3D"" Servi= ce Design and Mental Health: a bibliometric analysis using the <= span style=3D"font-family:Arial; color:#808080">ProKnow-C method

= Design de Servi=C3=A7o e Sa=C3=BAde Mental: uma an=C3=A1lise bibliom=C3=A9t= rica por meio do m=C3=A9todo ProKnow-C

Eugenio Andr=C3=A9s D=C3= =ADaz Merino

https://orci= d.org/0000-0002-7113-6031

Rodrigo Augusto d= e Sousa Cavalcante

ht= tps://orcid.org/0000-0001-6773-7718

Mestre em Design. Universidade Federal de Santa Catarina (UFSC) = =E2=80=93 Brasil. rodrigo_171192@hotmail.com

Rogerio Tadeu de Oliveira Lac= erda

https://orcid.org/00= 00-0002-5151-172X

Doutor = em Engenharia de Produ=C3=A7=C3=A3o. Universidade Federal de Santa Catarina= (UFSC) =E2=80=93 Brasil. rogerlarceda@gmail.com

Doutor em Engenharia de Produ=C3=A7=C3=A3o. Universidade Federal de Santa = Catarina (UFSC) =E2=80=93 Brasil. eugenio.merino@ufsc.br

&= #xa0;

= ABSTRACT

The aim of thi= s research is to analyze publications on the topic of Service Design and Me= ntal Health, as addressed in the scientific community through the Knowledge= Development Process =E2=80=93 Constructivist (ProKnow-C) method, in order = to identify trends, recurring themes, relevant authors, and potential gaps = in the literature. The methodology involved the selection of scientific art= icles from the Scopus and Web of Science databases, applying thematic align= ment and academic impact criteria. From an initial set of 2,458 articles, 2= 7 comprised the final portfolio. The results highlighted the predominance o= f publications with low visibility, with 21 articles having fewer than 100 = citations, although five articles stood out for their higher scientific rec= ognition. Authors such as Lia Patr=C3=ADcio and Jane Farmer emerged as key = references, with a focus on terms such as Service Design, Co-design, and Pr= imary Health Care. The journals PLoS One and Psychiatric Services were iden= tified as the most relevant. It is concluded that the field is still in a c= onsolidation phase, requiring further theoretical and practical development= , especially regarding participatory approaches and the integration of tech= nologies. The study suggests a systematic analysis of the selected content = and the formulation of future research questions to explore the identified = gaps.

Keywords: Design and Health; Healthcare Service; Mental Health; <= /span>Proknow-C.

= ;

RESU= MO

A pesquisa tem como = objetivo analisar as publica=C3=A7=C3=B5es sobre o tema Design de Servi=C3= =A7o e Sa=C3=BAde mental, que v=C3=AAm sendo abordadas na comunidade cient= =C3=ADfica por meio do m=C3=A9todo Knowledge Development Process Constructivist (ProKnow-C), a fim de identificar tend=C3=AA= ncias, temas recorrentes, autores relevantes e poss=C3=ADveis lacunas na li= teratura. A metodologia envolveu a sele=C3=A7=C3=A3o de artigos cient=C3=AD= ficos nas bases Scopus e Web of Science, aplicando crit=C3=A9rios de alinhamento tem=C3=A1tico e i= mpacto acad=C3=AAmico. Dos 2.458 artigos inicialmente identificados, 27 com= puseram o portf=C3=B3lio final. Os resultados destacaram a predomin=C3=A2nc= ia de publica=C3=A7=C3=B5es com baixa visibilidade, sendo 21 artigos com me= nos de 100 cita=C3=A7=C3=B5es, embora cinco artigos tenham se destacado por= maior reconhecimento cient=C3=ADfico. Autores como Lia Patr=C3=ADcio e Jan= e Farmer emergiram como refer=C3=AAncias, com enfoque em termos como Service Design, Co-de= sign e Primary Health Care. Os peri=C3=B3dicos PLoS One e= Psychiatric Se= rvices foram os mais relevantes. C= onclui-se que o campo ainda est=C3=A1 em consolida=C3=A7=C3=A3o, necessitan= do de maior desenvolvimento te=C3=B3rico e pr=C3=A1tico, especialmente em a= bordagens participativas e integra=C3=A7=C3=A3o de tecnologias. O estudo su= gere a an=C3=A1lise sistem=C3=A1tica do conte=C3=BAdo selecionado e a formu= la=C3=A7=C3=A3o de quest=C3=B5es de pesquisa futuras para aprofundar lacuna= s identificadas.

Palavras-chave: Design e sa=C3=BAde; Servi=C3=A7o em Sa=C3=BAde; Sa=C3=BAde Me= ntal; Proknow-C.

Recebido em 11/06/2025.= Aprovado em 07/08/2025. Ava= liado pelo sistema double blind peer review. Publ= icado conforme normas da ABNT.

https://doi.org/10.22279/navus.v16.2151

1 INTRODUCTION

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Patr=C3=ADcio et al. (2020) des= cribe that service design for healthcare has transformative potential when = integrating human-centered approaches with evidence-based methods. "Accurat= e, relevant health information is required to support evidence-based policy= and service design and to ensure that services reach and benefit target co= mmunities" (Lazarus et al., 2020, p. 5).

Farmer and Nimegeer (2014) argue that community participation can stre= ngthen primary healthcare service design in rural areas by incorporating lo= cal contexts into the development of more acceptable solutions. Furthermore= , Braune et al<= /span>. (2021) emphasize that service des= ign can enhance healthcare delivery through digital services by integrating= technology into the system, fostering user engagement, and supporting coll= aborative clinical decision-making.

According to Poleza, D=C3= =A1vila, and Ribeiro Junior (2020), efficient management can significantly = improve healthcare services by identifying gaps in information exchange and= use among professionals. The adoption of technologies enhances work organi= zation, streamlining processes and contributing to safer, more efficient, a= nd patient-centered care.

When applied, service design in heal= thcare demonstrates potential in devising new services, in addition to bein= g a replicable and low-cost process for community participation. However, g= aining a deeper understanding of how to include multiple stakeholders in th= e process and manage the associated risks and impasses may reveal a weaknes= s in this approach (Nimegeer et al., 2016). Never= theless, even in different contexts, service design proves promising. Yet, = the effective inclusion of diverse stakeholders may encounter challenges du= ring the process. Persistent power imbalances can undermine equitable user = participation, particularly in mental health services, requiring design app= roaches that are more attuned to contexts marked by coercion and vulnerabil= ity (Tindall et= al., 2021).

Teixeira= , Pinho, and Patr=C3=ADcio (2019) highlight a scarcity of interdisciplinary= studies integrating service design and healthcare. Farmer and Nimegeer (20= 14) argue that this collaborative approach =E2=80=93 participation in syste= mic changes in healthcare service design =E2=80=93 may yield ambiguous and = unpredictable outcomes, revealing the inherent complexity of incorporating = multiple knowledge systems and local contexts into service planning.=

Service design can foster more inclusive and user-experience-sensiti= ve practices, particularly in mental healthcare, by accounting for the comp= lex relationships among professionals, patients, and institutions (Tindall<= /span> et al., 2021). In this context, Santos and Hoffma= nn (2016) emphasize that service design can enhance public governance's cap= acity to respond to social demands more precisely and empathetically. By co= nsidering user journeys and integrating diverse stakeholders in service co-= creation, it promotes greater efficiency, innovation, and alignment with pu= blic-interest objectives.

In this context, the research aims t= o analyze scientific publications on service design and mental health throu= gh the Knowledge Development Process-Constructivist (ProKnow-C) method, in = order to identify trends, recurring themes, relevant authors, and potential= gaps in the literature.

Silva, Ramos, and Triska (2017) estab= lish service design as an emerging multidisciplinary field intersecting inn= ovation and user experience, while identifying research gaps in its applica= tion across diverse contexts, including healthcare, technology, and educati= on. Schenkel et= al. (2024) demonstrate service de= sign's potential in sensitive areas such as accessibility, showcasing user-= centered approaches that foster inclusion and empathy. The use of tools suc= h as personas and user journey maps enables a nuanced understanding of cont= exts and experiences, enhancing service effectiveness through more humanize= d solutions, particularly in scenarios of psychosocial vulnerability.

The research is structured into five sections: (1) introduction; (= 2) theoretical framework, developed based on articles selected through the = ProKnow-C method; (3) methodological procedures for the selection bibliogra= phic portfolio; (4) results of the bibliometric analysis; and (5) final con= siderations.

2 CONCEPTUAL FRAMEWORK=

2= .1 Service Design

Shaw et al. (2018, p. 1) argue that service design "is about reinventin= g the service process to achieve a greater (and often different kind of) im= pact, as opposed to simply improving existing processes and workflows". Acc= ording to Patr=C3=ADcio et al. (2020), service de= sign employs an approach that combines service conception with systems thin= king.

To understand its core characteristics, service design a= ims to examine and simplify the relationships between service elements and = consumer perspectives (Anderson, Nasr, Rayburn, 2017). Furthermore, it faci= litates information visualization through holistic, creative, participatory= , and user-centered approaches (Teixeira; Pinho; Patr=C3=ADcio, 2019; Patr= =C3=ADcio et al= ., 2020).

Service des= ign is widely employed in both business and public sector contexts to enhan= ce processes and deliver consistent, beneficial user experiences (Braune et al., 2021). As Chowdhury and Quaddus (2016, p. 1= 67) assert, "service providers shall design services that reflect the attri= butes of generating positive perception and experience among customers".

Patr=C3=ADcio et al. (2020) emphasize = that service design contributes to healthcare system transformation by adop= ting participatory, human-centered approaches that enable the creation of s= olutions better tailored to patient needs. Anderson, Nasr, and Rayburn (201= 7) highlight the growing interest in service design, demonstrating its appl= ication in complex sectors such as healthcare. By integrating multiple disc= iplines and incorporating user experiences, this approach facilitates the d= evelopment of more effective services aligned with the needs of patients, c= aregivers, and healthcare professionals.

In demonstrating the= importance of adapting its approaches to clinical environmental specificit= ies, service design emerges as a distinct element in service conception, br= idging theory and practice while fostering innovations that address users= =E2=80=99 actual needs (Mar=C3=ADn et al., 2019).=

Service design enhances the value of systemic approaches to p= rocess improvement in healthcare settings by accounting for the interrelati= onships among users, technologies, and resources, thereby promoting strateg= ic solutions that optimize experiences for patients, caregivers, and health= care professionals (Braune et al., 2021).<= /p>

2.= 2 Health Service

Shaw et al. (2018) argue that user experience is fundamental to the serv= ice, as it not only encompasses understanding what is being delivered but a= lso aims to improve and sustain the system. According to Patr=C3=ADcio et al. (2020), healthcare systems worldwide seek to f= ocus their services on people-centered care through a holistic approach. Ho= wever, several barriers exist, such as lack of standardization in informati= on collection; absence of mutual respect and trust in information sharing; = organizational culture; misalignment of incentives in the external environm= ent; among other factors that hinder the implementation of a collaborative = user-oriented healthcare system.

"When consumers share control= of their healthcare service experiences with caregivers, this can enhance = well-being outcomes for all participants in the service system" (Anderson; = Nasr; Rayburn; 2017, p. 107). Patr=C3=ADcio et al= . (2020) argue that a holistic and systemic approach enables the understand= ing and design of a healthcare system that integrates patient care with a j= ourney capable of preventing adverse situations, thereby enhancing the over= all experience within the system.

The healthcare service syste= m emphasizes the importance of multiple stakeholders in promoting patient w= ell-being, highlighting the need for collaborative networks between provide= rs and patients (Patr=C3=ADcio et al., 2018). Sha= w et al<= span style=3D"font-family:Arial">. (2018, p. 3) argue that

= "it is this latter goal, to re-orient the routines of health service provid= ers for more creative and effective services, that constitutes the more cha= llenging objective of service design and implementation science".

According to Patr=C3=ADcio et al. (2020, p. 8= 96), when understanding healthcare routines, "Patients, nurses, family, med= ical specialists and other actors of the healthcare ecosystem contribute th= eir knowledge and experience to understanding the service needs and develop= ing new ideas". In this context, it is essential to enhance service managem= ent and efficiency to ensure quality and accessible care for users (Anderso= n; Nasr; Rayburn, 2017).

2.3 Mental Health

<= /p>

Costa, Colugnati, and Ronzani (2015) emphasize the need for coordinat= ion among mental health services through integrated networks of stakeholder= s in healthcare systems. As evidenced by the Institute for Health Policy St= udies (IEPS), key challenges in mental health public policies include "lack= of qualified information about service availability, matrix support, thera= peutic itineraries, referral and counter-referral systems, and funding" (Ro= sa et al= ., 2022, p. 5).

Samartzis an= d Talias (2020, p. 2) describe variations in mental health service quality = "both between and within countries, which clinically take the form of diffe= rent distances, within each health system, between the clinical guidelines = of international scientific societies and daily clinical practice". In this= context, the lack of information transparency across different settings li= mits the development of public policies "based on evidence, constrains soci= al oversight capacity, and reduces population access to care, leaving peopl= e uninformed about treatment and prevention options" (Rosa et al., 2022, p. 5).

Mental health is a fundamental = component of social well-being. To effectively meet population demands, thi= s process requires a continuous and high-quality mental health service syst= em (Samartzis; Talias, 2020). Laitila et al. (201= 8) demonstrate the importance of patient engagement in the effectiveness me= ntal health service, highlighting three key factors: adequate infrastructur= e, a patient-centered approach, and multisectoral cooperation.

<= p style=3D"margin-top:0pt; margin-bottom:0pt; text-indent:36pt; text-align:= justify; line-height:115%; font-size:10pt">Chrystal et a= l. (2015, p. 7) emphasize that hom= eless individuals constitute a population vulnerable to mental health probl= ems and note that factors that are "conducive to a positive primary care ex= perience remain understudied and yet potentially important to ongoing effor= ts to foster patient-centered care for vulnerable populations".

<= p style=3D"margin-top:0pt; margin-bottom:0pt; text-indent:36pt; text-align:= justify; line-height:115%; font-size:10pt">The pursuit of mental health care can be influenced by the stigma associa= ted with such services, representing a dual structural and social barrier t= o accessing treatment, thereby hindering the provision of care tailored to = individuals' needs (Corrigan; Druss; Perlick, 2014). To overcome these barr= iers, service design and co-design approaches emerge as collaborative strat= egies involving users, professionals, and other stakeholders, enabling cont= inuous service improvement and better alignment with population needs (Tind= all et al., 2021).

3 METHODS<= /p>

To achieve this objective, we conducted a bibliom= etric analysis to systematically map scientific publications on Service Des= ign and Mental Healthcare, aiming to identify: (1) temporal trends, (2) rec= urring themes, (3) key authors and institutions, and (4) gaps in the litera= ture.

For the bibliometric analysis development, we employed t= he Knowledge Development Process-Constructivist (ProKnow-C) method. This ap= proach integrates the foundations of the Multicriteria Decision= Aid-Constructivist (MCDA-C) methodology by adopting a construc= tivist perspective that enables the active participation of the decision-ma= ker in the process (Lacerda et al., 2017; Lacerda= et al., 2021).

The method is compo= sed of four stages (Figure 1). It provides an informational framework for s= electing relevant articles to compose a bibliographic portfolio on a specif= ic research topic (Lacerda; Ensslin; Ensslin, 2012; Lima; Lacerda; Becker, = 2023). The methodological stages consist of: (i) selecting articles related= to the research topic; (ii) conducting a bibliometric analysis of the docu= ment corpus; (iii) performing a systemic analysis; and (iv) formulating res= earch questions and objectives.

Figure 1 - Steps of Proknow-= C

3D""

Source: adapted from Oliveira et al. (2017, p. 377)

This article addresses only Stages 1 and 2 of the P= roKnow-C process. Although Stages 3 and 4 remain relevant for future resear= ch, they were excluded from the current study due to scope limitations, as = the focus is exclusively on the bibliographic portfolio construction and re= presentativeness analysis. Stage 1 involved establishing: (a) research them= atic axes, (b) keyword sets, (c) combined search strategies, (d) selection = criteria, and (e) database filters. The search was conducted across the tit= le, abstract, and keyword fields (Lacerda; Ensslin; Ensslin, 2012; Silva et al., 2018). Two multidisciplinary databases were= selected - Scopus and Web of Science - covering diverse subject areas. The= detailed search strategies are presented in Table 1, with journal articles= published between 2014 and 2023 serving as eligibility criteria.

Table 1 - Keyword Search Strategy

Axis Combinations	Databases
Scopus	Web of Science
=E2=80=9CService Design=E2=80=9D AND =E2=80=9CHe= alth Service=E2=80=9D	= 682	= 121
=E2=80=9CService Design=E2=80=9D AND Hos= pital	403	= 100
=E2=80=9CService Design=E2=80=9D AND =E2=80=9CMental Hea= lth=E2=80=9D	273	122
=E2=80=9CService System=E2=80=9D AND =E2=80=9CHea= lth Service=E2=80=9D	<= span style=3D"font-family:Arial">1038	= 223
=E2=80=9CService System=E2=80=9D AND Hos= pital	617	= 234
=E2=80=9CService System=E2=80=9D AND =E2=80=9CMental Hea= lth=E2=80=9D	417	210
Total	4440

Source: Authors (2024)

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Following the search completion, the article screening pr= ocess commenced. For this phase, we employed the reference manager Mendeley= (version 1.19.8) to store files in RIS format and remove duplicates, yield= ing 2,458 articles. Subsequently, title screening was conducted based on th= ematic alignment with the research objectives, resulting in the exclusion o= f 1,913 articles and the advancement of 545 articles to the subsequent scre= ening phase.

From these 545 articles, Google Scholar was used = to verify the citation count of each paper=C3=A7. The articles were ranked = in descending order of citations and exported to a spreadsheet in the onlin= e version of Excel. Subsequently, Pareto's Principle was applied to establi= sh a threshold value for identifying the most scientifically influential pu= blications (Lacerda; Ensslin; Ensslin, 2012).

Among the 545 a= rticles, one exhibited an exceptionally high citation count (2,079), standi= ng out from the others. To prevent sample bias, this article was excluded f= rom the Pareto Principle percentage calculation. The remaining articles acc= ounted for a total of 11,301 citations, with 158 articles representing 80.2= 7% of all citations, thereby confirming their scientific impact. Additional= ly, articles cited 22 times or more were included, consistent with the Pare= to Principle (Lacerda, Ensslin, Ensslin, 2012).

The subsequent= screening filter involved abstract review. From this process, 114 articles= were excluded due to thematic misalignment, while 44 were selected for the= ir relevance to the research scope and established scientific recognition.<= /span>

Regarding the 387 articles lacking scientific recognition (rep= resenting 19.73% of citations under Pareto's Principle), an additional scre= ening process was implemented using the following criteria: (i) articles pu= blished within the last two years (insufficient time to accumulate citation= s); and (ii) articles older than two years required at least one co-author = appearing among the 44 pre-selected papers (those with thematic alignment a= nd scientific recognition) (Lacerda; Ensslin; Ensslin, 2012). This process = yielded only one included article, as depicted in Figure 2.

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Figure 2 - Research Portfolio Selection Process

3D""

Source: Authors (2024)

Following comprehensive screening, 45 articles were selected for full-t= ext review. This process yielded 27 articles comprise the final research po= rtfolio, as detailed in Table 2.

Table 2 - Articles Comprisin= g the Research Portfolio

= <= p style=3D"margin-top:0pt; margin-bottom:0pt; text-align:justify; line-heig= ht:115%; font-size:10pt">12

Orlowski et al. (2016)

<= td style=3D"border-bottom-style:solid; border-bottom-width:1pt; padding:2pt= 2pt 2pt 2.25pt; vertical-align:bottom">

The impact of service design and process managemen= t on clinical quality: An exploration of synergetic effects

Community participation for rural healthcare design= : Description and critique of a method

Id.=	Author= s	Title
1	Corrigan;= Druss; Perlick (2014)	The impact = of mental illness stigma on seeking and participating in mental health care=
2	= Anderson; Nasr; Rayburn (2017) =	Transformative service research and service = design: synergistic effects in healthcare
3	= Patr=C3=ADcio e= t al. (2020)	Leveraging service design for healthcare transformation= : toward people-centered, integrated, and technology-enabled healthcare sys= tems
4	Shaw et al.= (2018)	Beyond =E2=80=9Cimplementa= tion=E2=80=9D: digital health innovation and service design
5	Chowdhury; Quaddus (2016)	A multi-phased QFD based optimization approach to sustainable ser= vice design
6	Patr=C3=ADcio et al. (2018)	Service = Design for Value Networks: Enabling Value Cocreation Interactions in Health= care
7	Halsall et al. (2019)	Trends in mental health= system transformation: Integrating youth services within the Canadian cont= ext
8	Samartzis; Talias (2020)	Assessing and improving the quality in mental h= ealth services
9	Farmer; Nimegeer (2014)	Community participation to design r= ural primary healthcare services
10	Chrystal= et al. (2015)	Experience of primary care among homeless individuals with mental he= alth conditions
11	Tindall et al. (2021)	A first-ha= nd experience of co-design in mental health service design: Opportunities, = challenges, and lessons
Voronka (2019)	The mental health peer worker as inf= ormant: performing authenticity and the paradoxes of passing
13	Jacob et al. (2016)=	Designing services for frequent attender= s to the emergency department: A characterisation of this population to inf= orm service design
14	A Rural= Youth Consumer Perspective of Technology to Enhance Face-to-Face Mental He= alth Services
15	Kerman et al. (2019)	Perceptions = of Service Use Among Currently and Formerly Homeless Adults with Mental Hea= lth Problems
16	Ding (2015)
17	Mar=C3=ADn et al. (2019)	Integrating a gait analysis test in hos= pital rehabilitation: A service design approach
18	Laitila = et al. (2018)	Service users=E2=80=99 views regarding user involvem= ent in mental health services: A qualitative study
19	Liu e= t al. (2018)	Survey on the use of mental health services and help-se= eking behaviors in a community population in Northwestern China <= /td>
20	Braune et al. (2021)	Shaping workflows in digital and remote= diabetes care during the COVID-19 pandemic via service design: Prospective= , longitudinal, open-label feasibility trial
21	Teixeira; Pinho; Patr=C3=ADcio (2019)	Bringing service design to the development of health information s= ystems: The case of the Portuguese national electronic health record=
22	Hu et al. (2017)	Expanding the mental health workforce = in China: Narrowing the mental health service gap
23	Nimegeer et al. (2016)
2= 4	Ha= n et al<= span style=3D"font-family:Arial">. (2018)	Service design oriented multidisciplinary collaborative team care s= ervice model development for resolving drug related problems
25	Lazarus et al. (2020)	Novel health systems service design ch= ecklist to improve healthcare access for marginalised, underserved communit= ies in Europe
26	Salgado et al. (2017)	Using a serv= ice design model to develop the =E2=80=9CPassport to Safer Birth=E2=80=9D i= n Nigeria and Uganda
27	Ramos et al. (2022)	Cyclical exper= ience-based design: A proposal for engaging stakeholders in a co-creative m= odel for primary health care service design

Source: Authors (20= 24)

&= #xa0;

These articles will undergo bibliometric analysis as par= t of Stage 2 of the Proknow-C framework, which consists of three phases: (i= ) bibliometric analysis of the selected articles; (ii) bibliometric analysi= s of the references contained within these articles; and (iii) classificati= on of the articles according to their academic relevance within the sample = (Lacerda; Ensslin; Ensslin, 2012; Silveira; Lacerda; Dias, 2024)

4 BIB= LIOMETRIC ANALYSIS

The study examined four= key bibliometric indicators: (1) journals (publication sources), (2) autho= rs (productivity and collaboration patterns), (3) keywords (co-occurrence a= nalysis), and (4) citations (scientific impact).

4.1 Bibliometric analysis of selected articles

The research portfolio (n =3D 27) was analyzed, beginning with = the journal indicator. Twenty-five distinct journals were identified, as sh= own in Figure 3.

Figure 3 - Journals in the Research Portfolio

Source: Authors (2024)<= /p>

PLoS ONE was the only journal featuring three publications in the po= rtfolio, while all others contained just one article each.

With respect to the author indi= cator, the sample contained 141 distinct authors. As demonstrated in Figure= 4, only five authors showed significant publication frequency, while the r= emaining 136 authors were single-article contributors.

<= p style=3D"margin-top:0pt; margin-bottom:0pt; text-align:center; line-heigh= t:115%; font-size:10pt">Figure 4 - Most R= elevant Authors in the Research Portfolio

Source: Authors (2= 024)

&= #xa0;

Among the 141 identified authors, Lia Patr=C3=ADcio emer= ged as the most prolific contributor, with three articles. Jane Farmer, Amy= Nimegeer, Nelson Figueiredo de Pinho, and Jorge Grenha Teixeira each contr= ibuted two publications. For enhanced academic profiling, supplementary dat= a was extracted from Scopus database, with complete metrics presented in Ta= ble 3.

Table 3 - Characteristics of the Prominent Authors in the Research Portfo= lio

1996

Author=	Country of Affiliation=	h-index=	Documen= ts Indexed in Scopus	= Ci= tations Received in Scopus	First Document Indexed in Scopus
Patr= =C3=ADcio, L	Portugal	28	60	4.672	2003
Farmer, J.	Australia	32	153	2.878
Nimegeer, A.	United Kingdom=	7	<= p style=3D"margin-top:0pt; margin-bottom:0pt; text-align:justify; line-heig= ht:115%; font-size:10pt">8	1= 87	2011
Pinho, N. F.	Belgium	5	14	282	2012
Teixeira, J. G.	Portugal	12	26	1.105=	2011

Source: Authors (2025)

The affiliation of these authors= is predominantly concentrated in Europe (n =3D 4). Regarding publications,= Jane Farmer stands out with 153 works, followed by Lia Patr=C3=ADcio with = 60, both indexed in the Scopus database. In addition, both are the most cit= ed authors in the database, with Lia Patr=C3=ADcio accumulating 4,672 citat= ions and Jane Farmer, 2,878. Another highlight is Jane Farmer's long public= ation history, with her first indexed work dating back to 1996.

<= p style=3D"margin-top:0pt; margin-bottom:0pt; text-indent:36pt; text-align:= justify; line-height:115%; font-size:10pt">Regarding the keyword indicator, the textual analysis identified 88 uniqu= e descriptors across the 27-article portfolio. Figure 5 displays the result= ing word cloud.

Figure 5 - Word Cloud of= Keywords

3D""

Source: Authors (2025)

The term "Ser= vice Design" was the most frequently used, appearing 10 times, followed by = "Co-design" and "Primary health care," which were cited 3 times each. Addit= ionally, "Community engagement," "Community participation," "Electronic Hea= lth Records," "Health care," "Health Information Systems," "Health services= ," "Healthcare services," "Mental health," "Rural health," and "Sustainabil= ity" were mentioned twice. The remaining terms appeared only once.

From the word cloud, an emerging relationship between Service Design a= nd Co-design can be observed, indicating a trend toward collaboration in th= e development of healthcare solutions. The presence of terms related to Pri= mary Health Care, Community Engagement, and Community Participation highlig= hts a research focus on community involvement. Furthermore, the occurrence = of terms linked to Electronic Health Records and Health Information Systems= underscores the intersection between service studies and health technology= . The mapping reveals potential trends and discussions that have been prior= itized in academic research on Service Design applied to healthcare, allowi= ng for the identification of current directions and opportunities for futur= e exploration.

4.2 Bibliometric analysis o= f the references of the selected articles

= An analysis was conducted of the references from the 27 articles comprising= the research portfolio, with emphasis on the journals, the articles' citat= ion counts, and the authors. A total of 1,196 cited articles were identifie= d in the references, including only peer-reviewed journal articles; the rem= aining items were excluded.

In the journal indicator, the anal= ysis identified 514 distinct journals in the research portfolio's reference= s. Figure 6 below displays the 20 most frequently occurring ones.

Figure 6 - Journals of the Ref= erences in the Research Portfolio

3D""

Source: Authors (2024)

The journal Psychiatric Services was the most prominent, appearing in 4= 7 articles, followed by the Journal of Service Research (23 articles) and t= he Journal of Operations Management (19 articles). Among these highlighted = journals, Psychiatric Services, Journal of Operations Management, BMC Healt= h Services Research, Journal of Service Management, International Journal o= f Medical Informatics, and PLoS One accounted for the highest number of pub= lications in the bibliographic portfolio, with the latter being the most si= gnificant.

In the citation indicator, among the 1,196 articles= analyzed, the 10 most cited articles were identified, as shown in Table 4 = below.

Table 4 - Top 10 Most Cited Articles in the Research= Portfolio References

Zadeh (1965)

Numbe= r of Citations	Author=	Title
219.575	Braun; Clarke (2006)	Using thematic analysis in psychology
124.889	Fuzzy sets
46.901	Parasuraman; Zeithaml; Berry (1= 985)	A conceptual model of service qu= ality and its implications for future research
43.521	Kroenke; Spitzer; Wil= liams (2001)	The PHQ-9: Validity of = a brief depression severity measure.
42.604	Harris et al. (2009)	Research electronic d= ata capture (REDCap)--a metadata-driven methodology and workflow process fo= r providing translational research informatics support.
40.937	Heckman (197= 9)	Sample selection bias as a specifi= cation error
34.156	Arnstein (1969)	A= ladder of citizen participation.
31.801	Graneheim; Lundman (2004)	Qualitative content analysis in nursing resea= rch: Concepts, procedures and measures to achieve trustworthiness
31= .346	To= ng; Sainsbury; Craig (2007)	Consolida= ted criteria for reporting qualitative research (COREQ): a 32- item checkli= st for interviews and focus groups.
30.152	Elo; Kyng=C3=A4s (2008)	The qualitative content analysis process =

Source: Authors (2025)

In the author indicator, 3,775 dist= inct authors were identified in the bibliographic portfolio references, wit= h the top 10 most prominent shown in Figure 7 below.

Figure 7= - Most Relevant Authors in the References of the Research Portfolio=

3D""

Source: Authors (2024)

Author Pat= rick William Corrigan stands out with 28 articles, followed by Ronald C. Ke= ssler (n=3D18), Anthony F. Jorm (n=3D16), Matthias Claus Angermeyer (n=3D14= ), Bruce George Link (n=3D14), Lia Patr=C3=ADcio (n=3D14), Stephen Louis Va= rgo (n=3D14), Jane Farmer (n=3D13), Robert Alan Rosenheck (n=3D13), and Ray= mond P. Fisk (n=3D12). Additional author data were collected from the Scopu= s database, with complete results presented in Table 5 below.

Table 5 - Characteristics of the Prominent Auth= ors in the References of the Research Portfolio

= <= td style=3D"border-right-style:solid; border-right-width:1pt; border-bottom= -style:solid; border-bottom-width:1pt; padding:5pt; vertical-align:top">

Link, B. G.=

6.208

Author	Country of Affiliation	h-index	Documents Indexed in Scopus <= /td>	Citations Received in Scopus	<= p style=3D"margin-top:0pt; margin-bottom:0pt; line-height:115%; font-size:1= 0pt">Fir= st Document Indexed in Scopus
Corrigan, P. W.	United St= ates	103	472<= /p>	42.827	1996
Kessler, R.= C.	United States	263	1.262	= 312.338	1996
Jorm, A. F.	Australia	119	790	64.752	1996
Angermeyer, M. C.	Austria	112	635	= 60.095	1996
United States	96	336	48.269	1996
Patr=C3=ADcio, L	Portugal	28	60	4.672	2003
Vargo, S. L.	United States	59	121	38.642	1998
Farmer, J.	Au= stralia	32	153	2.878	1996
Rosenheck, = R. A.	United States	= 107 <= /td>	993	= 54.359	1996
Fisk, R. P.	United States	32	86	1996

Source: Authors (2025)

This anal= ysis reveals institutional affiliations concentrated in North America (n=3D= 6), followed by Europe (n=3D2) and Oceania (n=3D2). Regarding scholarly out= put, Ronald C. Kessler leads with 1,262 Scopus-indexed publications, preced= ing Robert Alan Rosenheck, who has 993 publications. In citation impact, Ro= nald C. Kessler dominates with 312,338 citations, followed by Anthony F. Jo= rm, with 64,752 citations. Female researchers Lia Patr=C3=ADcio and Jane Fa= rmer also emerge as prominent contributors in the research portfolio.

4.3 Classification of articles according to aca= demic relevance

This analysis incorporated= both authors and journals from the research portfolio and its references, = comprising a total corpus of 1,223 articles. Author relevance was establish= ed through a comparative analysis between the 10 most prominent portfolio a= uthors and those appearing in the references, as illustrated in Figure 8.

<= /span>

= ;

= 0;

&#x= a0;

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= Figure 8 - Authors=E2=80=99 Relevance

Source: Authors (2025)

When comparin= g the most cited authors from the research portfolio with its references, t= he analysis reveals that Lia Patr=C3=ADcio appears with three citations in = the portfolio versus 14 in the references; Jane Farmer with two and 13, res= pectively; and Jorge Grenha Teixeira with two and six. Regarding reference = citations, Patrick William Corrigan stands out with 28 citations (only one = in the portfolio), while Raymond P. Fisk has 12 citations in the references= compared to one in the portfolio. For the journal indicator, a comparison = was made between the portfolio and its references, as shown in Figure 9.

Figure 9= - Most Representative Journal

3D""

Source: Authors (2025)

When comparing the most cited articles from the research portfolio= with its references, PLoS One emerges as the most representative journal o= n the topic, with three articles in the portfolio versus 10 in the referenc= es. Another notable case is Psychiatric Services, represented by one articl= e in the portfolio compared to 47 in the references.

In the i= ndicator of author representativeness in the portfolio articles, the analys= is examined the relationship between (1) the most cited authors in the port= folio's references and (2) their Google Scholar citation counts, as demonst= rated in Figure 10.

Figure 10 - Authors=E2=80=99 Representativeness

Source: Authors (2025)

Analysis reveals that among the 27 = research portfolio articles, only six have received more than 100 citations= . The remaining 21 articles, while thematically relevant (first quadrant), = show limited academic recognition. The third quadrant contains five article= s with established academic recognition (authors cited more than 15 times).= The fourth quadrant features one article with dual distinction: academic i= mpact (author citations) and scientific influence (over 2,000 citations).

5 CONCLUSIONS

This research examined p= ublications on Service Design and Mental Health using the ProKnow-C method,= which identified a bibliographic portfolio of 27 scientific articles. The = analysis revealed that: (i) 21 articles have fewer than 100 citations, indi= cating limited scientific recognition; (ii) 5 articles exceed 100 citations= ; and (iii) 1 prominent article, authored by a leading researcher, has over= 2,000 citations. These findings suggest that the field of "Service Design = and Mental Health" remains in a consolidation phase and requires greater ac= ademic visibility.

The analysis identified the following promi= nent authors: Lia Patr=C3=ADcio, Jane Farmer, Amy Nimegeer, Nelson Figueire= do de Pinho, and Jorge Grenha Teixeira. Regarding journals, PLoS One emerge= d as the most significant, while the most frequent keywords were Service De= sign, Co-design, and Primary health care.

The ProKnow-C applic= ation enabled identification of the most relevant articles on the topic. Ho= wever, subsequent methodological phases are still required: (i) systematic = content analysis, to thoroughly examine the theoretical approaches, researc= h methods, and application contexts of the selected articles; and (ii) rese= arch question formulation, to map gaps in the literature and guide future s= tudies. Together, these phases aim to advance knowledge in Service Design a= nd Mental Health by strengthening its conceptual foundation and identifying= new research directions.

ACKNOWLEDGMENTS

This study was financed in part by the Coordena=C3=A7=C3=A3o de Aperfe= i=C3=A7oamento de Pessoal de N=C3=ADvel Superior - Brasil (CAPES-PROEX) - F= inance Code 001.

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