For this month’s discussion on implementation science, I am joined by Dr. Kurt Stange to share our thoughts on an important topic related to implementation science – stakeholder engagement. There is an emerging consensus that a different type of translational or implementation science is needed to address many seemingly intractable problems and to translate health research into practice and policy. The science should be relationship-centered and utilize partnership-based scientific methods that combine rigor, relevance, and stakeholder engagement.
According to many, this type of approach is already in practice. However, there seems to be a discrepancy between what is claimed and what is actually found when the research is assessed on objective measures of engagement/partnership (e.g., asking questions of research partners, team members or patients; observe, or document, interaction characteristics). It’s about ‘walking our talk’ and not about using vague, politically correct terms in our proposals. It’s about reflecting upon how well we are doing in implementing true partnerships. It takes time to build relationships, but the investment makes all the difference and translational science needs to better identify and utilize methods of measuring and reporting on these levels of participation and engagement.
These principles and related actions operate at multiple levels and involve different partners and stakeholders at each level. In this brief call to action, we simplify this multi-level challenge into three prototypic levels of partnership: (1) patient-practitioner; (2) research team; and (3) community research. Important at each level is the ability to listen and not immediately advise; share rather than control (and often give up large amounts of control); and modify approaches based on input from others. Below, we speculate about how to tell when one is ‘walking the talk’.
At the Individual (e.g. Consumer or End-user; Practitioner) level, certain factors determine the degree to which research is patient-centered and includes: who makes the final decisions; distribution of talk time and interruptions; how tailored an intervention is to an individual's values, preferences and culture; and whether there is any systematic collection and documentation of individual/patient perspective, preferences, values, or person-directed goals.
At the Team level, another set of factors indicates whether research teams are transdisciplinary and team-based, and includes: distribution of talk time; who proposes vs. tweaks ideas; who prepares the agenda; and how equitable the budgets, outputs and credit are. Please see the recent issue of Translational Behavioral Medicine to learn more about team-based science.
At the Community Engagement level, there are several potential ‘ bottom line’ indicators including: the entity controlling the budget and the percent allocated to various partners; the entity developing the agenda for academic-community meetings; the number and openness of meetings; and how research changes as a result of community input (or not).
At each level, a key measure of success is the degree to which partners are committed, and whether the relationship among partners has the potential to transcend the specific project. In summary, the IS field needs both ‘gold standard measures’ (for when level of partnership is the central issue) and pragmatic measures (for standard use) to assess and transparently report on the level of partnership.
We invite those interested in this topic of community engagement and measurement to join us on May 20th, 3:00-4:00pm ET for our next “Advanced Topics in IS Research” webinar which will focus on Community Based Participatory Research (CBPR) measures and will be led by Drs. Nina Wallerstein and Bonnie Duran. Registration and details coming soon. See an archive of this session below.
In the meantime, we should be self-reflective and cautious when claiming to be patient-centered, team-based, and community engaged, especially if lacking consistent feedback or documentation to confirm such representations. We offer the above reflections not as any definitive word, but as our initial thinking in the hopes of stimulating debate and sharing practical measures used by partners at multiple levels. Please join share your thoughts here -- Are we already "Walking our talk"? Where do you see the field needing to go? How are you measuring level of partnership and engagement?
Russell E. Glasgow, PhD and Kurt C. Stange, MD, PhD