Table 3 Cross-cutting themes that emerged from the persona scenario groups

Team use of information

The collection of information and generation of reports sent to the clinical team including:

- flagged information

- how information is distilled into a report

- how report is received and initially assessed

- follow up upon including referrals

Interprofessional Primary Care Team

Technology

Role clarity

Defined tasks performed by clinicians, volunteers, and community members including:

- specific new roles (e.g., volunteer coordinator and TAPESTRY champion)

- general interactions between volunteers, patients and their families

- expectations given during volunteer training.

Interprofessional Primary Care Team

Volunteers

Community Services

Patients

Logistics

Program information about:

- managing team coordination

- volunteer matching

- scheduling home visits

- ensuring feasibility of IT components

Interprofessional Primary Care Team

Volunteers

Technology

Patients

Privacy and Confidentiality

Related to:

- communicating and information sharing in a safe and protected way, between all actors (facilitated with technology)

- building trust

- gaining consent from patients

- ensuring data accuracy and accessibility agreements.

Volunteers

Community Services

Technology

Patients

Using the personal health record

Related to the use of the PHR:

- by patients, with or without the assistance of volunteers

- the volunteer to facilitate communication

- the team to monitor patients

Technology

Patients

Communication

Relaying information:

- between patients (via the volunteer) and the clinic

- considering how the team and volunteers would communicate their experiences

Volunteers

Technology

Patients

Enrollment and publicity

Recruitment and enrollment of clinical teams and individual patients in Health TAPESTRY including:

- the overall communication plan

- public face (TAPESTRY marketing campaign)

Interprofessional Primary Care Team

Volunteers

Patients

Connection

Coordination of care to patients including:

- within the clinic

- out to the community

- facilitated by system navigation

Interprofessional Primary Care Team

Community Services

Patients

Technology