A voyage of Discovery in Dundee: Navigating complexity as an embedded researcher.
published 26/04/23
Jenny Gillespie is a Senior Health Promotion Officer within NHS Taysides Public Health Directorate *.
Jenny shares her experience of supporting a developmental evaluation of a Whole Systems Approach to Diet and Healthy Weight led by Public Health Intervention Responsive Study Team (PHIRST). Jenny reflects on being a part-time embedded researcher on the study whilst simultaneously operationalising the approach in her NHS role.
In 2018 I was in my 2nd year of a PhD and also supporting colleagues in NHS Tayside (where I had worked as a dietitian since 2009) to co-produce a local plan called ‘Helping Taysides's Children and Young People to Feel Great and Ready to Learn’ which aligned with the Scottish Governments national 'A Healthier Future - Diet and Healthy Weight Delivery Plan' and ambition to halve childhood obesity by 2030. The pilot of a Whole Systems Approach (WSA) to address high population levels of childhood overweight and obesity was initiated in Dundee City in 2019.
Putting the Evidence into Practice using Whole Systems Approach Methodology
Myself and 2 other workers, one NHS and one Local Authority, were trained in Public Health Englands Whole Systems Approach to Obesity Guide, 6 phase methodology, over a 7month period from October 2019. Other local areas across Scotland (Scottish Government ‘Early Adopter’ areas) and the UK were implementing Whole Systems Approaches to address public health issues such as population levels of obesity. Yet there were very few examples of the evaluation of such approaches.
Dundee's experience of adaptating our WSA to the new digital world is captured in this webinar from November 2021 (start at 1hour 10min 40secs in until 1hour 38 min).
Generating practice based evidence by evaluation of a Whole Systems Approach
Dundee was awarded evaluation support from Public Health Intervention Response Study Team (PHIRST) and began an Evaluability Assessment (EA) by May 2021. A Theory of Change, development evaluation design and key evaluation questions were co-produced (see images to the left)
I was helping to facilitate the EA process by supporting and encouraging colleagues who were also involved in the WSA process, to contribute to the evaluation. This initial phase was completed by the end of October 2021, taking longer than the projected timeframe, meaning that key evaluation milestones shifted in view of key contextual factors, including:
Reality 1: We don’t want to add to the ‘burden’ of our colleagues with yet another ‘ask’
Encouraging health, local authority and third sector practitioners to prioritise evaluation and research activity when the squeeze on resource and associated pressures means that everyone is having to do more, with less, is extremely challenging.
The impact of COVID-19 and the cost of living crisis, on staff and service working at both an operational and strategic level across organisations, is unprecedented.
Researchers must seek to better understand the barriers and enablers for practitioners to engage in evaluation and research from the outset of a project and funders must take these into consideration when project timescales are proposed.
Reality 2: Translation of academic theories into something that is meaningful to practitioner.
Often, academic language is off putting to health, local authority and third sector practitioners and this can mean they disengage with evaluation activities that are perceived to be ‘too academic’.
This is often a two-way challenge - academics are not familiar with the language used by practitioners – in many cases different terms can be used that actually mean the same thing, leading to confusion.
This is exacerbated when stakeholders come from multi-agencies who themselves have terms and acronyms that are not easily understood by those from other disciplines.
Reaching a shared understanding in how key points are articulated is important and again requires some time.
In spite of the challenges associated with the evaluability process, our stakeholders (practitioners who were involved in some way with the WSA in Dundee) shaped the evaluation aim, research questions and work packages.
It also highlighted the value that an embedded researcher acould bring to the study. Acting as a link betweeen the academic research teams and practitioners, working on the ground.
A useful paper that outlines some key reflections from embedded researchers supporting other Whole Systems Approaches is available here.
Navigating Complexity as an Embedded Researcher
The PHIRST researchers felt an embedded researcher role would strengthen the evaluation activities associated with progressing the evaluation and operationalising Work Package 1-4. This opportunity came about In late 2021 and I had had just submitted my PhD thesis.
Despite feeling slightly jaded (an under-statement, anyone who has jsut submitted a PhD will know!), it was too good an opportunity to miss and I put my name forward and was delighted to have been offered the role for 12 month on a 0.5FTE basis in January 2022.
This afforded me the capacity to prioritise the evaluation over my many other operational activities (that I would continue with on a 0.3FTE basis).
I soon began joining weekly meetings with the wider research team to drive forward the activities needed for each work package that are described in detail in our evaluation report. From a practical point of view I was regularly attending meetings, facilitating workshops, maintaining relationships with stakeholders and keeping them informed about developments.
Being both the embedded researcher on the evaluation whilst simultaneously implementing WSA methodology came with both strengths and limitations and there was often overlap in the roles.
The ‘real world’ challenges associated with pressures and squeeze on resource within NHS and LAs and tight timeframe for project evaluation, described earlier remained the biggest challenges.
For example there was no back fill of my 0.5FTE post for the duration of my embedded researcher role.
Building and maintaining relationships that enable stakeholder who are already stretched in their work to ‘buy-in’ to the value of robust evaluation takes considerable effort and time particularly when the translation of academic theories and terms is also required.
Communication with colleagues and practitioners and wider knowledge mobilisation (KM) about the evaluation.
Keeping stakeholders up-to-date with progress was important and this took the form of a variety of methods e.g. papers presented at committee, quarterly sway newsletter to answering questions from stakeholders ad-hoc via email.
Working alongside the research associate for KM in developing a KM log and plan that captured the range of opportunities to share information.
Building research and evaluation capacity within our local system has been enabled by the Peer researcher activity in WP 2 and it is hoped this will leave a legacy to facilitate ongoing evaluation beyond the PHIRST study.
Many thanks to NIHR, PHIRST researcher team and my NHS manager for supporting my embedded researcher role.
When the world of research and practice collide, transformational change happens. 🙂
Please explore other areas of Dundee's WSA website for further details or email jenny.gillespie@nhs.scot