Toward a science of transdisciplinary action research

"We all see things through a different lens based on our life experiences": co-production of a web-based implementation toolkit with stakeholders across the health and social care system

Background

Implementing new innovations across the health and social care system is complex, involving many factors that in recent years have been compounded by Covid-19. While a plethora of implementation tools and frameworks are available, there are limitations in terms of their design and accessibility. Co-production is a valuable mechanism for developing tools that have utility and accessibility for those tasked with using them in health and social care organisations and there is growing acknowledgement of increasing the role of co-production in implementation science. This paper provides novel insight into co-production practices and relevance to implementation science by reporting findings from a study to co-produce a web-based implementation toolkit (WIT) that is accessible, usable and designed to support adaptive implementation across health and social care systems. Key themes relating to the process of co-production are outlined and the value of using co-production in implementation processes are discussed.

Methods

A web-based survey (n = 36) was conducted with a range of stakeholders across health and social care. Findings identified a need for WIT. Survey respondents were invited to express interest in becoming part of a co-production group and to take part in three online interactive workshops to co-produce WIT. Workshops took place with the group (n = 12) and focused on key developmental stages of WIT.

Results

Online co-production workshops were integral to the development and refinement of WIT. Benefits of using this process identified three interrelated themes: (i) Co-designing key features of the toolkit, (ii) Co-producing a toolkit with utility for users across health and social care settings, (iii) Co-producing a toolkit to support the implementation journey. Our approach of undertaking co-production as a dialogic process enabled generation of these themes. To illuminate discussion of these themes we draw upon iterative co-development of the "active ingredients" of key components (e.g., interactive Implementation Wheel) and functions (e.g., interactive "pop-up" definitions of keyword) and features (e.g., case studies) of WIT.

Conclusion

Using a co-production approach with a range of end-users across health and social care systems, highlights the benefits of understanding implementation processes for users in these settings. User-centred design and processes for ensuring accessibility readily support the translation of implementation into rapidly changing health and social care systems to benefit outcomes for patients, their families, carers, service users and practitioners.

Optimising a co-production framework for developing public health interventions: application and testing of school-based Research Action Groups

Existing frameworks for developing public health interventions have limited guidance for researchers on how to work with stakeholders to co-produce context-specific interventions. To address this, a promising framework for the co-production of public health interventions was developed through a previous review of school-based co-production. The present study aimed to optimise this co-production framework through applying and testing it in real-world secondary school contexts. Within schools, Research Action Groups (RAGs) were established with multiple school stakeholders supported by an external facilitator to use school data to produce school-specific mental health and wellbeing interventions. A mixed method process evaluation of two contextually diverse case study secondary schools in the UK was used to optimise the co-production framework. The process evaluation sought the views of those involved (students, school staff, school Senior Management Team (SMT) members, and the external co-production facilitator/researcher) on the co-production functions they were involved in so they could be modified, if needed. Data collected for the process evaluation during co-production were a researcher diary (n = 45 entries), and observations of student photography (n = 21) and RAG meetings (n = 8). Post co-production, interviews, and surveys with RAG students (n = 18) and staff (n = 8), and two school-specific SMT focus groups (n = 10) were conducted. The study identified four recommendations to optimise and integrate co-production into real world practice. They include the need to: assess schools for their readiness to undertake co-production; more effectively communicate the necessity to have stakeholders from the whole system involved; work with SMTs throughout co-production functions; involve stakeholders outside the school to support producing solutions to change school mental health and wellbeing priorities. The framework is intended to be used by researchers to integrate stakeholders into a shared decision-making process to develop interventions that meet the needs and contexts of individual schools. It could be transferred to other settings to support the development of public health interventions for other health areas, and populations. Further evaluation to test its use in other settings is needed.

Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review

BACKGROUND

An estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review.

METHODS

The scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question.

RESULTS

A total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms.

CONCLUSION

Important barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.

Co-design and Development of Implementation Strategies: Enhancing the PAX Good Behaviour Game in Australian Schools

Effective implementation strategies are important for take-up of programs in schools. However, to date, few implementation strategies have been co-designed with teachers and support staff (including principals) in Australia. The aim of this study was to iteratively co-design multiple implementation strategies to enhance the delivery of mental health prevention program, PAX Good Behaviour Game, in New South Wales primary schools. The secondary aim was to evaluate the acceptability of the implementation strategies from the perspective of school staff. Twenty-nine educational staff (including principals) informed the co-design of the implementation strategies across three phases. Phase 1 involved a rapid review of the literature and stakeholder meetings to agree upon potential evidence-based strategies. Phase 2 involved focus group discussions with educational staff to co-design implementation strategies. Phase 3 involved semi-structured interviews with school staff to assess strategy acceptability after implementation at 6-months post-baseline. Data were analysed using deductive, framework analysis. The final co-designed intervention included nine implementation strategies accessible through a toolkit delivered to the school's leadership team. These strategies were deemed acceptable in school settings that experienced periods of both face-to-face and remote learning due to the changing COVID-19 situation in 2021. This paper contributes to the implementation literature by transparently reporting how educational staff-informed implementation strategies were iteratively co-designed. This will provide a roadmap for other researchers to co-design implementation strategies to further support the delivery of evidence-based prevention programs in schools.

Development and evaluation of a school-based physical literacy intervention for children in Germany: protocol of the PLACE study

Introduction

Fueled by the COVID-19 pandemic, the physical activity behavior of children has reached a concerning level nowadays. By empowering individuals to be physically active throughout the life course, the concept of physical literacy has recently gained increasing attention and adopts a holistic-integrative perspective on PA promotion. Although the field has successively attempted to translate the conceptual ideas of physical literacy into interventions, the theoretical base is heterogeneous and is often lacking within interventions. Furthermore, several countries, including Germany, have not equally adopted the concept yet. Therefore, the goal of the present study protocol is to describe the development and evaluation approach of a PL intervention ("PLACE") for children in grades three and four within the German all-day schooling system.

Methods

The physical literacy intervention cultivates explicit theory-content links and comprises 12 heterogeneous sessions (each 60-90 min in length). The study contains three different phases with two initial pilot studies and a subsequent main study. The two pilot studies take a mixed-methods character by drawing on quantitative pre-post-designs as well as interviews with children (in groups). In the main study, we will longitudinally compare the course of PL values (five outcome domains: physical, affective, cognitive, social, behavioral) between two study arms: school classes of children are either assigned to an intervention condition (regular physical education and health care plus PL intervention) or to a control condition (regular physical education and health care only).

Discussion

The findings of this study will provide evidence on how to structure a multicomponent intervention in Germany based on the PL concept. In summary, the results will report on the effectiveness of the intervention and, therefore, decide whether to scale-up the intervention.

Temporal development of high-performance translational teams

Successful translation involves the coupled application of knowledge-generating research with product development to advance a device, drug, diagnostic, or evidence-based intervention for clinical adoption to improve human health. Critical to the success of the CTSA consortium, translation can be more effectively accomplished by training approaches that focus on improving team-emergent knowledge skills and attitudes (KSAs) linked to performance. We earlier identified 15 specific evidence-informed, team-emergent competencies that facilitate translational team (TT) performance. Here, we examine the SciTS literature describing developmental, temporal dynamics, and adaptive learning stages of interdisciplinary teams and integrate these with real-world observations on TT maturation pathways. We propose that TTs undergo ordered developmental phases, each representing a learning cycle that we call Formation, Knowledge Generation, and Translation. We identify major activities of each phase linked to development goals. Transition to subsequent phases is associated with a team learning cycle, resulting in adaptations that enabling progression towards clinical translation. We present known antecedents of stage-dependent competencies and rubrics for their assessment. Application of this model will ease assessment, facilitate goal identification and align relevant training interventions to improve performance of TTs in the CTSA context.

Competencies supporting high-performance translational teams: A review of the SciTS evidence base

A translational team (TT) is a specific type of interdisciplinary team that seeks to improve human health. Because high-performing TTs are critical to accomplishing CTSA goals, a greater understanding of how to promote TT performance is needed. Previous work by a CTSA Workgroup formulated a taxonomy of 5 interrelated team-emergent competency "domains" for successful translation: 1). affect, 2). communication, 3). management, 4). collaborative problem-solving, and 5). leadership. These Knowledge Skills and Attitudes (KSAs) develop within teams from the team's interactions. However, understanding how practice in these domains enhance team performance was unaddressed. To fill this gap, we conducted a scoping literature review of empirical team studies from the broader Science of Team Science literature domains. We identified specific team-emergent KSAs that enhance TT performance, mapped these to the earlier "domain" taxonomy, and developed a rubric for their assessment. This work identifies important areas of intersection of practices in specific competencies across other competency domains. We find that inclusive environment, openness to transdisciplinary knowledge sharing, and situational leadership are a core triad of team-emergent competencies that reinforce each other and are highly linked to team performance. Finally, we identify strategies for enhancing these competencies. This work provides a grounded approach for training interventions in the CTSA context.

Examining the influence of group diversity on the functioning of community-based participatory research partnerships: A mixed methods study

Public health has endorsed the use of community-based participatory research (CBPR) to address health inequities involving diverse and marginalized communities. However, few studies have examined how group diversity among members of CBPR partnerships influenced how well the partnerships achieve their goals of addressing health inequities through equitable collaboration. We conducted secondary, convergent, mixed methods analysis to (1) evaluate the association between group diversity and participatory decision-making within CBPR partnerships, and (2) identify the perceived characteristics, benefits, and challenges of group diversity within CBPR partnerships. Using data from a cross-site study of federally funded CBPR partnerships, we analyzed and integrated data from surveys of 163 partnerships (n = 448 partners) and seven in-depth case study interviews (n = 55 partners). Quantitatively, none of the measured characteristics of group diversity was associated with participatory decision-making within the partnerships. Qualitatively, we found that partnerships mainly benefited from membership differences in functional characteristics (e.g., skillset) but faced challenges from membership differences in sociocultural characteristics (e.g., gender and race). The integrated findings suggest the need to further understand how emergent group characteristics and how practices that engage in group diversity contribute to collective functioning of the partnerships. Attention to this area can help promote health equity achievements of CBPR partnerships.

Challenges and opportunities in coproduction: reflections on working with young people to develop an intervention to prevent violence in informal settlements in South Africa

Coproduction is widely recognised as essential to the development of effective and sustainable complex health interventions. Through involving potential end users in the design of interventions, coproduction provides a means of challenging power relations and ensuring the intervention being implemented accurately reflects lived experiences. Yet, how do we ensure that coproduction delivers on this promise? What methods or techniques can we use to challenge power relations and ensure interventions are both more effective and sustainable in the longer term? To answer these questions, we openly reflect on the coproduction process used as part of Siyaphambili Youth ('Youth Moving Forward'), a 3-year project to create an intervention to address the social contextual factors that create syndemics of health risks for young people living in informal settlements in KwaZulu-Natal province in South Africa. We identify four methods or techniques that may help improve the methodological practice of coproduction: (1) building trust through small group work with similar individuals, opportunities for distance from the research topic and mutual exchanges about lived experiences; (2) strengthening research capacity by involving end users in the interpretation of data and explaining research concepts in a way that is meaningful to them; (3) embracing conflicts that arise between researchers' perspectives and those of people with lived experiences; and (4) challenging research epistemologies through creating spaces for constant reflection by the research team. These methods are not a magic chalice of codeveloping complex health interventions, but rather an invitation for a wider conversation that moves beyond a set of principles to interrogate what works in coproduction practice. In order to move the conversation forward, we suggest that coproduction needs to be seen as its own complex intervention, with research teams as potential beneficiaries.

The Benefits, Barriers, and Risks of Big-Team Science

Progress in psychology has been frustrated by challenges concerning replicability, generalizability, strategy selection, inferential reproducibility, and computational reproducibility. Although often discussed separately, these five challenges may share a common cause: insufficient investment of intellectual and nonintellectual resources into the typical psychology study. We suggest that the emerging emphasis on big-team science can help address these challenges by allowing researchers to pool their resources together to increase the amount available for a single study. However, the current incentives, infrastructure, and institutions in academic science have all developed under the assumption that science is conducted by solo principal investigators and their dependent trainees, an assumption that creates barriers to sustainable big-team science. We also anticipate that big-team science carries unique risks, such as the potential for big-team-science organizations to be co-opted by unaccountable leaders, become overly conservative, and make mistakes at a grand scale. Big-team-science organizations must also acquire personnel who are properly compensated and have clear roles. Not doing so raises risks related to mismanagement and a lack of financial sustainability. If researchers can manage its unique barriers and risks, big-team science has the potential to spur great progress in psychology and beyond.

Multi-, Inter-, and Transdisciplinarity within the Public Health Workforce: A Scoping Review to Assess Definitions and Applications of Concepts

In light of the current public health challenges, calls for more inter- and transdisciplinarity in the public health workforce are increasing, particularly to respond to complex and intersecting health challenges, such as those presented by the climate crisis, emerging infectious diseases, or military conflict. Although widely used, it is unclear how the concepts of multi-, inter-, and transdisciplinarity are applied with respect to the public health workforce. We conducted a scoping review and qualitative content analysis to provide an overview of how the concepts of multi-, inter-, and transdisciplinarity are defined and applied in the academic literature about the public health workforce. Of the 1957 records identified, 324 articles were included in the review. Of those, 193, 176, and 53 mentioned the concepts of multi-, inter-, and transdisciplinarity, respectively. Overall, 44 articles provided a definition. Whilst definitions of multidisciplinarity were scarce, definitions of inter- and transdisciplinarity were more common and richer, highlighting the aim of the collaboration and the blurring and dissolution of disciplinary boundaries. A better understanding of the application of multi-, inter-, and transdisciplinarity is an important step to implementing these concepts in practice, including in institutional structures, academic curricula, and approaches in tackling public health challenges.

Let's Do It Online?! Challenges and Lessons for Inclusive Virtual Participation

Within the broader framework of the EU-H2020 EdiCitNet project—a large-scale collaborative project with a multi-stakeholder approach—there is the opportunity to observe participatory planning approaches to mainstream nature-based, edible solutions to solve specific social urban problems in an international group of six cities—Berlin (Germany), Carthage (Tunisia), Sant Feliu de Llobregat (Spain), Letchworth (United Kingdom), Šempeter pri Gorici (Slovenia), and Lomé (Togo). One year after the project started, the COVID-19 pandemic made it necessary to transfer most participatory planning processes to online platforms. This new format presented challenges to planning and voluntary stakeholder engagement due to different capacities regarding technical requirements as well as location-specific social circumstances. In this paper, we aim to shed light on the potentials and trade-offs in shifting to online participation and who gets to participate under digital Participatory Action Research (PAR) circumstances. We used a mixed-methods approach to evaluate the planning progress and the transition to working online in the six cities during the first wave of the pandemic. The study identifies critical implications of COVID-19 on participatory planning processes, the challenges for online participation, and the effectiveness of measures applied to tackle those challenges. The transition to online participatory planning described in this paper emphasizes organizational rather than technical remedies. While the planning progress in all cities was delayed, some faced significant challenges in the transition to online due to the lack of technical or community capacities. This was fostered through the diverse and new realities of the stakeholders ranging from meeting existential needs to adapting to alternative forms of working and caring. The reflections in this paper offer learnings from the disruptions caused by COVID-19 to better understand how participatory planning processes can be managed online along the lines of equity, access, and participation. The findings demonstrate how participatory processes in the ongoing crisis can be maintained, with relevance to future waves of this and other pandemics.

Building a Life Course Intervention Research Framework

OBJECTIVES

To report on first steps toward building a Life Course Intervention Research Framework (LCIRF) to guide researchers studying interventions to improve lifelong health.

METHODS

The Life Course Intervention Research Network, a collaborative national network of >75 researchers, service providers, community representatives and thought leaders, participated in an iterative review process. Building on the revised Medical Research Council Guidance for Developing and Evaluating Complex Interventions, they identified 12 additional key models with features for inclusion in the LCIRF, then incorporated the 12 characteristics identified by the Life Course Intervention Research Network as actionable features of Life Course Interventions to produce the new LCIRF.

RESULTS

The LCIRF sets out a detailed step-wise approach to intervention development: (1) conceptualization and planning, (2) design, (3) implementation, (4) evaluation, and (5) spreading and scaling of interventions. Each step is infused with life course intervention characteristics including a focus on (1) collaborative codesign (2) health optimization, (3) supporting emerging health development capabilities (4) strategic timing, (5) multilevel approaches, and (6) health equity. Key features include a detailed transdisciplinary knowledge synthesis to inform intervention development; formation of strong partnerships with family, community, and youth representatives in intervention codesign; a means of testing the impact of each intervention on biobehavioral processes underlying emerging health trajectories; and close attention to intervention context.

CONCLUSIONS

This first iteration of the LCIRF has been largely expert driven. Next steps will involve widespread partner engagement in framework refinement and further development. Implementation will require changes to the way intervention studies are organized and funded.

Transdisciplinary Communities of Practice to Resolve Health Problems in Southeast Asian Artisanal and Small-Scale Gold Mining Communities

Artisanal and small-scale gold mining (ASGM) has been a major part of people's livelihood in the rural areas of many developing countries, including those in Southeast Asia (SEA). Nevertheless, because of the use of mercury, ASGM activities have significant local and global adverse impacts on the environment and ASGM community health. Although there have been many monodisciplinary projects by academic researchers and governments to solve the environmental and health problems in SEA ASGM communities, they have not been sufficient to solve the complex socioeconomic problems. This review first outlines the nature of the SEA ASGM activities and the consequent environmental, community health, and socioeconomic problems and then introduces an approach using transdisciplinary communities of practice that involves both academic and nonacademic participants to relieve these wicked ASGM problems and to improve the environmental governance and community health in ASGM communities in SEA.

Can the interconnection between public health and social work help address current and future population health challenges? A public health viewpoint

The debate over the function and role of public health in all societies (high, middle, and low-income) still continues today. Public health needs to interact with the social and translational sciences to achieve the best possible scientific evidence and practice aimed at development of effective policies for individual and population health practices. As a field, public health is most suited for development of transdisciplinary education, research and practice—improving population health would entail embedding with a variety of other disciplines including social work. Public health and social work in many ways share the same beginnings as well as their role in advocacy for social and health equity. For this reason, the transdisciplinary profession of public health social work is well placed to develop and build the inter-professional and cross-sectoral collaboration that is needed to address the many health challenges of the 21st century, based on theories, knowledge and interventions from both public health and social work. Furthermore, the profession can help in attempting to close the health inequalities gap, address social isolation, family violence and homelessness, advance long and productive lives, create social responses to the changing environment, reduce economic inequality, harness technology for social good, and work toward the achievement of justice and equality of opportunity.

Identifying actions to foster cross-disciplinary global health research: a mixed-methods qualitative case study of the IMPALA programme on lung health and tuberculosis in Africa

OBJECTIVES

To identify actions for fostering cross-disciplinary research (CDR) skills and collaborations in global health, and to produce recommendations for improving the design, implementation and management of cross-disciplinary global health research programmes.

DESIGN

Using a North-South global health research programme as a case study-and following an adapted framework-we conducted qualitative research using document reviews, semi-structured interviews (purposive sampling) and participatory observation. We used baseline survey findings to identify potential interviewees and tailor interview guides.

SETTING

Our case study was a 4.5-year (2017-2021) programme, namely, the International Multidisciplinary Programme to Address Lung Health and Tuberculosis in Africa (IMPALA). Led by a UK research institute, IMPALA spanned 22 partner organisations from 13 countries (10 in sub-Saharan Africa), and involved five research discipline groups: clinical science, social science, health systems, health economics and policy/research capacity.

PARTICIPANTS

Thirty-one IMPALA members were interviewed (July 2018-November 2019), with interviewees evenly split by gender (16 female and 15 male) and by Global North/South institution (15 non-African and 16 African). Twenty-five (81%) were researchers, comprising 18 senior researchers (professors, readers, associate professors and senior lecturers) and seven early career researchers (assistant professors, lecturers, research fellows, postdocs, research assistants and PhD students). Twenty-four programme events were observed (September 2018-April 2020) and 49 documents were reviewed (December 2017-April 2020). All 66 IMPALA staff were sent the baseline survey, receiving 51 responses (43/56 researchers and 8/10 non-researchers).

RESULTS

Fourteen themes emerged, which suggested that CDR-while valued by many-is not universally understood, and the time it requires is often underestimated. We found that fostering CDR and managing tensions needs planning and continuous discussions and interactions. A shared vision with explicitly agreed goals and roles and active management of cross-disciplinary activities is essential.

CONCLUSIONS

Active planning, implementation and management of cross-disciplinary activities are essential for the success of cross-disciplinary global health research and should be separate from the primary research activities.

Expanding collaborative autoethnography into the world of natural science for transdisciplinary teams

Wicked problems such as climate change and the COVID-19 pandemic require authentically transdisciplinary approaches to achieving effective collaboration. There exist several research approaches for identifying the components and interactions of complex problems; however, collaborative autoethnography provides an empirical way to collect and analyze self-reflection that leads to transformative change. Here, we present a case study of collaborative autoethnography, applied as a tool to transform research practice among a group of natural and social scientists, by constructively revealing and resolving deep, often unseen, disciplinary divides. We ask, "How can natural and social scientists genuinely accept, respect, and share one another's approaches to work on the wicked problems that need to be solved?" This study demonstrates how disciplinary divisions can be successfully bridged by open-minded and committed collaborators who are prepared to recognize the academic bias they bring to their research and use this as a platform of strength.

Implementing the Co-Immune Open Innovation Program to Address Vaccination Hesitancy and Access to Vaccines: Retrospective Study

Background

The rise of major complex public health problems, such as vaccination hesitancy and access to vaccination, requires innovative, open, and transdisciplinary approaches. Yet, institutional silos and lack of participation on the part of nonacademic citizens in the design of solutions hamper efforts to meet these challenges. Against this background, new solutions have been explored, with participatory research, citizen science, hackathons, and challenge-based approaches being applied in the context of public health.

Objective

Our aim was to develop a program for creating citizen science and open innovation projects that address the contemporary challenges of vaccination in France and around the globe.

Methods

We designed and implemented Co-Immune, a program created to tackle the question of vaccination hesitancy and access to vaccination through an online and offline challenge-based open innovation approach. The program was run on the open science platform Just One Giant Lab.

Results

Over a 6-month period, the Co-Immune program gathered 234 participants of diverse backgrounds and 13 partners from the public and private sectors. The program comprised 10 events to facilitate the creation of 20 new projects, as well as the continuation of two existing projects, to address the issues of vaccination hesitancy and access, ranging from app development and data mining to analysis and game design. In an open framework, the projects made their data, code, and solutions publicly available.

Conclusions

Co-Immune highlights how open innovation approaches and online platforms can help to gather and coordinate noninstitutional communities in a rapid, distributed, and global way toward solving public health issues. Such initiatives can lead to the production and transfer of knowledge, creating novel solutions in the public health sector. The example of Co-Immune contributes to paving the way for organizations and individuals to collaboratively tackle future global challenges.

Application of community - engaged dissemination and implementation science to improve health equity

Community engagement is critical to accelerate and improve implementation of evidence-based interventions to reduce health inequities. Community-engaged dissemination and implementation research (CEDI) emphasizes engaging stakeholders (e.g., community members, practitioners, community organizations, etc.) with diverse perspectives, experience, and expertise to provide tacit community knowledge regarding the local context, priorities, needs, and assets. Importantly, CEDI can help improve health inequities through incorporating unique perspectives from communities experiencing health inequities that have historically been left out of the research process. The community-engagement process that exists in practice can be highly variable, and characteristics of the process are often underreported, making it difficult to discern how engagement of community partners was used to improve implementation. This paper describes the community-engagement process for a multilevel, pragmatic randomized trial to increase the reach and impact of evidence-based tobacco cessation treatment among Community Health Center patients; describes how engagement activities and the resulting partnership informed the development of implementation strategies and improved the research process; and presents lessons learned to inform future CEDI research.

Intervening for sustainable change: Tailoring strategies to align with values and principles of communities

This paper presents a rationale for tailoring implementation strategies within a values-driven implementation approach. Values-driven implementation seeks to organize implementers around clarifying statements of their shared values in ways that harmonize implementation dynamics related to individual and group mental models, relationships among implementers, and the implementation climate. The proposed approach to tailoring strategies is informed by systems theory and emphasizes the need to focus on both tangible events and behaviors, as well deeper patterns, structures, relationships, and mental models, in order to increase the likelihood of sustaining implementation efforts and improving outcomes for people and communities. We offer for consideration three specific sets of context determinants that are under-represented in the implementation literature and that emerge as especially relevant within a systems approach to identifying and successfully tailoring implementation strategies in the implementation setting including relationships, mental models, and implementation climate.

The Nurse+Engineer as the Prototype V-Shaped Professional

BACKGROUND

Descriptions of convergence research include promises to solve complex societal problems, such as environmental determinants of health and social determinants of health, through the integration of diverse disciplines, such as nursing and engineering, to create novel frameworks, such as the V-shaped professional.

PURPOSE

The purpose of this paper was to define the nurse+engineer as a prototypical V-shaped professional.

METHODS

Starting from a description of the I-shaped discipline of nursing and the I-shaped discipline of engineering, we follow an intentional pathway to define the concept of the nurse+engineer as a new V-shaped professional.

FINDINGS

Examples of the nurse+engineer at the bedside and the nurse+engineer in the community are highlighted to support a theoretical definition of the V-shaped nurse+engineer.

DISCUSSION

Implications of the nurse+engineer in the workforce and practical recommendations for training nurse+engineer professionals are provided to improve healthcare policy, practice, research, and education through scientific discovery and innovation.

Reducing Kidney Discard With Artificial Intelligence Decision Support: the Need for a Transdisciplinary Systems Approach

PURPOSE OF REVIEW

A transdisciplinary systems approach to the design of an artificial intelligence (AI) decision support system can more effectively address the limitations of AI systems. By incorporating stakeholder input early in the process, the final product is more likely to improve decision-making and effectively reduce kidney discard.

RECENT FINDINGS

Kidney discard is a complex problem that will require increased coordination between transplant stakeholders. An AI decision support system has significant potential, but there are challenges associated with overfitting, poor explainability, and inadequate trust. A transdisciplinary approach provides a holistic perspective that incorporates expertise from engineering, social science, and transplant healthcare. A systems approach leverages techniques for visualizing the system architecture to support solution design from multiple perspectives.

SUMMARY

Developing a systems-based approach to AI decision support involves engaging in a cycle of documenting the system architecture, identifying pain points, developing prototypes, and validating the system. Early efforts have focused on describing process issues to prioritize tasks that would benefit from AI support.

Development of a web-based discharge education intervention to improve the postdischarge recovery of general surgical patients

BACKGROUND

Postoperative complications contribute to unplanned hospital readmissions, reoperations, and increased mortality for surgical patients. Discharge education for general surgical patients is often inadequate, and challenged by organizational, clinician and patient factors.

PURPOSE

This research describes the development of the web-based discharge education intervention to improve patients' knowledge, skills, and confidence in self-managing their recovery after general surgery.

METHODS

The intervention was informed by the UK Medical Research Council guidance for developing and evaluating complex interventions and Knowledge-to-Action framework, consisting of four iterative stages. Stakeholder engagement was undertaken throughout the development process and a logic model was utilized to map the working mechanism of the intervention. The concept of patient activation and Knowles adult learning theory underpinned the development process.

RESULTS

The literature review and stakeholders' engagement in qualitative interviews and a series of meetings resulted in a web-based discharge education program with three different components: (1) post general surgery warning signs; (2) post general surgery everyday care instructions; and (3) animation video on wound potential wound complications.

CONCLUSION

The web-based discharge education was developed according to the needs and preferences of healthcare providers and general surgical patients. Despite the rigorous and systematic approach used to develop the intervention, its effectiveness requires testing.

CLINICAL RELEVANCE

This comprehensive iterative approach serves as a guide for others planning web-based interventions designed for surgical patients and the research approach used may inform those developing web-based interventions for other patient groups.

Handrails through the Swamp? A Pilot to Test the Integration and Implementation Science Framework in Complex Real-World Research

The socio-environmental challenges the world faces are ‘swamps’: situations that are messy, complex, and uncertain. The aim of this paper is to help disciplinary scientists navigate these swamps. To achieve this, the paper evaluates an integrative framework designed for researching complex real-world problems, the Integration and Implementation Science (i2S) framework. As a pilot study, we examine seven inter and transdisciplinary agri-environmental case studies against the concepts presented in the i2S framework, and we hypothesise that considering concepts in the i2S framework during the planning and delivery of agri-environmental research will increase the usefulness of the research for next users. We found that for the types of complex, real-world research done in the case studies, increasing attention to the i2S dimensions correlated with increased usefulness for the end users. We conclude that using the i2S framework could provide handrails for researchers, to help them navigate the swamps when engaging with the complexity of socio-environmental problems.

Developing a whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: a case-study of innovative local practice within The School Health Research network

Background

The evidence-base for whole school approaches aimed at improving student mental health and wellbeing remains limited. This may be due to a focus on developing and evaluating de-novo, research-led interventions, while neglecting the potential of local, contextually-relevant innovation that has demonstrated acceptability and feasibility. This study reports a novel approach to modelling and refining the programme theory of a whole-school restorative approach, alongside plans to scale up through a national educational infrastructure in order to support robust scientific evaluation.

Methods

A pragmatic formative process evaluation was conducted of a routinized whole-school restorative approach aimed at improving student mental health and wellbeing in Wales.

Results

The study reports the six phases of the pragmatic formative process evaluation. These are: 1) identification of innovative local practice; 2) scoping review of evidence-base to identify potential programme theory; outcomes; and contextual characteristics that influence implementation; 3) establishment of a Transdisciplinary Action Research (TDAR) group; 4) co-production and confirmation of an initial programme theory with stakeholders; 5) planning to optimise intervention delivery in local contexts; and 6) planning for feasibility and outcome evaluation. The phases of this model may be iterative and not necessarily sequential.

Conclusions

Formative, pragmatic process evaluations can support researchers, policy-makers and practitioners in developing robust scientific evidence-bases for acceptable and feasible local innovations that do not already have a clear evidence base. The case of a whole-school restorative approach provides a case example of how such an evaluation may be undertaken.

Exploring and Illustrating the (Inter-)Disciplinarity of Waste and Zero Waste Management

The aim of this research was to explore the composition, contribution and arrangement of scientific disciplines, across the spectrum from, traditional waste management, to alternative, contemporary approaches, such as the zero waste and circular economy movements. The purpose of this research is to better address the challenge of waste by enhancing the understanding and future employment of interdisciplinary theory and practice. The first outcome of the review strategy employed in this research was to, illustrate a generic rubric of scientific disciplines and to highlight and discuss key disciplines most obviously connected to waste management. This graphic illustration was then overlain with the findings from systematically reviewing a diverse range of indicators and sources of insight and information on the disciplines and interdisciplinarity evident across the spectrum from waste to zero waste management approaches. The resulting final graphic illustrates the intense disciplinarity and hence, the significant interdisciplinary requirement of (zero) waste management. An observation emerging from this research is that, successfully managing the globalised complexity of waste issues and in this, addressing the challenges of climate change and sustainable development, requires cultivating synergy between multiple scientific and practical disciplines. The scope of this challenge increases with the adoption of more holistic, aspirational, countercultural approaches, such as zero waste. It is argued that, enhancing interdisciplinary training and collaboration in research, education and industry/community practice, will improve performance across the spectrum of worldviews, from waste to zero waste.

The Digitalization Sustainability Matrix: A Participatory Research Tool for Investigating Digitainability

Rapidly increasing applications of Digitalization and Artificial Intelligence (D&AI) are already impacting our day-to-day life substantially, along with social and economic prospects worldwide. The accelerating utilization of D&AI has stirred the discussion concerning the responsible application of technologies for assisting the implementation of the Sustainable Development Goals (SDGs). D&AI can raise productivity, lower costs, reduce resource intensity, and enable efficient public services. However, there are also risks and downsides that we all must identify and tackle to address any potential short-/long-term undesired impact. Notably, there exists a gap in knowledge about the mutual relationships between D&AI and the 17 SDGs. To address this gap and gather broader perspectives of experts on the potential uses and pitfalls of D&AI for SDGs and their respective indicators, we propose a participatory research approach: the Digitalization–Sustainability Matrix (DSM). The DSM serves as a means for collaborative methods, such as participatory action research (PAR), for the knowledge production process. We exercised the DSM in the Digitainable Thinkathon event, a gathering of experts from diverse sectors and backgrounds for capturing the action-oriented dialogues concerning the use of D&AI technologies for the indicators of SDGs 4 (Education) and 13 (Climate Action). As a tool, the DSM aided in the discussion by systematically capturing transdisciplinary knowledge generated on several aspects, such as: (1) the need for research–practice nexus action; (2) data-capturing efforts and social considerations; (3) collaborative planning for utilizing the power of D&AI; (4) lessons from the diverse community to encourage the purposeful use of technologies. Overall, the proposed approach effectively triggered a discussion on the crucial aspects that need to be considered for D&AI’s practices, a step towards deep-rooting the transdisciplinary perspectives for meaningful use of D&AI for SDGs.

Collaborating to co-produce strategies for delivering adolescent sexual and reproductive health interventions: processes and experiences from an implementation research project in Nigeria

Implementation science embraces collaboration between academic researchers and key stakeholders/implementers for the dual purpose of capacity building and context-adaptation. Co-production ensures that knowledge created with inputs from various groups of stakeholders is more reflective of local contexts. This paper highlights the experiences of academic researchers and non-academic implementers in collaborating to design implementation strategies for improving access to sexual and reproductive information and services for adolescents. Data were collected through primary and secondary sources. Detailed review of project documents such as minutes of research meetings, reports of workshops and outputs of group work activities enabled detailed description of the processes and steps of co-designing implementation strategies. Information on experiences and perspectives of benefits of the collaborative were collected through in-depth interviews of non-academic partners and focus group discussion with academic researchers. Narrative synthesis was done for information extracted through document review. Thematic analysis of qualitative interviews was done. The process of designing implementation strategies happened in three chronological steps of setting up the collaborative, selecting intervention areas and convening partners’ meetings to design strategies. Specific activities include stakeholder engagement, situation analysis, selection of intervention areas, designing the implementation strategies and pre-testing implementation tools. The process of analysing and selecting collaborators was iterative, and facilitated by having an ‘insider’ key informant. Working with key stakeholders enabled knowledge sharing and exchange among partners. Information sharing within the collaborative facilitated shifting of mindsets about adolescent sexual and reproductive health, and contextual adaptation of names and labels given to strategies. Co-producing implementation strategies with non-academic implementers enabled stakeholder ownership of implementation strategies and set the scene for their adoption in implementation settings. Some challenges of co-production of knowledge are that it is time consuming; involves several iterations that may influence coherence of strategies; involves multiple interests and priorities and poses a threat to fidelity.

Conserving biodiversity takes a plan: How planners implement ecological information for biodiversity conservation

Conserving biodiversity is critical to the sustainability of human settlements, and stands to benefit from collaboration between ecologists focused on understanding natural systems and planners balancing social, environmental, and economic priorities. Drawing from the socially-situated definition of 'sustainability', we sought to understand the relationship between ecologists and planners by probing how planners in the southeastern US prioritize and engage with biodiversity conservation and ecological information, and how context influences these decisions. We find that context matters, e.g., higher jurisdictional population density was positively associated with prioritizing tree cover and diversity. We find, also, that while biodiversity conservation and ecological information are valuable to planners, planners rely heavily on their colleagues to inform conservation-related activities and prioritize conservation topics that differ from ecological research foci. Improved communication by ecologists and context-specific transdisciplinary sustainability research, especially that which incorporates the primary role of elected officials in biodiversity conservation, may help to integrate ecological science and planning practice.

Stakeholders' experiences of the public health research process: time to change the system?

BACKGROUND

The importance of engaging stakeholders in the research process is well recognised. Whilst engagement is important, guidelines and practices vary for how stakeholders should be involved in research and how to facilitate effective collaborative relationships.

METHODS

This study aimed to explore the perspectives and experiences of stakeholders involved in the policy and practice area of outdoor space and non-communicable disease prevention. Stakeholders interviewed included academics, practitioners, policy-makers, knowledge brokers and a funder.

RESULTS

The findings suggest that stakeholders had positive experiences when engaged meaningfully in the research process, where research projects were carefully planned and managed with attention to context and culture, and where the research team was effective, respectful and communicative. These factors help to facilitate the translation of research into policy and practice. However, multiple challenges of collaborative research were identified which related to structural and systemic challenges, building and maintaining relationships, use and collection of data and information, cultural perceptions of research and research generation, and getting evidence into action. Participants felt that changing the funding system, exploring more collaborative research methodologies, improved research translation, and more effective collaborative relationships at all stages of the research process could address some of these challenges.

CONCLUSIONS

The findings highlight that, whilst stakeholder engagement in research was considered important, structural, cultural and individual practices impacted how this worked in practice. Identifying and testing solutions to address these challenges could improve synergies between research, policy, and practice and lead to the production of impactful research that reduces wastage of public funding, improves implementation of findings and ultimately improves public health outcomes.

Applying one health methods to improve cocoa production in Bougainville: A case study

Cocoa production is the major contributor to livelihoods for farming families that constitute nearly two-thirds of the population of the Autonomous Region of Bougainville, a Province in Papua New Guinea (PNG). These families, living mostly in subsistence poverty as a result of the Bougainville Civil War (1988–98), have significantly reduced cocoa production. Efforts to rebuild the industry have not been realised, due to known agricultural factors such as labour shortages, pests and diseases, poor support for farmers from trained agricultural extension officers and inefficient cocoa supply chains. But cocoa production involves factors other than agricultural ones. This article describes how we applied One Health methods to design and undertake a 6-year research project in Bougainville to improve cocoa productivity. Maximising the health and wellbeing of farming families and increasing agricultural productivity we argue, requires an in-depth understanding of the non-linear interactions between health, labour, household decision-making, yields and incomes.

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One Health research provides understanding and potential solutions to improving cocoa farmer livelihoods.

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Detailed preparation is essential for trusting transdisciplinary partnerships.

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Agreed communication strategies are essential.

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Regional Hubs and Village Resource Centres provide learning, practice and information sharing.

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A Cocoa-Health Framework describes best practice in healthcare and agriculture for villages.

Preparing interdisciplinary leadership for a sustainable future

Urgent sustainability challenges require effective leadership for inter- and trans-disciplinary (ITD) institutions. Based on the diverse experiences of 20 ITD institutional leaders and specific case studies, this article distills key lessons learned from multiple pathways to building successful programs. The lessons reflect both the successes and failures our group has experienced, to suggest how to cultivate appropriate and effective leadership, and generate the resources necessary for leading ITD programs. We present two contrasting pathways toward ITD organizations: one is to establish a new organization and the other is to merge existing organizations. We illustrate how both benefit from a real-world focus, with multiple examples of trajectories of ITD organizations. Our diverse international experiences demonstrate ways to cultivate appropriate leadership qualities and skills, especially the ability to create and foster vision beyond the status quo; collaborative leadership and partnerships; shared culture; communications to multiple audiences; appropriate monitoring and evaluation; and perseverance. We identified five kinds of resources for success: (1) intellectual resources; (2) institutional policies; (3) financial resources; (4) physical infrastructure; and (5) governing boards. We provide illustrations based on our extensive experience in supporting success and learning from failure, and provide a framework that articulates the major facets of leadership in inter- and trans-disciplinary organizations: learning, supporting, sharing, and training.

A Transdisciplinary Approach is Essential to Community-based Research with American Indian Populations

Social determinants of health and their effects on health outcomes create a complex system, with interaction between social, economic, physical, and biological factors necessitating research take a holistic approach. Transdisciplinary research, one of the three core values of the Collaborative Research Center for American Indian Health, seeks to go beyond methods of knowledge production occurring solely within disciplinary boundaries, because real-world societal problems do not adhere to such restrictions. Community involvement is an essential component for successful research partnerships with American Indian and Alaska Native (AI/AN) communities. We posit that transdisciplinary approaches, which considers community-level expertise as an equitable component on the research team, show great potential for advancing research in AI/AN communities.

Lessons learned about harmonizing survey measures for the CSER consortium

INTRODUCTION

Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium.

METHODS

A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing.

RESULTS

Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects.

CONCLUSIONS

In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.

Transdisciplinary interventions for environmental sustainability

This paper presents a case study of a transdisciplinary research based on an ex-post assessment of the environmental and socio-behavioral contexts of solid waste management in Lebanese peri-urban communities. Lessons learned are compiled into the Transdisciplinary Interventions for Environmental Sustainability conceptual framework. The approach starts with building a team of researchers and non-academic partners, continues with co-creating solution-oriented knowledge, and ends by integrating and applying the produced knowledge. The co-created knowledge includes the environmental and socio-behavioral ex-post assessment's results. The former reveals low air pollution levels, evidence of waste-related water contamination, and higher self-reported frequencies of ill-health symptoms and diseases closer to the landfill. The latter indicates that the community's perception about waste production differs from the real accounting of generated waste. Nine lessons are identified: (1) inherent common interest between the researchers and the community, (2) flexible interdisciplinary research team, (3) representative citizen committee, (4) contextually-informed outreach coordinator, (5) iterative research process accounting for the shifting socio-political context, (6) common expectations of the research process, (7) boundary objects leading to spin-off activities in the same setting, (8) effective communication strategy, and (9) ex-post assessment of subsequent societal and scientific impacts. The non-phased framework links all nine pointers in a logical order to ease scalability. The study answers a global need for a unified, clear, broadly adopted framework for transdisciplinarity and a deeper understanding of factors ensuring full-circle knowledge co-creation in waste-related contexts in the global South. The study offers managerial and research implications and suggests avenues for further research.

Towards Convergence: How to Do Transdisciplinary Environmental Health Disparities Research

Increasingly, funders (i.e., national, public funders, such as the National Institutes of Health and National Science Foundation in the U.S.) and scholars agree that single disciplines are ill equipped to study the pressing social, health, and environmental problems we face alone, particularly environmental exposures, increasing health disparities, and climate change. To better understand these pressing social problems, funders and scholars have advocated for transdisciplinary approaches in order to harness the analytical power of diverse and multiple disciplines to tackle these problems and improve our understanding. However, few studies look into how to conduct such research. To this end, this article provides a review of transdisciplinary science, particularly as it relates to environmental research and public health. To further the field, this article provides in-depth information on how to conduct transdisciplinary research. Using the case of a transdisciplinary, community-based, participatory action, environmental health disparities study in California's Central Valley provides an in-depth look at how to do transdisciplinary research. Working with researchers from the fields of social sciences, public health, biological engineering, and land, air, and water resources, this study aims to answer community residents' questions related to the health disparities they face due to environmental exposure. Through this case study, I articulate not only the logistics of how to conduct transdisciplinary research but also the logics. The implications for transdisciplinary methodologies in health disparity research are further discussed, particularly in the context of team science and convergence science.

Applying a social-ecological framework to Yucheng: 40 years after exposure to polychlorinated biphenyls and dibenzofurans

Although many epidemiological studies have been conducted on Yucheng cohorts, this incident has rarely been examined from social-ecological perspectives. This study adopted a social-ecological model as a framework to provide a more complete description of Yucheng in order to understand its effects on affected individuals, communities, and society. At first, recent studies on Yucheng victim's health effects  was updated. Long-term follow-up studies of Yucheng cohort have revealed the adverse health effects exerted on victims and their children. Subsequently, this study uses the disaster ecology model as a conceptual framework to review Yucheng. The movements of Yucheng victims and their supporters have constituted a primary actor for promoting the personal and legal rights of Yucheng victims. Finally, this study discusses how to improve future studies to effectively assist victims in their recovery from this incident.

Educators' perceptions of organisational readiness for implementation of a pre-adolescent transdisciplinary school health intervention for inter-generational outcomes

Organisational readiness is an implementation pre-requisite to gain its members' appropriate and committed use of the intervention. Implementation climate and organisational readiness for implementing change were evaluated conjointly to assess organisational readiness for an obesity and HIV health intervention that imparts health information directly to Grade 6 learners, and indirectly to their parents/caregivers in their home environment. The study objectives were to assess the level of organisational readiness at schools and to identify organisational factors (facilitators, barriers and contextual factors). A mixed-methods approach collected data from five public schools in Gauteng, South Africa. Forty-six educators and school management answered a self-administered questionnaire and contributed to a focus group discussion at each school. Mean scores with standard deviations, or median scores with interquartile ranges, were calculated to determine levels of organisational readiness. Qualitative data were transcribed and analysed thematically. The overall implementation climate and organisational readiness for implementing change median scores were acceptable, at 3.6 (IQR 3.2-4.1) and 4.3 (IQR 3.8-4.9), respectively. Results indicated that educators collectively valued the change highly enough to commit to its implementation, and that the motivation for the intervention, associated goals and objectives, the realisation for change, and the benefits thereof were well-comprehended by educators. Thirteen barriers and 13 facilitators were identified. The perceived degree of fit between the significance and values attached to the intervention by educators, and how these would be received by the target group (parents and learners) was also beneficial. Key barriers and facilitators indicated that the intervention needed to be a fit with existing workflows and educational systems. Contextual factors such as intervention appropriateness and acceptability as well as sensitivity to HIV were identified. These findings suggested proactive improvements to further improve the intervention and its implementation strategy.

Placing Transdisciplinarity in Context: A Review of Approaches to Connect Scholars, Society and Action

Complex sustainability problems (e.g., climate change) are challenging to understand and manage, leading to an increase in approaches that connect scholars to society and research to action (collaborative approaches). The transdisciplinary approach (TDA) represents one such approach. While TDA is new to many, there are several prior collaborative approaches including collaborative adaptive management, knowledge integration, participatory action research, and indigenous/local knowledge. Other contemporary and parallel approaches include citizen science, translational science, evidence-based practice, and knowledge with action. The varied disciplinary roots and problem areas contribute to a lack of interaction among these parallel but distinct approaches, and among the scholars and stakeholders who practice them. In this paper, we consider the connections, complementarities and contradictions among these distinct but related collaborative approaches. This review offers insights into the interaction between science and practice, including the importance of social processes and recognition of different ways of knowing, as well as how to conduct collaborative approaches on a variety of scales and think about how to generalize findings. The review suggests a need to rethink roles and relationships in the process of knowledge co-creation, both extending the roles of researchers and practitioners, creating new hybrid roles for “pracademics”, and placing greater awareness on issues of power.

A classroom-based intervention targeting working memory, attention and language skills in 4-5 year olds (RECALL): study protocol for a cluster randomised feasibility trial

BACKGROUND

There is international recognition of the need for creative, classroom-based interventions to support children at risk of low academic achievement and well-being, due to poor attention and language skills on school entry. Working memory (WM) is a cognitive skill that is strongly associated with attention and language skills. There has been speculation that WM training, embedded within typical educational activities, may improve children's WM skills and produce transfer effects to real-world skills such as attention and language. However, little is known about the effectiveness of this approach.'Recall to Enhance Children's Attention, Language and Learning' (RECALL) is a novel, 6-week, classroom-based intervention targeting WM, attention and language skills in 4-5 year olds. RECALL was co-produced with health professionals, teachers and parents. This protocol describes the rationale, methods and analysis plan for a proposed cluster randomised feasibility trial of this RECALL programme.

METHODS

This is a three-arm, cluster randomised feasibility trial comparing RECALL to an existing programme (active control), and no-intervention (education as usual). We will recruit six schools in socially disadvantaged areas in one region of the UK. Two schools will be randomly allocated to each arm of the trial. In each school, one class of children (ages 4-5 years) of approx. 30 children will be involved in this study. Ten children in each class will be sampled purposefully for outcome measurement including: standardised assessments of WM, language and attention skills; teacher ratings of attention; and parent ratings of functional communication skills. These will be administered at baseline and 1-week post-intervention in order to test the acceptability of the measures. A process evaluation using semi-structured interviews with participants will explore the acceptability of RECALL and the procedures employed in this trial.

DISCUSSION

This feasibility study will explore the acceptability of RECALL to the health professionals and teachers who will deliver it and inform the optimal design of the programme. The inclusion of an active control group and the blinding of outcomes assessors enhance rigour in this study. The findings will determine whether this study can be scaled-up into a definitive cluster randomised trial to evaluate the effectiveness of RECALL.

TRIAL REGISTRATION

ISRCTN13633886. Registered 7 Sept 2018.

Didactic Strategies to Promote Competencies in Sustainability

Higher education is a principal agent for addressing the sustainable development goals proposed by the 2030 Agenda, because of its key mission of knowledge generation, teaching and social innovation for sustainability. In order to achieve this, higher education needs to integrate transversally the values of sustainability in the way of developing the field of management, as well as research, university life and, of course, teaching. This paper focuses on teaching, and more specifically on the didactic strategies considered most relevant for training in sustainability competencies in college students, according to the guidelines commonly accepted by the international academic community. Through collaborative work among experts from six Spanish universities taking part in the EDINSOST project (education and social innovation for sustainability), funded by the Spanish R&D+i Program, in this paper the role of five active learning strategies (service learning, problem-based learning, project-oriented learning, simulation games and case studies) in education for sustainability are reviewed, and a systematic approach of their implementation in higher education settings is presented. The results provide a synthesis of their objectives, foundations, and stages of application (planning, implementation, and learning assessment), which can be used as valuable guidelines for teachers.

Large-Scale Transdisciplinary Collaboration for Adaptation Research: Challenges and Insights

An increasing number of research programs seek to support adaptation to climate change through the engagement of large-scale transdisciplinary networks that span countries and continents. While transdisciplinary research processes have been a topic of reflection, practice, and refinement for some time, these trends now mean that the global change research community needs to reflect and learn how to pursue collaborative research on a large scale. This paper shares insights from a seven-year climate change adaptation research program that supports collaboration between more than 450 researchers and practitioners across four consortia and 17 countries. The experience confirms the importance of attention to careful design for transdisciplinary collaboration, but also highlights that this alone is not enough. The success of well-designed transdisciplinary research processes is also strongly influenced by relational and systemic features of collaborative relationships. Relational features include interpersonal trust, mutual respect, and leadership styles, while systemic features include legal partnership agreements, power asymmetries between partners, and institutional values and cultures. In the new arena of large-scale collaborative science efforts, enablers of transdisciplinary collaboration include dedicated project coordinators, leaders at multiple levels, and the availability of small amounts of flexible funds to enable nimble responses to opportunities and unexpected collaborations.

Research–Practice Partnership: Application to Implementation of Multitiered System of Supports in Early Childhood Education

Purpose

Research–practice partnerships (RPPs) offer a tool for identifying, generating, and implementing evidence-based strategies that improve practice, policies, and client outcomes. We offer a description of RPPs and elements that facilitate successful utilization. The origin of RPPs, various approaches, and anticipated barriers are discussed. We illustrate some of the challenges and rewards of establishing an RPP using an example of a project that sought to implement a multitiered system of supports among a variety of early childhood education classrooms in a large urban school district.

Method

A planning/leadership team established objectives and used surveys, focus groups, classroom observations, professional development records, and student outcome data to inform decision making.

Results

The district's progress in implementing multitiered system of supports in early childhood and ways in which implementation plans were modified as a result of data-based decision making are described. A number of unexpected obstacles interfered with original plans, requiring significant revisions in our theory of change and new strategies to overcome challenges.

Conclusion

This illustration helps elucidate critical elements of RPPs and highlights their applicability to researchers and practitioners in communication sciences and disorders.

Challenges in developing collaborative interdisciplinary research between gastroenterologists and engineers

The role of technology in healthcare is rapidly evolving. However, it can be argued that gastroenterology has not kept pace with other medical fields due to the multifaceted needs of this speciality and other issues. Innovation in healthcare technology increasingly requires interdisciplinary collaboration between engineers and clinicians. Nevertheless, working in such an interdisciplinary environment can be challenging due to factors such as working culture, communication and difference in priorities. We surveyed the views of clinicians specialising in gastroenterology and engineers on interdisciplinary health research. The 21 respondents expressed a range of opinions on the perceived benefits and challenges of interdisciplinary collaboration. Though engineers and clinicians recognised its advantages, they expressed a need for further improvement. However, engineers and clinicians differed in how best this could be achieved. The results of this survey are discussed with reference to the literature on interdisciplinary collaboration.

A Transdisciplinary Complex Adaptive Systems (T-CAS) Approach to Developing a National School-Based Culture of Prevention for Health Improvement: the School Health Research Network (SHRN) in Wales

The paper reflects on a transdisciplinary complex adaptive systems (T-CAS) approach to the development of a school health research network (SHRN) in Wales for a national culture of prevention for health improvement in schools. A T-CAS approach focuses on key stages and activities within a continuous network cycle to facilitate systems level change. The theory highlights the importance of establishing transdisciplinary strategic partnerships to identify and develop opportunities for system reorientation. Investment in and the linking of resources develops the capacity for key social agents to take advantage of disruption points in the re-orientated system, and engagement activities develop the network to facilitate new social interactions and opportunities for transdisciplinary activities. A focus on transdisciplinary action research to co-produce interventions, generate research evidence and inform policy and practice is shown to play an important part in developing new normative processes that act to self-regulate the emerging system. Finally, the provision of reciprocal network benefits provides critical feedback loops that stabilise the emerging adaptive system and promote the network cycle. SHRN is shown to have embedded itself in the system by securing sustainability funding from health and education, a key role in national and regional planning and recruiting every eligible school to the network. It has begun to reorient the system to one of evidence generation (56 research studies co-produced) and opportunities for data-led practice at multiple levels. Further capacity development will be required to capitalise on these. The advantages of a complex systems approach to address barriers to change and the transferability of a T-CAS network approach across settings and cultures are highlighted.

Team Science, Justice, and the Co-Production of Knowledge

Science increasingly consists of interdisciplinary team-based research to address complex social, biomedical, public health, and global challenges through a practice known as team science. In this article, I discuss the added value of team science, including participatory team science, for generating scientific knowledge. Participatory team science involves the inclusion of public stakeholders on science teams as co-producers of knowledge. I also discuss how constructivism offers a common philosophical foundation for both community psychology and team science, and how this foundation aligns well with contemporary developments in science that emphasize the co-production of knowledge. I conclude with a discussion of how the co-production of knowledge in team science can promote justice.

Participation as Relational Space: A Critical Approach to Analysing Participation in Sustainability Research

In the field of sustainability, scholars, and policy-makers herald the transformative power of participation in knowledge production. However, a discrepancy between these expectations and the limited understanding of the complex interactions constituting participation processes can be observed. With the aim of critically analysing these complex interactions, this paper develops a conceptual perspective on participation as a relational space which is formed in the interplay of structures and processes. This perspective is applied to the analysis of empirical literature in sustainability research, development research, and science and technology studies. The literature review guided by the proposed conceptualisation systematically draws together the rich experience with participation in knowledge production. Elements constituting participation spaces along the dimensions ‘structures’ and ‘actors’ are identified and discussed in relation to ‘processes’ of space-making: (i) (in)coherences with reference system, (ii) resources, (iii) timing, (iv) expectations, (v) mutual trust, and (vi) worldviews and values. Power relations are found to pervade the three dimensions. Enhanced conceptual-analytical clarity of the elements constituting participation spaces provides a differentiated basis for discussing the transformative power of participatory knowledge production. By stimulating reflexivity on the making of participation, this approach contributes to better understanding when spaces of participation have the capacity to become spaces of transformation.