Table 2 Stakeholder influence on catalyst film construction

Are there lessons from other teams creating catalyst films, or using EBCD, that can inform our own team process?

All project team members were invited to identify key informants to fully inform our process

Key informant input influenced our team to:

Three informant groups were identified; one by a consumer advisor and two by the PIs

Prioritize emotional salience over strictly adhering to representation in order to maximize the ability to act on the information shared

All team members were invited to attend key informant interviews; PIs, research staff and consumer advisors were represented at every meeting

Highlight positive as well as negative experiences

Include footage discussing experiences with depression in general, not just with health care

How do we envision these films will be used in the United States?

All team members were invited to share insights and those with extensive experience in quality improvement (QI) in the United States shared observed barriers to patient participant involvement (PPI) generally

Clinician and PI experience drove the decision to “market” films for use broadly in QI and education in the US through description in a generalized guidebook, with a goal of maximizing uptake and spread

Clinicians (in focus groups) and patient experience ambassadors (in interviews) were asked about their expectations for film usage

One consumer advisor was strongly opposed to this decision to not describe films as solely a product for Accelerated Experience Based Co-Design (AEBCD)

Entire project team agreed with key informants who stressed that balance is important: “films can be most effective if they focus not just on experiences with services, but on what it is like to live with the particular illness or condition focused on in the project”

How should film design differ from UK films?

Team members, clinician focus groups and patient experience ambassadors viewed excerpts of a UK catalyst film and were asked about content and length for use in QI in the United States

Stakeholders agreed to two adaptations”

US context requires shorter films

Actors should not be used in films

Do we have sufficient actionable clips in existing and newly obtained footage?

PI/clinician and clinician re-coded transcripts for actionable material and then shared results with the whole team

Team included segments from re-coded original transcripts after extensive and iterative deliberation. We also noted specific limitations in existing footage, and made collective decision to include actionable footage from new interviews with patient experience ambassadors

In a parallel process, research staff was re-interviewing patient experience ambassadors to inform use of film, and identified that interviews included additional actionable insights

Which clips should make the final cut, and in what order should they be presented?

Multiple rounds of individual team member review and group discussions

Key informants stressed that it is critical that content balance positive and negative, leading with the former if possible so that the film is “modeling good care, so those watching will know if they are not living up to that example”

Input from key informants about balancing emotional range of content

Patient experience ambassadors’ stressed that films should contain a message of “hope and change” to convey that young adults have expectations from their care teams and desire engagement

Input from patient experience ambassadors about emphasizing “hope and change” in the films

What should these films be called?

Identified that name “trigger film” used in the UK would not be appropriate for the US context, brainstormed other possible names, brought question to key informants

Decided on “catalyst film,” as these films are designed to rally viewers to action for improvement

How do we ensure ample representation while prioritizing the ability to act on the information shared?

Team reviewed multiple drafts of the film and identified missing experiences (e.g. LGBTQI and BIPOC representation)

Team agreed to review additional transcripts and clips to ensure representation without sacrificing the ability to act on the information shared

PIs asked advisor/ambassador if she would consider being re-interviewed for additional on-camera BIPOC representation

Advisor/ambassador agreed to be re-interviewed

How do we respond to the reality that many BIPOC participants elect to remain anonymous?

Team discussed options to expand non-anonymous clips and how to message about use of silhouettes

Advisor/ambassador agreed to have new footage used

PI asked advisor/ambassador if they would be willing to be re-interviewed on camera

PIs agreed to find additional actionable clips of BIPOC participants

Team discussed how best to visually represent participants who wished to remain anonymous

Team determined they did not want to use actors and discussed other options including mirroring choices made by participants on the HealthexperiencesUSA website (e.g. flowers, silhouettes) and agreed on the use of distinct and humanized silhouettes

Team ultimately decided that statement about use of silhouettes would not elaborate on identity or reasons for decision to remain anonymous