Table 1.

An Example of the Sequential Transformation of the Pad

Practice No.*	Need or Idea	Innovations and Modifications in Tools or Processes
2	Requests a list of titles of all support materials for health behavior change that are available on the Web site to more easily direct patients to specific topics.	Facilitator generates a hard-copy list of available titles organized by topic.
4	Requests paper handouts of patient support materials printed from the Web site for patients with low computer literacy. Requests handouts be organized in a number-based filing system used in conjunction with the list of titles from practice 2.	Facilitator prints selected handouts from Web site and numbers them for easy organization and access. List of titles of patient support materials is numbered, resulting in a numbering key used by staff to identify available handouts.
5	Requests a paper handout system similar to that of practice 4, but suggests a patient self-serve file would better suit their needs. Suggests that clinicians should write the handout number on the Pad to allow patients to access handouts in the file themselves.	A numbered file of handouts is placed in a publicly accessible area so that patients can retrieve hand-outs themselves as they exit by referring to the number their clinician wrote on the Pad.
6	Requests a patient self-serve handout system similar to that of practice 5. Clinical staff notes inefficiency of writing a number on the Pad and suggests placing handout numbers on the Pad itself so clinicians can simply circle the appropriate number.	Facilitator expands the size of the Pad from a half sheet to a full sheet to accommodate a list of numbers.
7	Requests a self-serve handout system, but notes inefficiency of looking for handout title on a separate piece of paper, then circling a number; suggests incorporating the title listing/numbering key itself on the Pad.	The title listing/numbering key is fully incorporated into the full-page Pad.

*Practices were numbered in the order of enrollment.