ABSTRACT:
Translating evidence-based interventions for non-communicable chronic diseases into routine Primary Health Care (PHC) remains a challenge complex health systems. The CARDIO initiative was designed to strengthen prevention and care for chronic conditions, particularly hypertension, diabetes, obesity, and hypercholesterolemia, within Brazil’s Unified Health System, addressing the gap evidence and practice. Design thinking was adopted as an implementation strategy to support service adaptation, stakeholder engagement, and sustainability of interventions. This study presents implementation research using design thinking as a participatory approach. Guided by the double-diamond framework (diagnosis, exploration, co-creation, and implementation), the methodology combined situational analysis, evidence review, and co-creation workshops with PHC managers, health professionals, and service users. The process emphasized governance alignment, local ownership, and iterative intervention adaptation, in line with implementation science frameworks. The application of design thinking enabled the development of an integrated, adaptable, and scalable package of solutions to strengthen the prevention and management of non-communicable chronic diseases in PHC, with a focus on cardiovascular risk. Co-creation with managers, health professionals, and service users generated context-sensitive interventions replicable with minimal adaptation across diverse settings. The impact of the CARDIO initiative has been documented in nine scientific publications, including a study published in the Journal of the American Heart Association¹. In São Paulo, hypertension control rates increased from 12.3% to 31.2%, with a projected 7.9% reduction in cardiovascular mortality over ten years¹. Economic evaluation demonstrated cost-effectiveness (ICER USD 784 per QALY)². In Brazil, the initiative reached 44 municipalities and 1,077 PHC units, with a potentially impacted population of 15,195,294, with ongoing implementation and international expansion in Portugal. The CARDIO initiative demonstrates that design thinking is a robust implementation strategy for strengthening PHC in health systems. By integrating co-creation, governance, and adaptation, the approach bridges evidence and practice, supports large-scale implementation, and offers lessons for global public health.