The following steps were taken in the development of Hope & Main. They serve as a primer for the creation of anygraphic novella:

1. Start with research

Extensive research and firsthand experience of the National Kidney Foundation showed the need for a "pictographic" solution. While the numerous multimedia tactics of the Foundation are effective with professionals and many patients, a significant share of the patient audience is unable or unwilling to use the Internet, resistant to most print materials, and unreceptive to educational DVDs—in fact, unreceptive to most of today's media mix. They need information in more visual form, independent of electronic media. The solution was to create a series of comic strips forming a graphic novel: Hope & Main.

2. Begin writing

The creative team behind Hope & Main crafted a "story bible," just as creators of a television show do. They wrote "back stories" for each character (information that may never appear in the actual novel but helps the creators make characters more credible). They also created a full script for the first installment of the novella, plus outlines for five more—to demonstrate a firm grasp of the subject matter, to show the development of the Hope & Main characters and plot lines, and to prove that the concept can sustain interest over a series.

3. Illustrate

After determining the preferred style of rendering the characters, the novella's palette, and other visual details, the team screened artists—dozens of potential candidates—before finding the right one. Working with the artist, they went through numerous sketches and revisions of renderings of each character to achieve the right look in "personality," age, wardrobe, and other details. With a total of 10 characters—five patients and five professionals—each had to be clearly delineated.

Throughout, the editorial board reviewed sketches and final renderings of each character, as well as the script. The first Hope & Main came together in the form of black and white rough sketches organized into panels. These were reviewed and revised before text was added.

The entire team of collaborators, including the editorial board, reviewed the next version. Numerous changes were made in text and illustrations before creating a full-color version. Once again, more changes were made to both the illustrations and text. Once finalized, the novella was produced (and even translated into Spanish!)