Navigating the complexity of a collaborative, system-wide public health programme: learning from a longitudinal qualitative evaluation of the ActEarly City Collaboratory.
Child health
Collaboration
Consortium
Evaluation
Inequalities
Interdisciplinary
Programme management
Public health
Qualitative
Systems
Journal
Health research policy and systems
ISSN: 1478-4505
Titre abrégé: Health Res Policy Syst
Pays: England
ID NLM: 101170481
Informations de publication
Date de publication:
02 Oct 2024
02 Oct 2024
Historique:
received:
25
07
2024
accepted:
18
09
2024
medline:
3
10
2024
pubmed:
3
10
2024
entrez:
2
10
2024
Statut:
epublish
Résumé
Addressing the upstream social determinants of health (e.g. built environment, education) can reduce the burden of non-communicable diseases. To do so effectively often requires system-wide collaboration. However, collaborating across multiple sectors, organizations and disciplines within a complex system can be challenging. ActEarly was a public health research consortium that aimed to improve child health by building an interdisciplinary, cross-city partnership to develop and/or evaluate upstream interventions, increase research capacity and improve collaboration between researchers, local authorities and communities. This paper explores ActEarly's experiences of navigating complexity to identify mechanisms that supported its implementation and proposes recommendations for future intersectoral and interdisciplinary population health research collaborations. We conducted a longitudinal qualitative study of ActEarly, integrating findings from inductive documentary analysis of internal documents (mainly meetings minutes and reports) (n = 114) and interviews (n = 70) with 45 consortium members at three different timepoints (2018, 2021, 2023). Participants worked across different organizations, cities, roles and levels of seniority in the consortium. Clarity, Unity, Flexibility and Feasibility were seen as the key mechanisms required to support ActEarly's implementation. Clear aims, governance structures and communication were necessary to manage the uncertainty of the complex system. A unified approach, characterized by strong relationships, having a shared vision and communal access to resources supported effective collaboration. Flexibility was required to adjust to different ways of working, respond to wider system events and manage the consortium. Establishing feasible aims that responded to the limitations of the system, the available resources and research infrastructure was required for teams to deliver the work. Implementing multi-faceted programmes in a complex system can be challenging. We recommend that future whole-systems consortia seeking to improve population health build Clarity, Unity, Flexibility and Feasibility into their programmes, noting the complex interrelationships between these factors. Iterative reflections from all parties should support delivery amidst the uncertainty that comes with running a population health research collaboration, and strong leadership and governance should play a key role in ensuring that these are built into foundations the programme.
Sections du résumé
BACKGROUND
BACKGROUND
Addressing the upstream social determinants of health (e.g. built environment, education) can reduce the burden of non-communicable diseases. To do so effectively often requires system-wide collaboration. However, collaborating across multiple sectors, organizations and disciplines within a complex system can be challenging. ActEarly was a public health research consortium that aimed to improve child health by building an interdisciplinary, cross-city partnership to develop and/or evaluate upstream interventions, increase research capacity and improve collaboration between researchers, local authorities and communities. This paper explores ActEarly's experiences of navigating complexity to identify mechanisms that supported its implementation and proposes recommendations for future intersectoral and interdisciplinary population health research collaborations.
METHODS
METHODS
We conducted a longitudinal qualitative study of ActEarly, integrating findings from inductive documentary analysis of internal documents (mainly meetings minutes and reports) (n = 114) and interviews (n = 70) with 45 consortium members at three different timepoints (2018, 2021, 2023). Participants worked across different organizations, cities, roles and levels of seniority in the consortium.
FINDINGS
RESULTS
Clarity, Unity, Flexibility and Feasibility were seen as the key mechanisms required to support ActEarly's implementation. Clear aims, governance structures and communication were necessary to manage the uncertainty of the complex system. A unified approach, characterized by strong relationships, having a shared vision and communal access to resources supported effective collaboration. Flexibility was required to adjust to different ways of working, respond to wider system events and manage the consortium. Establishing feasible aims that responded to the limitations of the system, the available resources and research infrastructure was required for teams to deliver the work.
CONCLUSIONS
CONCLUSIONS
Implementing multi-faceted programmes in a complex system can be challenging. We recommend that future whole-systems consortia seeking to improve population health build Clarity, Unity, Flexibility and Feasibility into their programmes, noting the complex interrelationships between these factors. Iterative reflections from all parties should support delivery amidst the uncertainty that comes with running a population health research collaboration, and strong leadership and governance should play a key role in ensuring that these are built into foundations the programme.
Identifiants
pubmed: 39358795
doi: 10.1186/s12961-024-01227-2
pii: 10.1186/s12961-024-01227-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
138Subventions
Organisme : UK Prevention Research Partnership
ID : MR/S037527/1
Informations de copyright
© 2024. The Author(s).
Références
Marmot M, Bell R. Social determinants and non-communicable diseases: time for integrated action. BMJ. 2019. https://doi.org/10.1136/bmj.l251 .
doi: 10.1136/bmj.l251
pubmed: 31653611
pmcid: 6526681
World Health Organization. Social Determinants of Health. 2024; https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 . Accessed 1 Jul 2024.
de Montigny JG, Desjardins S, Bouchard L. The fundamentals of cross-sector collaboration for social change to promote population health. Glob Health Promot. 2019. https://doi.org/10.1177/1757975917714036 .
doi: 10.1177/1757975917714036
pubmed: 28805502
Rutter H, Savona N, Glonti K, Bibby J, Cummins S, Finegood DT, et al. The need for a complex systems model of evidence for public health. Lancet. 2017. https://doi.org/10.1016/S0140-6736(17)31267-9 .
doi: 10.1016/S0140-6736(17)31267-9
pubmed: 29198562
Rittel HWJ, Webber MM. Dilemmas in a general theory of planning. Policy Sci. 1973. https://doi.org/10.1007/BF01405730 .
doi: 10.1007/BF01405730
Walton M. Setting the context for using complexity theory in evaluation: boundaries, governance and utilisation. Evid Policy. 2016. https://doi.org/10.1332/174426415X14298726247211 .
doi: 10.1332/174426415X14298726247211
McGill E, Er V, Penney T, Egan M, White M, Meier P, Whitehead M, Lock K, Anderson de Cuevas R, Smith R, Savona N, Rutter H, Marks D, de Vocht F, Cummins S, Popay J, Petticrew M. Evaluation of public health interventions from a complex systems perspective: a research methods review. Soc Sci Med. 2021. https://doi.org/10.1016/j.socscimed.2021.113697 .
doi: 10.1016/j.socscimed.2021.113697
pubmed: 33508655
Egan M, Mcill E, Penney T, Anderson de Cuevas R, Er V, Orton L, et al. NIHR SPHR guidance on systems approaches to local public health. Evaluation Part 2: what to consider when planning a systems evaluation. London: National Institute for Health Research School for Public Health Research; 2019.
Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J, Knowledge Transfer Study Group. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q. 2003. https://doi.org/10.1111/1468-0009.t01-1-00052 .
doi: 10.1111/1468-0009.t01-1-00052
pubmed: 12841049
pmcid: 2690219
Kothari A, MacLean L, Edwards N. Increasing capacity for knowledge translation: understanding how some researchers engage policy makers. Evid Policy. 2009. https://doi.org/10.1332/174426409X395402 .
doi: 10.1332/174426409X395402
Brownson RC, Baker EA, Deshpande AD, Gillespie KN. Evidence-based public health. Oxford: Oxford University Press; 2018.
Jessani NS, Valmeekanathan A, Babcock C, Ling B, Davey-Rothwell MA, Holtgrave DR. Exploring the evolution of engagement between academic public health researchers and decision-makers: from initiation to dissolution. Health Res Policy Sys. 2020. https://doi.org/10.1186/s12961-019-0516-0 .
doi: 10.1186/s12961-019-0516-0
Hanefeld J, Mayhew S, Legido-Quigley H, Martineau F, Karanikolos M, Blanchet K, Liverani M, Mokuwa EY, McKay G, Balabanova D. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan. 2018. https://doi.org/10.1093/heapol/czx183 .
doi: 10.1093/heapol/czx183
pubmed: 30517618
pmcid: 6415725
Di Ruggiero E, Papadopoulos A, Steinberg M, Blais R, Frandse N, Valcour J, Penney G. Strengthening collaborations at the public health system–academic interface: a call to action. Can J Public Health. 2020. https://doi.org/10.17269/s41997-020-00436-w .
doi: 10.17269/s41997-020-00436-w
pubmed: 33175335
pmcid: 7656888
Bryson JM, Crosby BC, Stone MM. Designing and implementing cross-sector collaborations: needed and challenging. Public Admin Rev. 2015. https://doi.org/10.1111/puar.12432 .
doi: 10.1111/puar.12432
Diez Roux AV. Complex systems thinking and current impasses in health disparities research. Am J Public Health. 2011. https://doi.org/10.2105/AJPH.2011.300149 .
doi: 10.2105/AJPH.2011.300149
pubmed: 21778505
Amey MJ, Brown DF. Interdisciplinary collaboration and academic work: a case study of a university-community partnership. New Dir Teach Learn. 2005. https://doi.org/10.1002/tl.194 .
doi: 10.1002/tl.194
Choi BC, Pak AW. Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education and policy: 2. Promotors, barriers, and strategies of enhancement. Clin Invest Med. 2007. https://doi.org/10.25011/cim.v30i6.2950 .
doi: 10.25011/cim.v30i6.2950
pubmed: 18053389
Collyer TA, Smith KE. An atlas of health inequalities and health disparities research: “How is this all getting done in silos, and why?” Soc Sci Med. 2020. https://doi.org/10.1016/j.socscimed.2020.113330 .
doi: 10.1016/j.socscimed.2020.113330
pubmed: 32971486
pmcid: 7449896
Huckel Schneider C, Blyth F. Challenges of integrating evidence into health policy and planning: linking multiple disciplinary approaches. Public Health Res Pract. 2017. https://doi.org/10.17061/phrp2721719 .
doi: 10.17061/phrp2721719
pubmed: 28474056
Robinson T, Bailey C, Morris H, Burns P, Melder A, Croft C, et al. Bridging the research–practice gap in healthcare: a rapid review of research translation centres in England and Australia. Health Res Policy Sys. 2020. https://doi.org/10.1186/s12961-020-00621-w .
doi: 10.1186/s12961-020-00621-w
Calancie L, Frerichs L, Davis MM, Sullivan E, White AM, et al. Consolidated framework for collaboration research derived from a systematic review of theories, models, frameworks and principles for cross-sector collaboration. PLoS ONE. 2021. https://doi.org/10.1371/journal.pone.0244501 .
doi: 10.1371/journal.pone.0244501
pubmed: 33395449
pmcid: 7781480
Van Vooren NJE, Janssen LMS, Drewes HW, et al. How to collaborate for health throughout the project timeline—a longitudinal study reflecting on implemented strategies in three projects for a healthy living environment. BMC Public Health. 2023. https://doi.org/10.1186/s12889-022-14898-9 .
doi: 10.1186/s12889-022-14898-9
pubmed: 36627586
pmcid: 9831012
Towe VL, Leviton L, Chandra A, Sloan JC, Tait M, Orleans T. Cross-sector collaborations and partnerships: essential ingredients to help shape health and well-being. Health Aff. 2016. https://doi.org/10.1377/hlthaff.2016.0604 .
doi: 10.1377/hlthaff.2016.0604
National Institute for Health and Care Research. NIHR invests a further £55m to tackle health inequalities through local government research. 2023. https://www.nihr.ac.uk/news/nihr-invests-a-further-55m-to-tackle-health-inequalities-through-local-government-research/34972 . Accessed 22 May 2024.
UK Prevention Research Partnership. Background. 2024. https://ukprp.org/about-us/background/ . Accessed 25 Jun 2024.
Wright J, Hayward AC, West J, et al. ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing [version 1; peer review: 2 approved]. Wellcome Open Res. 2019. https://doi.org/10.12688/wellcomeopenres.15443.1 .
doi: 10.12688/wellcomeopenres.15443.1
pubmed: 32954010
pmcid: 6913213
Davidoff F, Dixon-Woods M, Leviton L, Michie S. Demystifying theory and its use in improvement. BMJ Quality Safety. 2015;24(3):228–38.
doi: 10.1136/bmjqs-2014-003627
pubmed: 25616279
pmcid: 4345989
Woulfe J, Oliver TR, Zahner SJ, Siemering KQ. Multisector partnerships in population health improvement. Prev Chron Dis. 2010. http://www.cdc.gov/pcd/issues/2010/nov/10_0104.htm . Accessed 15 Jul 2024.
Such E, Smith K, Woods HB, Meier P. Governance of intersectoral collaborations for population health and to reduce health inequalities in high-income countries: a complexity-informed systematic review. Int J Health Policy Manag. 2022. https://doi.org/10.34172/IJHPM.2022.6550 .
doi: 10.34172/IJHPM.2022.6550
pubmed: 35219286
pmcid: 10105187
Mansukoski L, Lockyer B, Creaser A, Sheringham J, Sheard L, Garnett P, et al. Meta-evaluation of a whole systems programme, ActEarly: a study protocol. PLoS ONE. 2023. https://doi.org/10.1371/journal.pone.0280696 .
doi: 10.1371/journal.pone.0280696
pubmed: 37262082
pmcid: 10234514
City of Bradford Metropolitan District Council. Understanding Bradford District, Intelligence Bulletin: Health and Life Expectancy. 2020. https://ubd.bradford.gov.uk/about-us/health-and-life-expectancy/ . Accessed 3 Jun 2024.
Office for National Statistics. Census 2021. 2021. https://www.ons.gov.uk/census Accessed 25 May 2024
City of Bradford Metropolitan District Council. Population Report 2021 Census, Intelligence Bulletin: Population. 2021. https://ubd.bradford.gov.uk/about-us/2021-census/ . Accessed 24 May 2024.
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019. https://doi.org/10.1080/2159676X.2019.1628806 .
doi: 10.1080/2159676X.2019.1628806
Bowen GA. Document analysis as a qualitative research method. Qual Res J. 2009. https://doi.org/10.3316/QRJ0902027 .
doi: 10.3316/QRJ0902027
Newbury-Birch D, Harbin K, Adamson A, Asthana S, Batey C, Buffardi AL, Curley J, Dezateux C, Divers A, Fitzsimmons E, Forbes LJ. Establishing research ecosystems in local government: ten lessons from the front line of the first year of the NIHR health determinants research collaborations (HDRCs). NIHR Open Res. 2024. https://doi.org/10.3310/nihropenres.1115225.1 .
doi: 10.3310/nihropenres.1115225.1
Verlinden S, Wynen J, Kleizen B, Verhoest K. Blurred lines: exploring the impact of change complexity on role clarity in the public sector. Review of public personnel administration. Rev Public Personnel Administ. 2023. https://doi.org/10.1177/0734371X221093573 .
doi: 10.1177/0734371X221093573
Koon AD, Rao KD, Tran NT, Ghaffar A. Embedding health policy and systems research into decision-making processes in low- and middle-income countries. Health Res Policy Sys. 2013. https://doi.org/10.1186/1478-4505-11-30 .
doi: 10.1186/1478-4505-11-30
Littlecott HJ, Fox KR, Stathi A, Thompson JL. Perceptions of success of a local UK public health collaborative. Health Promot Int. 2015. https://doi.org/10.1093/heapro/dav088 .
doi: 10.1093/heapro/dav088
pmcid: 5444252
Kerasidou A. The role of trust in global health research collaborations. Bioethics. 2018. https://doi.org/10.1111/bioe.12536 .
doi: 10.1111/bioe.12536
pubmed: 30480821
pmcid: 6563149
Siemens L, Smith J, Liu Y. Mapping disciplinary differences and equity of academic control to create a space for collaboration. Can J High Educ. 2014. https://doi.org/10.47678/cjhe.v44i2.183760 .
doi: 10.47678/cjhe.v44i2.183760
Petiwala A, Lanford D, Landers G, et al. Community voice in cross-sector alignment: concepts and strategies from a scoping review of the health collaboration literature. BMC Public Health. 2021. https://doi.org/10.1186/s12889-021-10741-9 .
doi: 10.1186/s12889-021-10741-9
pubmed: 33849498
pmcid: 8042631
Hawe P, Shiell A, Riley T. Theorising interventions as events in systems. Am J Community Psychol. 2009. https://doi.org/10.1007/s10464-009-9229-9 .
doi: 10.1007/s10464-009-9229-9
pubmed: 19390961
Jiang K, Le Y, Zheng X, Zhang X, Ouyang L. Toward a systematic understanding of megaproject improvisation. Int J Proj Manag. 2023. https://doi.org/10.1016/j.ijproman.2023.102529 .
doi: 10.1016/j.ijproman.2023.102529
Ciuchta MP, O’Toole J, Miner AS. The organizational improvisation landscape: taking stock and looking forward. J Manag. 2021. https://doi.org/10.1177/014920632 .
doi: 10.1177/014920632
Yammarino FJ, Spangler WD, Bass BM. Transformational leadership and performance: a longitudinal investigation. Leadersh Q. 1993. https://doi.org/10.1016/1048-9843(93)90005-E .
doi: 10.1016/1048-9843(93)90005-E
Bass BM, Bass R. The bass handbook of leadership: theory, research, and managerial applications (4th ed.). Free Press. 2008
Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021. https://doi.org/10.1136/bmj.n2061 .
doi: 10.1136/bmj.n2061
pubmed: 34593508
pmcid: 8482308