Health Research Program

Involving stakeholders and establishing a strong IR partnership

Implementation research and delivery science gathers data that describe how a program or intervention is being implemented and then uses that information to strengthen implementation and improve health outcomes. Program stakeholders play an important role in IR. Stakeholders are people or groups who have an interest or concern in the program. For example, the stakeholders in a newborn health program may include the Ministry of Health, health providers, patients, donors and other partners, community members, and professional societies, among others.

In the conduct of implementation research, it is important to consider which stakeholder groups should be involved in the IR or even represented in the partnership overseeing the IR (“IR partnership”). The IR partnership takes all decisions regarding the IR and is the focal point where stakeholder views on the IR are considered. Involving stakeholder representatives in the IR not only allows them to bring perspectives from their backgrounds to contribute to the IR effort, but also builds bridges to the stakeholder communities that they represent—bridges that can be important for communicating findings from the IR and creating support for changes that are made as a result of the IR. In some cases, failing to include key stakeholder groups can even cause the overall IR effort to fail, as unhappy stakeholder groups may refuse to support the research or resist changes that are introduced based on the IR findings.

TIP#5_Figure 5.1_Sept 14

Who are the stakeholders for IR?

Box 5.1: Program beneficiaries Engaging beneficiaries in the IRDS process helps to maximize the benefits of IRDS. Approaches such as human-centered design (HCD) that focus on understanding the needs of the beneficiaries are important to achieving success in IRDS.IR stakeholders include people and groups who have an interest or concern in the program that is being studied or the research itself. This might include individuals, groups or organizations that are involved with implementing or overseeing the program, those who benefit directly from the program, and interest groups who are not directly involved with the program. Stakeholders also include organizations or individuals who are able to influence the program or the IR such as policymakers, donors and funding agencies, researchers, and technical experts. Figure 5.1 presents categories of stakeholders for IR.  Program beneficiaries (i.e., clients, or end-users) and other critical stakeholder groups such as professional associations should not be overlooked. (Boxes 5.1 and 5.2). Box 5.2: Involving professional associations In one country, the government used IR to compare the implementation of two different regimens for treatment of pneumonia in newborns at the household level by auxiliary health workers (AHWs). The government considered the Pediatric Association to be a key stakeholder and engaged them in the IR to build their support for treatment of pneumonia by AHWs at the household level—treatment that formerly could only be provided by physicians in health facilities.

Benefits of involving stakeholders

The IR leadership should identify key stakeholders early in the IR planning phase and develop systems to engage them throughout the IR process, which will help to:

  • identify factors that influence the success of the program (positively or negatively).
  • assess local health challenges (and opportunities) and the health system’s readiness to respond.
  • raise awareness about the health program, IR processes, and benefits of participating in IR.
  • build commitment from the government and donors to support the intervention.
  • create shared vision, health program ownership, political will, and accountability.
  • reduce participant’s fears of risks and harms from participating in a research process.

Establishing a strong IR partnership

At the heart of successful IR lies a strong partnership made up of individuals committed to working together toward a common goal: producing relevant, reliable information in real-time that can be used to strengthen program implementation. Some stakeholders will be part of this core IR partnership that is directly responsible for preparing and conducting the IR effort, as well as engaging other stakeholders to make sure the study results are used for program improvement. All IR partners are key stakeholders and the distinction between these two groups may be fluid, with IR partnership roles evolving and adapting as the IR process proceeds.

Typical roles on an IR partnership

Ensuring an effective IR process requires securing the participation of relevant actors. Ideally this would involve a partnership between researchers, implementers, and policymakers/government, while ensuring a voice for beneficiaries in the process.  Because implementation efforts tend to be complex, IR partnerships often require diverse actors with a range of expertise, skills, and perspectives. While the composition of an IR partnership will depend on factors such as the focus, scope and complexity of the research, the local context and customs, available budget, and any donor requirements, the IR partnership should represent a balance of program knowledge, technical skills (i.e. research/ methodological or program area content expertise), and decision-making influence (Box 5.3). Box 5.3: A diverse set of stakeholders brings value to the IRDS partnership: Knowledge of broader intervention context—national plan or municipal programs—to ensure suitability of IRDS Familiarity with local setting and cultural norms to inform improvement strategies. Practice-based understanding about whether a research method or program solution can succeed. Knowledge about system stakeholders’ attitudes on key issues. Understanding of how policies and regulations are implemented, enforced, and how this might affect plans for improvements. Leverage over processes needed for eventual scale-up or integration and sustainability of program changes. Intuition about whether a research method or program solution will succeed.

Inclusion of appropriate Ministry/ government official(s) is critical in ensuring the broader national (policy) and subnational (implementation) context is considered.  These players will also be critical in informing eventual scale-up efforts to sustain successful interventions.

The IR partnership should be formed before research activities start, but additional or different partners should be added as needs are clarified and gaps are identified. The size of the IR partnership will vary by research project and one partner may take on more than one role. Informal meetings with the managers and implementers of the program being studied, other local implementing partners, researchers experienced in IR, or key government counterparts can help gauge individual or institutional capacity to contribute to the partnership (both skills/expertise and resources) when considering additional partners.  One place to start might be to build on and engage with entities that are part of existing national working groups that already include a cross-section of stakeholders interested in the IR being proposed.

 

Develop a Partnering Agreement

Working with partners can be challenging—the larger the partnership, the more complex things become. Partners have their own perspectives, interests, and level of authority or influence. Each member may be under different sources of pressure due to organizational cycles and time constraints. The partners should plan and develop some ground rules so all members have a clear understanding of why, when, where, and how the partnership will work together. These ground rules should be documented in a partnership agreement or memorandum of understanding (MoU)Box 5.4 lists some issues your partnership should consider including in the agreement.  While these agreements do not need to be formal signed documents, the process of developing them together can provide an opportunity for identifying and solving potential areas of conflict before they become a problem and for team-building that will strengthen the partnership throughout the IR. Box 5.4: A Partnering Agreement should… State a vision of what IR results will generate. Explain roles of all partners prior to, during and following the research phase. Establish how decisions will be made—e.g. governance and leadership structure. Clarify resource contributions (in-kind, financial, or human) by each partner. Develop initial schedule of IRDS partnership meetings, stating frequency and process. Establish guidelines for conflict management and resolution. Develop data ownership/sharing guidelines

Getting the partnership started

Once members are selected and the partnership agreement is drafted, an initial meeting can be held to launch the IR project. Topics to discuss might include setting priorities, formulating initial research objectives, defining member responsibilities, identifying any capacity gaps within the partnership, preliminary planning and budgeting the project, and strategies to set up your partnership for success.  Prioritizing effective communication, encouraging participation by and interaction among partners, and capitalizing on the strengths of each partner are the keys to maintaining a strong collaboration throughout the IR process.

How to engage stakeholders and the IR partnership

Once you have established the core IR partnership and identified the broader set of key stakeholders, a strategy for engaging them must be developed.  While involving and mobilizing multiple stakeholders might seem challenging, tools such as the Stakeholder Analysis Matrix can help to understand what each stakeholder group can contribute to the IR and clarify how to best involve them. Completing a tool such as this might require convening discussions with stakeholders, but taking the time to map each stakeholder groups’ key characteristics will help you to:

  • Understand their relationship with the program/intervention
  • Realize what they value about the program and as well as their level of influence
  • Identify what they can contribute to the IR effort (e.g., ideas, information, support, effort)
  • Consider whether and how they might block or obstruct the IR process
  • Develop ideas for how and when they can best be involved

You can then use this detailed stakeholder mapping to identify activities, roles, tasks, and goals that together will ensure each individual’s/group’s meaningful involvement in the IR effort from beginning to end. Figure 5.2 presents a conceptual diagram of how to manage stakeholder involvement during IR. The IR partnership leadership should do this by agreeing upon expectations with stakeholders, using appropriate techniques to establish communication and engage different groups, and taking time to create an open, respectful dialogue among stakeholders. The IR partnership should use different techniques to engage stakeholders and ensure that learning and exchange of information flows among stakeholders.

TIP#5_Figures_Sept 25

One way to encourage participation is to arrange for interactions between partners where they can learn from each other and build trust. For example, team members involved in program implementation can invite other members to the field to observe or participate in program activities that will help them understand implementation-related processes. In turn, researchers can help other team members understand methodological issues more easily. Other regular opportunities for team members to interact—face-to-face meetings or informal social gatherings, such as dinner meetings—help to build relationships and trust so that all partners feel free to express their opinions, talk about their experiences and to disagree with others.  The process of stakeholder engagement is dynamic, and leadership should be open to change over the duration of the IR effort.

Often, particularly with large, complex IR projects that have the potential to significantly impact program practices, it is useful to identify a sub-group of stakeholders that can support the larger goal of using results to inform action. This group of actors is often identified following a stakeholder analysis and can be formalized into a research advisory committee.

How stakeholders support IR

Suppose that you are a partner in an IR effort that is about to start. You have just completed a stakeholder analysis and identified a set of key stakeholders who together have technical expertise, knowledge of and experience with the local context, and a commitment to (or power to) change the program. In concrete terms, what can you expect them to contribute to IR? While the answer to this question will vary across IR efforts, Figure 5.3 provides some insights/suggestions. The figure presents a graphic description of IR stakeholders (center box), the information that builds their capacity to contribute (left-hand box), and some examples of tasks and roles that stakeholders may carry out during three time periods (right-hand box): preparing for IR; conducting the IR; and following the conclusion of the research activities.

TIP#5_Figure 5.3_Sept 14

Before beginning, you will need to give stakeholders information that will enable them to support the IR effort. For example, you might bring stakeholders together to review DHS and other data, including the results of any formative data you conducted with program beneficiaries (see TIP #8 for more on conducting formative research with beneficiaries). You might ask stakeholders to interpret the data, suggest reasons for any problems or successes that the data show, and suggest changes to the program that would test solutions to any problems. Some stakeholders may even have data that could be used to inform the IR, reducing the need for additional data collection.  Importantly, beneficiaries and other community stakeholders should be incorporated into the IR partnership as active participants – inserting their voice into the problem identification, proposed solutions, and regular review of findings. You will almost certainly provide stakeholders with updates during the data collection period, and then provide them with a summary of ultimate findings. Bringing key stakeholders together routinely to review the data can help to understand the findings and provide important perspectives on how the program might be adapted based on those findings. In addition, stakeholders have an important role to play in communicating (and acting on) results after the IR is completed.


Key resources

Stakeholder Engagement in Implementation Research:

Stakeholder Mapping Tools:

Building Partnerships and Coalitions

Human Centered Design Toolkit:

Participatory methods for stakeholder engagement:

Establishing a strong IRDS Collaboration


References
  1. Aarons, G., Reeder, K., Miller, C., & Stadnick, N. (2019). Identifying strategies to promote team science in dissemination and implementation research. Journal of Clinical and Translational Science, 1-8.
  2. Bauer MS & Kirchner J. (2029) Implementation science: What is it and why should I care?  Psychiatry research.
  3. Proctor, E. K., Powell, B. J., Baumann, A. A., Hamilton, A. M., & Santens, R. L. (2012). Writing implementation research grant proposals: ten key ingredients. Implementation Science, 7(1), 96.
  4. ‘Building and managing a research team – https://www.vitae.ac.uk/doing-research/leadership-development-for-principal-investigators-pis/building-and-managing-a-research-team.