Background:
The HIV outpatient clinic of Amsterdam University Medical Centers (AUMC)is implementing digital patient-reported outcomes measures (PROMS) in routine care to improve the quality of life (QoL) for people living with HIV (PWH). We were asked to design tools to promote the participation of patient groups from Ghana and Nigeria.

Methods:
Two sets of methodologies were used: qualitative research methods informed the development of a ‘patient journey’ and design-thinking methodologies informed the tool development. Participant observation and in-depth semi-structured interviews were conducted to gain insights into patient- and system-related characteristics. Design-thinking methodologies facilitated the transformation of qualitative data into insights that drove design concepts. Three ideation methodologies were used to create four concepts, leading to the final concept.

Results:
Observations of 17 individual consultations (6 female, 11 male) at the HIV outpatient clinic resulted in six recurring themes. These themes were: Personal relationship; Disclosure; Impact of the diagnosis; Health literacy & Health involvement; Communication; No-shows. The observations and additional literature research informed the development of an interview guide. Seven interviews (5 female, 2 male) were conducted with participants from Ghana and Nigeria. The observations and interviews informed the patient journey (PJ). The PJ showed that patients experience stress and anxiety prior to and during their hospital visit but fully trust doctors and nurses. Based on the insights the design challenge was addressed, leading to the following concepts: “Peer support community”; “Wellbeing Diary”; “Waiting Room Inspiration”; “Hospital Roadmap”.

Conclusions:
Amsterdam UMC will adopt the “Wellbeing Diary” which embodies the following characteristics: independence from relying on other organisations or infrastructure for implementation; a visual design that can be used independent of literacy level; and its affordability. The paper diary will provide a low-threshold tool for people to record PROMs-like experiences that will prepare them for their consultations at the outpatient clinic.