Incorporating practitioner knowledge to test and improve a new conceptual framework for healthy urban design and planning

Figures & data

Figure 1. THRIVES framework (Towards Healthy Urbanism: InclusiVe Equitable Sustainable).

Table 1. Count of professions represented at the workshop.

Profession and employment	Count of options represented*		Count of participants by option
Profession(s)	Sub-total	Total	No.	%
Built Environment	-	19	12	60%
Planning	8		-	-
Architecture	3		-	-
Urban design	3		-	-
Other (not specified)	3		-	-
Landscape architect	1		-	-
Access consultant	1		-	-
Public health	8	8	7	35%
Built environment and publichealth	-	-	1	5%
Employment organisation(s)
Public sector	-	10	-	-
Local government	5		-	-
National government	2		-	-
Other public sector	3		-	-
Private sector	-	5	-	-
University	-	4	-	-
Self-employed	-	4	-	-
Charity	-	1	-	-
Unemployed	-	1	-	-

Note that the count of professions represented is the number of times each profession/employment organisation was selected by participants. Participants were able to select multiple answers. No.: Number.

Table 2. Participant demographics.

Characteristic		Count/proportion of participants by option
		No.	%
Years of experience in the profession	Less than 5 years	2	10%
	5 to 10 years	3	15%
	10–15 years	1	5%
	More than 15 years	14	70%
Age	20–30	2	10%
	31–40	2	10%
	41–50	3	15%
	51–60	7	35%
	Over 60	6	30%
Gender	Female	9	45%
	Male	11	55%

Other options included ‘other’ and ‘prefer not to say’ and these were not chosen.

Table 3. Participatory workshop agenda.

Time	Activity	Lead
13:30	Arrival, Lunch and Networking	N/A
14.00	Welcome and Introductions	DC staff
14.10	Overview – Healthy Urban Design and Planning Framework	Helen Pineo
14.20	Q&A
14:30	Group exercise 1: ‘Thinking-aloud’ Testing Working in pairs (20 mins), Working in groups (20 mins), Giving summary of feedback to the room (20 mins)	DC staff
15.30	Break	N/A
15:40	Group Exercise 2: ‘Rose, Thorn, Bud’ Working individually (10 mins), Working in groups to cluster & theme (20 mins), Giving summary of feedback to the room (15 mins)	DC staff
16:25	Workshop summary & Next steps	Helen Pineo
16:30	Close	DC staff

DC: Design Council.

Figure 2. Preliminary healthy urban design and planning framework.

*Community services denotes employment, education, cultural, retail, leisure, healthcare and other facilities.

Table 4. Representative examples of critical and positive design-related feedback received on post-it notes.

Theme	Examples of critical feedback	Examples of positive feedback
Familiarity	‘Looks very similar to others [which] detracts from [its] value’	‘Looks like familiar model so easy to look at’
	‘How will it help me? – looks obvious; – not stimulating’	‘Looks like existing frameworks, not new, familiar to public health’
Central theme	‘Inside out? Planetary health should be the biggest rather than the core’	‘Equitable, sustainable and inclusive are good core principles’
	‘The order should be human health in the middle’	‘Planetary health at core [is positive]’
	‘Association with other models makes the eyes want it to be the inverse’	‘Good to have equitable at the centre to compared to traditional model i.e. individual at the centre’
Inter-connections and logic	‘Would a mind map be more helpful – arrows?’	‘Recognition of multiple scales and their interaction’
	‘Develop logic and coherence – hierarchy, arrows’	‘Demonstrates inter linkages in a holistic way, whole system way’.
	‘Difficult to understand the hierarchies’	‘Looks like a lot of info at first but clear when you go through it’
	‘Missing the complexity’	‘Feels like a good high-level framework’
	‘Restrictive’	‘Complex, captures many relevant issues and make sense, intuitively’
Design	‘Do not use block caps’	‘Good colour coding’
	‘Blue too [National Health Service]’	‘Circular is good’
	‘Visual is difficult for non-health community’	‘Multiple layers is good – planetary to human’
	‘Not pictorial therefore not immediate engagement without instructions’	‘It makes sense’
	‘Mixture of graphical information (dotted lines and arrows, gradation of colour) what is the hierarchy of information’

Table 5. Representative examples of critical and positive feedback about scales of health impact received via post-it notes.

Critical feedback	Positive feedback
‘Some points in the eco system also have impact on human health’	‘Embracing all scales, and encouraging us to consider global to local’
‘Planetary health should be the outer ring – the order is arbitrary’	‘It makes comprehensive connections across scales’
‘Don’t understand first two levels of human health’	‘Brings together human, eco, planetary health and tries to link it to levels of action and influence’

Figure 3. Participants doing the ‘Thinking-aloud’ exercise.

Figure 4. Participants finding themes in the ‘Rose, Thorn, Bud’ exercise.

Table 6. Representative examples of critical and positive feedback about implementing the Framework grouped by themes.

Theme	Critical feedback	Positive feedback
Immediate route to application	‘Does not generate solutions’	‘Could help or inform future local plans’
	‘Doesn’t suggest avenues to explore i.e. actions’	‘Scale is relevant to practice. Health connects people together’
	‘Factors related to decision making could be added’	‘Could really support population and human health chapter in EIA’
	‘Needs more consideration of politics and politicians (N)’	‘Connecting this to value and benefits makes it practical’
	‘Everywhere is different’	‘Useful framework for HIA’
Tools	‘What are the indicators? How to measure outcomes?’	‘Could be a great tool for achieving inter/trans disciplinary action and communication, focused on an issue’
	‘Needs to connect to tools and measures’	‘This process helps by: allowing us to describe our proposals against useful goals’
	‘Needs a chart that connects it with reality’
Stakeholder collaboration	‘Needs buy in from multiple organisations, challenging’	‘The integrated approach to health has potential to break down professional barriers’
	‘Language important for shared understanding’	‘Has the potential to be used by a wide range of actors in built environment’
	‘Silo working how to identify and capture right groups to engage’	‘Could connect different disciplines’

Table 7. Paraphrased participant feedback about the Framework design and summary of changes between preliminary and current versions.

Paraphrased participant feedback	Summary of changes to the preliminary Framework
Overall design needs improvement (colours, interconnections across scales and design/planning goals, avoiding capital letters, meaning of lines).	Procured professional graphic designer to support improvements to the visual diagram.
Needs to differentiate scales of decision-making from health impact scales.	Inserted new scales that are associated with urban built environment decision-making.
Lack of clarity about comprehensiveness of design and planning goals and association with each scale of health impact.	Used design and narrative description to indicate that design and planning goals are examples at each scale.
Inconsistency in design and planning goals with inclusion of outcomes (physical activity) and built environment components (water infrastructure).	Changed words to create consistency across terms.
Opportunity to clarify the purpose of the Framework and integrate wider sense of social value and thriving	Changed name from ‘healthy urban design and planning framework’ to THRIVES – Towards Healthy uRbanism: InclusiVe Equitable Sustainable.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, HP.