Building Evidence While Working With and In Communities
Ecological perspectives and theories allow prevention researchers and others to understand factors that impact social challenges – recognizing the who, how, when and where of an issue. Understanding our social ecology can also help us with facilitating inclusion and partnership – that is, working alongside communities. Yet, in adolescent health and teen pregnancy prevention, most evidence-based interventions focus on individual behavior change, with solutions oftentimes coming from outside spaces and places.
This issue brief sought to deepen our understanding of what it means to move innovations to evidence base across the entire social ecology while emphasizing working in and with communities.
This issue brief was possible because of a partnership with researchers from a large southern university (discussed below) and a presentation at the 15th European Society for Prevention Research conference in Cremona, Italy (September, 2024).
To give some background, researchers at Texas A&M University noted an important need in their work – to identify evaluation strategies that better fit innovative program models. The team at Texas A&M reached out to 1000 Feathers to undertake an exploratory effort to examine evaluation barriers and solutions to innovative adolescent health and teen pregnancy prevention. Together we formed the Innovation Partnership, a collaboration between researchers and consultants that capitalized on the collective knowledge and wisdom of those in the adolescent health and teen pregnancy prevention space, and as we would come to find out, other disciplines and fields of study. The team settled on four key framing objectives to move forward, which included:
challenging the requirements of adolescent health and teen pregnancy prevention evidence-based lists, clearinghouses, and repositories;
promoting adolescent health and teen pregnancy prevention transdisciplinary partnerships;
identifying innovative research and evaluation barriers; and
identifying innovative research and evaluation opportunities.
The project took place from January – June 2024 and was guided by a four-step framework often used by us at 1000 Feathers to help organizations solve complex challenges. While this general framework was used with Texas A&M to help them with solving their complex challenge, the specifics of the work was contextualized to their unique needs.
Over the course of about six months, we used a series of kickoff and planning meetings and a literature scan to help understand the challenge; we connected with folks across the United States to speak into the challenge and offer insights and potential solutions; we engaged in multiple participatory experiences to understand the data and create solutions; and we co-created an innovation cycle and essential conditions. This brief is focused on the folks that we talked with and the themes from the conversations at the intersection of innovation to evidence base (purpose of the partnership with Texas A&M) and prevention in and with communities (theme of the conference).
The folks that we talked with, called Changemakers in our project, represented states from across the United States, from Maryland to Pennsylvania and Oregon and from Florida to South Carolina and Texas. Many of the Changemakers were situated at an institute but they were also positioned at universities, government agencies, foundations, and programmatic and clinical practices. About half of the Changemakers served in a directorship role while others were researchers, Chief Executive Officers, evaluators, or designers. And while many of the Changemakers had a wide skillset and familiarity with several issue areas, many were method-forward, meaning that their work and partnerships centered around research, evaluation, implementation, or similar work areas first.
Changemakers were contacted by a member of the 1000 Feathers team, many times leaning on peer-to-peer connections or pre-established relationships. All Changemakers received the same details about the conversations (i.e., purpose, parties involved, consent, and stipend), gave permission to the use of their information, and some opted for a stipend for their time. The Changemaker conversations took place over Zoom and were recorded with permission. To begin understanding the Changemaker conversations, 1000 Feathers started with a conventional content analysis. This included reviewing the audio recordings and transcripts; developing codes based on conversations and project context; and re-reading notes and transcripts to re-apply codes and themes based on the framing objectives.
The Changemaker conversation produced three broad themes in moving innovations to evidence:
Challenges, Solutions, and Opportunities.
In terms of challenges, we heard from Changemakers that mental models (i.e., differing philosophies on innovation, systems and change work, and research and evaluation strategies) and adaptations (i.e., need for nuanced understanding that evidence works differently for diverse individuals, groups, and communities, and that not all evidence can or should be translated for others) were common concerns when working in and with communities. Not only do our core values and beliefs impact how we approach solving complex challenges, prevention research, and working with communities, but they can also differ from our colleagues and communities. We also heard a need for a new approach to adaptations, specifically just because a solution has evidence that alone is not reason enough for it to be adapted.
In terms of solutions, we heard from Changemakers that values and practices (i.e., community driven, led, and as expert change efforts; multidisciplinary teams with different knowledge, skills, and abilities) and ongoing learning (i.e., institute ongoing and communities of learning; educate on systems thinking, design, and change; teaching rapid evaluation and ethics and elements of randomized controlled trials) were key to working in and with communities. Not only should members of the community be part of multidisciplinary teams, but people from the community should be the drivers of the change efforts. Similarly, all initial and ongoing learning activities should include members of the community and the multidisciplinary team.
In terms of opportunities, we heard from Changemakers that elements of working in and with communities were paramount to creating a new evidence paradigm (i.e., create broad standard of evidence by changing how everyone learns about how evidence, who is involved in evidence making, and how gets to decide what evidence is) and new evidence continuum (i.e., build evidence across the social ecology so that communities have an evidence continuum to work with in their change efforts), and to changing how we think about and act on dissemination and implementation (i.e., improve research translation; create implementation trainings). Members of the community need to be central to how evidence is created, from driving research to deciding what constitutes evidence, and members of the community need to be part of defining evidence beyond programs to solutions that cross the social ecology. Additionally, when we put our research into practice, members of the community should be integral throughout that process.
So, what do our findings mean? If we look across the findings from the mental models (challenge), values and practices (solution), and new evidence paradigm (opportunities), we are reminded that:
Everyone thinks differently and has different values and beliefs about innovation, research, evaluation, prevention, and the social issues we seek to change; and
Our current practices and structures show that innovations can only be created in a certain way, based on current constraints.
Do our findings matter? Practically or otherwise? Changemakers noted a crucial link between our values and our behaviors (i.e., practices).
We can acknowledge and capitalize on the power of attitudes, values, and beliefs. If we can build a new set, we can potentially see a difference in behaviors.
Building attitudes, values, and behaviors via inclusive practices – bringing more people into more spaces – we can change how innovation is done.
Where, then, should we start to take action to make change?
We can create shared values. We don’t have to change everyone’s firmly held beliefs (i.e., mental models) but we can create shared values for the issue at hand, for prevention, and for working in and with communities.
We can use our time, talents, and treasures to co-create, define, and produce evidence across the social ecology (i.e., new evidence continuum), not just at the individual behavior change level.
We can act within our learning spaces (i.e., dissemination and implementation) – everyone can and should be included in systems, research and evaluation, translation, and implementation learning.
This issue brief sought to deepen our understanding of what it means to move innovations to evidence base across the entire social ecology while emphasizing working in and with communities. These results were part of a larger project aimed at changing and disrupting our current innovation to evidence system. Be on the lookout for the report soon, which has all the details of the project and the full results.
