Section lead: Maryum Zaidi, PhD
Implementation Science Partner Engagement
This section provides a rationale for why community and partner engagement is important for integrating health equity in implementation science and gives examples of how this has been done effectively. In this section, we intentionally use “community and partner engagement” over “stakeholder engagement” due to the negative connotations of the word “stakeholder” in some indigenous communities. The choice of terminology depends on the specific context and the relationships between the parties involved. However, the word “stakeholder” is deeply rooted in colonial practices in which these communities had no legal rights. The term “stakeholder” implies that all parties involved have equal rights, which is not the case in all circumstances. Hence, we use language that focuses on building partnerships rooted in community-based participatory research.1,2,3 “Community” refers to a group of people or organizations defined by function (such as an industry), geography (such as a metropolitan area), shared interests or characteristics (such as ethnicity, sexual orientation, or occupation), or by a combination of these dimensions that facilitates an action at a local level.4 “Partners” can be defined in the context of a community, industry, or other fields with predetermined roles and responsibilities.5 Overall, “community partner" tends to emphasize collaboration, cooperation, and a shared sense of purpose with a specific community, while "stakeholders" is a broader term that encompasses all parties with an interest in a given project or organization, regardless of their level of involvement or alignment of goals. Both terms partner and stakeholder have their place, and the choice between them depends on the specific context as far as these terms are being used within their specific context. The term "community partner" is preferred when researchers seek equal power sharing and co-production throughout the life cycle of research with their communities of focus.
Equity-focused IS research requires a deep understanding of the assets and needs of populations and communities and of the systems, policies, and other contextual factors that underlie health inequities.6,7,8 Health inequality is often discussed in relation to economic, social, and racial/ethnic constructs. However, there are many other dimensions of inequities, such as gender, immigration status, sexual orientation, and geographic areas that require attention. IS-trained investigators wishing to make an impact on advancing health equity will benefit from engaging community partners who can help to ensure that implementation research is grounded in the lived experiences of the populations experiencing inequities.9
Equity-focused research depends on actively engaging and partnering with multiple stakeholders, leveraging existing resources, establishing shared objectives, and combining knowledge and action to achieve a more equitable distribution of power and the benefits of an intervention among all involved parties. 8 Implementation science can benefit from community partner engagement to yield better outcomes in EBP, particularly for communities experiencing health inequities.7,10,11 Insufficiently involving those affected by the issues in health interventions and EBPs can worsen inequities, leading to less acceptable and appropriate interventions with reduced reach and effectiveness. The partners closest to the problems hold the closest solutions for their communities. Engaging them provides valuable insights into issues, risks, and protective factors, leading to relevant strategies and enhancing sustainability, multilevel benefits, external validity, and transferability to other settings.8
The next section presents planning considerations for IS researchers interested in developing meaningful community or partner engagement in health equity-focused implementation research.
1. What does it mean to have meaningful community or partner engagement?
Community engagement occurs along a spectrum, as shown in Table 3 (adapted from Facilitating Power).12
Implementation researchers in IS can utilize this visual guide to assess how their design actively involves their community partners.
Table 3. Spectrum of Community or Partner Engagement
|Stance toward community
|Preparation or placation
|Community engagement goals
|Deny access to decision-making process
|Provide community with relevant information
|Gather input from community
|Ensure community needs and assets are integrated into process and informed intervention development/planning
|Ensure community capacity to play a leadership role in decision-making and the implementation of decisions
|Foster democratic participation and equity through community-driven decision-making; bridge divide between community and research governance
|Examples of activities
Closed door meetings
Community organizing and advocacy
Open planning forums
Memorandums of understanding (MOUs) with community-based organizations
Community advisory committees
Collaborative data analysis
Co-design and Co-implementation
Community-driven planning and ownership
Participatory Action Research
Cooperative models including Participatory budgeting
40%–50% community involvement
50%–70% community partners
|80%-100% community partners and community-driven processes ideally generate new values and resources that can be invested in solutions
2. What is a useful mindset for engaging communities and/or partners in implementation science that integrates a focus on health equity?
Researchers should be interested in incorporating community perspectives into their IS research, particularly to improve equity. For example, consider taking the following actions:
- Check with community partners to see if the problems they face are being addressed in the proposed research.
- Take the time to build trust and relationships—do not go into a new community and expect your ideas to be embraced immediately as an outsider.
- Seek to understand other experiences a community may have had with research or with your institution.
- Consider the bi-directional relationship: What are the benefits, skills, or resources that you bring? How can the community partners benefit from participation or engagement?
- Analyze the team and consider the diversity of viewpoints that may be needed to reach the community.
- Consider ways to redistribute power and resources.
3. What are useful approaches to defining and determining the meaningfulness, relevance, and impact of the research, and to whom?
- Consider the role of belonging, trust, and power. Low levels of trust between the community partners and local institutions are an enormous barrier to engagement and transformation. Community engagement across the life cycle of research, from design to implementation to evaluation creates the best possible conditions for change in meaningful and effective ways. Feelings of belonging to collective and cultural identity are a powerful source of motivation for active involvement and leadership and sustainability of research initiatives. IS researchers can take into account the following:
- If you are not a part of the community/partner group you are working with, what are you doing to meaningfully engage, hire, compensate, and build trust with those communities?
- Inclusion of diverse perspectives and groups in research partnerships goes beyond mere representation. True inclusions include clearly stated intention, culturally appropriate actions, and deliberate creation of welcoming environments that foster a sense of belonging. Explore innovative options for involvement that go beyond the usual methods of participation, such as meetings, conference calls, and Zoom calls. Embrace the idea of accommodating constraints by offering adaptable and imaginative alternatives to engagement, like prerecorded videos or opportunities after meetings to share further thoughts and ideas.13
Consideration of Implementation Science in Health Care Context vs. Other Settings
Even though implementation science is the scientific study of the methods to promote the uptake of research findings into routine health care in clinical, organizational, or policy contexts, there can be differences in health care versus other settings in the community. In health care, implementation science has to be tailored to the target population, cultural settings, and goals. It is similar to patient care, in which a diagnosis precedes treatment choice.14 Therefore, the principle of partner engagement is of utmost importance in health-care-related implementation science to select the EBP to achieve health equity. This may not be the case in other settings, such as in education or environmental policy sectors, where partner engagement may be desirable; however, relevant evidence-based practices from other settings may be implemented to achieve desired outcomes.15,16
Types of Community and Partner Engagements to Consider
Among various approaches, two prominent methods, namely community-based participatory research (CBPR) and the Patient-Centered Outcomes Research Institute's (PCORI) Engagement Rubric, provide principles and best practices to assist researchers in effectively engaging with communities and partners during their research process. As researchers develop community and partner engagement plans, these principles can serve as a foundation. These different kinds of engagement strategies are listed at DICEmethods.org,17 where researchers can explore various approaches, methods, and tools for meaningful community and partner engagement according to their budget and time.
A few other categories of consideration in community and partner engagement are suggested by Boaz et al.18 The authors have indicated that community and partner engagement can be organized into three groups for implementation science researchers to consider: organizational-based, value-based, and practice-based. Organizational-based engagement will revolve around specific objectives such as organizational learning or resource development. Values-based engagement will entail a shared commitment to the values with the community and partners. Lastly, practice-based engagement will incorporate the identification and involvement of partners in the iterative and ongoing research process.18
Community and partner co-creation with the researchers is emphasized by Perez Jolles et al.19 The authors suggested that such an approach to collaboration is critical to achieving meaningful implementation and offers a synergistic approach to goal attainment. They explained the co-creation process for IS researchers as working with community partners willing to share their knowledge, skill sets, and resources to work toward a goal they plan, design, test, and implement. They emphasized that such collaborations can be nurtured by addressing the power imbalance and trust among the involved partners. Their article presents three federally funded examples based on the EPIS framework (Exploration, Preparation, Implementation, and Sustainment).
Other Community Partner Engagement Examples
1. Use of community collaborative advisory board for serious mental illness in a new population provider group20
This study was conducted in partnership with a public mental health clinic that serves predominantly Hispanic/Latino clients to incorporate mental health managers. A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations. The adaptation process included fostering collaborations between community advisory board members, understanding the needs of the local population through mixed methods needs assessment (literature review and group discussions), reviewing interventions objectives to identify targets for adaptation and eventually developing the adapted intervention. By using this approach, an existing intervention (mental health care manager) was adapted by using community partner engagement.
2. Community-based, participatory-research-based design of community health worker breast cancer training program21
A community-based participatory research (CBPR) study conducted from 2017 to 2019 informed the design of a training curriculum for community health workers (CHWs) and educational dissemination materials. Twenty-two CHWs were trained, and knowledge gains were measured using a one-group pre-and post-test design. Triangulated evaluation consisted of field observations of CHW-client interactions, CHW self-reports, and rapid assessment surveys of community members. The training curriculum resulted in significant, sustained breast cancer knowledge gains among CHWs when comparing pre-, post-, and 4- to 6-month post-training follow-up test scores. Field observations of educational materials dissemination, CHW self-reported evaluations, and community rapid assessment surveys at three health fairs demonstrated that this was an effective strategy to engage female Hispanic/Latino farmworkers in breast cancer education.
3. CBPR-based project conducted in three Massachusetts communities to build capacity among community-based organizations to find, adapt, and evaluate EBPs systematically22
Researchers and community-based organizations co-created a training intervention to build capacity among community-based organization staff members to systematically find, adapt, and evaluate EBPs. PLANET MassCONECT is a CBPR project conducted in three Massachusetts communities. The community advisory committee and study team co-developed and refined the capacity-building training intervention and evaluations. They employed local community health educators in each partner community. The Participatory Approach to Knowledge Translation (PaKT) Framework guided the PLANET MassCONECT intervention. Community organizations can use the website (https://planetmassconect.org) to find the EBP that can be applicable to their communities and learn how to make a plan for implementation.
4. Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: A community-engaged approach23
In this qualitative study, 18 community key informants were interviewed to understand existing capacity for health programming among Catholic parishes, characterize parishes’ resource gaps and capacity-building needs implementing cancer control EBPs, and elucidate strategies for delivering capacity-building assistance to parishes to facilitate implementation of EBIs.
Implementation of evidence-based interventions needs to be considered from the partners’ perspective. Researchers may need to develop new interventions or adapt existing interventions with the help of community and clinical partners. This approach ensures that the intervention becomes more pertinent, efficient, and enduring when applied to the target community. By actively involving community partners as equal collaborators in the research process, they gain empowerment and an enhanced sense of self-efficacy.
- Sharfstein JM. Banishing "Stakeholders". Milbank Q. 2016;94(3):476-9.doi: 10.1111/1468-0009.12208
- Minkler M. Community-based research partnerships: Challenges and opportunities. J Urban Health. 2005;82(2 Suppl 2):ii3-12.doi:10.1093/jurban/jti034
- Wallerstein N, Oetzel JG, Sanchez-Youngman S, Boursaw B, Dickson E, Kastelic S, et al. Engage for Equity: A long-term study of community-based participatory research and community-engaged research practices and outcomes. Health Educ Behav. 2020;47(3):380-90. doi: 10.1177/1090198119897075.
- Pinto RM, Park S, Miles R, Ong PN. Community engagement in dissemination and implementation models: A narrative review. Implementation Research and Practice. 2021;2. doi:10.1177/2633489520985305
- Salsberg J, Parry D, Pluye P, Macridis S, Herbert CP, Macaulay AC. Successful strategies to engage research partners for translating evidence into action in community health: A critical review. Journal of Environmental and Public Health. 2015;2015:191856. doi: 10.1155/2015/191856.
- Clarke AR, Goddu AP, Nocon RS, Stock NW, Chyr LC, Akuoko JA, et al. Thirty years of disparities intervention research: What are we doing to close racial and ethnic gaps in health care? Medical care. 2013;51(11):1020-1026. doi: 10.1097/MLR.0b013e3182a97ba3
- Minkler M, Salvatore A, Chang C. Participatory approaches for study design and analysis in dissemination and implementation research. Dissemination and implementation research in health: Translating science to practice. 2012;192:212.doi: 10.1093/acprof:oso/9780199751877.003.0010
- Brownson RC, Kumanyika SK, Kreuter MW, Haire-Joshu D. Implementation science should give higher priority to health equity. Implementation Science. 2021;16(1):28. https://doi.org/10.1186/s13012-021-01097-0
- Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. Implementation Research and Practice. 2021;2:26334895211049482. https://doi.org/10.1177/263348952110494
- Israel BA, Coombe CM, Cheezum RR, Schulz AJ, McGranaghan RJ, Lichtenstein R, et al. Community-based participatory research: A capacity-building approach for policy advocacy aimed at eliminating health disparities. American Journal of Public Health. 2010;100(11):2094-102.doi: 10.2105/AJPH.2009.170506
- Ramanadhan S, Davis MM, Armstrong R, Baquero B, Ko LK, Leng JC, et al. Participatory implementation science to increase the impact of evidence-based cancer prevention and control. Cancer Causes & Control. 2018;29(3):363-9. doi: 10.1007/s10552-018-1008-1
- Gonzalez R. The spectrum of community engagement to ownership. Oakland, CA. 2019.
- PCORI. Equity and Inclusion Guiding Engagement Principles 2021. Available from: https://www.pcori.org/sites/default/files/Equity-and-Inclusion-Guiding-Engagement-Principles.pdf.
- Wensing M. Implementation science in healthcare: Introduction and perspective. Z Evid Fortbild Qual Gesundhwes. 2015;109(2):97-102.doi: 10.1016/j.zefq.2015.02.01415. doi:10.1016/j.zefq.2015.02.014
- Lyon RA. Implementation of science and practice in education sector. Available from: https://education.uw.edu/sites/default/files/Implementation%20Science%20Issue%20Brief%20072617.pdf
- NIH. Implementation Science in Environmental Health. 2022.
- DICEmethods. Stakeholder Engagement Navigator: University of Colorado Anschutz Medical Campus. Available from: https://dicemethods.org/.
- Boaz A, Hanney S, Borst R, O’Shea A, Kok M. How to engage stakeholders in research: Design principles to support improvement. Health Research Policy and Systems. 2018;16(1):60. doi:10.1186/s12961-018-0337-6
- Perez Jolles M, Willging CE, Stadnick NA, Crable E, Lengnick-Hall R, Hawkins J, et al. Understanding implementation research collaborations from a co-creation lens: Recommendations for a path forward. Frontiers in Health Services. 2022:2:942658. doi:10.3389/frhs.2022.942658
- Cabassa LJ, Gomes AP, Meyreles Q, Capitelli L, Younge R, Dragatsi D, et al. Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness. Implementation Science. 2014;9(1):178. doi:10.1186/s13012-014-0178-9
- Rodriguez NM, Casanova F, Pages G, Claure L, Pedreira M, Touchton M, et al. Community-based participatory design of a community health worker breast cancer training intervention for South Florida Latinx farmworkers. PLoS One. 2020;15(10):e0240827. doi:10.1371/journal.pone.0240827
- Ramanadhan S, Minsky S, Martinez-Dominguez V, Viswanath K. Building practitioner networks to support dissemination and implementation of evidence-based programs in community settings. Translational Behavioral Medicine. 2017;7(3):532-41. doi:10.1007/s13142-017-0488-y
- Leyva B, Allen JD, Ospino H, Tom LS, Negrón R, Buesa R, et al. Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: A community-engaged approach. Translational Behavioral Medicine. 2017;7(3):517-28. doi:10.1007/s13142-017-0513-1