the Portuguese-speaking community.
“It was fun to create the prototype. If it fails, we move on. Having that conversation with people to see what works for them is really important - we get rid of any power dynamic where we’re telling them what to do. This early conversation builds trust and helps people feel comfortable to participate. All of the tools we create come from these conversations - it’s a very creative process.” - Nadia Antonio, Project Manager
They’re now working with around 35 households within Lambeth, and would like to engage more with different parts of the community. The Portuguese diaspora is diverse and LPWP found that households from the African diaspora were less engaged. This is why prototyping is so useful - they were able to test the approach and can now adapt it to the very specific needs of different parts of the community.
They’ve also found opportunities to improve the partnerships element of the model.
“Partnerships are important to help deliver the services that we can’t deliver ourselves, such as domestic violence support. Some of these work very well, like our signposting to Stockwell Partnership for welfare support. Others need more development. We want to ensure that we can meet the full range of household needs, and partnerships are a key part of that.” - Nadia Antonio, Project Manager
Discover how user-centred design and collaborative engagement can create impactful change. Contact us to explore how Unboxed can help your organisation tackle inequalities and empower communities through innovative approaches.