Abstract
Background
Interdisciplinary collaboration and stakeholder engagement are key ingredients in implementation science research. However, effective and efficient collaboration can be limited by the complexity of implementation science terms. In this article, we argue that the development and use of plain language implementation science terms is an essential step to facilitate collaboration and engagement.
Method
We present an example of plain language development to portray the process and the potential benefits plain language can have on implementation science research. Implementation scientists and intervention experts codeveloped plain language implementation terms as a part of an implementation-effectiveness trial in western Kenya and in preparation for a stakeholder collaborative design meeting.
Results
The developed plain language terms facilitated wider stakeholder understanding and integration of implementation science findings that could inform the design of a stakeholder-led implementation coaching program.
Conclusions
We encourage the use of the plain language terms presented in this article, further translation, and additional development of other plain language terms for implementation science constructs.
Keywords: collaboration, stakeholder, plain language, coaching, global, task shifting
Plain Language Summary
Implementation science jargon can limit research collaborations with community and research partners. This article describes the importance of using plain language in implementation research and provides readers with an example of plain language terms used in a global implementation research project. We encourage implementation scientists and practitioners to use plain language when describing implementation science constructs to improve research and practice collaboration.
Introduction
One goal of implementation science is to reduce the knowledge-practice gap so that effective interventions are delivered successfully in real-world settings. To address the gap, scientists have developed strategies to support implementation. Generally, our field agrees that interdisciplinary partnership and collaboration with communities and organizations delivering interventions are necessary to ensure strategy relevance, feasibility, and appropriateness. However, achieving effective partnership and collaboration requires that researchers and stakeholders (e.g., treatment providers and youth consumers) can communicate well with each other. While specialized fields of science can—and do—have specialized language for efficient communication among scientists, this specialized language can impede partnership and collaboration objectives with stakeholders and researchers with varied backgrounds. The use of plain language—rather than specialized language—can also balance power differentials between researchers and community members (Mulvale et al., 2016). Westerlund et al.’s (2019) editorial calls for further developing “practical implementation science,” including a need for translation of scientific jargon into easy-to-understand, plain-language terms (see also Armson et al., 2018). As an indicator of our fields’ interest, colleagues long encouraged Geoff Curran to publish his simplified implementation science teaching tool that uses plain language to describe key concepts and implementation science's place among related fields (Curran, 2020) (accessed > 12,000 times).
We present plain language terms we developed for implementation science constructs. Our dissemination of these plain language terms was motivated by two experiences: (a) conference attendee enthusiasm when terms were shared in a Society for Implementation Research Collaboration conference plenary (Dorsey et al., 2019) and (b) benefits of plain language terms for facilitating communication and research collaborations among individuals with varying degrees of implementation science training. We share our terms, process, and benefits to encourage other plain language efforts.
Plain Language Terms
Context
Our plain language term development was part of a hybrid implementation-effectiveness trial of a youth-focused mental health intervention in western Kenya (Dorsey et al., 2020). The aim of the trial, Building and Sustaining Interventions for Children (BASIC), is to identify implementation policies and practices (IPPs) in health and education that lead to the successful implementation of a culturally adapted, trauma-focused cognitive-behavioral intervention, Pamoja Tunaweza (PT). In BASIC, teachers and community health volunteers (CHVs) were trained and supervised to provide PT in sequential phases. Our first step was to utilize a mixed-method approach to identify which IPPs supported successful early implementation of PT, to guide an implementation coaching program for future sites (REDACTED). The goal was for implementation coaching to be collaboratively delivered by experienced lay counselors and PT experts. The PT experts were PT lay trainers and supervisors employed by Ace Africa (AA), the NGO that leads BASIC. The BASIC research team, which included AA, the University of Washington (UW), and Duke University, wanted to collaboratively design the implementation coaching program with lay counselors, organizational leaders, and ministry officials. The BASIC team wanted to present the mixed-methods study results in a way that stakeholders with varied experiences could easily understand and use findings to inform the implementation coaching program.
Prior to presenting the mixed-methods study findings to stakeholders, implementation science experts from UW (SD, RDM, CS) and PT/intervention experts (acknowledgments) from AA collaboratively developed plain language terms and phrases that described implementation science constructs. Over the prior year, UW, Duke, and AA teams spent time updating implementation science constructs, definitions, and measures to be culturally appropriate. This included one in-person, 5-day meeting in Kenya in 2017 and additional audio/video calls. In preparation for the 2018 stakeholder meeting, the BASIC team met in-person in advance and reviewed findings from the mixed-methods study. To guide plain language term development, UW implementation science experts asked the AA intervention experts to explain, in their own words, how they would describe each construct to a community member. Terms were recorded for use in the 2018 stakeholder meeting (Table 1).
Table 1.
Plain Language Terms
| Original implementation science term a | Plain language terms |
|---|---|
| Implementation leadership | Leaders who are supportive, passionate, and positive about Pamoja Tunaweza b |
| Implementation climate | A workplace that is supportive, passionate, and positive about Pamoja Tunaweza b |
| Organizational climate | Supportive/unsupportive working environment |
| Commitment to the intervention | Counselors who are passionate about Pamoja Tunaweza b |
Note. UW = University of Washington; BASIC = building and sustaining interventions for children; IPP = implementation policies and practice.
Two other plain language terms were developed by UW implementation science experts on the BASIC research team, but are not included here because they were not developed through the described collaborative process with intervention experts. These terms are “goal” for a specific IPP and its function, and “solution” for specific forms an IPP might take.
Different program names or “the program” could replace “Pamoja Tunaweza.”
To better clarify this process, we provide an example of how “implementation leadership” was transformed into plain language. We use this example throughout to describe how we used plain language terms in our collaboration. Strategic implementation leadership describes leadership that is strategically focused on achieving successful implementation and encompasses leadership behaviors that indicate knowledge of the intervention and support for the implementation process and the intervention implementers (Aarons et al., 2014). Results from the mixed-methods study suggested that higher implementation leadership by school leaders was associated with teacher-counselors’ receiving more intervention support from other teachers (e.g., releasing children from extracurricular activities). Coded qualitative interviews identified leadership strategically focused on implementation, including supportive behaviors by leaders and perceived attitudinal aspects that aligned with the concept of inspiring motivation, conceptually part of transformational leadership (Bass & Avolio, 1993). Counselors described their motivation when school leaders talked passionately about PT or attended PT supervision. In this way, strategic implementation leadership consisted of both behavioral and attitudinal aspects of leadership. While this leader involvement aligns with the concept of knowledgeable leadership, the described effect was that counselors were inspired to practice and be more committed to PT.
After we shared results and discussed findings, intervention experts discussed variations in construct wording among themselves, deciding upon: “leaders who are supportive, passionate, and positive about Pamoja Tunaweza,” a plain language term encapsulating leadership support and inspiring motivation, conveying how a leader impacts PT delivery. Intervention experts similarly reported observing this kind of leadership, which they described as leading to counselor behavior change.
We followed the same steps for other terms that required translation (Table 1), sharing and discussing results, considering wording variations, and deciding on the best term. AA team members then used these plain language terms to present study findings to stakeholders on the first day of the in-person stakeholder meeting. Continuing with our example, we were able to present findings at the stakeholder meeting in a way that allowed all stakeholders to consider how to incentivize and support high implementation leadership at new sites. Immediately following the presentation of study findings, stakeholders were using plain language terms to discuss findings, integrating them into their own points about how to implement an effective implementation coaching program to support PT. We observed stakeholders prompting others to brainstorm how to work with school leaders from the first coaching meeting to ensure that leaders are supportive, passionate, and positive and that other teachers would support PT. BASIC team members and stakeholders consistently used the same plain language terms throughout small group design work for the implementation coaching program.
The plain language terms guided stakeholders in developing a six-meeting, approximately 1-hr implementation coaching program. The first coaching meeting with new sites was 1–2 months before PT training (preparation phase), with the additional five coaching meetings at important intervals during implementation (e.g., posttraining and predelivery) and early sustainment (Aarons et al., 2011). During Day 3 of the stakeholder meeting, experienced counselors who would codeliver implementation coaching were rehearsing delivery using role-plays. They scheduled all initial coaching meetings for the immediately following 2 weeks. A UW team member who is an implementation expert, Kenyan, and Kiswahili-speaking attended two coaching meetings and directly observed the experienced counselors persuasively conducting the coaching meeting and using plain language terms.
Impact
The BASIC research team was energized by the meaningful, rich, and productive conversations during the stakeholder meeting, facilitated by plain language use. Stakeholders discussed the importance of leadership and work environment (vs. focusing only on providers). They discussed ways to ensure leaders’ involvement in coaching and levels of leadership (e.g., head teachers and deputy teachers). We hope others can use our terms in their work and/or engage with partners to develop their own terms. We recognize terms presented in this article were created in and for the BASIC context and may need revision for other contexts. However, we believe that having examples of plain language terms can ignite creative thinking among other teams.
Accomplishing our research objectives necessitated development of plain language terms. A recent review characterizing stakeholder engagement found that stakeholders were most often engaged with limited depth and were rarely given decision-making power (Triplett et al., 2022). Our experience suggests that translation can help empower a higher level of engagement. We acknowledge these efforts require time, resources, and trusting relationships between researchers and community partners.
Plain language terms can have benefits that extend beyond community partnership collaborations. Implementation specialists are often engaged in collaboration with scientists outside our field. If we aim to have an impact, the more efficiently (e.g., understanding one another quickly) and effectively (e.g., communications lead to shared benefit for objectives) we communicate the greater our potential impact. Translation may be particularly important for collaborations with scientists in regions that have traditionally limited access to formal implementation science training. Transparent and collaborative communication is key in ensuring equitable partnerships in global health research. Allocating time and resources to building plain language terminology to facilitate stronger communication can further propel global partnerships and research.
Conclusion
Plain language implementation science terms facilitated stakeholder and community engagement in the development of a program to support successful implementation of a mental health intervention in western Kenya. We encourage the development, use, and sharing of plain language terms for effective communication and collaboration.
Acknowledgments
We thank the Ace Africa leadership: Augustine I. Wasonga and Cyrilla Amanya. We also thank the Ace Africa PT supervisors/experts and interviewers: Elijah Agala, Lilian Nandutu Aluka, Rose Chemuku, Oliver Hillary, Brigid Karakacha, Moses Malaba, Emmanuel Muli, Patrick Musa Masika, Micah Nalianya, Bernard Wafula Nambafu Nabalia, Michael Nangila, Sheila Wambui Nderitu, Daisy Anyango Okoth, Omariba Anne Nyaboke, Victor Shalakha, Annette Sulungai, Sylvia Wafula, and Nelly Wandera. We are grateful to the Ministry of Health, Ministry of Education, Teachers Service Commission, participating schools, communities, children, and families who are taking part in BASIC.
Footnotes
Author Note: Caroline Soi is now at 21GRAMS and Rosemary Meza is at Kaiser Permanente Washington Health Research Institute.
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dorsey is an international Trauma-focused Cognitive Behavioral Therapy (TF-CBT) trainer, the intervention on which Pamoja Tunaeza was based and has received compensation for TF-CBT training and consultation. Dorsey and Whetten have been PIs on grants focused on testing TF-CBT. The authors declare no other conflicts of interest.
Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this research project was supported by a grant to the first and fifth authors by the National Institute of Mental Health (R01 MH112633; Dorsey and Whetten, MPIs; P50 MH126219; Dorsey and Weiner, MPIs) and an NIMH-funded Diversity Supplement (MH112633; Meza). In addition, the research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number F31MH130041; Johnson. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Center for Evidence and Implementation provided additional funding to support BASIC. The funders/sponsors have no role in the study design or analysis.
ORCID iDs: Shannon Dorsey https://orcid.org/0000-0001-6240-0294
Clara Johnson https://orcid.org/0000-0002-9838-1846
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