literature review about action research

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• Published: 27 April 2023

Participatory action research

• Flora Cornish   ORCID: orcid.org/0000-0002-3404-9385 1 ,
• Nancy Breton   ORCID: orcid.org/0000-0002-8388-0458 1 ,
• Ulises Moreno-Tabarez   ORCID: orcid.org/0000-0002-3504-8624 2 ,
• Jenna Delgado 3 ,
• Mohi Rua 4 ,
• Ama de-Graft Aikins 5 &
• Darrin Hodgetts 6  

Nature Reviews Methods Primers volume  3 , Article number:  34 ( 2023 ) Cite this article

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Participatory action research (PAR) is an approach to research that prioritizes the value of experiential knowledge for tackling problems caused by unequal and harmful social systems, and for envisioning and implementing alternatives. PAR involves the participation and leadership of those people experiencing issues, who take action to produce emancipatory social change, through conducting systematic research to generate new knowledge. This Primer sets out key considerations for the design of a PAR project. The core of the Primer introduces six building blocks for PAR project design: building relationships; establishing working practices; establishing a common understanding of the issue; observing, gathering and generating materials; collaborative analysis; and planning and taking action. We discuss key challenges faced by PAR projects, namely, mismatches with institutional research infrastructure; risks of co-option; power inequalities; and the decentralizing of control. To counter such challenges, PAR researchers may build PAR-friendly networks of people and infrastructures; cultivate a critical community to hold them to account; use critical reflexivity; redistribute powers; and learn to trust the process. PAR’s societal contribution and methodological development, we argue, can best be advanced by engaging with contemporary social movements that demand the redressingl of inequities and the recognition of situated expertise.

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Introduction.

For the authors of this Primer, participatory action research (PAR) is a scholar–activist research approach that brings together community members, activists and scholars to co-create knowledge and social change in tandem 1 , 2 . PAR is a collaborative, iterative, often open-ended and unpredictable endeavour, which prioritizes the expertise of those experiencing a social issue and uses systematic research methodologies to generate new insights. Relationships are central. PAR typically involves collaboration between a  community with lived experience of a social issue and professional researchers, often based in universities, who contribute relevant knowledge, skills, resources and networks. PAR is not a research process driven by the imperative to generate knowledge for scientific progress, or knowledge for knowledge’s sake; it is a process for generating knowledge-for-action and knowledge-through-action, in service of goals of specific communities. The position of a PAR scholar is not easy and is constantly tested, as PAR projects and roles straddle university and community boundaries, involving unequal  power relations and multiple, sometimes conflicting interests. This Primer aims to support researchers in preparing a PAR project, by providing a scaffold to navigate the processes through which PAR can help us to collaboratively envisage and enact emancipatory futures.

We consider PAR an emancipatory form of scholarship 1 . Emancipatory scholarship is driven by interest in tackling injustices and building futures supportive of human thriving, rather than objectivity and neutrality. It uses research not primarily to communicate with academic experts but to inform grassroots collective action. Many users of PAR aspire to projects of liberation and/or transformation . Users are likely to be critical of research that perpetuates oppressive power relations, whether within the research relationships themselves or in a project’s messages or outcomes, often aiming to trouble or transform power relations. PAR projects are usually concerned with developments not only in knowledge but also in action and in participants’ capacities, capabilities and performances.

PAR does not follow a set research design or particular methodology, but constitutes a strategic rallying point for collaborative, impactful, contextually situated and inclusive efforts to document, interpret and address complex systemic problems 3 . The development of PAR is a product of intellectual and activist work bridging universities and communities, with separate genealogies in several Indigenous 4 , 5 , Latin American 6 , 7 , Indian 8 , African 9 , Black feminist 10 , 11 and Euro-American 12 , 13 traditions.

PAR, as an authoritative form of enquiry, became established during the 1970s and 1980s in the context of anti-colonial movements in the Global South. As anti-colonial movements worked to overthrow territorial and economic domination, they also strived to overthrow symbolic and epistemic injustices , ousting the authority of Western science to author knowledge about dominated peoples 4 , 14 . For Indigenous scholars, the development of PAR approaches often comprised an extension of Indigenous traditions of knowledge production that value inclusion and community engagement, while enabling explicit engagements with matters of power, domination and representation 15 . At the same time, exchanges between Latin American and Indian popular education movements produced Orlando Fals Borda’s articulation of PAR as a paradigm in the 1980s. This orientation prioritized people’s participation in producing knowledge, instead of the positioning of local populations as the subject of knowledge production practices imposed by outside experts 16 . Meanwhile, PAR appealed to those inspired by Black and postcolonial feminists who challenged established knowledge hierarchies, arguing for the wisdom of people marginalized by centres of power, who, in the process of survivance, that is, surviving and resisting oppressive social structures, came to know and deconstruct those structures acutely 17 , 18 .

Some Euro-American approaches to PAR are less transformational and more reformist, in the action research paradigm, as developed by Kurt Lewin 19 to enhance organizational efficacy during and after World War II. Action research later gained currency as a popular approach for professionals such as teachers and nurses to develop their own practices, and it tended to focus on relatively small-scale adjustments within a given institutional structure, instead of challenging power relations as in anti-colonial PAR 13 , 20 . In the late twentieth century, participatory research gained currency in academic fields such as participatory development 21 , 22 , participatory health promotion 23 and creative methods 24 . Although participatory research includes participants in the conceptualization, design and conduct of a project, it may not prioritize action and social change to the extent that PAR does. In the early twenty-first century, the development of PAR is occurring through sustained scholarly engagements in anti-colonial 5 , 25 , abolitionist 26 , anti-racist 27 , 28 , gender-expansive 29 , climate activist 30 and other radical social movements.

This Primer bridges these traditions by looking across them for mutual learning but avoiding assimilating them. We hope that readers will bring their own activist and intellectual heritages to inform their use of PAR and adapt and adjust the suggestions we present to meet their needs.

Four key principles

Drawing across its diverse origins, we characterize PAR by four key principles. The first is the authority of direct experience. PAR values the expertise generated through experience, claiming that those who have been marginalized or harmed by current social relations have deep experiential knowledge of those systems and deserve to own and lead initiatives to change them 3 , 5 , 17 , 18 . The second is knowledge in action. Following the tradition of action research, it is through learning from the experience of making changes that PAR generates new knowledge 13 . The third key principle is research as a transformative process. For PAR, the research process is as important as the outcomes; projects aim to create empowering relationships and environments within the research process itself 31 . The final key principle is collaboration through dialogue. PAR’s power comes from harnessing the diverse sets of expertise and capacities of its collaborators through critical dialogues 7 , 8 , 32 .

Because PAR is often unfamiliar, misconstrued or mistrusted by dominant scientific 33 institutions, PAR practitioners may find themselves drawn into competitions and debates set on others’ terms, or into projects interested in securing communities’ participation but not their emancipation. Engaging communities and participants in participatory exercises for the primary purpose of advancing research aims prioritized by a university or others is not, we contend, PAR. We encourage PAR teams to articulate their intellectual and political heritage and aspirations, and agree their core principles, to which they can hold themselves accountable. Such agreements can serve as anchors for decision-making or counterweights to the pull towards inegalitarian or extractive research practices.

Aims of the Primer

The contents of the Primer are shaped by the authors’ commitment to emancipatory, engaged scholarship, and their own experience of PAR, stemming from their scholar-activism with marginalized communities to tackle issues including state neglect, impoverishment, infectious and non-communicable disease epidemics, homelessness, sexual violence, eviction, pollution, dispossession and post-disaster recovery. Collectively, our understanding of PAR is rooted in Indigenous, Black feminist and emancipatory education traditions and diverse personal experiences of privilege and marginalization across dimensions of race, class, gender, sexuality and disability. We use an inclusive understanding of PAR, to include engaging, emancipatory work that does not necessarily use the term PAR, and we aim to showcase some of the diversity of scholar-activism around the globe. The contents of this Primer are suggestions and reflections based on our own experience of PAR and of teaching research methodology. There are multiple ways of conceptualizing and conducting a PAR project. As context-sensitive social change processes, every project will pose new challenges.

This Primer is addressed primarily to university-based PAR researchers, who are likely to work in collaboration with members of communities or organizations or with activists, and are accountable to academic audiences as well as to community audiences. Much expertise in PAR originates outside universities, in community groups and organizations, from whom scholars have much to learn. The Primer aims to familiarize scholars new to PAR and others who may benefit with PAR’s key principles, decision points, practices, challenges, dilemmas, optimizations, limitations and work-arounds. Readers will be able to use our framework of ‘building blocks’ as a guide to designing their projects. We aim to support critical thinking about the challenges of PAR to enable readers to problem-solve independently. The Primer aims to inspire with examples, which we intersperse throughout. To illustrate some of the variety of positive achievements of PAR projects, Box  1 presents three examples.

Box 1 What does participatory action research do?

The Tsui Anaa Project 60 in Accra, Ghana, began as a series of interviews about diabetes experiences in one of Accra’s oldest indigenous communities, Ga Mashie. Over a 12-year period, a team of interdisciplinary researchers expanded the project to a multi-method engagement with a wide range of community members. University and community co-researchers worked to diagnose the burden of chronic conditions, to develop psychosocial interventions for cardiovascular and associated conditions and to critically reflect on long-term goals. A health support group of people living with diabetes and cardiovascular conditions, called Jamestown Health Club (JTHC), was formed, met monthly and contributed as patient advocates to community, city and national non-communicable disease policy. The project has supported graduate collaborators with mixed methods training, community engagement and postgraduate theses advancing the core project purposes.

Buckles, Khedkar and Ghevde 39 were approached by members of the Katkari tribal community in Maharashtra, India, who were concerned about landlords erecting fences around their villages. Using their institutional networks, the academics investigated the villagers’ legal rights to secure tenure and facilitated a series of participatory investigations, through which Katkari villagers developed their own understanding of the inequalities they faced and analysed potential action strategies. Subsequently, through legal challenges, engagement with local politics and emboldened local communities, more than 100 Katkari communities were more secure and better organized 5 years later.

The Morris Justice Project 74 in New York, USA, sought to address stop-and-frisk policing in a neighbourhood local to the City University of New York, where a predominantly Black population was subject to disproportionate and aggressive policing. Local residents surveyed their neighbours to gather evidence on experiences of stop and frisk, compiling their statistics and experiences and sharing them with the local community on the sidewalk, projecting their findings onto public buildings and joining a coalition ‘Communities United for Police Reform’, which successfully campaigned for changes to the city’s policing laws.

Experimentation

This section sets out the core considerations for designing a PAR project.

Owing to the intricacies of working within complex human systems in real time, PAR practitioners do not follow a highly proceduralized or linear set of steps 34 . In a cyclical process, teams work together to come to an initial definition of their social problem, design a suitable action, observe and gather information on the results, and then analyse and reflect on the action and its impact, in order to learn, modify their understanding and inform the next iteration of the research–action cycle 3 , 35 (Fig.  1 ). Teams remain open throughout the cycle to repeating or revising earlier steps in response to developments in the field. The fundamental process of building relationships occurs throughout the cycles. These spiral diagrams orient readers towards the central interdependence of processes of participation, action and research and the nonlinear, iterative process of learning by doing 3 , 36 .

Participatory action research develops through a series of cycles, with relationship building as a constant practice. Cycles of research text adapted from ref. 81 , and figure adapted with permission from ref. 82 , SAGE.

Building blocks for PAR research design

We present six building blocks to set out the key design considerations for conducting a PAR project. Each PAR team may address these building blocks in different ways and with different priorities. Table  1 proposes potential questions and indicative goals that are possible markers of progress for each building block. They are not prescriptive or exhaustive but may be a useful starting point, with examples, to prompt new PAR teams’ planning.

Building relationships

‘Relationships first, research second’ is our key principle for PAR project design 37 . Collaborative relationships usually extend beyond a particular PAR project, and it is rare that one PAR project finalizes a desired change. A researcher parachuting in and out may be able to complete a research article, with community cooperation, but will not be able to see through the hard graft of a programme of participatory research towards social change. Hence, individual PAR projects are often nested in long-term collaborations. Such collaborations are strengthened by institutional backing in the form of sustainable staff appointments, formal recognition of the value of university–community partnerships and provision of administrative support. In such a supportive context, opportunities can be created for achievable shorter-term projects to which collaborators or temporary researchers may contribute. The first step of PAR is sometimes described as the entry, but we term this foundational step building relationships to emphasize the longer-term nature of these relationships and their constitutive role throughout a project. PAR scholars may need to work hard with and against their institutions to protect those relationships, monitoring potential collaborations for community benefit rather than knowledge and resource extraction. Trustworthy relationships depend upon scholars being aware, open and honest about their own interests and perspectives.

The motivation for a PAR project may come from university-based or community-based researchers. When university researchers already have a relationship with marginalized communities, they may be approached by community leaders initiating a collaboration 38 , 39 . Alternatively, a university-based researcher may reach out to representatives of communities facing evident problems, to explore common interests and the potential for collaboration 40 . As Indigenous scholars have articulated, communities that have been treated as the subjects or passive objects of research, commodified for the scientific knowledge of distant elites, are suspicious of research and researchers 4 , 41 . Scholars need to be able to satisfy communities’ key questions: Who are you? Why should we trust you? What is in it for our community? Qualifications, scholarly achievements or verbal reassurances are less relevant in this context than past or present valued contributions, participation in a heritage of transformational action or evidence of solidarity with a community’s causes. Being vouched for by a respected community member or collaborator can be invaluable.

Without prior relationships one can start cold, as a stranger, perhaps attending public events, informal meeting places or identifying organizations in which the topic is of interest, and introducing oneself. Strong collaborative relationships are based on mutual trust, which must be earned. It is important to be transparent about our interests and to resist the temptation to over-promise. Good PAR practitioners do not raise unrealistic expectations. Box  2 presents key soft skills for PAR researchers.

Positionality is crucial to PAR relationships. A university-based researcher’s positionalities (including, for example, their gender, race, ethnicity, class, politics, skills, age, life stage, life experiences, assumptions about the problem, experience in research, activism and relationship to the topic) interact with the positionalities of community co-researchers, shaping the collective definition of the problem and appropriate solutions. Positionalities are not fixed, but can be changing, multiple and even contradictory 42 . We have framed categories of university-based and community-based researchers here, but in practice these positionings of ‘insiders’ and ‘outsiders’ are often more complex and shifting 43 . Consideration of diversity is important when building a team to avoid  tokenism . For example, identifying which perspectives are included initially and why, and whether members of the team or gatekeepers have privileged access owing to their race, ethnicity, class, gender and/or able-bodiedness.

The centring of community expertise in PAR does not mean that a community is ‘taken for granted’. Communities are sites of the production of similarity and difference, equality and inequalities, and politics. Knowledge that has the status of common sense may itself reproduce inequalities or perpetuate harm. Relatedly, strong PAR projects cultivate  reflexivity 44 among both university-based and community-based researchers, to enable a critical engagement with the diversity of points of view, positions of power and stakes in a project. Developing reflexivity may be uncomfortable and challenging, and good PAR projects create a supportive culture for processing such discomfort. Supplementary files  1 and   2 present example exercises that build critical reflexivity.

Box 2 Soft skills of a participatory action researcher

Respect for others’ knowledge and the expertise of experience

Humility and genuine kindness

Ability to be comfortable with discomfort

Sharing power; ceding control

Trusting the process

Acceptance of uncertainty and tensions

Openness to learning from collaborators

Self-awareness and the ability to listen and be confronted

Willingness to take responsibility and to be held accountable

Confidence to identify and challenge power relations

Establishing working practices

Partnerships bring together people with different sets of norms, assumptions, interests, resources, time frames and working practices, all nested in institutional structures and infrastructures that cement those assumptions. University-based researchers often take their own working practices for granted, but partnership working calls for negotiation. Academics often work with very extended time frames for analysis, writing and review before publication, hoping to contribute to gradually shifting agendas, discourses and politics 45 . The urgency of problems that face a community often calls for faster responsiveness. Research and management practices that are normal in a university may not be accessible to people historically marginalized through dimensions that include disability, language, racialization, gender, literacy practices and their intersections 46 . Disrupting historically entrenched power dynamics associated with these concerns can raise discomfort and calls for skilful negotiation. In short, partnership working is a complex art, calling for thoughtful design of joint working practices and a willingness to invest the necessary time.

Making working practices and areas of tension explicit is one useful starting point. Not all issues need to be fully set out and decided at the outset of a project. A foundation of trust, through building relationships in building block 1, allows work to move ahead without every element being pinned down in advance. Supplementary file  1 presents an exercise designed to build working relationships and communicative practices.

Establishing a common understanding of the issue

Co-researchers identify a common issue or problem to address. University-based researchers tend to justify the selection of the research topic with reference to a literature review, whereas in PAR, the topic must be a priority for the community. Problem definition is a key step for PAR teams, where problem does not necessarily mean something negative or a deficit, but refers to the identification of an important issue at stake for a community. The definition of a problem, however, is not always self-evident, and producing a problem definition can be a valid outcome of PAR. In the example of risks of eviction from Buckles, Khedkar and Ghevde 39 (Box  1 ), a small number of Katkari people first experienced the problem in terms of landlords erecting barbed wire fences. Other villages did not perceive the risk of eviction as a big problem compared with their other needs. Facilitating dialogues across villages about their felt problems revealed how land tenure was at the root of several issues, thus mobilizing interest. Problem definitions are political; they imply some forms of action and not others. Discussion and reflexivity about the problem definition are crucial. Compared with other methodologies, the PAR research process is much more public from the outset, and so practices of making key steps explicit, shareable, communicable and negotiable are essential. Supplementary file  3 introduces two participatory tools for collective problem definition.

Consideration of who should be involved in problem definition is important. It may be enough that a small project team works closely together at this stage. Alternatively, group or public meetings may be held, with careful facilitation 5 . Out of dialogue, a PAR team aims to agree on an actionable problem definition, responding to the team’s combination of skills, capacities and priorities. A PAR scholar works across the university–community boundary and thus is accountable to both university values and grassroots communities’ values. PAR scholars should not deny or hide the multiple demands of the role because communities with experience of marginalization are attuned to being manipulated. Surfacing interests and constraints and discussing these reflexively is often a better strategy. Creativity may be required to design projects that meet both academic goals (such as when a project is funded to produce certain outcomes) and the community’s goals.

For example, in the context of a PAR project with residents of a public housing neighbourhood scheduled for demolition and redevelopment, Thurber and colleagues 47 describe how they overcame differences between resident and academic researchers regarding the purposes of their initial survey. The academic team members preferred the data to be anonymous, to maximize the scientific legitimacy of their project (considered valuable for their credibility to policymakers), whereas the resident team wanted to use the opportunity to recruit residents to their cause, by collecting contact details. The team discussed their different objectives and produced the solution of two-person survey teams, one person gathering anonymous data for the research and a second person gathering contact details for the campaign’s contact list.

Articulating research questions is an early milestone. PAR questions prioritize community concerns, so they may differ from academic-driven research questions. For example, Buckles, Khedkar and Ghevde 39 facilitated a participatory process that developed questions along the lines of: What are the impacts of not having a land title for Katkari people? How will stakeholders respond to Katkari organizing, and what steps can Katkari communities take towards the goal of securing tenure? In another case, incarcerated women in New York state, USA, invited university academics to evaluate a local college in prison in the interest of building an empirical argument for the value of educational opportunities in prisons 38 , 48 Like other evaluations, it asked: “What is the impact of college on women in prison?” But instead of looking narrowly at the impact on re-offending as the relevant impact (as prioritized by politicians and policymakers), based on the incarcerated women’s advice, the evaluation tracked other outcomes: women’s well-being within the prison; their relationships with each other and the staff; their children; their sense of achievement; and their agency in their lives after incarceration.

As a PAR project develops, the problem definition and research questions are often refined through the iterative cycles. This evolution does not undermine the value of writing problem definitions and research questions in the early stages, as a collaboration benefits from having a common reference point to build from and from which to negotiate.

Observing, gathering and generating materials

With a common understanding of the problem, PAR teams design ways of observing the details and workings of this problem. PAR is not prescriptive about the methods used to gather or generate observations. Projects often use qualitative methods, such as storytelling, interviewing or ethnography, or participatory methods, such as body mapping, problem trees, guided walks, timelines, diaries, participatory photography and video or participatory theatre. Gathering quantitative data is an option, particularly in the tradition of participatory statistics 49 . Chilisa 5 distinguishes sources of spatial data, time-related data, social data and technical data. The selected methods should be engaging to the community and the co-researchers, suited to answering the research questions and supported by available professional skills. Means of recording the process or products, and of storing those records, need to be agreed, as well as ethical principles. Developing community members’ research skills for data collection and analysis can be a valued contribution to a PAR project, potentially generating longer-term capacities for local research and change-making 50 .

Our selection of data generation methods and their details depends upon the questions we ask. In some cases, methods to explore problem definitions and then to brainstorm potential actions, their risks and benefits will be useful (Supplementary file  3 ). Others may be less prescriptive about problems and solutions, seeking to explore experience in an open-ended way, as a basis for generating new understandings (see Supplementary file  2 for an example reflective participatory exercise).

Less-experienced practitioners may take a naive approach to PAR, which assumes that knowledge should emerge solely from an authentic community devoid of outside ideas. More established PAR researchers, however, work consciously to combine and exchange skills and knowledge through dialogue. Together with communities, we want to produce effective products, and we recognize that doing so may require specific skills. In Marzi’s 51 participatory video project with migrant women in Colombia, she engaged professional film-makers to provide the women with training in filming, editing and professional film production vocabulary. The women were given the role of directors, with the decision-making power over what to include and exclude in their film. In a Photovoice project with Black and Indigenous youth in Toronto, Canada, Tuck and Habtom 25 drew on their prior scholar–activist experience and their critical analysis of scholarship of marginalization, which often uses tropes of victimhood, passivity and sadness. Instead of repeating narratives of damage, they intended to encourage desire-based narratives. They supported their young participants to critically consider which photographs they wanted to include or exclude from public representations. Training participants to be expert users of research techniques does not devalue their existing expertise and skills, but takes seriously their role in co-producing valid, critical knowledge. University-based researchers equally benefit from training in facilitation methods, team development and the history and context of the community.

Data generation is relational, mediated by the positionalities of the researchers involved. As such, researchers position themselves across boundaries, and need to have, or to develop, skills in interpreting across boundaries. In the Tsui Anaa Project (Box  1 ) in Ghana, the project recruited Ga-speaking graduate students as researchers; Ga is the language most widely spoken in the community. The students were recruited not only for their language skills, but also for their Ga cultural sensibilities, reflected in their sense of humour and their intergenerational communicative styles, enabling fluid communication and mutual understanding with the community. In turn, two community representatives were recruited as advocates to represent patient perspectives across university and community boundaries.

University-based researchers trained in methodological rigour may need reminders that the process of a PAR project is as important as the outcome, and is part of the outcome. Facilitation skills are the most crucial skills for PAR practitioners at this stage. Productive facilitation skills encourage open conversation and collective understandings of the problem at hand and how to address it. More specifically, good facilitation requires a sensitivity to the ongoing and competing social context, such as power relations, within the group to help shift power imbalances and enable participation by all 52 . Box  3 presents a PAR project that exemplifies the importance of relationship building in a community arts project.

Box 3 Case study of the BRIDGE Project: relationship building and collective art making as social change

The BRIDGE Project was a 3-week long mosaic-making and dialogue programme for youth aged 14–18 years, in Southern California. For several summers, the project brought together students from different campuses to discuss inclusion, bullying and community. The goal was to help build enduring relationships among young people who otherwise would not have met or interacted, thereby mitigating the racial tensions that existed in their local high schools.

Youth were taught how to make broken tile mosaic artworks, facilitated through community-building exercises. After the first days, as relationships grew, so did the riskiness of the discussion topics. Youth explored ideas and beliefs that contribute to one’s individual sense of identity, followed by discussion of wider social identities around race, class, sex, gender, class, sexual orientation and finally their identities in relationship to others.

The art-making process was structured in a manner that mirrored the building of their relationships. Youth learned mosaic-making skills while creating individual pieces. They were discouraged from collaborating with anyone else until after the individual pieces were completed and they had achieved some proficiency. When discussions transitioned to focus on the relationship their identities had to each other, the facilitators assisted them in creating collaborative mosaics with small groups.

Staff facilitation modelled the relationship-building goal of the project. The collaborative art making was built upon the rule that no one could make any changes without asking for and receiving permission from the person or people who had placed the piece (or pieces) down. To encourage participants to engage with each other it was vital that they each felt comfortable to voice their opinions while simultaneously learning how to be accountable to their collaborators and respectful of others’ relationships to the art making.

The process culminated in the collective creation of a tile mosaic wall mural, which is permanently installed in the host site.

Collaborative analysis

In PAR projects, data collection and analysis are not typically isolated to different phases of research. Instead, a tried and tested approach to collaborative analysis 53 is to use generated data as a basis for reflection on commonalities, patterns, differences, underlying causes or potentials on an ongoing basis. For instance, body mapping, photography, or video projects often proceed through a series of workshops, with small-scale training–data collection–data analysis cycles in each workshop. Participants gather or produce materials in response to a prompt, and then come together to critically discuss the meaning of their productions.

Simultaneously, or later, a more formal data analysis may be employed, using established social science analytical tools such as grounded theory, thematic, content or discourse analysis, or other forms of visual or ethnographic analysis, with options for facilitated co-researcher involvement. The selection of a specific orientation or approach to analysis is often a low priority for community-based co-researchers. It may be appropriate for university-based researchers to take the lead on comprehensive analysis and the derivation of initial messages. Fine and Torre 29 describe the university-based researchers producing a “best bad draft” so that there is something on the table to react to and discuss. Given the multiple iterations of participants’ expressions of experiences and analyses by this stage, the university-based researchers should be in a position that their best bad draft is grounded in a good understanding of local perspectives and should not appear outlandish, one-sided or an imposition of outside ideas.

For the results and recommendations to reflect community interests, it is important to incorporate a step whereby community representatives can critically examine and contribute to emerging findings and core messages for the public, stakeholders or academic audiences.

Planning and taking action

Taking action is an integral part of a PAR process. What counts as action and change is different for each PAR project. Actions could be targeted at a wide range of scales and different stakeholders, with differing intended outcomes. Valid intended outcomes include creating supportive networks to share resources through mutual aid; empowering participants through sharing experiences and making sense of them collectively; using the emotional impact of artistic works to influence policymakers and journalists; mobilizing collective action to build community power; forging a coalition with other activist and advocacy groups; and many others. Selection between the options depends on underlying priorities, values, theories of how social change happens and, crucially, feasibility.

Articulating a theory of change is one way to demonstrate how we intend to bring about changes through designing an action plan. A theory of change identifies an action and a mechanism, directed at producing outcomes, for a target group, in a context. This device has often been used in donor-driven health and development contexts in a rather prescriptive way, but PAR teams can adapt the tool as a scaffolding for being explicit about action plans and as a basis for further discussions and development of those plans. Many health and development organizations (such as Better Evaluation ) have frameworks to help design a theory of change.

Alternatively, a community action plan 5 can serve as a tangible roadmap to produce change, by setting out objectives, strategies, timeline, key actors, required resources and the monitoring and evaluation framework.

Social change is not easy, and existing social systems benefit, some at the expense of others, and are maintained by power relations. In planning for action, analysis of the power relations at stake, the beneficiaries of existing systems and their potential resistance to change is crucial. It is often wise to assess various options for actions, their potential benefits, risks and ways of mitigating those risks. Sometimes a group may collectively decide to settle for relatively secure, and less-risky, small wins but with the building of sufficient power, a group may take on a bigger challenge 54 .

Ethical considerations are fundamental to every aspect of PAR. They include standard research ethics considerations traditionally addressed by research ethics committees or institutional review boards (IRBs), including key principles of avoidance of harm, anonymity and confidentiality, and voluntary informed consent, although these issues may become much more complex than traditionally presented, when working within a PAR framework 55 . PAR studies typically benefit from IRBs that can engage with the relational specificities of a case, with a flexible and iterative approach to research design with communities, instead of being beholden to very strict and narrow procedures. Wilson and colleagues 56 provide a comprehensive review of ethical challenges in PAR.

Beyond procedural research ethics perspectives, relational ethics are important to PAR projects and raise crucial questions regarding the purpose and conduct of knowledge production and application 37 , 57 , 58 . Relational ethics encourage an emphasis on inclusive practices, dialogue, mutual respect and care, collective decision-making and collaborative action 57 . Questions posed by Indigenous scholars seeking to decolonize Western knowledge production practices are pertinent to a relational ethics approach 4 , 28 . These include: Who designs and manages the research process? Whose purposes does the research serve? Whose worldviews are reproduced? Who decides what counts as knowledge? Why is this knowledge produced? Who benefits from this knowledge? Who determines which aspects of the research will be written up, disseminated and used, and how? Addressing such questions requires scholars to attend to the ethical practices of cultivating trusting and reciprocal relationships with participants and ensuring that the organizations, communities and persons involved co-govern and benefit from the project.

Reflecting on the ethics of her PAR project with young undocumented students in the USA, Cahill 55 highlights some of the intensely complex ethical issues of representation that arose and that will face many related projects. Determining what should be shared with which audiences is intensely political and ethical. Cahill’s team considered editing out stories of dropping out to avoid feeding negative stereotypes. They confronted the dilemma of framing a critique of a discriminatory educational system, while simultaneously advocating that this flawed system should include undocumented students. They faced another common dilemma of how to stay true to their structural analysis of the sources of harms, while engaging decision-makers invested in the current status quo. These complex ethical–political issues arise in different forms in many PAR projects. No answer can be prescribed, but scholar–activists can prepare themselves by reading past case studies and being open to challenging debates with co-researchers.

The knowledge built by PAR is explicitly knowledge-for-action, informed by the relational ethical considerations of who and what the knowledge is for. PAR builds both  local knowledge and conceptual knowledge. As a first step, PAR can help us to reflect locally, collectively, on our circumstances, priorities, diverse identities, causes of problems and potential routes to tackle them.

Such local knowledge might be represented in the form of statistical findings from a community survey, analyses of participants’ verbal or visual data, or analyses of workshop discussions. Findings may include elements such as an articulation of the status quo of a community issue; a participatory analysis of root causes and/or actionable elements of the problem; a power analysis of stakeholders; asset mapping; assessment of local needs and priorities. Analysis goes beyond the surface problems, to identify underlying roots of problems to inform potential lines of action.

Simultaneously, PAR also advances more global conceptual knowledge. As liberation theorists have noted, developments in societal understandings of inequalities, marginalization and liberation are often led by those battling such processes daily. For example, the young Black and Indigenous participants working with Tuck and Habtom 25 in Toronto, Canada, engaged as co-theorists in their project about the significance of social movements to young people and their post-secondary school futures. Through their photography project, they expressed how place, and its history, particularly histories of settler colonialism, matters in cities — against a more standard view that treated the urban as somehow interchangeable, modern or neutral. The authors argue for altered conceptions of urban and urban education scholarly literatures, in response to this youth-led knowledge.

A key skill in the art of PAR is in creating achievable actions by choosing a project that is engaging and ambitious with achievable elements, even where structures are resistant to change. PAR projects can produce actions across a wide range of scales (from ‘small, local’ to ‘large, structural’) and across different temporal scales. Some PAR projects are part of decades-long programmes. Within those programmes, an individual PAR project, taking place over 12 or 24 months, might make one small step in the process towards long-term change.

For example, an educational project with young people living in communities vulnerable to flooding in Brazil developed a portfolio of actions, including a seminar, a native seeds fair, support to an individual family affected by a landslide, a campaign for a safe environment for a children’s pre-school, a tree nursery at school and influencing the city’s mayor to extend the environmental project to all schools in the area 30 .

Often the ideal scenario is that such actions lead to material changes in the power of a community. Over the course of a 5-year journey, the Katkari community (Box  1 ) worked with PAR researchers to build community power to resist eviction. The community team compiled households’ proof of residence; documented the history of land use and housing; engaged local government about their situations and plans; and participated more actively in village life to cultivate support 39 . The university-based researchers collected land deeds and taught sessions on land rights, local government and how to acquire formal papers. They opened conversations with the local government on legal, ethical and practical issues. Collectively, their legal knowledge and groundwork gave them confidence to remove fencing erected by landlords and to take legal action to regularize their land rights, ultimately leading to 70 applications being made for formal village sites. This comprised a tangible change in the power relation between landlords and the communities. Even here, however, the authors do not simply celebrate their achievements, but recognize that power struggles are ongoing, landlords would continue to aggressively pursue their interests, and, thus, their achievements were provisional and would require vigilance and continued action.

Most crucially, PAR projects aim to develop university-based and community-based researchers’ collective agency, by building their capacities for collaboration, analysis and action. More specifically, collaborators develop multiple transferable skills, which include skills in conducting research, operating technology, designing outputs, leadership, facilitation, budgeting, networking and public speaking 31 , 59 , 60 .

University-based researchers build their own key capacities through exercising and developing skills, including those for collaboration, facilitation, public engagement and impact. Strong PAR projects may build capacities within the university to sustain long-term relationships with community projects, such as modified and improved infrastructures that work well with PAR modalities, appreciation of the value of long-term sustained reciprocal relations and personal and organizational relationships with communities outside the university.

Applications

PAR disrupts the traditional theory–application binary, which usually assumes that abstract knowledge is developed through basic science, to then be interpreted and applied in professional or community contexts. PAR projects are always applied in the sense that they are situated in concrete human and social problems and aim to produce workable local actions. PAR is a very flexible approach. A version of a PAR project could be devised to tackle almost any real-world problem — where the researchers are committed to an emancipatory and participatory epistemology. If one can identify a group of people interested in collectively generating knowledge-for-action in their own context or about their own practices, and as long as the researchers are willing and able to share power, the methods set out in this Primer could be applied to devise a PAR project.

PAR is consonant with participatory movements across multiple disciplines and sectors, and thus finds many intellectual homes. Its application is supported by social movements for inclusion, equity, representation of multiple voices, empowerment and emancipation. For instance, PAR responds to the value “nothing about us without us”, which has become a central tenet of disability studies. In youth studies, PAR is used to enhance the power of young people’s voices. In development studies, PAR has a long foundation as part of the demand for greater participation, to support locally appropriate, equitable and locally owned changes. In health-care research, PAR is used by communities of health professionals to reflect and improve on their own practices. PAR is used by groups of health-care service users or survivors to give a greater collective power to the voices of those at the sharp end of health care, often delegitimized by medical power. In environmental sciences, PAR can support local communities to take action to protect their environments. In community psychology, PAR is valued for its ability to nurture supportive and inclusive processes. In summary, PAR can be applied in a huge variety of contexts in which local ownership of research is valued.

Limitations to PAR’s application often stem from the institutional context. In certain (often dominant) academic circles, local knowledge is not valued, and contextually situated, problem-focused, research may be considered niche, applied or not generalizable. Hence, research institutions may not be set up to be responsive to a community’s situation or needs or to support scholar–activists working at the research–action boundary. Further, those who benefit from, or are comfortable with, the status quo of a community may actively resist attempts at change from below and may undermine PAR projects. In other cases, where a community is very divided or dispersed, PAR may not be the right approach. There are plenty of examples of PAR projects floundering, failing to create an active group or to achieve change, or completely falling through. Even such failures, however, shed light on the conditions of communities and the power relations they inhabit and offer lessons on ways of working and not working with groups in those situations.

Reproducibility and data deposition

Certain aspects of the open science movement can be productively engaged from within a PAR framework, whereas others are incompatible. A key issue is that PAR researchers do not strive for reproducibility, and many would contest the applicability of this construct. Nonetheless, there may be resonances between the open science principle of making information publicly available for re-use and those PAR projects that aim to render visible and audible the experience of a historically under-represented or mis-represented community. PAR projects that seek to represent previously hidden realities of, for example, environmental degradation, discriminatory experiences at the hands of public services, the social history of a traditionally marginalized group, or their neglected achievements, may consider creating and making public robust databases of information, or social history archives, with explicit informed permission of the relevant communities. For such projects, making knowledge accessible is an essential part of the action. Publicly relevant information should not be sequestered behind paywalls. PAR practitioners should thus plan carefully for cataloguing, storing and archiving information, and maintaining archives.

On the other hand, however, a blanket assumption that all data should be made freely available is rarely appropriate in a PAR project and may come into conflict with ethical priorities. Protecting participants’ confidentiality can mean that data cannot be made public. Protecting a community from reputational harm, in the context of widespread dehumanization, criminalization or stigmatization of dispossessed groups, may require protection of their privacy, especially if their lives or coping strategies are already pathologized 25 . Empirical materials do not belong to university-based researchers as data and cannot be treated as an academic commodity to be opened to other researchers. Open science practices should not extend to the opening of marginalized communities to knowledge exploitation by university researchers.

The principle of reproducibility is not intuitively meaningful to PAR projects, given their situated nature, that is, the fact that PAR is inherently embedded in particular concrete contexts and relationships 61 . Beyond reproducibility, other forms of mutual learning and cross-case learning are vitally important. We see increasing research fatigue in communities used, extractively, for research that does not benefit them. PAR teams should assess what research has been done in a setting to avoid duplication and wasting people’s time and should clearly prioritize community benefit. At the same time, PAR projects also aspire to produce knowledge with wider implications, typically discussed under the term generalizability or transferability. They do so by articulating how the project speaks to social, political, theoretical and methodological debates taking place in wider knowledge communities, in a form of “communicative generalisation” 62 . Collaborating and sharing experiences across PAR sites through visits, exchanges and joint analysis can help to generalize experiences 30 , 61 .

Limitations and optimizations

PAR projects often challenge the social structures that reproduce established power relations. In this section, we outline common challenges to PAR projects, to prompt early reflection. When to apply a workaround, compromise, concede, refuse or regroup and change strategy are decisions that each PAR team should make collectively. We do not have answers to all the concerns raised but offer mitigations that have been found useful.

Institutional infrastructure

Universities’ interests in partnerships with communities, local relevance, being outward-facing, public engagement and achieving social impact can help to create a supportive environment for PAR research. Simultaneously, university bureaucracies and knowledge hierarchies that prize their scientists as individuals rather than collaborators and that prioritize the methods of dominant science can undermine PAR projects 63 . When Cowan, Kühlbrandt and Riazuddin 45 proposed using gaming, drama, fiction and film-making for a project engaging young people in thinking about scientific futures, a grants manager responded “But this project can’t just be about having fun activities for kids — where is the research in what you’re proposing?” Research infrastructures are often slow and reluctant to adapt to innovations in creative research approaches.

Research institutions’ funding time frames are also often out of sync with those of communities — being too extended in some ways and too short in others 45 , 64 . Securing funding takes months and years, especially if there are initial rejections or setbacks. Publishing findings takes further years. For community-based partners, a year is a long time to wait and to maintain people’s interest. On the other hand, grant funding for one-off projects over a year or two (or even five) is rarely sufficient to create anything sustainable, reasserting precarity and short-termism. Institutions can better support PAR through infrastructure such as bridging funds between grants, secure staff appointments and institutional recognition and resources for community partners.

University infrastructures can value the long-term partnership working of PAR scholars by recognizing partnership-building as a respected element of an academic career and recognizing collaborative research as much as individual academic celebrity. Where research infrastructures are unsupportive, building relationships within the university with like-minded professional and academic colleagues, to share work-arounds and advocate collectively, can be very helpful. Other colleagues might have developed mechanisms to pay co-researchers, or to pay in advance for refreshments, speed up disbursement of funds, or deal with an ethics committee, IRB, finance office or thesis examiner who misunderstands participatory research. PAR scholars can find support in university structures beyond the research infrastructure, such as those concerned with knowledge exchange and impact, campus–community partnerships, extension activities, public engagement or diversity and inclusion 64 . If PAR is institutionally marginalized, exploring and identifying these work-arounds is extremely labour intensive and depends on the cultivation of human, social and cultural capital over many years, which is not normally available to graduate students or precariously employed researchers. Thus, for PAR to be realized, institutional commitment is vital.

Co-option by powerful structures

When PAR takes place in collaboration or engagement with powerful institutions such as government departments, health services, religious organizations, charities or private companies, co-option is a significant risk. Such organizations experience social pressure to be inclusive, diverse, responsive to communities and participatory, so they may be tempted to engage communities in consultation, without redistributing power. For instance, when ‘photovoice’ projects invite politicians to exhibitions of photographs, their activity may be co-opted to serving the politician’s interest in being seen to express support, but result in no further action. There is a risk that using PAR in such a setting risks tokenizing marginalized voices 65 . In one of our current projects, co-researchers explore the framing of sexual violence interventions in Zambia, aiming to promote greater community agency and reduce the centrality of approaches dominated by the Global North 66 . One of the most challenging dilemmas is the need to involve current policymakers in discussions without alienating them. The advice to ‘be realistic’, ‘be reasonable’ or ‘play the game’ to keep existing power brokers at the table creates one of the most difficult tensions for PAR scholars 48 .

We also caution against scholars idealizing PAR as an ideal, egalitarian, inclusive or perfect process. The term ‘participation’ has become a policy buzzword, invoked in a vaguely positive way to strengthen an organization’s case that they have listened to people. It can equally be used by researchers to claim a moral high ground without disrupting power relations. Depriving words of their associated actions, Freire 7 warns us, leads to ‘empty blah’, because words gain their meaning in being harnessed to action. Labelling our work PAR does not make it emancipatory, without emancipatory action. Equally, Freire cautions against acting without the necessary critical reflection.

To avoid romanticization or co-option, PAR practitioners benefit from being held accountable to their shared principles and commitments by their critical networks and collaborators. Our commitments to community colleagues and to action should be as real for us as any institutional pressures on us. Creating an environment for that accountability is vital. Box  4 offers a project exemplar featuring key considerations regarding power concerns.

Box 4 Case study: participatory power and its vulnerability

Júba Wajiín is a pueblo in a rural mountainous region in the lands now called Guerrero, Mexico, long inhabited by the Me’phaa people, who have fiercely resisted precolonial, colonial and postcolonial displacement and dispossession. Using collective participatory action methods, this small pueblo launched and won a long legal battle that now challenges extractive mining practices.

Between 2001 and 2012, the Mexican government awarded massive mining concessions to mining companies. The people of Júba Wajiín discovered in mid-2013 that, unbeknown to them, concessions for mining exploration of their lands had been awarded to the British-based mining company Horschild Mexico. They engaged human rights activists who used participatory action research methods to create awareness and to launch a legal battle. Tlachinollan, a regional human rights organization, held legal counselling workshops and meetings with local authorities and community elders.

The courts initially rejected the case by denying that residents could be identified as Indigenous because they practised Catholicism and spoke Spanish. A media organization, La Sandia Digital , supported the community to collectively document their syncretic religious and spiritual practices, their ability to speak Mhe’paa language and their longstanding agrarian use of the territory. They produced a documentary film Juba Wajiin: Resistencia en la Montaña , providing visual legal evidence.

After winning in the District court, they took the case to the Supreme Court, asking it to review the legality and validity of the mining concessions. Horschild, along with other mining companies, stopped contesting the case, which led to the concessions being null and void.

The broader question of Indigenous peoples’ territorial rights continued in the courts until mid-2022 when the Supreme Court ruled that Indigenous peoples had the constitutional right to be consulted before any mining activities in their territory. This was a win, but a partial one. ‘Consultations’ are often manipulated by state and private sectors, particularly among groups experiencing dire impoverishment. Júba Wajiín’s strategies proved successful but the struggle against displacement and dispossession is continual.

Power inequalities within PAR

Power inequalities also affect PAR teams and communities. For all the emphasis on egalitarian relationships and dialogue, communities and PAR teams are typically composed of actors with unequal capacities and powers, introducing highly complex challenges for PAR teams.

Most frequently, university-based researchers engaging with marginalized communities do not themselves share many aspects of the identities or life experiences of those communities. They often occupy different, often more privileged, social networks, income brackets, racialized identities, skill sets and access to resources. Evidently, the premise of PAR is that people with different lives can productively collaborate, but gulfs in life experience and privilege can yield difficult tensions and challenges. Expressions of discomfort, dissatisfaction or anger in PAR projects are often indicative of power inequalities and an opportunity to interrogate and challenge hierarchies. Scholars must work hard to undo their assumptions about where expertise and insights may lie. A first step can be to develop an analysis of a scholar’s own participation in the perpetuation of inequalities. Projects can be designed to intentionally redistribute power, by redistributing skills, responsibilities and authority, or by redesigning core activities to be more widely accessible. For instance, Marzi 51 in a participatory video project, used role swapping to distribute the leadership roles of chairing meetings, choosing themes for focus and editing, among all the participants.

Within communities, there are also power asymmetries. The term ‘community participation’ itself risks homogenizing a community, such that one or a small number of representatives are taken to qualify as the community. Yet, communities are characterized by diversity as much as by commonality, with differences across sociological lines such as class, race, gender, age, occupation, housing tenure and health status. Having the time, resources and ability to participate is unlikely to be evenly distributed. Some people need to devote their limited time to survival and care of others. For some, the embodied realities of health conditions and disabilities make participation in research projects difficult or undesirable 67 . If there are benefits attached to participation, careful attention to the distribution of such benefits is needed, as well as critical awareness of the positionality of those involved and those excluded. Active efforts to maximize accessibility are important, including paying participants for their valued time; providing accommodations for people with health conditions, disabilities, caring responsibilities or other specific needs; and designing participatory activities that are intuitive to a community’s typical modes of communication.

Lack of control and unpredictability

For researchers accustomed to leading research by taking responsibility to drive a project to completion, using the most rigorous methods possible, to achieve stated objectives, the collaborative, iterative nature of PAR can raise personal challenges. Sense 68 likens the facilitative role of a PAR practitioner to “trying to drive the bus from the rear passenger seat—wanting to genuinely participate as a passenger but still wanting some degree of control over the destination”. PAR works best with collaborative approaches to leadership and identities among co-researchers as active team members, facilitators and participants in a research setting, prepared to be flexible and responsive to provocations from the situation and from co-researchers and to adjust project plans accordingly 28 , 68 , 69 . The complexities involved in balancing control issues foreground the importance of reflexive practice for all team members to learn together through dialogue 70 . Training and socialization into collaborative approaches to leadership and partnership are crucial supports. Well-functioning collaborative ways of working are also vital, as their trusted structure can allow co-researchers to ‘trust the process’, and accept uncertainties, differing perspectives, changes of emphasis and disruptions of assumptions. We often want surprises in PAR projects, as they show that we are learning something new, and so we need to be prepared to accept disruption.

The PAR outlook is caught up in the ongoing history of the push and pull of popular movements for the recognition of local knowledge and elite movements to centralize authority and power in frameworks such as universal science, professional ownership of expertise, government authority or evidence-based policy. As a named methodological paradigm, PAR gained legitimacy and recognition during the 1980s, with origins in popular education for development, led by scholars from the Global South 16 , 32 , and taken up in the more Global-North-dominated field of international development, where the failings of externally imposed, contextually insensitive development solutions had become undeniable 21 . Over the decades, PAR has both participated in radical social movements and risked co-option and depoliticization as it became championed by powerful institutions, and it is in this light that we consider PAR’s relation to three contemporary societal movements.

Decolonizing or re-powering

The development of PAR took place in tandem with anti-colonial movements and discourses during the 1970s and 1980s, in which the colonization of land, people and knowledge were all at stake. During the mid-2010s, calls for decolonization of the university were forced onto the agenda of the powerful by various groups, including African students and youth leading the ‘Rhodes Must Fall’, ‘Fees must Fall’ and ‘Gandhi must Fall’ movements 71 , followed by the eruption of Black Lives Matter protests in 2020 (ref. 72 ). PAR is a methodology that stands to contribute to decolonization-colonization through the development of alternatives to centralizing knowledge and power. As such, the vitality of local and global movements demanding recognition of grassroots knowledge and the dismantling of oppressive historical power–knowledge systems heralds many openings and exciting potential collaborations and causes for PAR practitioners 73 , 74 . As these demands make themselves felt in powerful institutions, they create openings for PAR.

Yet, just as PAR has been subject to co-option and depoliticization, the concept of decolonization too is at risk of appropriation by dominant groups and further tokenization of Indigenous groups, as universities, government departments and global health institutions absorb the concept, fitting it into their existing power structures 41 , 75 . In this context, Indigenous theorists in Aotearoa/New Zealand are working on an alternative concept of ‘re-powering Indigenous knowledge’ instead of ‘decolonizing knowledge’. By doing so, they centre Indigenous people and their knowledge, instead of the knowledge or actions of colonizers, and foreground the necessity of changes to power relations. African and African American scholars working on African heritage and political agency have drawn on the Akan philosophy of Sankofa for a similar purpose 76 . Sankofa derives from a Twi proverb Se wo were fi na wosan kofa a yenkyiri (It is not taboo to fetch what is at risk of being left behind). Going back to fetch what is lost is a self-grounded act that draws on the riches of Indigenous history to re-imagine and restructure the future 77 . It is also an act independent of the colonial and colonizing gaze. Contributing to a mid-twenty-first century re-powering community knowledge is a promising vision for PAR. More broadly, the loud voices and visionary leadership of contemporary anti-racist, anti-colonial, Indigenous, intersectional feminist and other emancipatory movements provide a vibrant context to re-invent and renew PAR.

Co-production

In fields concerned with health and public service provision, a renewed discourse of respectful engagement with communities and service users has centred in recent years on the concept of  co-production 78 . In past iterations, concepts such as citizen engagement, patient participation, community participation and community mobilization had a similar role. Participatory methods have proved their relevance within such contexts, for example, providing actionable and wise insights to clinicians seeking to learn from patients, or to providers of social services seeking to target their services better. Thus, the introduction of co-production may create a receptive environment for PAR in public services. Yet again, if users are participating in something, critical PAR scholars should question in which structures they are participating, instantiating which power relations and to whose benefit. PAR scholars can find themselves compromised by institutional requirements. Identifying potential compromises, lines that cannot be crossed and areas where compromises can be made; negotiating with institutional orders; and navigating discomfort and even conflict are key skills for practitioners of PAR within institutional settings.

One approach to engaging with institutional structures has been to gather evidence for the value of PAR, according to the measures and methods of dominant science. Anyon and colleagues 59 systematically reviewed the Youth PAR literature in the United States. They found emerging evidence that PAR produces positive outcomes for youth and argued for further research using experimental designs to provide harder evidence. They make the pragmatic argument that funding bodies require certain forms of evidence to justify funding, and so PAR would benefit by playing by those rules.

A different approach, grounded in politics rather than the academy, situates co-production as sustained by democratic struggles. In the context of sustainability research in the Amazon, for instance, Perz and colleagues 79 argue that the days of externally driven research are past. Mobilization by community associations, Indigenous federations, producer cooperatives and labour unions to demand influence over the governance of natural resources goes hand in hand with expectations of local leadership and ownership of research, often implemented through PAR. These approaches critically question the desirability of institutional, external funding or even non-monetary support for a particular PAR project.

Global–local inequality and solidarity

Insufferable global and local inequalities continue to grow, intensified by climate catastrophes, the coronavirus disease 2019 (COVID-19) pandemic and extreme concentrations of wealth and political influence, and contested by increasingly impactful analyses, protests and refusals by those disadvantaged and discriminated against. Considering the impact of the COVID-19 pandemic on PAR projects, Auerbach and colleagues 64 identify increasing marketization and austerity in some universities, and the material context of growing pressure on marginalized communities to simply meet their needs for survival, leaving little capacity for participating in and building long-term partnerships. They describe university-based researchers relying on their own capacities to invent new modes of digital collaboration and nourish their partnerships with communities, often despite limited institutional support.

We suggest that building solidaristic networks, and thus building collective power, within and beyond universities offers the most promising grounding for a fruitful outlook for PAR. PAR scholars can find solidarity across a range of disciplines, traditions, social movements, topics and geographical locations. Doing so offers to bridge traditions, share strategies and resonances, build methodologies and politics, and crucially, build power. In global health research, Abimbola and colleagues 80 call for the building of Southern networks to break away from the dominance of North–South partnerships. They conceptualize the South not only as a geographical location, as there are of course knowledge elites in the South, but as the communities traditionally marginalized from centres of authority and power. We suggest that PAR can best maximize its societal contribution and its own development and renewal by harnessing the diverse wisdom of knowledge generation and participatory methods across Southern regions and communities, using that wisdom to participate in global solidarities and demands for redistribution of knowledge, wealth and power.

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Acknowledgements

The authors thank their PAR collaborators and teachers, who have shown us how to take care of each other, our communities and environments. They thank each other for generating such a productive critical thinking space and extending care during challenging times.

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Involving multiple team members in the analysis and interpretation of materials generated, typically in iterative cycles of individual or pair work and group discussion.

Both a structure and a process, community refers to a network of often diverse and unequal persons engaged in common tasks or actions, stakes or interests that lead them to form social ties or commune with one another.

A process through which a person or group’s activities are altered or appropriated to serve another group’s interests.

A term typically used in service provision to describe partnership working between service providers and service users, to jointly produce decisions or designs.

A call to recognize and dismantle the destructive legacies of colonialism in societal institutions, to re-power indigenous groups and to construct alternative relationships between peoples and knowledges that liberate knowers and doers from colonial extraction and centralization of power.

Scholarship that creates knowledge of the conditions that limit or oppress us to liberate ourselves from those conditions and to support others in their own transformations.

Injustices in relation to knowledge, including whose knowledge counts and which knowledge is deemed valid or not.

Research that extracts information and exploits relationships, places and peoples, producing benefit for scholars or institutions elsewhere, and depleting resources at the sites of the research.

Knowledge that is rooted in experience in a particular social context, often devalued by social science perspectives that make claims to generalizability or universality.

The relationships of domination, subordination and resistance between individuals or social groups, allowing some to advance their perspectives and interests more than others.

A methodological practice through which scholars critically reflect on their own positionality and how it impacts on participants and co-researchers, understanding of the topic and the knowledge produced.

An approach to ethical conduct that situates ethics as ongoingly negotiated within the context of respectful relationships, beyond following the procedural rules often set out by ethics committees.

A dual role in which scholars use their knowledge (scholarship) to tackle injustices and instigate changes (activism) in collaboration with marginalized communities and/or organizations.

Doing something or appointing a person for reasons other than in the interest of enabling meaningful change.

A systemic change in which relationships and structures are fundamentally altered, often contrasted with smaller-scale changes such as varying or refining existing relations.

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Use of Action Research in Nursing Education

Susan d. moch.

1 Department of Nursing, College of Nursing and Health Sciences, University of Wisconsin-Eau Claire, 105 Garfield Avenue, P.O. Box 4004, Eau Claire, WI 54702-4004, USA

R. Todd Vandenbark

2 Vogel Library, Wartburg College, No. 225, 100 Wartburg Blvd, P.O. Box 1003, Waverly, IA 50677, USA

Shelley-Rae Pehler

3 Department of Nursing, College of Nursing and Health Sciences, No. 219 Nursing Building, University of Wisconsin-Eau Claire, 105 Garfield Ave, P.O. Box 4004, Eau Claire, WI 54702, USA

Angela Stombaugh

4 Center for Excellence in Teaching and Learning, University of WI-Eau Claire, Eau Claire, WI, USA

Purpose. The purpose of this article is to describe action research in nursing education and to propose a definition of action research for providing guidelines for research proposals and criteria for assessing potential publications for nursing higher education. Methods. The first part of this project involved a search of the literature on action research in nursing higher education from 1994 to 2013. Searches were conducted in the CINAHL and MEDLINE databases. Applying the criteria identified, 80 publications were reviewed. The second part of the project involved a literature review of action research methodology from several disciplines to assist in assessing articles in this review. Results. This article summarizes the nursing higher education literature reviewed and provides processes and content related to four topic areas in nursing higher education. The descriptions assist researchers in learning more about the complexity of both the action research process and the varied outcomes. The literature review of action research in many disciplines along with the review of action research in higher education provided a framework for developing a nursing-education-centric definition of action research. Conclusions. Although guidelines for developing action research and criteria for publication are suggested, continued development of methods for synthesizing action research is recommended.

1. Introduction

Despite the call for knowledge development in nursing education [ 1 – 3 ] and concerns about the lack of dissemination of nursing education knowledge [ 4 , 5 ], limited research to guide nursing education is available. The use of action research in knowledge development and in assessing nursing knowledge for publications could increase nursing knowledge. At its core, action research methodology involves a systematic research process and thoughtful reflection on the process for making a change. The purpose of this article is to describe action research in nursing education and to propose a definition of action research that provides both guidelines for action research proposals and criteria for potential action research publications in nursing higher education.

Although publications on action research are available in nursing higher education in some countries, the use of action research is much more prevalent in related disciplines. Use of action research is evident in addressing health disparities [ 6 , 7 ], leadership/organization development [ 8 – 11 ], and nursing practice in general [ 12 ]. Action research is also widely used within all levels of education. At the K-12 level, research is often discussed as personal or collaborative reflection to delineate educational outcomes [ 13 – 15 ]. According to some authors, action research in higher education makes the research more applicable to the real world through combining research and practice [ 16 , 17 ]. In 2005, Herr and Anderson [ 18 ] described how action research proposals and dissertations are evaluated. However, acceptance of action research in higher education has been difficult because of the historical focus on empirical research and behavioral outcomes [ 19 , 20 ] and because of misconceptions about action research itself [ 21 ].

Due to the increasing use of action research in many disciplines and the need for outcome research in nursing higher education, a review of action research in nursing higher education literature was undertaken to describe action research in nursing education. A definition of action research that provides both guidelines for developing action research proposals and criteria for assessing potential action research publications for nursing higher education was developed. And much like action research methodology, the process used in this review study was iterative, in that, after a review was completed, it became apparent that a clear, consistent, and actionable definition was needed. Using existing definitions and ideas from several disciplines, the authors propose a new definition of action research. For this project, the definition proposed was used in assessing the body of literature on nursing higher education research.

2.1. Literature Review Process of Action Research in Nursing

The first part of this project involved a search of the literature in nursing higher education related to action research. Searches were conducted in the CINAHL and MEDLINE databases using the search string “action research” AND nurs ∗ AND education , including all articles from 1994 to 2013. Initially, 386 articles were retrieved. They were initially evaluated based on review of each title and abstract, eliminating those articles that were dissertations, conference abstracts, or articles pertaining to nursing practice. Also eliminated were items not directly related to nursing education, such as postdegree continuing education, as well as those that did not offer a description of a systematic research processes. Since few of the articles before 2003 described the research process and met the criteria identified, a decision was made to eliminate those published before 2003, leaving 80 publications.

While completing the initial review, the research team found that not having a consistent definition for action research hampered their efforts for determining which articles should be included in the review. Based on the initial review of articles, a working definition for action research was developed (described in detail below). The remaining 80 citations were then reviewed in detail, with an additional 41 being articles eliminated because they did not meet the criteria of the author definition as identified from a second general literature review on action research definitions. The final inclusion criteria for the higher education research articles were as follows:

• Published between 2003 and 2013
• Related to higher education in nursing
• Indicated which action research methodology was used
• Included a clear description of the research methodology
• Stated which data collection processes were employed
• Analyzed findings and/or process of the research

This process is diagrammed in Figure 1 .

3. Results and Discussion

3.1. building a definition of action research.

The many variations in approaches to action research became apparent in the nursing education literature review. Reviewing the nursing articles initially included looking at all research articles that included action research in nursing higher education. However, as stated earlier, upon review of the higher education articles, many variations of “action research” were found. Therefore, a review of definitions and key concepts of action research was completed to develop criteria for inclusion of articles for the review. The following paragraphs include both definitions and key concepts of action research from a variety of disciplines.

Action research methods are based on many broad philosophical and theoretical traditions such as Freire [ 22 ], Lewin [ 23 ], and Schön [ 11 ]. The various traditions and the manner in which action research is employed in the disciplines provide great diversity in action research. In addition, definitions of action research within disciplines can often emphasize different components. Discussion of these traditions and/or definitions within the research report can provide important information for framing the research and is suggested. For instance, within the body of organizational development literature, action research is “a term for describing a spectrum of activities that focus on research, planning, theorizing, learning, and development” which includes a “process of research and learning through the researcher's long-term relationship with a problem” [ 24 , p. 4]. Another important reference to action research in education clarifies that both action and research are involved in the term so that systematic data collection processes must be in place for the research component [ 25 ]. The “action” in the research can involve evaluation of a process being used or demonstration of a change over time, both of which require clear data collection processes. Action research, often used in educational research [ 26 ], is promoted as a way to integrate teaching and learning [ 27 ]. Kemmis [ 28 ] promotes the importance of both knowledge and change as results through action research. From a social sciences perspective, Reason and Bradbury [ 29 ] describe action research as a participatory process for developing practical knowledge for solutions to issues of importance. In a later article, Bradbury Huang [ 21 ] emphasized the importance of the integration of practice and research or the merging of “understand and act” (pg. 93) and promote “actionability” (pg. 103) as important to the research process. In the same article, Bradbury Huang also shared “suggestions” for publishing articles in the Action Research journal.

Within nursing, action research definitions have been proposed and used in the organization of reported research. Margaret Newman, an early nurse theorist, proposed an action research definition in Theory Development in Nursing [ 30 ]. According to Newman, action research involves “the collaboration of the researcher in the real-world situation of the client system with the purposes of improving the situation, developing the competencies of the system, and generating new knowledge” (p. 71). Although useful for a general understanding of the action research process, this definition does not provide enough direction for nurse educators in developing research and publishing outcomes. Winter and Munn-Giddings [ 31 ] describe action research as a “single activity which is simultaneously a form of inquiry and a form of practical action” (p. 5) and “involves people in a process of change, which is based in professional, organizational or community action” (p. 5). Four types of research foci for action research were proposed by Hart and Bond [ 32 ] and used to organize research in a nursing-related evidence-based practice article [ 12 ]. The four types, based on the theoretical underpinnings of action research, included the following: experimental, organizational, professionalizing, and empowering.

In a systematic literature review of action research published in the Journal of Research in Nursing , Munn-Giddings and colleagues found 24 different names attributed to the action research method [ 33 ]. Terms often associated with action research in nursing include community-based action research, participatory action research, appreciative inquiry, cooperative inquiry, praxis, process knowledge, reflective practice, and pattern recognition. Although definitions for some of these research processes exist, the definitions do not provide enough direction for nursing education research and publication.

3.2. Action Research Definition

Action research methodology is a systematic research process that can be articulated by the researcher, involving data collection and analysis as well as reflection and discussion with coresearchers or others for the purpose of making change in a situation over time .

This proposed definition addresses a number of shortcomings in the existing literature, both in and out of nursing education. It can provide researchers with a common starting point for conducting higher education research, where, because of the stage of knowledge development, the participation of collaborators in change, or for other reasons, using more traditional research through involving control groups, large numbers of subjects, or multiple sites may not be appropriate.

The definition calls for a systematic research process that can be articulated by the researcher , which assists in developing and publishing research. Adding the component of that can be articulated by the researcher is important because action research can include great variability in process, but the need for describing how the research was done is important to research development and dissemination in nursing education. Involving data collection and analysis is essential for identifying research outcomes as called for in nursing.

The components of reflection and discussion with coresearchers or others include the need to demonstrate reflection on the research in order to consider important factors that may affect the outcomes. The discussion component also includes the possibility of collaboration with practice partners to affect change or the implementation of the research. Including collaborations with coresearchers such as students or community partners in the development and process of the research project is also possible. At times, reflection includes representatives of those directly affected by any proposed changes, such as in participatory action research or community-based collaboration. While this methodology directly involves the researchers in an iterative and reflective research process, varying degrees of participation can be employed [ 34 ]. Reflection and discussion with coresearchers may be less relevant in some nursing education contexts.

Making a change in a situation over time implies that such research is primarily concerned with outcomes such as change leading to improvement with quality data and analysis resulting in dissemination of knowledge. Making change is important in action research and is implied in its name, including and involving both action (change) and research. This often involves engagement with a project for several years, such as continual improvement in learning outcomes which contributes to change over time. It is collaborative in nature, with the researcher(s) playing the part of active participant or actor in the research. And the power of this role can be used to promote change and create new knowledge [ 35 ].

As described previously, the author definition provided a general framework for exclusion of articles within the action research in higher education literature review. The final 39 articles selected included a systematic research process, and many, but not all, incorporated reflection and discussion with coresearchers or others for the purpose of making change in a situation over time . However, since the components of the action research definition emerged from both the review of action research definitions and the nursing education action research articles, a decision was made to retain reflection and discussion with coresearchers or others and making change in a situation over time in the definition.

3.3. Applying the Definition Structure

The following is a summary of the action research articles found in nursing higher education. Summarizing action research is challenging because all elements of the action research process and its outcomes (such as all the components of the definition) are important for understanding the research. For instance, a systematic research process that can be articulated by the researcher may be different for each study due to the use of different yet valid processes. Often the description of the research is detailed and includes how the collaborators were involved or how data was collected through meetings, discussions, or surveys. In addition, challenges arise in summarizing this particular literature research because the topic of  “action research in nursing higher education” is very broad. No narrowing of the research focus was used in this study, so many different topics, processes, and collaborations are included. Thus the articles are organized according to four general topic areas in nursing higher education with the purpose of providing an overview of the subject matter and the types of action research available. The author intent is to encourage understanding about the possibilities that exist in conducting action research in regard to content focus as well as in variety of methodology. A summary table of some information is included (see Table 1 ), but the central idea or topic of the articles within each group is also presented in narrative form through summaries to assist readers and potential future researchers considering an action research approach. To facilitate greater understanding of this methodology, the research process from one article is highlighted at the end of each summary to demonstrate action research process within each topic area. Within each article example, action research issues such as the research tradition, dilemmas in conducting the research, and identified “action” for the research are also shared if identified in the research report.

Overview of review articles' focus, participants/researchers, and data collection tools.

The general topic areas are as follows:

• Theory: research conducted in a nonclinical, in-classroom setting, often with a focus on knowledge sharing
• Clinical: instruction-related research with an experiential component
• Curricular: research applied to nursing curriculum at the department or school/college level
• Graduate: focus on research with students in nursing graduate programs.

3.4. Theory

The use of action research methodology to improve or enrich student learning in nursing education ranged from the individual instructor to the class as a whole and from lecture content to facilitating professional development. Research within the classroom involved student feedback that shifted the focus of lectures from the instructor to the students [ 36 ]; improved the structure and effectiveness of cooperative learning activities [ 37 ]; refocused course content from family health policy to clinical ethics [ 38 ]; incorporated artistic aspects of the humanities into two graduate-level nursing classes [ 39 ]; and helped deepen nursing students' understanding of the challenges of living in poverty [ 40 ]. Also, a participatory action research approach helped administrators better understand the needs of clinical facilitators who supervise student nurses which led to increased feedback and mentoring among facilitators [ 41 ]. The diversity in approaches, settings, and areas of focus demonstrate how action research can bring real and immediate improvements to nursing education courses.

As an example of how one article discusses the action research process, Smith-Stoner and Molle [ 37 ] sought to develop a systematic way of implementing cooperative learning in the nursing classroom using action research to evaluate their efforts. They wanted to determine if cooperative learning could improve learning outcomes. The authors cite several theoretical and action research definition sources and note that classroom action research was used. Their research progressed through four cycles of action followed by reflection, with student feedback serving as the data collected each step of the way. Meeting every two weeks, faculty reflected on their successes, challenges, and student reactions to the variation in instruction format. Limited dilemmas were reported and the action portion of the research involved changes in classes that was articulated and instituted. The reflection and discussion among the “actors” or coresearchers also encouraged learning about teaching. Implications for using cooperative learning with nursing students are identified.

3.5. Clinical

For the articles related to the clinical experience, the purpose of the action research design varied greatly. Research that included patients or the community allowed students to partner with parents who have children with disabilities [ 42 ] and to help a community prepare for a disaster [ 43 ]. Other articles involved working to improve communication between students and nurses in the clinical setting [ 44 ]; developing a new teaching strategy to improve therapeutic communication in nursing students [ 45 ]; designing a new clinical role to improve the theory/practice gap [ 46 ]; exposing students to working in long-term care [ 47 ]; developing interprofessional collaboration during simulation-based learning [ 48 ]; and applying new strategies for student evaluation. Some student evaluation strategies included a portfolio approach [ 49 ] and patient involvement in student evaluation [ 50 ]. Such a variety of situations and problems addressed by action research in the reviewed literature demonstrates how action research was used to increase nursing outcome knowledge in clinical aspects of nursing education.

Research on efforts to attract nursing students to aged care [ 47 ] provides an example of applying action research in a clinical setting. In order to overcome nursing students' perception of caring for the elderly as unattractive at best, researchers and nurse preceptors collaborated to create a more welcoming and supportive orientation for student nurses. Applying Kemmis' [ 51 ] definition of action research, Robinson and colleagues facilitated critical self-reflections and critique among the preceptors in order to “develop and implement strategies to address problem issues” (p. 356). The research processes are clearly described and demonstrate change over time. Data is collected and analyzed at each stage and presented in table form as quotes, combined with a set of recommendations. Dilemmas in conducting the research are not described, but the actions on the part of the researchers and nurse preceptors demonstrated a difference in student perceptions of aged care.

3.6. Curricular

Twenty-three articles in this review focused on the curricular aspects of nursing education. While resulting changes varied greatly, five general themes emerged in the use of an action research approach. First, concepts infused throughout the curriculum were often explored, including professional identity [ 52 ], caring [ 53 ], and cultural safety [ 54 ]. A second theme was action research that required collaboration and partnerships among hospitals and universities to advance the curricula [ 55 – 60 ]. Third, action research was used to initiate curricula change related to degree requirements [ 61 , 62 ] and assessment [ 49 , 63 , 64 ]. Fourth, a number of articles focused on making innovative curricular changes to address student or faculty concerns [ 65 – 70 ]. Action research was also used to focus on student selection [ 71 ] and retention [ 72 , 73 ] as well as encouraging student involvement in faculty research [ 74 ]. The large volume of articles in the literature suggests that the method is fluid enough to work with complicated problems that stretch beyond one course.

One research example that demonstrates change over time described a several year action research process that encouraged dialogue and identified outcomes related to involving practice partners in the educational process [ 56 ]. The study focused on perceived needs of practice partners to continue collaboration within the university despite no payment for clinical teaching and other services. Participatory action research was cited as the tradition or definition used in the research process. The many political and contextual variables related to payment and volunteer involvement by practitioners were identified through the process. The identification of these variables involved making frequent decisions about how to include the information from the many data sources such as meeting notes, discussions, interviews, reflective diaries and formal reports. The researchers also discussed continued attention to the “participatory” nature of the action research process used. The action aspect of the study identified the complex dialogue, the participatory process involved, and the possible strategies for university leaders to adopt in regard to continued collaboration with service partners.

3.7. Graduate

A majority of the curricular articles reviewed focus on undergraduate and certificate-level programs. The investigations into changes at the graduate level involved evaluation and development of graduate curricula with practice partners, students, and educators. Articles that focused on advanced-practice clinical or community health included using portfolios to prompt student self-evaluation of learning [ 63 ], developing a framework for organizational partnerships in midwifery education [ 55 ] and sharing qualitative data from meetings and focus groups in evaluating unpaid clinical supervision in a university setting [ 56 ]. Other graduate-related research included creating an alternative yet sustainable model of online learning through flexible curriculum design [ 75 ], critically examining the implementation of a specialist in nursing education postgraduate degree offered by 5 universities over 2.5 years [ 62 ]; integrating the humanities into graduate-level nursing education [ 39 ]; involving advanced-practice nursing students in faculty research [ 74 ]; incorporating research, evaluation, and reflection into daily teaching practice [ 38 ]; facilitating effective online student interactions [ 66 ]; mentoring young, emerging nursing leaders as a part of succession-planning [ 69 ]. These publications offer concrete examples of how an action research approach could enhance and enrich the graduate education experience.

A community health example of action research in nursing education outlines a very significant but difficult area to study using more traditional research approaches [ 67 ]. The authors describe a collaborative approach to developing course materials with community teaching partners and students while incorporating collaborative decision making and the various contexts involved with student experiences. The authors describe the research tradition of cooperative inquiry used and articulate the collaborative process between faculty, providers and students. Outcomes for the project include specific modules such as “Specialist Nursing in the Home” that was developed through dialogue between students and clinical teaching partners to assist students in learning about making clinical decisions together while employing knowledge of the home and neighborhood context. The outcomes of this project provides impetus for action for others interested in a similar topic and also provides examples of course modules. In action research methodology, both the process of the research and the product of the research provide knowledge and contribute to the “actionability” of the project. The process of this research provided many dilemmas, such as choosing the research tradition, concern about identifying outcomes, and time necessary for self-reflection among the researchers. Initially the group sought to include students and community practice partners in the self-reflective process, but due to the outside demands of time for these groups, the self-reflection component of the project included only nurse lecturers.

4. Conclusions

This review provides an overview of the use of action research in nursing higher education literature. Because a previous review of practice articles included no definition of action research for this field [ 33 ], a clear and actionable definition was conceived by the authors of this paper. The definition was based on both a review of action research definitions and a review of action research articles in nursing education. Many components of the definition were then used to critically evaluate the body of literature on action research in higher education. Many articles found in this search had a limited or nonexistent description of action research methodology or lacked a systematic data collection process and were therefore excluded.

Even though Newman [ 30 ] advocated early on for use of action research in nursing due to the direct connection to practice, limited use is evident in nursing education. Clear and reproducible examples guided by an action research definition are needed to spotlight the research potential in the types of instruction and critical evaluation projects nurse educators complete. And while many of the articles provide evidence of outcomes for nursing education, summarizing the existing literature was made more difficult by the myriad and diverse ways action research has been applied to nursing higher education. The following recommendations were formulated to facilitate the development of more outcome knowledge for nursing higher education:

• Use the clear and actionable definition provided in this review for applying criteria for research development.
• Use the definition to provide publishers and reviewers criteria for reviewing potential action research publications.
• Develop and refine a method for efficiently and effectively sharing action research summaries for use in nursing education.

New knowledge to improve nursing higher education is needed and use of action research can help fill this gap. Through action research, variables such as context, collaboration with others, and change over time can be incorporated into the research. Enhancement of nursing education should include further development of effective knowledge transfer to clinical practice, process and outcome for interdisciplinary learning, best practices for learning about teaching for nursing professors, and skills for enabling use of research evidence for future clinicians. Some examples of possible action research projects that include current trends in healthcare include the following:

• Nursing faculty and interdisciplinary community healthcare teams collaborating to identify student roles in health promotion for obesity
• Within dedicated units in hospitals, nursing faculty and students, together with hospital staff develop clinical experiences across time that improve student learning while giving back to the unit
• Community partners joining with nursing students and faculty to promote the needs of young children in lieu of an acute care pediatric experience.

A review of publications in nursing education literature on this topic resulted in narrative reporting in four topic areas: theory, clinical, curricular, and graduate. A nursing-education-centric definition of action research was created based on the nursing literature review and review of action research in many disciplines and then used to evaluate nursing literature. The definition can also be used for assessing potential action research publications. Many of the articles initially reviewed lacked either a clear methodology or systematic data collection. This article summarizes the literature reviewed and provides topics, processes, and outcomes related to several areas in nursing higher education. The descriptions and discussions of the four examples from each topic area can assist researchers in learning more about the complexity of both the action research process and the varied outcomes. Although guidelines for developing action research and criteria for publication are suggested through the definition, the continuing development of methods for synthesizing the research is also essential for knowledge development.

Competing Interests

The authors declare no competing interests.

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What is context in knowledge translation? Results of a systematic scoping review

• Tugce Schmitt   ORCID: orcid.org/0000-0001-6893-6428 1 ,
• Katarzyna Czabanowska 1 &
• Peter Schröder-Bäck 1  

Health Research Policy and Systems volume  22 , Article number:  52 ( 2024 ) Cite this article

Metrics details

Knowledge Translation (KT) aims to convey novel ideas to relevant stakeholders, motivating their response or action to improve people’s health. Initially, the KT literature focused on evidence-based medicine, applying findings from laboratory and clinical research to disease diagnosis and treatment. Since the early 2000s, the scope of KT has expanded to include decision-making with health policy implications.

This systematic scoping review aims to assess the evolving knowledge-to-policy concepts, that is, macro-level KT theories, models and frameworks (KT TMFs). While significant attention has been devoted to transferring knowledge to healthcare settings (i.e. implementing health policies, programmes or measures at the meso-level), the definition of 'context' in the realm of health policymaking at the macro-level remains underexplored in the KT literature. This study aims to close the gap.

A total of 32 macro-level KT TMFs were identified, with only a limited subset of them offering detailed insights into contextual factors that matter in health policymaking. Notably, the majority of these studies prompt policy changes in low- and middle-income countries and received support from international organisations, the European Union, development agencies or philanthropic entities.

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Few concepts are used by health researchers as vaguely and yet as widely as Knowledge Translation (KT), a catch-all term that accommodates a broad spectrum of ambitions. Arguably, to truly understand the role of context in KT, we first need to clarify what KT means. The World Health Organization (WHO) defines KT as ‘the synthesis, exchange and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health’ [ 1 ]. Here, particular attention should be paid to ‘innovation’, given that without unpacking this term, the meaning of KT would still remain ambiguous. Rogers’ seminal work ‘Diffusion of Innovations’ [ 2 ] defines innovation as an idea, practice or object that is perceived as novel by individuals or groups adopting it. In this context, he argues that the objective novelty of an idea in terms of the amount of time passed after its discovery holds little significance [ 2 ]. Rather, it is the subjective perception of newness by the individual that shapes their response [ 2 ]. In other words, if an idea seems novel to individuals, and thereby relevant stakeholders according to the aforementioned WHO definition, it qualifies as an innovation. From this perspective, it can be stated that a fundamental activity of KT is to communicate ideas that could be perceived as original to the targeted stakeholders, with the aim of motivating their response to improve health outcomes. This leaves us with the question of who exactly these stakeholders might be and what kind of actions would be required from them.

The scope of stakeholders in KT has evolved over time, along with their prompted responses. Initially, during the early phases of KT, the focus primarily revolved around healthcare providers and their clinical decisions, emphasising evidence-based medicine. Nearly 50 years ago, the first scientific article on KT was published, introducing Tier 1 KT, which concentrated on applying laboratory discoveries to disease diagnosis or treatment, also known as bench-to-bedside KT [ 3 ]. The primary motivation behind this initial conceptualisation of KT was to engage healthcare providers as the end-users of specific forms of knowledge, primarily related to randomised controlled trials of pharmaceuticals and evidence-based medicine [ 4 ]. In the early 2000s, the second phase of KT (Tier 2) emerged under the term ‘campus-to-clinic KT’ [ 3 ]. This facet, also known as translational research, was concerned with using evidence from health services research in healthcare provision, both in practice and policy [ 4 ]. Consequently, by including decision-makers as relevant end-users, KT scholars expanded the realm of research-to-action from the clinical environment to policy-relevant decision-making [ 5 ]. Following this trajectory, additional KT schemes (Tier 3–Tier 5) have been introduced into academic discourse, encompassing the dissemination, implementation and broader integration of knowledge into public policies [ 6 , 7 ]. Notably, the latest scheme (Tier 5) is becoming increasingly popular and represents the broadest approach, which describes the translation of knowledge to global communities and aims to involve fundamental, universal change in attitudes, policies and social systems [ 7 ].

In other words, a noticeable shift in KT has occurred with time towards macro-level interventions, named initially as evidence- based policymaking and later corrected to evidence- informed policymaking. In parallel with these significant developments, various alternative terms to KT have emerged, including ‘implementation science’, ‘knowledge transfer’, and ‘dissemination and research use’, often with considerable overlap [ 8 ]. Arguably, among the plethora of alternative terms proposed, implementation science stands out prominently. While initially centred on evidence-based medicine at the meso-level (e.g. implementing medical guidelines), it has since broadened its focus to ‘encompass all aspects of research relevant to the scientific study of methods to promote the uptake of research findings into routine settings in clinical, community and policy contexts’ [ 9 ], closely mirroring the definition to KT. Thus, KT, along with activities under different names that share the same objective, has evolved into an umbrella term over the years, encompassing a wide range of strategies aimed at enhancing the impact of research not only on clinical practice but also on public policies [ 10 ]. Following the adoption of such a comprehensive definition of KT, some researchers have asserted that using evidence in public policies is not merely commendable but essential [ 11 ].

In alignment with the evolution of KT from (bio-)medical sciences to public policies, an increasing number of scholars have offered explanations on how health policies should be developed [ 12 ], indicating a growing focus on exploring the mechanisms of health policymaking in the KT literature. However, unlike in the earlier phases of KT, which aimed to transfer knowledge from the laboratory to healthcare provision, decisions made for public policies may be less technical and more complex than those in clinical settings [ 3 , 13 , 14 ]. Indeed, social scientists point out that scholarly works on evidence use in health policies exhibit theoretical shortcomings as they lack engagement with political science and public administration theories and concepts [ 15 , 16 , 17 , 18 ]; only a few of these works employ policy theories and political concepts to guide data collection and make sense of their findings [ 19 ]. Similarly, contemporary literature that conceptualises KT as an umbrella term for both clinical and public policy decision-making, with calls for a generic ‘research-to-action’ [ 20 ], may fail to recognise the different types of actions required to change clinical practices and influence health policies. In many respects, such calls can even lead to a misconception that evidence-informed policymaking is simply a scaled-up version of evidence-based medicine [ 21 ].

In this study, we systematically review knowledge translation theories, models and frameworks (also known as KT TMFs) that were developed for health policies. Essentially, KT TMFs can be depicted as bridges that connect findings across diverse studies, as they establish a common language and standardise the measurement and assessment of desired policy changes [ 22 ]. This makes them essential for generalising implementation efforts and research findings [ 23 ]. While distinctions between a theory, a model or a framework are not always crystal-clear [ 24 ], the following definitions shed light on how they are interpreted in the context of KT. To start with, theory can be described as a set of analytical principles or statements crafted to structure our observations, enhance our understanding and explain the world [ 24 ]. Within implementation science, theories are encapsulated as either generalised models or frameworks. In other words, they are integrated into broader concepts, allowing researchers to form assumptions that help clarify phenomena and create hypotheses for testing [ 25 ].

Whereas theories in the KT literature are explanatory as well as descriptive, KT models are only descriptive with a more narrowly defined scope of explanation [ 24 ]; hence they have a more specific focus than theories [ 25 ]. KT models are created to facilitate the formulation of specific assumptions regarding a set of parameters or variables, which can subsequently be tested against outcomes using predetermined methods [ 25 ]. By offering simplified representations of complex situations, KT models can describe programme elements expected to produce desired results, or theoretical constructs believed to influence or moderate observed outcomes. In this way, they encompass theories related to change or explanation [ 22 ].

Lastly, frameworks in the KT language define a set of variables and the relations among them in a broad sense [ 25 ]. Frameworks, without the aim of providing explanations, solely describe empirical phenomena, representing a structure, overview, outline, system or plan consisting of various descriptive categories and the relations between them that are presumed to account for a phenomenon [ 24 ]. They portray loosely-structured constellations of theoretical constructs, without necessarily specifying their relationships; they can also offer practical methods for achieving implementation objectives [ 22 ]. Some scholars suggest sub-classifications and categorise a framework as ‘actionable’ if it has the potential to facilitate macro-level policy changes [ 11 ].

Context, which encompasses the entire environment in which policy decisions are made, is not peripheral but central to policymaking, playing a crucial role in its conceptualisation [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. In the KT literature, the term ‘context’ is frequently employed, albeit often with a lack of precision [ 35 ]. It tends to serve as a broad term including various elements within a situation that are relevant to KT in some way but have not been explicitly identified [36]. However, there is a growing interest in delving deeper into what context refers to, as evidenced by increasing research attention [ 31 , 32 , 37 , 38 , 39 , 40 , 41 ]. While the definition of context in the transfer of knowledge to healthcare settings (i.e. implementing health policies, programmes or measures at the meso-level) has been systematically studied [ 36 , 37 , 42 , 43 ], the question of how KT scholars detail context in health policymaking remains unanswered. With our systematic scoping review, we aim to close this gap.

While KT TMFs, emerged from evidence-based medicine, have historically depicted the use of evidence from laboratories or healthcare organisations as the gold standard, we aimed to assess in this study whether and to what extent the evolving face of KT, addressing health policies, succeeded in foregrounding ‘context’. Our objective was thus not to evaluate the quality of these KT TMFs but rather to explore how scholars have incorporated contextual influences into their reasoning. We conducted a systematic scoping review to explore KT TMFs that are relevant to agenda-setting, policy formulation or policy adoption, in line with the aim of this study. Therefore, publications related to policy implementation in healthcare organisations or at the provincial level, as well as those addressing policy evaluation, did not meet our inclusion criteria. Consequently, given our focus on macro-level interventions, we excluded all articles that concentrate on translating clinical research into practice (meso-level interventions) and health knowledge to patients or citizens (micro-level interventions).

Prior systematic scoping reviews in the area of KT TMFs serve as a valuable foundation upon which to build further studies [ 44 , 45 ]. Using established methodologies may ensure a validated approach, allowing for a more nuanced understanding of KT TMFs in the context of existing scholarly work. Our review methodology employed a similar approach to that followed by Strifler et al. in 2018, who conducted a systematic scoping review of KT TMFs in the field of cancer prevention and management, as well as other chronic diseases [ 44 ]. Their search strategy was preferred over others for two primary reasons. First, Strifler et al. investigated KT TMFs altogether, systematically and comprehensively. Second, unlike many other review studies on KT, they focused on macro-level KT and included all relevant keywords useful for the purpose of our study in their Ovid/MEDLINE search query [ 44 ]. For our scoping review, we adapted their search query with the assistance of a specialist librarian. This process involved eliminating terms associated with cancer and chronic diseases, removing time limitation on the published papers, and including an additional language other than English due to authors’ proficiency in German. We included articles published in peer-reviewed journals until November 2022, excluding opinion papers, conference abstracts and study protocols, without any restriction on publication date or place. Our search query is presented in Table  1 .

Following a screening methodology similar to that employed by Votruba et al. [ 11 ], the first author conducted an initial screening of the titles and abstracts of 2918 unique citations. Full texts were selected and scrutinised if they appeared relevant to the topics of agenda-setting, policy formulation or policy adoption. Among these papers, the first author also identified those that conceptualised a KT TMF. Simultaneously, the last author independently screened 2918 titles and abstracts, randomly selecting 20% of them to identify studies related to macro-level KT. Regarding papers that conceptualised a KT TMF, all those initially selected by the first author underwent a thorough examination by the last author as well. In the papers reviewed by these two authors of this study, KT TMFs were typically presented as either Tables or Figures. In cases where these visual representations did not contain sufficient information about ‘context’, the main body of the study was carefully scrutinised by both reviewers to ensure no relevant information was missed. Any unclear cases were discussed and resolved to achieve 100% inter-rater agreement between the first and second reviewers. This strategy resulted in the inclusion of 32 relevant studies. The flow chart outlining our review process is provided in Fig.  1 .

Flow chart of the review process

According to the results of our systematic scoping review (Table  2 ), the first KT TMF developed for health policies dates back to 2003, confirming the emergence of a trend that expanded the meaning of the term Knowledge Translation to include policymakers as end-users of evidence during approximately the same period. In their study, Jacobson et al. [ 46 ] present a framework derived from a literature review to enhance understanding of user groups by organising existing knowledge, identifying gaps and emphasising the importance of learning about new contexts. However, despite acknowledging the significance of the user group context, the paper lacks a thorough explanation of the authors’ understanding of this term. The second study in our scoping review provides some details. Recognising a shift from evidence-based medicine to evidence-based health policymaking in the KT literature, the article by Dobrow et al. from 2004 [ 30 ] emphasises the importance of considering contextual factors. They present a conceptual framework for evidence-based decision-making, highlighting the influence of context in KT. Illustrated through examples from colorectal cancer screening policy development, their conceptual framework emphasises the significance of context in the introduction, interpretation and application of evidence. Third, Lehoux et al. [ 47 ] examine the field of Health Technology Assessment (HTA) and its role in informing decision and policymaking in Canada. By developing a conceptual framework for HTA dissemination and use, they touch on the institutional environment and briefly describe contextual factors.

Notably, the first three publications in our scoping review are authored by scholars affiliated with Canada, which is less of a coincidence, given the role of Canadian Institutes of Health Research (CIHR), the federal funding agency for health research: The CIHR Act (Bill C-13) mandates CIHR to ensure that the translation of health knowledge permeates every aspect of its work [ 48 ]. Moreover, it was CIHR that coined the term Knowledge Translation, defining KT as ‘a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the health care system’ [ 49 ] . This comprehensive definition has since been adapted by international organisations (IOs), including WHO. The first document published by WHO that utilised KT to influence health policies dates back to 2005, entitled ‘Bridging the “know-do” gap: Meeting on knowledge translation in global health’, an initiative that was supported by the Canadian Coalition for Global Health Research, the Canadian International Development Agency, the German Agency for Technical Cooperation and the WHO Special Programme on Research and Training in Tropical Diseases [ 1 ]. Following this official recognition by WHO, studies in our scoping review after 2005 indicate a noticeable expansion of KT, encompassing a wider geographical area than Canada.

The article of Ashford et al. from 2006 [ 50 ] discusses the challenge of policy decisions in Kenya in the health field being disconnected from scientific evidence and presents a model for translating knowledge into policy actions through agenda-setting, coalition building and policy learning. However, the framework lacks explicit incorporation of contextual factors influencing health policies. Bauman et al. [ 51 ] propose a six-step framework for successful dissemination of physical activity evidence, illustrated through four case studies from three countries (Canada, USA and Brazil) and a global perspective. They interpret contextual factors as barriers and facilitators to physical activity and public health innovations. Focusing on the USA, Gold [ 52 ] explains factors, processes and actors that shape pathways between research and its use in a summary diagram, including a reference to ‘other influences in process’ for context. Green et al. [ 4 ] examine the gap between health research and its application in public health without focusing on a specific geographical area. Their study comprehensively reviews various concepts of diffusion, dissemination and implementation in public health, proposing ways to blend diffusion theory with other theories. Their ‘utilization-focused surveillance framework’ interprets context as social determinants as structures, economics, politics and culture.

Further, the article by Dhonukshe-Rutten et al. from 2010 [ 53 ] presents a general framework that outlines the process of translating nutritional requirements into policy applications from a European perspective. The framework incorporates scientific evidence, stakeholder interests and the socio-political context. The description of this socio-political context is rather brief, encompassing political and social priorities, legal context, ethical issues and economic implications. Ir et al. [ 54 ] analyse the use of knowledge in shaping policy on health equity funds in Cambodia, with the objective of understanding how KT contributes to the development of health policies that promote equity. Yet no information on context is available in the framework that they suggest. A notable exception among these early KT TMFs until 2010 is the conceptual framework for analysing integration of targeted health interventions into health systems by Atun et al. [ 55 ], in which the authors provide details about the factors that have an influence on the process of bringing evidence to health policies. Focusing on the adoption, diffusion and assimilation of health interventions, their conceptual framework provides a systematic approach for evaluating and informing policies in this field. Compared to the previous studies discussed above, their definition of context for this framework is comprehensive (Table  2 ). Overall, most of the studies containing macro-level KT TMFs published until 2010 either do not fully acknowledge contextual factors or provide generic terms such as cultural, political and economic for brief description (9 out of 10; 90%).

Studies published after 2010 demonstrate a notable geographical shift, with a greater emphasis on low- and middle-income countries (LMICs). By taking the adoption of the directly observed treatment, short-course (DOTS) strategy for tuberculosis control in Mexico as a case study, Bissell et al. [ 56 ] examine policy transfer to Mexico and its relevance to operational research efforts and suggest a model for analysis of health policy transfer. The model interprets context as health system, including political, economic, social, cultural and technological features. Focusing on HIV/AIDS in India, Tran et al. [ 57 ] explore KT by considering various forms of evidence beyond scientific evidence, such as best practices derived from programme experience and disseminated through personal communication. Their proposed framework aims to offer an analytical tool for understanding how evidence-based influence is exerted. In their framework, no information is available on context. Next, Bertone et al. [ 58 ] report on the effectiveness of Communities of Practice (CoPs) in African countries and present a conceptual framework for analysing and assessing transnational CoPs in health policy. The framework organises the key elements of CoPs, linking available resources, knowledge management activities, policy and practice changes, and improvements in health outcomes. Context is only briefly included in this framework.

Some other studies include both European and global perspectives. The publication from Timotijevic et al. from 2013 [ 59 ] introduces an epistemological framework that examines the considerations influencing the policy-making process, with a specific focus on micronutrient requirements in Europe. They present case studies from several European countries, highlighting the relevance of the framework in understanding the policy context related to micronutrients. Context is interpreted in this framework as global trends, data, media, broader consumer beliefs, ethical considerations, and wider social, legal, political, and economic environment. Next, funded by the European Union, the study by Onwujekwe et al. [ 60 ] examines the role of different types of evidence in health policy development in Nigeria. Although they cover the factors related to policy actors in their framework for assessing the role of evidence in policy development, they provide no information on context. Moreover, Redman et al. [ 61 ] present the SPIRIT Action Framework, which aims to enhance the use of research in policymaking. Context is interpreted in this framework as policy influences, i.e. public opinion, media, economic climate, legislative/policy infrastructure, political ideology and priorities, stakeholder interests, expert advice, and resources. From a global perspective, Spicer et al. [ 62 ] explore the contextual factors that influenced the scale-up of donor-funded maternal and newborn health innovations in Ethiopia, India and Nigeria, highlighting the importance of context in assessing and adapting innovations. Their suggested contextual factors influencing government decisions to accept, adopt and finance innovations at scale are relatively comprehensive (Table  2 ).

In terms of publication frequency, the pinnacle of reviewed KT studies was in 2017. Among six studies published in 2017, four lack details about context in their KT conceptualisations and one study touches on context very briefly. Bragge et al. [ 5 ] brought for their study an international terminology working group together to develop a simplified framework of interventions to integrate evidence into health practices, systems, and policies, named as the Aims, Ingredients, Mechanism, Delivery framework, albeit without providing details on contextual factors. Second, Mulvale et al. [ 63 ] present a conceptual framework that explores the impact of policy dialogues on policy development, illustrating how these dialogues can influence different stages of the policy cycle. Similar to the previous one, this study too, lacks information on context. In a systematic review, Sarkies et al. [ 64 ] evaluate the effectiveness of research implementation strategies in promoting evidence-informed policy decisions in healthcare. The study explores the factors associated with effective strategies and their inter-relationship, yet without further information on context. Fourth, Houngbo et al. [ 65 ] focus on the development of a strategy to implement a good governance model for health technology management in the public health sector, drawing from their experience in Benin. They outline a six-phase model that includes preparatory analysis, stakeholder identification and problem analysis, shared analysis and visioning, development of policy instruments for pilot testing, policy development and validation, and policy implementation and evaluation. They provide no information about context in their model. Fifth, Mwendera et al. [ 66 ] present a framework for improving the use of malaria research in policy development in Malawi, which was developed based on case studies exploring the policymaking process, the use of local malaria research, and assessing facilitators and barriers to research utilisation. Contextual setting is considered as Ministry of Health (MoH) with political set up, leadership system within the MoH, government policies and cultural set up. In contrast to these five studies, Ellen et al. [ 67 ] present a relatively comprehensive framework to support evidence-informed policymaking in ageing and health. The framework includes thought-provoking questions to discover contextual factors (Table  2 ).

Continuing the trend, studies published after 2017 focus increasingly on LMICs. In their embedded case study, Ongolo-Zogo et al. [ 68 ] examine the influence of two Knowledge Translation Platforms (KTPs) on policy decisions to achieve the health millennium development goals in Cameroon and Uganda. It explores how these KTPs influenced policy through interactions within policy issue networks, engagement with interest groups, and the promotion of evidence-supported ideas, ultimately shaping the overall policy climate for evidence-informed health system policymaking. Contextual factors are thereby interpreted as institutions (structures, legacies, policy networks), interests, ideas (values, research evidence) and external factors (reports, commitments). Focusing on the ‘Global South’, Plamondon et al. [ 69 ] suggest blending integrated knowledge translation with global health governance as an approach for strengthening leadership for health equity action. In terms of contextual factors, they include some information such as adapting knowledge to local context, consideration of the composition of non-traditional actors, such as civil society and private sector, in governance bodies and guidance for meaningful engagement between actors, particularly in shared governance models. Further, Vincenten et al. [ 70 ] propose a conceptual model to enhance understanding of interlinking factors that influence the evidence implementation process. Their evidence implementation model for public health systems refers to ‘context setting’, albeit without providing further detail.

Similarly, the study by Motani et al. from 2019 [ 71 ] assesses the outcomes and lessons learned from the EVIDENT partnership that focused on knowledge management for evidence-informed decision-making in nutrition and health in Africa. Although they mention ‘contextualising evidence’ in their conceptual framework, information about context is lacking. Focusing on Latin America and the Caribbean, Varallyay et al. [ 72 ] introduce a conceptual framework for evaluating embedded implementation research in various contexts. The framework outlines key stages of evidence-informed decision-making and provides guidance on assessing embeddedness and critical contextual factors. Compared to others, their conceptual framework provides a relatively comprehensive elaboration on contextual factors. In addition, among all the studies reviewed, Leonard et al. [ 73 ] present an exceptionally comprehensive analysis, where they identify the facilitators and barriers to the sustainable implementation of evidence-based health innovations in LMICs. Through a systematic literature review, they scrutinise 79 studies and categorise the identified barriers and facilitators into seven groups: context, innovation, relations and networks, institutions, knowledge, actors, and resources. The first one, context, contains rich information that could be seen in Table  2 .

Continuing from LMICs, Votruba et al. [ 74 ] present in their study the EVITA (EVIdence To Agenda setting) conceptual framework for mental health research-policy interrelationships in LMICs with some information about context, detailed as external influences and political context. In a follow-up study, they offer an updated framework for understanding evidence-based mental health policy agenda-setting [ 75 ]. In their revised framework, context is interpreted as external context and policy sphere, encompassing policy agenda, window of opportunity, political will and key individuals. Lastly, to develop a comprehensive monitoring and evaluation framework for evidence-to-policy networks, Kuchenmüller et al. [ 76 ] present the EVIPNet Europe Theory of Change and interpret contextual factors for evidence-informed policymaking as political, economic, logistic and administrative. Overall, it can be concluded that studies presenting macro-level KT TMFs from 2011 until 2022 focus mainly on LMICs (15 out of 22; close to 70%) and the majority of them were funded by international (development) organisations, the European Commission and global health donor agencies. An overwhelming number of studies among them (19 out of 22; close to 90%) provide either no information on contextual details or these were included only partly with some generic terms in KT TMFs.

Our systematic scoping review suggests that the approach of KT, which has evolved from evidence-based medicine to evidence-informed policymaking, tends to remain closely tied to its clinical origins when developing TMFs. In other words, macro-level KT TMFs place greater emphasis on the (public) health issue at hand rather than considering the broader decision-making context, a viewpoint shared by other scholars as well [ 30 ]. One reason could be that in the early stages of KT TMFs, the emphasis primarily focused on implementing evidence-based practices within clinical settings. At that time, the spotlight was mostly on content, including aspects like clinical studies, checklists and guidelines serving as the evidence base. In those meso-level KT TMFs, a detailed description of context, i.e. the overall environment in which these practices should be implemented, might have been deemed less necessary, given that healthcare organisations, such as hospitals to implement medical guidelines or surgical safety checklists, show similar characteristics globally.

However, as the scope of KT TMFs continues to expand to include the influence on health policies, a deeper understanding of context-specific factors within different jurisdictions and the dynamics of the policy process is becoming increasingly crucial. This is even more important for KT scholars aiming to conceptualise large-scale changes, as described in KT Tier 5, which necessitate a thorough understanding of targeted behaviours within societies. As the complexity of interventions increases due to the growing number of stakeholders either affecting or being affected by them, the interventions are surrounded by a more intricate web of attitudes, incentives, relationships, rules of engagement and spheres of influence [ 7 ]. The persisting emphasis on content over context in the evolving field of KT may oversimplify the complex process of using evidence in policymaking and understanding the society [ 77 ]. Some scholars argue that this common observation in public health can be attributed to the dominance of experts primarily from medical sciences [ 78 , 79 , 80 ]. Our study confirms the potential limitation of not incorporating insights from political science and public policy studies, which can lead to what is often termed a ‘naïve’ conceptualisation of evidence-to-policy schemes [ 15 , 16 , 17 ]. It is therefore strongly encouraged that the emerging macro-level KT concepts draw on political science and public administration if KT scholars intend to effectively communicate new ideas to policymakers, with the aim of prompting their action or response. We summarised our findings into three points.

Firstly, KT scholars may want to identify and pinpoint exactly where a change should occur within the policy process. The main confusion that we observed in the KT literature arises from a lack of understanding of how public policies are made. Notably, the term ‘evidence-informed policymaking’ can refer to any stage of the policy cycle, spanning from agenda-setting to policy formulation, adoption, implementation and evaluation. Understanding these steps will allow researchers to refine their language when advocating for policy changes across various jurisdictions; for instance, the word ‘implementation’ is often inappropriately used in KT literature. As commonly known, at the macro-level, public policies take the form of legislation, law-making and regulation, thereby shaping the practices or policies to be implemented at the meso- and micro-levels [ 81 ]. In other words, the process of using specific knowledge to influence health policies, however evidence-based it might be, falls mostly under the responsibility and jurisdiction of sovereign states. For this reason, macro-level KT TMFs should reflect the importance of understanding the policy context and the complexities associated with policymaking, rather than suggesting flawed or unrealistic top-down ‘implementation’ strategies in countries by foregrounding the content, or the (public) health issue at hand.

Our second observation from this systematic scoping review points towards a selective perception among researchers when reporting on policy interventions. Research on KT does not solely exist due to the perceived gap between scientific evidence and policy but also because of the pressures the organisations or researchers face in being accountable to their funding sources, ensuring the continuity of financial support for their activities and claiming output legitimacy to change public policies [ 8 ]. This situation indirectly compels researchers working to influence health policies in the field to provide ‘evidence-based’ feedback on the success of their projects to donors [ 82 ]. In doing so, researchers may overly emphasise the content of the policy intervention in their reporting to secure further funding, while they underemphasis the contextual factors. These factors, often perceived as a given, might actually be the primary facilitators of their success. Such a lack of transparency regarding the definition of context is particularly visible in the field of global health, where LMICs often rely on external donors. It is important to note that this statement is not intended as a negative critique of their missions or an evaluation of health outcomes in countries following such missions. Rather, it seeks to explain the underlying reason why researchers, particularly those reliant on donors in LMICs, prioritise promoting the concept of KT from a technical standpoint, giving less attention to contextual factors in their reasoning.

Lastly, and connected to the previous point, it is our observation that the majority of macro-level KT TMFs fail to give adequate consideration to both power dynamics in countries (internal vs. external influences) and the actual role that government plays in public policies. Notably, although good policymaking entails an honest effort to use the best available evidence, the belief that this will completely negate the role of power and politics in decision-making is a technocratic illusion [ 83 ]. Among the studies reviewed, the framework put forth by Leonard et al. [ 73 ] offers the most comprehensive understanding of context and includes a broad range of factors (such as political, social, and economic) discovered also in other reviewed studies. Moreover, the framework, developed through an extensive systematic review, offers a more in-depth exploration of these contextual factors than merely listing them as a set of keywords. Indeed, within the domains of political science and public policy, such factors shaping health policies have received considerable scholarly attention for decades. To define what context entails, Walt refers in her book ‘Health Policy: An Introduction to Process and Power’ [ 84 ] to the work of Leichter from 1979 [ 85 ], who provides a scheme for analysing public policy. This includes i) situational factors, which are transient, impermanent, or idiosyncratic; ii) structural factors, which are relatively unchanging elements of the society and polity; iii) cultural factors, which are value commitments of groups; and iv) environmental factors, which are events, structures and values that exist outside the boundaries of a political system and influence decisions within it. His detailed sub-categories for context can be found in Table  3 . This flexible public policy framework may offer KT researchers a valuable approach to understanding contextual factors and provide some guidance to define the keywords to focus on. Scholars can adapt this framework to suit a wide range of KT topics, creating more context-sensitive and comprehensive KT TMFs.

Admittedly, our study has certain limitations. Despite choosing one of the most comprehensive bibliographic databases for our systematic scoping review, which includes materials from biomedicine, allied health fields, biological and physical sciences, humanities, and information science in relation to medicine and healthcare, we acknowledge that we may have missed relevant articles indexed in other databases. Hence, exclusively using Ovid/MEDLINE due to resource constraints may have narrowed the scope and diversity of scholarly literature examined in this study. Second, our review was limited to peer-reviewed publications in English and German. Future studies could extend our findings by examining the extent to which contextual factors are detailed in macro-level KT TMFs published in grey literature and in different languages. Given the abundance of KT reports, working papers or policy briefs published by IOs and development agencies, such an endeavour could enrich our findings and either support or challenge our conclusions. Nonetheless, to our knowledge, this study represents the first systematic review and critical appraisal of emerging knowledge-to-policy concepts, also known as macro-level KT TMFs. It successfully blends insights from both biomedical and public policy disciplines, and could serve as a roadmap for future research.

The translation of knowledge to policymakers involves more than technical skills commonly associated with (bio-)medical sciences, such as creating evidence-based guidelines or clinical checklists. Instead, evidence-informed policymaking reflects an ambition to engage in the political dimensions of states. Therefore, the evolving KT concepts addressing health policies should be seen as a political decision-making process, rather than a purely analytical one, as is the case with evidence-based medicine. To better understand the influence of power dynamics and governance structures in policymaking, we suggest that future macro-level KT TMFs draw on insights from political science and public administration. Collaborative, interdisciplinary research initiatives could be undertaken to bridge the gap between these fields. Technocratic KT TMFs that overlook contextual factors risk propagating misconceptions in academic circles about how health policies are made, as they become increasingly influential over time. Research, the systematic pursuit of knowledge, is neither inherently good nor bad; it can be sought after, used or misused, like any other tool in policymaking. What is needed in the KT discourse is not another generic call for ‘research-to-action’ but rather an understanding of the dividing line between research-to- clinical -action and research-to- political -action.

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Schmitt, T., Czabanowska, K. & Schröder-Bäck, P. What is context in knowledge translation? Results of a systematic scoping review. Health Res Policy Sys 22 , 52 (2024). https://doi.org/10.1186/s12961-024-01143-5

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A scoping review of academic and grey literature on migrant health research conducted in Scotland

• G. Petrie 1 ,
• K. Angus 2 &
• R. O’Donnell 2  

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Migration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current population were born abroad. Migration and ethnicity are determinants of health, and information on the health status of migrants to Scotland and their access to and barriers to care facilitates the planning and delivery of equitable health services. This study aimed to scope existing peer-reviewed research and grey literature to identify gaps in evidence regarding the health of migrants in Scotland.

A scoping review on the health of migrants in Scotland was carried out for dates January 2002 to March 2023, inclusive of peer-reviewed journals and grey literature. CINAHL/ Web of Science/SocIndex and Medline databases were systematically searched along with government and third-sector websites. The searches identified 2166 journal articles and 170 grey literature documents for screening. Included articles were categorised according to the World Health Organisation’s 2016 Strategy and Action Plan for Refugee and Migrant Health in the European region. This approach builds on a previously published literature review on Migrant Health in the Republic of Ireland.

Seventy-one peer reviewed journal articles and 29 grey literature documents were included in the review. 66% were carried out from 2013 onwards and the majority focused on asylum seekers or unspecified migrant groups. Most research identified was on the World Health Organisation’s strategic areas of right to health of refugees, social determinants of health and public health planning and strengthening health systems. There were fewer studies on the strategic areas of frameworks for collaborative action, preventing communicable disease, preventing non-communicable disease, health screening and assessment and improving health information and communication.

While research on migrant health in Scotland has increased in recent years significant gaps remain. Future priorities should include studies of undocumented migrants, migrant workers, and additional research is required on the issue of improving health information and communication.

Peer Review reports

The term migrant is defined by the International Organisation for Migration as “ a person who moves away from his or her place of usual residence, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons. The term includes several well-defined legal categories of people, including migrant workers; persons whose particular types of movements are legally-defined, such as smuggled migrants; as well as those whose status are not specifically defined under international law, such as international students.” [ 1 ] Internationally there are an estimated 281 million migrants – 3.6% of the world population, including 26.4 million refugees and 4.1 million asylum seekers – the highest number ever recorded [ 2 ]. The UN Refugee Society defines the term refugee as “ someone who has been forced to flee his or her country because of persecution, war or violence…most likely, they cannot return home or are afraid to do so .” The term asylum-seeker is defined as “someone whose request for sanctuary has yet to be processed.” [ 3 ].

Net-migration to Europe was negative in the 19th century due to higher levels of emigration, however in the mid-20th century immigration began to rise, because of an increase in migrant workers and following conflicts in the Middle East and North Africa [ 4 ]. Current migration drivers include conflicts alongside world-wide economic instability, exacerbated by the Covid-19 pandemic [ 5 ]. Environmental damage due to climate change is expected to inflate the number of asylum seekers entering Europe in future [ 6 ]. The increase in migration to Europe is not a short-term influx but a long-term phenomenon, and European nations must adapt and find solutions to resulting financial, safeguarding and health challenges [ 7 ].

Data on healthcare use by migrants in Europe is variable, which means cross-country comparisons are inadequate [ 8 ]. Many countries do not record migration information within health records and all use disparate criteria to classify migrant status. The lack of comparative data hinders public health surveillance and effective interventions [ 9 ]. Even where information is available, results can be contradictory due to the multifarious migrant population. Migrants have a wide range of origin countries, socio-economic position, age and journeys undertaken which can affect health status [ 10 ].

Migrants initially may have better health than the general population, known as the ‘Healthy Migrant effect’ [ 11 ]. However, health declines with increasing length of residence [ 12 ] and over time to levels comparable with the general population [ 13 ]. Second generation immigrants may have higher mortality than average [ 14 ]. The process of acculturation to the host country, with adoption of unhealthy lifestyle and behaviours, increases the risk for chronic disease [ 15 ]. In addition, inequalities in health of migrants compared to host populations has been confirmed by wide-ranging research [ 16 ].

Host countries may limit healthcare access, with undocumented migrants sometimes only entitled to emergency care [ 17 ]. Even when access is granted, inequitable services can affect quality of care due to language barriers and cultural factors [ 18 ]. Poor working/living conditions and discrimination can exacerbate health inequalities [ 12 ]. Processing facilities for asylum seekers are frequently overpopulated, stressful environments [ 19 ] and threat of deportation, lack of citizenship rights and integration can negatively affect health and access to care [ 20 ]. Undocumented workers are unprotected by health and safety legislation leading to dangerous working conditions and injuries [ 15 ].

A systematic review of migrant health in the European Union (EU) found migrants have worse self-perceived health than the general population [ 21 ]. Research evidence indicates increased prevalence of cardiovascular disease, diabetes, mental health disorders and adverse pregnancy outcomes. Exposure to conflict, harsh travel conditions and suboptimal vaccine programmes can mean higher risk of communicable disease [ 22 ]. Scoping reviews have also been conducted to describe trends within migration health research in the United Kingdom (UK) [ 23 ] and identify gaps for future research agendas in the UK [ 23 ] and in the Republic of Ireland [ 24 ].

Almost three-quarters (73%) of published migration health research in the UK has been conducted in England, focusing primarily on infectious diseases and mental health. There is limited evidence on the social determinants of health, access to and use of healthcare and structural and behavioural factors behaviours that influence migrant health in the UK [ 23 ]. By contrast, a large amount of the migration research conducted in the Republic of Ireland has focused on the social determinants of health, and on health system adaptations, with a paucity of research focusing on improving health information systems [ 24 ].

Migration and Health in Scotland

Immigration to Scotland began to rise in 2003 with the expansion of the EU [ 25 ]. The population in Scotland increased from 5.11 million to 5.47 million between 2005 and 2020 and is predicted to continue rising until 2028 [ 26 ] despite low birth rates, with the increased population resulting from inward migration [ 27 ]. Scotland’s population is becoming more ethnically diverse [ 28 ] and susceptibility to different health conditions varies by ethnic group, which has implications for the planning and provision of health services [ 29 ]. 7% of the current Scottish population are non-UK nationals and 10% were born outside Britain. The commonest countries of origin were Poland, Ireland, Italy, Nigeria and India [ 30 ].

Within Scotland, linking health data to ethnicity is standard in order to monitor and improve health of minority groups [ 31 ]. Ethnic background can differ from country of birth which means migration status cannot be assumed [ 32 ], although health inequalities experienced by migrants often extend to affect all ethnic minority groups [ 33 ]. The Scottish Health and Ethnicity Linkage Study (SHELS) linked census data to health records of 91% of the population which has provided information on mortality and morbidity by ethnic group and country of birth [ 34 ]. SHELS research indicates that the white-Scottish population have a higher mortality rate than other ethnic groups. This may be consequent to the comparatively poor health of the Scottish population relative to other European nations: high mortality rates in the general population may cause a perception that the health of minorities is more advantageous than in reality [ 35 ].

Cezard et al’s [ 13 ] analysis of self-perceived health among people in Scotland found that being born abroad had a positive impact on health status. Health declined with increased length of residence, which may be explained by cultural convergence with the majority population. Allik et al. [ 36 ] compared health inequalities by ethnic background and found that with increasing age, health differences reduced thus people aged over 75 of all ethnicities had similar or worse health status than White-Scottish people. While working-age migrants appear to be healthier than the White Scottish population, it cannot be assumed that in future this would extend to older age groups.

Research has shown deprivation as a cause of heath inequalities among ethnic minority and migrant groups [ 37 ]. The socio-economic status of minority ethnic groups in Scotland is unusual, as most are of similar or higher status than the white-Scottish population [ 38 ]. Therefore, public health interventions targeting deprivation may not address risk-factors for ethnic minorities and migrants [ 36 ]. Further research on determinants of health in migrants can help with planning and design of inclusive policies.

The 2011 census indicated that 50% of immigrants lived in the cities of Edinburgh, Glasgow, and Aberdeen. Glasgow had a greater percentage of non-European immigrants due to participation in the Asylum dispersal programme [ 39 ]. 10% of UK asylum seekers are placed in Glasgow, but records are not kept following approval of asylum claims, therefore the size of the refugee population is unknown [ 40 ]. While immigration is controlled by the British government, in policy areas devolved to the Scottish government, refugees and asylum seekers have more rights than elsewhere in UK, including access to primary healthcare for undocumented migrants [ 40 ]. Despite the mitigating effect of Scottish policies, asylum seekers’ health is worsened by the asylum process and associated poverty, marginalisation, and discrimination [ 40 ]. Health deteriorates with increasing length of time in the asylum system [ 40 ] and asylum seekers and refugees have additional health needs and require enhanced support [ 41 ]. Research on the health needs of asylum seekers in Scotland is required to ensure adequate healthcare.

Aim and objectives

While scoping reviews on migrant health have been carried out in Europe [ 12 ], Ireland [ 24 ] and the UK [ 23 ] none are currently specific to the Scottish context. Given the devolved government of Scotland and demographics described above, a targeted review would help to clarify research priorities, with the aim of improving health and health care within the migrant community in Scotland. This work therefore builds on the published scoping review of migrant health in the Republic of Ireland [ 24 ]. The authors recommend replication of the study in other countries to facilitate cross-country comparison. Our aim was to scope peer-reviewed research and grey literature on migrant health conducted in Scotland and identify any gaps in the evidence. Our objectives were to: [1] understand the extent of the available research by topic area [2] summarise the types of research already conducted, populations studied, topics covered and approaches taken [3], map the existing research conducted in Scotland and [4] identify areas for future research based on any gaps in the evidence identified.

A scoping review was conducted as they can aid detection of evidence gaps [ 42 ] and allow incorporation of grey literature in topics with insufficient published research [ 43 ]. Arksey and O’Malley’s [ 44 ] five stage scoping review framework was used.

Stage 1: identifying the research question

Arskey and O’Malley [ 44 ] suggest maintaining a broad approach to identifying the research question, in order to generate breadth of coverage. On this basis, and in line with the research question identified in the Villarroel et al. [ 24 ] scoping review, our research question was framed as follows: What is the scope, main topics and gaps in evidence in the existing literature on health of international migrants living in Scotland? Arksey and O’Malley [ 44 ] highlight the importance of defining terminology at the outset of scoping reviews. For consistency, we used the broad definition of ‘migrant’ as per Villaroel et al. [ 24 ], from the International Organisation for Migration (IOM) [ 1 ]. References to refugees or asylum seekers followed the United Nations Refugee Agency definitions [ 3 ].

Stage 2: identifying relevant studies

Electronic database searches identified reports alongside a grey literature search, in line with Arskey and O’Malley’s [ 44 ] guidance to search for evidence via different sources. CINAHL, Web of Science, SocIndex and Medline academic databases were selected with input from co-authors. Search terms for the review were based upon those used by Villaroel et al. [ 24 ] with additional relevant terms from Hannigan et al. [ 9 ] The strategy combined three sets of terms for: Migrants (e.g., refugee, migrant, immigrant or newcomer), Scotland and Health. Both free text terms and index terms were used and adapted to the 4 academic databases and searches were run on 10th March 2023 (see Additional File 1 for database search strategies). Thirteen Government, University, and third-sector websites in Scotland were scoped for selection then hand-searched for grey literature (listed in Additional File 1 ).

Stage 3: study selection

Net-migration to Scotland increased in the 2000s [ 27 ] hence a date range of January 2002-March 2023 was used to identify evidence. The search was limited to English only. Inclusion/exclusion criteria for the studies were based on those used by Villaroel et al. [ 24 ] and expanded upon following discussion with co-authors (see Table  1 ). Reports were included if based on primary or secondary research on the health of international migrants in Scotland and used qualitative, quantitative or mixed methods research design. International or UK based reports were only included if Scottish results were documented separately. Reports on the health of ethnic minority groups in Scotland was included if place of birth was recorded. Research on internal (non-international) migrants within Scotland, either moving from one Scottish area to another or from another part of the United Kingdom to Scotland, were excluded.

Stage 4: data charting

All records were saved to RefWorks for screening. Records were first screened at title/abstract stage with 10% independently checked by the co-authors. The remaining reports were single screened using full text by the first author. Data from the included records was extracted and organised in tabular form under the following headings, which were agreed by team members: article type (peer-reviewed article or grey literature), publication date, geographical setting, study/intervention’s target population, funding, primary research focus on migrant health (y/n), study objective, data collection method, study design (qualitative/quantitative/mixed) and main finding. Reports were not critically appraised in this scoping review.

Stage 5: collating, summarising and reporting results

A report (either a peer-reviewed journal article or grey literature report) is used as our unit of analysis. In order to present the range of research identified, reports were grouped by the different headings in our data charting table and the outcomes considered for relevance to our scoping review’s aim. Our Results summarise the recency, focus, study designs and funding sources of the identified research, followed by the geographical settings and whether Scotland was included in international research reports. Reports were grouped by their study population and further sub-divided by publication type and geographical area for summarising. Finally, the WHO’s European strategy and action plan (SAAP) for refugee and migrant health [ 7 ] is a policy framework designed to help governments and other stakeholders monitor and improve migrant health in Europe. There are nine strategic areas in the WHO’s SAAP, which prioritise the most salient issues. In line with Villaroel et al’s [ 24 ] approach and in order to compare scoping review outcomes, these areas were used to categorise the findings of this review. Each report was matched to the most appropriate SAAP:

Establishing a Framework for Collaborative Action.

Advocating for the right to health of refugees.

Addressing the social determinants of health.

Achieving public health preparedness and ensuring an effective response.

Strengthening health systems and their resilience.

Preventing communicable disease.

Preventing and reducing the risks caused by non-communicable disease.

Ensuring ethical and effective health screening and assessment.

Improving health information and communication.

The primary focus (aims and objectives) of each report was used to identify the relevant SAAP area/areas. To improve reliability, results were compared using coding criteria used in Villaroel et al’s study (MacFarlane 2023, personal communication, 31st May). 10% of the reports were checked by one co-author to ensure consistent coding to SAAP categories. Any instances of uncertainty in mapping reports to the relevant SAAP area/areas were discussed and resolved by team members.

This scoping review of the literature on migrant health in Scotland identified 2166 records from academic literature databases, following duplicate removal, and 170 records from website searches (see Fig.  1 ). Following screening, a total of 71 peer-reviewed journal articles and 29 grey literature studies (totalling 100 reports) were included for analysis (Results table and reference list are presented in Additional File 2 ).

Flow chart illustrating the identification of sources of evidence included in the scoping review

Overall findings

The majority of reports were published between 2013 and 2022. Fifty-eight reports (58%) focused exclusively on migrant health [ 18 , 39 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ]. 23 centred on health but included other populations in addition to migrants – for example research on ethnic minorities or other vulnerable groups [ 13 , 31 , 35 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 ]. Seventeen reports were included where the sample population were migrants, but the primary topic was not health – for example destitution, integration, and service needs [ 27 , 73 , 74 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 ]. Health data was reported as part of the wider subject matter. One report [ 136 ] looked at the social determinants of breastfeeding including migrant status and one [ 137 ] compared attitudes to aging and family support between countries.

Funding sources were not declared for 35 (35%) of reports. The Scottish Government funded 20 reports (20%) [ 13 , 27 , 32 , 39 , 45 , 46 , 47 , 66 , 77 , 88 , 99 , 100 , 101 , 102 , 113 , 116 , 119 , 121 , 129 , 134 ]. Other common sources of funding included Government funded public bodies ( n  = 13) [ 45 , 48 , 49 , 50 , 51 , 52 , 53 , 104 , 107 , 113 , 116 , 131 , 136 ], the Scottish Health Service ( n  = 18) (either the National Health Service (NHS) [ 13 , 54 , 56 , 57 , 58 , 59 , 102 , 113 , 116 ], local NHS trusts [ 45 , 60 , 61 , 77 , 102 , 103 , 112 ] or by Public Health Scotland [ 13 , 113 ]) Eleven reports (11%) were funded by Universities. The charity sector financed 15 (15%) reports [ 53 , 63 , 66 , 69 , 70 , 71 , 72 , 73 , 74 , 103 , 111 , 123 , 125 , 132 , 138 ] and the EU and Scottish local authorities funded four reports each [ 45 , 62 , 75 , 76 , 77 , 102 , 125 , 135 ]. Professional bodies financed one report [ 126 ] as did the Japanese government [ 64 ]. No reports received funding from the business sector. The biggest sources of funding for grey literature were Refugee charities (40%) and the Scottish government (30%) (see Fig. 2 ).

Sources of funding for migrant health research in Scotland

Research methods and data collection

52% of reports used qualitative research methods. Forty-five reports (86%) collected data using 1–1 interviews and 24 (46%) used focus groups. Other methods of data collection included questionnaires (six studies (11%)), workshops (two studies (3.85%)) and observation (two studies (3.85%)). Oral/written evidence, guided play sessions, family case studies and participatory activity sessions were used in one report each.

28% of reports used quantitative research methods, most commonly cross section design (ten studies (36%)) and cohort design (18 studies (64%)). Information was obtained from databases including medical records, Census data and national records in 21 reports (75%). Questionnaires were used in six reports (21%). Other methods including body measurements, food diaries, blood samples, interviews and case reviews were used in 1 report each.

20% of reports used mixed methods. The most common method of data collection was questionnaires in 14 reports (70%), interviews in ten reports (50%), focus groups in seven reports (35%), workshops in three reports (13.6%), and databases in three reports (13.6%). Other methods included literature review in two reports (10%), case note reviews in two reports (10%) and one reports each used mapping and school records.

Geographical areas of study

Ninety-one reports were situated in Scotland, of which 35 (38.5%) covered the whole country and 56 (61.5%) specified a city or area where research was undertaken. Some UK and international reports also specified the area of Scotland. The largest share of research within Scotland overall was in Glasgow with 36 reports, followed by Edinburgh with 16 reports, Lothian with six reports, Aberdeen with five reports and Grampian with three reports. The Northeast, Stirling, Highlands, Inverness, Lanarkshire, Motherwell and Selkirk had one report in each area.

There were seven international reports, three on mortality by country of birth [ 75 , 76 , 78 ], one on cross cultural communication [ 79 ], one on maternity care in Poland and Scotland [ 99 ], one comparing attitudes to aging in China and Scotland [ 137 ] and one on the link between birthweights and integration of migrants [ 64 ]. The remaining two reports were UK based, one on immunisation of Roma and traveller communities [ 117 ] and one on the link between ethnic diversity and mortality [ 104 ]. All the included international and UK reports documented the Scottish data separately within results.

Migrant population

Thirty-one reports included all migrants in the study population. The remaining reports included 30 studies on asylum seekers/refugees, 11 on Polish migrants, ten on Africans, six each on South Asians/Chinese/European, three on Arabs, and two on Roma populations (see Fig.  3 ). Most reports did not specify the country of origin for Asylum seekers and refugees - where country of birth was specified, reports were also included in the appropriate category.

Migrant populations studied in health research in Scotland

Grey literature and peer-reviewed reports differed in population focus. The most common populations of interest in grey literature were asylum seekers/refugees consisting of 18 reports (62%) [ 27 , 47 , 54 , 55 , 59 , 63 , 70 , 71 , 72 , 73 , 74 , 123 , 125 , 127 , 128 , 132 , 134 , 138 ] while for peer-reviewed journals 24 reports (34%) focused on all migrants [ 13 , 35 , 45 , 48 , 64 , 76 , 78 , 79 , 80 , 81 , 104 , 105 , 108 , 109 , 113 , 114 , 115 , 116 , 118 , 120 , 121 , 122 , 136 ].

Migrant study population also differed by local area; Glasgow city, where the majority of research occurred, had 18 reports of 36 (50%) on Asylum seekers/refugees [ 47 , 48 , 52 , 53 , 54 , 55 , 58 , 63 , 70 , 71 , 72 , 82 , 83 , 127 , 128 , 130 , 138 , 139 ] eight reports (22%) on Africans [ 52 , 53 , 84 , 85 , 86 , 87 , 106 , 107 ], seven reports (19%) on all migrants [ 45 , 48 , 80 , 102 , 104 , 105 , 121 ] and two reports (5.5%) on Roma migrants [ 103 , 117 ]. Other populations had one reports each. In Edinburgh five reports of 16 (31%) were on the Polish population [ 56 , 67 , 68 , 89 , 90 ], and two reports (12.5%) on Asylum seekers/refugees [ 60 , 133 ], Chinese [ 62 , 137 ], South Asian [ 46 , 119 ], all migrants [ 105 , 121 ] and Africans [ 87 , 107 ]. The remaining migrant groups had one report each. Other areas of Scotland show no clear pattern with studies in disparate migrant population groups.

Number of reports per Strategic and Action Plan (SAAP) Area

SAAP Area mapping

1. establishing a framework for collaborative action.

Nine reports had a primary focus on collaborative action and were categorised under SAAP area 1 (see Fig.  4 ) [ 66 , 70 , 72 , 73 , 103 , 125 , 129 , 132 , 134 ]. Four reports (33%) used a mixed methods study design, the remaining five reports (67%) used a qualitative design. One report [ 66 ] focused on the epidemiology of female genital mutilation and a proposed intervention strategy. One report [ 66 ] focused on the epidemiology of female genital mutilation and a proposed intervention strategy. One report [ 103 ] evaluated service provision to the Roma community in Glasgow. The remaining reports focused on refugees and asylum seekers: four [ 73 , 125 , 132 , 134 ] evaluations of refugee integration projects, one [ 70 ] on services available to pregnant women, and one [ 72 ] an assessment of a peer-education service. One report [ 129 ] was a review of service provisions for migrants during the Covid-19 pandemic. All reports in SAAP area 1 were grey literature and three (37.5%) had a primary focus on migrant health while four (50%) focused on integration, one (11%) included data on ethnic minorities and one (11%) on services during the covid-19 pandemic. The majority (seven reports (78%)) were also categorised to another SAAP area most commonly area 2 (five studies (55%)) or area 5 (four studies (44%)).

2. Advocating for the right to health of refugees

Nineteen reports focused on SAAP area 2, advocating for the right to health of refugees (see Fig.  4 ) [ 47 , 52 , 53 , 54 , 55 , 63 , 70 , 71 , 83 , 103 , 123 , 124 , 125 , 127 , 128 , 129 , 134 , 138 , 140 ]. Sixteen reports (84%) had a qualitative study design and the remaining three (16%) reports used mixed methods. Nine reports (47%) focused on the health impact of the asylum system [ 52 , 55 , 71 , 74 , 123 , 127 , 128 , 129 , 138 ], five (26%) on health and access to care [ 47 , 54 , 83 , 103 , 124 ], two (10.5%) on maternity care [ 63 , 70 ], two (10.5%) on integration services [ 125 , 134 ] and one report on mental health in HIV positive migrants [ 53 ]. Nine reports (47%) had a primary focus on migrant health while the remaining 10 (53%) also involved wider social issues. The majority (15 (79%)) of reports were grey literature. All the articles in this group overlapped with another SAAP area. Area 3 is the most common joint category with ten reports (53%) followed by area 5 with seven reports (37%), area 1 shares five reports (26%), while areas 4 and 8 share one report each (5%).

3. Addressing the social determinants of health

Twenty-nine reports were categorised to SAAP area 3 – addressing the social determinants of health (see Fig.  4 ) [ 13 , 27 , 45 , 50 , 52 , 55 , 60 , 62 , 63 , 65 , 68 , 71 , 74 , 80 , 81 , 82 , 91 , 92 , 93 , 102 , 112 , 123 , 124 , 127 , 128 , 136 , 137 , 138 ]. The majority (14 (48%)) used a qualitative study method, eight (28%) used quantitative methodology and the remaining seven reports (24%) used mixed methods. Nineteen reports (65.5%) were peer-reviewed journals [ 13 , 45 , 50 , 52 , 60 , 62 , 63 , 65 , 68 , 80 , 81 , 82 , 91 , 92 , 93 , 104 , 112 , 124 , 136 , 137 ] and ten (34.5%) were grey literature [ 27 , 55 , 63 , 71 , 74 , 102 , 123 , 127 , 128 , 138 ]. Ten reports (34.5%) discussed the effects of the asylum system on health [ 27 , 52 , 63 , 71 , 74 , 123 , 124 , 127 , 128 , 137 ] and one (3.5%) migration and health [ 50 ]. Six reports (21%) focused on culture and ethnicity [ 82 , 92 , 102 , 104 , 112 , 137 ], five reports (17%) discussed economic and environmental determinants of health [ 13 , 45 , 67 , 81 , 93 ] and five reports (17%) the health impact of social activities [ 55 , 60 , 62 , 80 , 91 ]. Of the remaining reports, one [ 65 ] discussed Brexit and mental health of European migrants and one discussed the effect of coping strategies on wellbeing in Polish migrants [ 68 ]. Most reports, 18 (62%) had a primary focus on migrant health [ 45 , 50 , 52 , 55 , 60 , 62 , 63 , 65 , 67 , 68 , 71 , 80 , 81 , 82 , 91 , 92 , 93 , 102 ], six reports (21%) discussed wider social factors in addition to health [ 74 , 123 , 124 , 127 , 128 , 138 ]. Of the remaining reports three (10%) looked at ethnic background and country of birth [ 13 , 112 , 136 ], one [ 27 ] included other vulnerable groups and one [ 137 ] included people living in China and Chinese migrants to Scotland. Thirteen reports were also categorised to one or more additional SAAP area - ten (34%) were also applicable to area 2 [ 52 , 55 , 63 , 71 , 74 , 123 , 124 , 127 , 128 , 138 ], three (10%) to area 5 [ 63 , 82 , 92 ] and one (7%) to area 4 [ 27 ].

4. Achieving public health preparedness and ensuring an effective response

Twenty-one reports were assigned to SAAP area 4 (see Fig.  4 ) [ 27 , 31 , 35 , 39 , 47 , 57 , 64 , 75 , 76 , 77 , 78 , 94 , 104 , 108 , 109 , 111 , 113 , 114 , 116 , 120 , 135 ] of which fourteen (67%) used quantitative research methods, four (19%) mixed methods and three (14%) qualitative methods. Thirteen (62%) reports were peer-reviewed journals [ 35 , 59 , 64 , 75 , 78 , 104 , 108 , 109 , 111 , 113 , 114 , 116 , 120 ] and eight (38%) grey literature [ 27 , 31 , 39 , 47 , 57 , 77 , 94 , 135 ]. Most reports (12 (57%)) focused on morbidity and mortality in migrant populations [ 31 , 35 , 64 , 75 , 76 , 78 , 104 , 108 , 109 , 113 , 114 , 116 ]. Six (29%) investigated health status and healthcare needs in migrant groups in Scotland [ 39 , 47 , 57 , 77 , 94 , 135 ]. Two reports (9.5%) analysed the epidemiology of HIV infections [ 111 , 120 ] and the remaining report focused on the health needs of young people during the covid-19 pandemic [ 27 ]. Nine reports (43%) had a primary focus on migrant health [ 39 , 47 , 55 , 64 , 75 , 76 , 77 , 78 , 94 ] while eight (38%) also analysed data by ethnicity [ 31 , 35 , 104 , 108 , 109 , 113 , 114 , 116 ]. Of the remaining reports, three (14%) included other populations within Scotland [ 27 , 111 , 120 ] and one (5%) included other characteristics in addition to health information [ 135 ]. Ten reports (48%) were also categorised to another SAAP area; one to area 2 [ 47 ], one to area 3 [ 27 ], four to area 5 [ 47 , 57 , 77 , 135 ], two to area 6 [ 111 , 120 ] and two to area 9 [ 31 , 108 ].

5. Strengthening health systems and their resilience

Twenty-nine reports were assigned to SAAP area 5 (see Fig.  4 ) [ 18 , 47 , 48 , 49 , 54 , 57 , 63 , 69 , 70 , 72 , 77 , 79 , 82 , 83 , 92 , 95 , 96 , 97 , 99 , 101 , 103 , 118 , 119 , 126 , 129 , 131 , 133 , 135 , 141 ] of which 23 (79%) used qualitative research methods. Three reports used quantitative methods (10.3%) and the remaining three used mixed methods (10.3%). Twelve reports (41%) examined migrants needs and experiences of health care [ 47 , 49 , 54 , 57 , 58 , 77 , 83 , 95 , 103 , 119 , 129 , 135 ], eight (24%) focused on pregnancy and childcare [ 63 , 70 , 92 , 96 , 97 , 99 , 101 , 118 ] and two (7%) on barriers to healthcare access [ 48 , 131 ]. Two reports (7%) evaluated healthcare programmes [ 72 , 133 ] and two focused on communication in primary care [ 79 ] and maternity services [ 69 ]. The remaining three reports (10%) covered sexual health [ 82 ], health information needs of Syrian refugees [ 126 ] and general practitioner training [ 18 ]. Nineteen (65.5%) were peer reviewed journals [ 18 , 48 , 49 , 58 , 69 , 79 , 82 , 83 , 92 , 95 , 96 , 97 , 99 , 101 , 118 , 119 , 125 , 131 , 133 ] and ten (34.5%) were grey literature [ 47 , 54 , 57 , 63 , 70 , 72 , 77 , 103 , 129 , 135 ]. Twenty-one (72%) had a primary focus on migrant health [ 18 , 47 , 48 , 49 , 54 , 57 , 58 , 63 , 69 , 70 , 72 , 77 , 79 , 82 , 83 , 92 , 95 , 96 , 97 , 99 , 101 ]. Six reports (21%) included research on other characteristics or services [ 103 , 126 , 129 , 131 , 133 , 135 ]. The remaining two reports (7%) included ethnic groups as well as migrants in the data [ 118 , 119 ]. Nineteen reports (65.5%) were also assigned to one or more other category areas: five reports (17%) to area 1 [ 47 , 70 , 72 , 103 , 129 ], five reports (17%) to area 2 [ 54 , 63 , 83 , 103 , 129 ], three reports (10%) to area 3 [ 63 , 82 , 92 ], four reports (14%) to area 4 [ 47 , 57 , 77 , 135 ], one (3.5%) to area 7 [ 119 ] and one (3.5%) to area 9 [ 48 ].

6. Preventing communicable diseases

Fourteen reports were assigned to SAAP area 6 (see Fig.  4 ) [ 56 , 61 , 87 , 88 , 89 , 90 , 105 , 106 , 107 , 111 , 115 , 117 , 120 , 122 ] of which four (31%) used quantitative methods, five (38%) used qualitative methods and five (38%) used mixed methods. Five reports (38.5%) examined immunisation behaviour [ 56 , 61 , 89 , 90 , 117 ], five (38%) on epidemiology and treatment of HIV [ 106 , 107 , 111 , 120 , 122 ]. The remaining four reports (31%) focused on tuberculosis in healthcare workers [ 115 ], malaria [ 105 ] and sexual health services [ 87 , 88 ]. Only one reports was grey literature [ 88 ], the remainder were peer-reviewed journals. Six reports (46%) had a primary focus on migrant health [ 56 , 61 , 87 , 88 , 89 , 90 ] while seven reports (54%) also included other at-risk groups in the analysis. Four reports (31%) were also assigned to another SAAP category, two (15%) to area 4 [ 111 , 120 ] and two (15%) to area 8 [ 88 , 115 ].

7. Preventing and reducing the risks posed by non-communicable diseases

Eight reports were categorised to SAAP area 7 (see Fig.  4 ) [ 46 , 51 , 59 , 84 , 85 , 86 , 98 , 119 ] of which six (75%) used qualitative research methods, one (12.5%) used quantitative methods and one (12.5%) used mixed methods. Only one report (12.5%) was grey literature [ 59 ] the remaining seven reports (87.5%) were peer-reviewed journals [ 48 , 87 , 92 , 126 , 127 , 128 , 140 ]. Three reports (37.5%) focused on health behaviours [ 51 , 85 , 98 ], two (25%) on mental health, two (25%) on diabetes and one (12.5%) on chronic disease. Seven reports(87.5%) had a primary focus on migrant health [ 46 , 51 , 59 , 84 , 85 , 86 , 98 ], with the remaining report (12.5%) including ethnic minority groups [ 119 ]. One report (12.5%) was also assigned to SAAP area number 5 [ 119 ].

8. Ensuring ethical and effective health screening and assessment

There were six reports assigned to category 8 (see Fig.  4 ) [ 53 , 88 , 100 , 110 , 115 , 121 ] of which two (33%) used a quantitative research method, three (50%) used a qualitative method and one used mixed methods. One report (14%) was grey literature [ 88 ] the remaining five reports (83%) were peer reviewed journals [ 53 , 100 , 110 , 115 , 121 ]. Three reports (50%) focused on cancer screening in migrant women [ 21 , 100 , 110 ], one (17%) analysed access to HIV testing among African migrants [ 53 ], one (17%) on T.B in healthcare workers [ 72 ] and one (17%) on sexual health [ 36 ]. Three reports (50%) had a primary focus on migrant health [ 53 , 88 , 100 ] while the remaining three reports (50%) included other at-risk groups in the analysis [ 110 , 115 , 121 ]. There were three reports which overlapped with other SAAP areas: one [ 53 ] (17%) was categorised to area 2 while two [ 88 , 115 ] (33%) were categorised to area 6.

9. Improving health information and communication

Three reports were assigned to SAAP area 9 (see Fig.  4 ) [ 31 , 108 , 130 ]. One of these (33%) used a qualitative approach, one (33%) used a quantitative approach and one (33%) used mixed methods. Two [ 108 , 130 ] (66%) were peer-reviewed journal articles and one [ 31 ] (33%) was grey literature. Two reports (66%) focused on improving migrant demographics and health information using databases [ 31 , 108 ] while one (33%) described an information-needs matrix for refugees and asylum seekers [ 130 ]. Two [ 31 , 108 ] included ethnicities in the data while one [ 130 ] had a primary focus on migrant health. Two reports [ 31 , 108 ] (66%) also applied to SAAP area 4 while one report [ 130 ] (33%) was in SAAP area 9 only.

To our knowledge this is the first scoping review conducted on migrant health in Scotland. A previous rapid literature review [ 94 ] found most research focused on health behaviours, mental health, communicable disease and use of and access to healthcare; however, the review limited migrant definition to those who had immigrated within five years and asylum seekers were not included.

In our review, the majority of reports were published from 2013 onwards, aligning with the expansion in migrant research internationally [ 142 ]. 52% used qualitative research methods, 28% used quantitative methods and 20% used mixed methods. 58% focused on migrant health: the remaining papers included other populations or health as part of a wider remit. Research funding was mostly provided by the Scottish Government, NHS, refugee charities and Universities. No studies received funding from the private sector, although this sector has the potential resource and capacity to play a key role in funding future research to improve migrant health in Scotland. Geographically, most studies took place in Glasgow (36%), nationwide (38.5%) or Edinburgh (16%) – other areas were under-represented including Aberdeen (5%), despite being the city with the largest migrant population [ 30 ]. There was a lack of studies in rural localities. These findings concur with a UK migrant health review by Burns et al. [ 23 ] where research was concentrated in larger cities and data was sparse in rural areas relative to the migrant population.

Half of the research identified that was conducted in Glasgow focused on asylum seekers/refugees. Glasgow was previously the only Scottish city to host asylum seekers [ 143 ] and currently supports the most asylum seekers of any local authority in the UK [ 29 ]. In April 2022, the UK government widened the Asylum dispersal scheme to all local authorities [ 144 ]. Around 70% of Scotland’s refugee support services are based in Glasgow and the South-west [ 145 ]. As reduced access to services may impact the health of asylum seekers, research in Glasgow may not be generalizable to other regions of Scotland.

Almost one-third (30%) of all reports focused on asylum seekers and refugees – an overrepresentation given that only 18% of migrants to the UK are asylum seekers [ 146 ] and as low as 2% of all migrants in Scotland [ 147 ]. Asylum seekers and refugees are at risk of poor health due to trauma, difficult journeys, overcrowded camps, poor nutrition and lack of access to healthcare [ 148 ]. They have worse maternity outcomes and increased rates of mental illness [ 149 ]. Increased research on health of asylum seekers and refugees is necessary due to their additional vulnerabilities [ 142 ]. However, asylum seeker’s country of origin was generally not specified. Asylum seekers have heterogenic backgrounds [ 150 ] and nationality and trauma experience affect health status [ 151 ]. Further research focused on specific nationalities of asylum seekers would enhance understanding of the health needs in this population.

Almost one-third (31%) of studies did not specify a migrant group. This concurs with a Norwegian migrant health study by Laue et al. [ 152 ] where 36% of research did not identify country of birth. Where nationality was identified, Polish, African and South Asian were most prevalent. Poles are the largest migrant group in Scotland, however for the other most common immigrant groups of Irish, Italian and Nigerian [ 30 ] there was an absence of research. No studies took place on Nigerian migrants – nine studies indicated African populations, but country of birth was not specified. Since March 2022, 23,000 Ukrainians have migrated to Scotland [ 153 ], however no studies on Ukrainians were identified currently. Research may be underway which is yet to be published.

Only one study explored the impact of Brexit on European migrants’ health despite 56% of migrants to Scotland being EU nationals [ 30 ]. Again, research may be taking place currently, which is yet to be published. No studies involved undocumented migrants despite this populations’ high rates of poor physical/mental health exacerbated by poor housing and working conditions [ 154 ]. An estimated 7.2–9.5% of the workforce in the UK are migrant workers who have higher risks of poor working conditions and injury [ 155 ]. Scotland depends on a migrant workforce for some industries such as agriculture [ 156 ] but only two research papers specified migrant workers.

Most research papers related to the right to health of refugees (SAAP 2), social determinants of health (SAAP 3), public health planning (SAAP 4) and strengthening health systems (SAAP 5). Areas with less research were frameworks for collaborative action (SAAP 1), preventing communicable disease (SAAP 6), preventing non-communicable disease (SAAP 7) and health screening and assessment (SAAP 8). Only three studies related to improving health information and communication (SAAP 9). Lebano et al. [ 12 ] conducted a literature review of migrant health in Europe and found data collection unreliable and disorganised. There is a lack of data on the numbers and types of migrants entering Scotland and research tends not to differentiate between ethnic minorities and migrants [ 94 ]. As poor-quality information hinders surveillance and planning of services SAAP area 9 is an important consideration for increased research.

Villarroel et al. [ 24 ] also found more research in SAAP areas 3 to 5 and less in areas 6 to 9. However, their study returned no results in category 1, collaborative action, or 2, the right to health of refugees, while this study assigned 9% of articles to category 1 and 19% to category 2. Most articles in our study relating to categories 1 and 2 were grey literature, which was excluded from the original Irish scoping review. This highlights a potential difference in the focus of peer-reviewed articles compared to government/refugee charity commissioned reports. Collaborative action and the right to health of refugees and asylum seekers are entwined in Scotland due to the complex policy environment; the social determinants of health such as housing, education, welfare rights and social integration are influenced by a variety of UK and Scottish statutory bodies as well as third sector organisations [ 157 ]. Despite this complexity, organisations work well together [ 158 ]. Further academic research in this area would enhance joint working practices and networks.

A scoping review in the UK [ 23 ] found similar quantities of research corresponding to SAAP areas 3, 2 and 9. However in Scotland areas 1, 5 and 8 were a combined 44% of included papers compared with 27.8% of results on health systems and structures in Burns et al’s [ 23 ] study. Almost half of the articles in SAAP areas 1,5 and 8 were grey literature, which was not included in Burns et al’s [ 23 ] review. Conversely, Burns et al. [ 23 ] found 81.9% of research in the UK related to epidemiology, equivalent to SAAP categories 4,6 and 7. In a Norwegian scoping review of migrant health [ 152 ] 65% of research was related to epidemiological data on health and disease. Only 42% of the research in this current study related to epidemiological data; the quantity of evidence was reduced by excluding combined research from the UK. As Scotland has higher mortality and morbidity than elsewhere in the UK [ 29 ] it is important to undertake further epidemiological research limited to Scotland.

Strengths and weaknesses

Strengths of this review include the use of the WHO’s SAAP categories [ 7 ] to classify data, in accordance with the Villarroel et al’s [ 24 ] study: this means results are linked to policy on migrant health and facilitates comparability to the Irish study results. Additionally results include data on migrant groups, locality, and funding of included papers; these highlight potential omissions for future research consideration. Results include diverse research methods and published and grey literature giving a wide overview of available evidence, reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) checklist (see Additional File 3 ) [ 159 ].

Limitations included the lack of an open-access protocol and search limitations of English language and selected databases. This means some relevant reports may be omitted. Due to time and resource limitations no quality appraisal was planned for included reports. Whilst we did not synthesise the findings for each topic area and migrant group, future systematic reviews could be undertaken to address this limitation and build on this work.

Conclusions

Immigration and ethnic diversity in Scotland have increased since 2002 which is reflected in the expansion of migrant health research. This review highlights evidence gaps including a lack of research in rural areas, undocumented migrants and migrant workers. There is a tendency to cluster asylum seekers together rather than differentiate between national groups. Within the SAAP areas there is less evidence relating to collaborative action, preventing communicable disease, preventing non-communicable disease and health screening and assessment. Further research is required on improving health information and communication for migrant populations in Scotland – a significant omission given the importance of accurate information for health service planning.

Availability of data and materials

All data analysed during this review comes from the papers listed in Additional file 2 .

Abbreviations

European Union

Human Immunodeficiency Virus

National Health Service

Strategy and Action Plan

The Scottish Health and Ethnicity Linkage Study

United Kingdom

World Health Organisation

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Acknowledgements

Thank-you to Professor Anne MacFarlane and PHD student Anne Cronin, of the University of Limerick, Ireland for sharing the coding guidelines currently used in an update to Villarroel et. al’s 2019 study on Migrant Health in the Republic of Ireland.

No funding was received for this work, which was undertaken as G. Petrie’s Master of Public Health dissertation module at the University of Stirling.

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KA, RO and GP finalised the study design collectively. GP conducted the searches, analysis and write up, with support from KA and RO. All three authors read and approved the manuscript prior to submission.

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Petrie, G., Angus, K. & O’Donnell, R. A scoping review of academic and grey literature on migrant health research conducted in Scotland. BMC Public Health 24 , 1156 (2024). https://doi.org/10.1186/s12889-024-18628-1

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• Pramukh Nanjundaswamy Vasist 1 &
• Satish Krishnan 2  

Research on fake news and false narratives is growing, and their ethical implications are increasingly garnering academic attention. This escalating crisis demands prompt consideration since its proliferation poses a significant threat to organizations and societies. As scholarly investigations garner pace in this field of inquiry, it warrants a critical appraisal of the extant body of knowledge on ethical issues related to fake news and false narratives. To this end, we analyze this growing corpus of research through an integrative review. We discuss the themes that emerge from the review, leverage key observations to establish links with business ethics, and offer propositions and a conceptual framework that serves as a basis for scholars to advance the literary space at the nexus of falsehood and business ethics. We deliberate on potential future research avenues and implications to practice.

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Vasist, P.N., Krishnan, S. Navigating the Ethical Terrain Around the Challenges of Fake News and False Narratives: An Integrative Literature Review and a Proposed Agenda for Future Research. J Bus Ethics (2024). https://doi.org/10.1007/s10551-024-05686-z

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Moving towards a mechanistic understanding of biostimulant impacts on soil properties and processes: A semi-systematic review Provisionally Accepted

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Biostimulants are gaining prominence in scientific research, with the potential to enhance plant productivity through benefits to crop yield/quality and tolerance to environmental stresses.Through possible improvements to nutrient use efficiency, they may also lessen the adverse environmental impacts of conventional inorganic fertilizer use in agriculture. The application of biostimulants is currently uncommon as a farming practice, with uncertain effectiveness in delivering these potential benefits. Current research focuses on biostimulant effects on plant physiological changes. There is little scientific evidence on the impact of biostimulants on soil properties (biological, physical or chemical) or soil functions. This knowledge gap should be addressed, considering the vital role of soil processes in the bioavailability of nutrients, as reflected in crop productivity. This review evaluates laboratory and field experimental work on the effectiveness of common, non-microbial biostimulants, with a focus on their modes of action within the soil matrix. Of 2,097 initial articles returned through the search strings, 10 were within the scope of this review. A common soil biostimulant mechanism emerges from this literature. This relates to the supply of nutrients provided by the biostimulants which stimulate native soil microbiology in mineralizing organic material in the soil, thus producing more bioavailable nutrients for plant uptake. Additionally, some articles link biostimulant effects to soil physical and chemical changes which in turn impact soil biology (and vice versa). However, there is inconsistent evidence to provide full support for these explanatory mechanisms. This review highlights the need for further research into the effect of biostimulants on the native soil microbiology and associated soil properties, to provide greater clarity on biostimulants' modes of action and greater mechanistic insights into how they can be used to improve crop production.

Keywords: Humic Substances, Protein Hydrolysates, Seaweed extracts, Soil functions, Soil Microbiology

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• March 20, 2024 - Notice of Informational Webinar for PAR-23-144, STrengthening Research Opportunities for NIH Grants (STRONG): Structured Institutional Needs Assessment and Action Plan Development for Resource Limited Institutions (RLIs) (UC2 - Clinical Trial Not Allowed). See Notice NOT-MD-24-011
• February 14, 2024 - Notice of NICHD Participation in PAR-23-144 "Strengthening Research Opportunities for NIH Grants (STRONG): Structured Institutional Needs Assessment and Action Plan Development for Resource Limited Institutions"). See Notice NOT-HD-24-007
• August 31, 2023 - Notice of Correction to Eligibility Criteria of PAR-23-144, STrengthening Research Opportunities for NIH Grants (STRONG): Structured Institutional Needs Assessment and Action Plan Development for Resource Limited Institutions (RLIs) (UC2). See Notice NOT-MD-23-018
• May 12, 2023 - Notice of Participation of the NIAAA in PAR-23-144. See Notice NOT-AA-23-012 .
• April 25, 2023 - Notice of NCCIH Participation in PAR-23-144, "STrengthening Research Opportunities for NIH Grants (STRONG): Structured Institutional Needs Assessment and Action Plan Development for Resource Limited Institutions (RLIs) (UC2 - Clinical Trial Not Allowed). See Notice NOT-AT-24-004
• August 5, 2022 - Implementation Details for the NIH Data Management and Sharing Policy - see Notice NOT-OD-22-189 .
• August 8, 2022 - New NIH "FORMS-H" Grant Application Forms and Instructions Coming for Due Dates on or after January 25, 2023 - See Notice NOT-OD-22-195 .
• August 31, 2022 - Implementation Changes for Genomic Data Sharing Plans Included with Applications Due on or after January 25, 2023 - See Notice NOT-OD-22-198 .

See Section III. 3. Additional Information on Eligibility .

The STrengthening Research Opportunities for NIH Grants (STRONG): The STRONG-RLI program will support research capacity needs assessments by eligible Resource-Limited Institutions (RLIs). The program will also support the recipient institutions to use the results of the assessments to develop action plans for how to meet the identified needs.

RLIs are defined as institutions with a mission to serve historically underrepresented populations in biomedical research that award degrees in the health professions (and in STEM fields and social and behavioral sciences) and have received an average of $0 to $25 million per year (total costs) of NIH Research Project Grant (RPG) support for the past three fiscal years.

August 18, 2023

All applications are due by 5:00 PM local time of applicant organization.

Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.

Not Applicable

It is critical that applicants follow the instructions in the Research (R) Instructions in the SF424 (R&R) Application Guide , except where instructed to do otherwise (in this NOFO or in a Notice from NIH Guide for Grants and Contracts).

Conformance to all requirements (both in the Application Guide and the NOFO) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV . When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions.

Applications that do not comply with these instructions may be delayed or not accepted for review.

There are several options available to submit your application through Grants.gov to NIH and Department of Health and Human Services partners. You must use one of these submission options to access the application forms for this opportunity.

• Use the NIH ASSIST system to prepare, submit and track your application online.
• Use an institutional system-to-system (S2S) solution to prepare and submit your application to Grants.gov and eRA Commons to track your application. Check with your institutional officials regarding availability.
• Use Grants.gov Workspace to prepare and submit your application and eRA Commons to track your application.

Part 2. Full Text of Announcement

Section i. notice of funding opportunity description.

Purpose: The purpose of the STRONG-RLI Notice of Funding Opportunity (NOFO) is to invite applications to conduct biomedical research capacity needs assessments by Resource-Limited Institutions (RLIs) and then to use the results of the assessments to create action plans for meeting identified needs. The program’s goal is to increase competitiveness in the biomedical research enterprise and foster institutional environments conducive to research career development. Awards are intended to support RLIs in analyzing their institutional research capacity needs and strengths. Resource-Limited Institutions (RLIs) are defined for this NOFO as institutions with a mission to serve historically underrepresented populations in biomedical research that award degrees in the health professions or the sciences related to health, in STEM fields including social and behavioral sciences, and have received an average of $0 to $25 million (total costs) per year of NIH research project grant (RPG) support for the past three fiscal years (as defined in Section III -Eligibility).

Background:

NIH’s ability to help ensure that the nation remains a global leader in scientific discovery and innovation is dependent upon a pool of highly talented scientists from diverse backgrounds who will help to further NIH's mission (see NOT-OD-20-031 ). NIH recognizes the importance of diversity in biomedical, clinical, behavioral, and social sciences (collectively termed "biomedical") research. This includes the diversification of NIH-funded institutions, where researchers with a wide range of skill sets and viewpoints can bring different perspectives, creativity, and individual enterprise to address complex scientific problems.

RLIs, as defined below, play an important role in supporting scientific research, particularly on diseases or conditions that disproportionately impact racial ethnic minority groups and other U.S. populations that experience health disparities. Although these institutions are uniquely positioned to engage underserved populations in research and in the translation of research advances into culturally competent, measurable and sustained improvements in health outcomes, they may benefit from enhancing their capacity to conduct and sustain cutting-edge health-related research.

NIH is committed to assisting RLIs in building institutional research capacity. Scientists at RLIs are critical to advancing knowledge in the biomedical research enterprise. NIH has many programs designed to support researchers at RLIs and broaden the participation of researchers through inclusive excellence across regions, institutions, and demographic groups. The role of RLIs in the nation’s overall competitiveness in research is integrally related to current resources, departmental and disciplinary strengths and capabilities, and campus research support systems and infrastructure. It is critical that RLIs recognize and utilize their research and organizational capabilities so they can leverage existing strengths and develop strategic approaches in areas that require additional attention. Structured needs assessments to examine research and organizational capabilities can offer metrics for short-term/long-term action plans. These assessments will enable institutions to develop benchmarks and action items to increase their competitiveness for NIH, Federal, and other funding opportunities.

RLIs face unique challenges depending on the institution type, resources, infrastructure, and policies as they seek to acquire NIH or other federal agency funding. The areas at RLIs that need to be identified and addressed to reduce the barriers to scientific advancement and increase independent research funding can best be determined by the institution itself. A fundamental principle for organizational development and change is the use of a structured assessment to understand these barriers.

This Funding Opportunity will provide resources to the institutions to 1) conduct the assessment of research infrastructure and other requirements that will enhance administrative and research resources, institutional policies, and expanded opportunities for faculty and students in the biomedical research enterprise; and 2) Use the results of these institutional assessments to develop action plans that will support the conduct of high-quality biomedical research.

Program Objectives:

The purpose of this NIH-wide initiative, STRONG-RLI, is to support research active RLIs to;1. conduct rigorous research capacity needs assessments.2. use the results of the assessments to develop action plans for how to meet the identified needs.

Because of the significant variability in the types of RLIs, two separate categories have been created for this initiative. Please refer to Section III for eligibility criteria for RLIs.

The two categories of research active RLIs are defined in Section III of the NOFO:

1) Low Research Active (LRA) : An RLI that is an undergraduate or graduate degree granting institution and has had less than six million dollars (total costs) in NIH research project grant (RPG) support per year in three of the last five years. In addition, undergraduate granting institutions must have at least 35% of undergraduate students supported by Pell grants.

2) High Research Active (HRA) : An RLI that grants doctoral degrees and has had between six million and 25 million dollars (total costs) in NIH RPG support per year in three of the last five years.

Both LRA and HRA RLIs must have a historical mission to support underrepresented groups in biomedical sciences. Each institution should describe the specific category into which they fit and provide documentation to verify those requirements.

Each RLI will provide details on how they plan to conduct their needs assessments and create/use/adapt/ instruments to study research capacity at the institution. Please note that institutional climate or culture assessment is not a priority for this funding announcement.

As part of the funding announcement , the recipient institutions are expected to use the results of needs assessments to develop action plans for short term and long term goals, to meet the identified needs . Applicants are encouraged to provide detailed approaches for conducting the needs assessment and action plan development. The action plan should include identification of possible sources of funding for increasing research capacity. The implementation of the action plan is beyond the scope of this funding opportunity.

A. Institutional Needs-Assessment for research capacity

NIH recognizes and values the heterogeneity in institutional settings and the students they serve. Applicants must describe their distinctive biomedical research and research training environment and the current services to support them.

Applicants for this needs assessment can use any available tools, or adapt existing tools, to fit their context and needs.

B. Development of Institutional Action Plans

• After completion of the needs assessment, the recipient institutions are expected to develop an action plan. The Institutional Action Plan for research capacity is intended to serve as a roadmap for enhancing the infrastructure and capacity at the applicant institution.
• The outcomes of the needs assessment should determine the capacity building interventions that the institution can undertake to strengthen the institutional framework and research capacity. The Institutional Action Plan that will be developed is expected to be supported by an institutional leader, e.g., the Provost or President (see Letters of Support).

C. Needs assessment topics may include (but are not limited to):

The institution will determine the needs assessment foci but may include broad categories such as administrative/research/student/faculty.

Administrative topics may include -

• Establishing or enhancing the Office of Sponsored Programs (OSP), examining efficiencies and staffing requirements and personnel needs for administrative support
• Available resources for effective business practices, automation, information dissemination, documentation and tracking progress for research activities,
• Process management and process improvement for grant application, grant award, and grant administration.

Research topics may include-

• Research infrastructure may include physical research facilities, lab equipment, and computing resources, core facility for technology, support staff, professional development, laboratories. Appropriate physical research facilities and skilled research support to enable competitiveness.
• Research readiness in areas, such as basic, behavioral or clinical research, grantsmanship support, seminars and workshops for grant writing, for sharing research ideas to enhance knowledge in the field. Potential and current scientific research areas of interest.
• Capacity to conduct Human Subjects Research
• Capacity for Community Engagement research
• Partnerships/ collaboration with other academic institutions, the public sector, and community-based organizations that are sustainable and equitable

Student and faculty topics may include-

• Training needs, Mentoring/Sponsorship, faculty development.
• Student resources for research, support for research experiences, and for post-bac and graduate career progression in biomedical research and in STEM topics
• Research staff recruitment and benefits packages, retention bonuses,
• Faculty teaching workloads that allow time for research pursuits, and department/college-based research staff and administrative support
• Institutional policies for assessment of teaching versus research assignments and support
• Tenure evaluations of faculty services for research, committee, community engagement, etc., protected time for research program development

Technical Assistance Webinar:

NIH will conduct a Technical Assistance Webinar for prospective applicants on July 21st from 2-3.30pm EST. Please join the webinar using the link below:

Join Zoom Meeting https://nih.zoomgov.com/j/1614627302?pwd=RmVXc0RjWjV2WTZsUzd1WmFSWU1NZz09&from=addon Meeting ID: 161 462 7302 Passcode: 919936 One tap mobile +16692545252,,1614627302#,,,,*919936# US (San Jose) +16468287666,,1614627302#,,,,*919936# US (New York)

See Section VIII. Other Information for award authorities and regulations.

Section II. Award Information

Cooperative Agreement: A support mechanism used when there will be substantial Federal scientific or programmatic involvement. Substantial involvement means that, after award, NIH scientific or program staff will assist, guide, coordinate, or participate in project activities. See Section VI.2 for additional information about the substantial involvement for this FOA.

The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types. Only those application types listed here are allowed for this NOFO.

Not Allowed: Only accepting applications that do not propose clinical trials.

Need help determining whether you are doing a clinical trial?

The number of awards is contingent upon NIH appropriations and the submission of a sufficient number of meritorious applications.

Application budgets for direct costs should not exceed $250,000/year.

The scope of the proposed project should determine the project period. The maximum project period is three years

NIH grants policies as described in the NIH Grants Policy Statement will apply to the applications submitted and awards made from this NOFO.

Section III. Eligibility Information

1. Eligible Applicants

Higher Education Institutions

• Public/State Controlled Institutions of Higher Education
• Private Institutions of Higher Education

The following types of Higher Education Institutions are always encouraged to apply for NIH support as Public or Private Institutions of Higher Education:

• Hispanic-serving Institutions
• Historically Black Colleges and Universities (HBCUs)
• Tribally Controlled Colleges and Universities (TCCUs)
• Alaska Native and Native Hawaiian Serving Institutions
• Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)

For this funding opportunity, an applicant must be a Resource-Limited Institution (RLI), defined as an institution with a mission to serve historically underrepresented populations that awards degrees in the health professions (and related sciences) and has received an average of $0 to $25 million per year (total costs) of NIH Research Project Grants (RPG) support for the past three fiscal years.

A mission to serve historically underrepresented populations may be demonstrated by a documented historical and current mission to educate students from any of the populations that have been identified as underrepresented in biomedical research as defined by the National Science Foundation NSF, see http://www.nsf.gov/statistics/wmpd/ ) (i.e., African Americans or Blacks, Hispanic or Latino Americans, American Indians, Alaska Natives, Native Hawaiians, U.S. Pacific Islanders, and persons with disabilities) or by a documented record of recruiting, training and/or educating, and graduating underrepresented students as defined by NSF (see above), which has resulted in increasing the institution's contribution to the national pool of graduates from underrepresented backgrounds who pursue biomedical research careers.

RLIs, as defined above, are classified into the following two categories for this opportunity:

Institutional letters will attest to the category of the institution whether they are LRA or HRA and provide information to verify which can be included as an attachment.

Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.

Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.

Foreign components, as defined in the NIH Grants Policy Statement , are not allowed.

Applicant Organizations

Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible. The NIH Policy on Late Submission of Grant Applications states that failure to complete registrations in advance of a due date is not a valid reason for a late submission.

• NATO Commercial and Government Entity (NCAGE) Code Foreign organizations must obtain an NCAGE code (in lieu of a CAGE code) in order to register in SAM.
• Unique Entity Identifier (UEI)- A UEI is issued as part of the SAM.gov registration process. The same UEI must be used for all registrations, as well as on the grant application.
• eRA Commons - Once the unique organization identifier is established, organizations can register with eRA Commons in tandem with completing their Grants.gov registrations; all registrations must be in place by time of submission. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
• Grants.gov Applicants must have an active SAM registration in order to complete the Grants.gov registration.

Program Directors/Principal Investigators (PD(s)/PI(s))

All PD(s)/PI(s) must have an eRA Commons account. PD(s)/PI(s) should work with their organizational officials to either create a new account or to affiliate their existing account with the applicant organization in eRA Commons. If the PD/PI is also the organizational Signing Official, they must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with their organization to develop an application for support. Individuals from diverse backgrounds, including underrepresented racial and ethnic groups, individuals with disabilities, and women are always encouraged to apply for NIH support. See, Reminder: Notice of NIH's Encouragement of Applications Supporting Individuals from Underrepresented Ethnic and Racial Groups as well as Individuals with Disabilities , NOT-OD-22-019 .

For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the SF424 (R&R) Application Guide.

2. Cost Sharing

This NOFO does not require cost sharing as defined in the NIH Grants Policy Statement.

3. Additional Information on Eligibility

Number of Applications

Only one application per institution (normally identified by having a unique UEI or NIH IPF number) is allowed

The NIH will not accept duplicate or highly overlapping applications under review at the same time, per 2.3.7.4 Submission of Resubmission Application . This means that the NIH will not accept:

• A new (A0) application that is submitted before issuance of the summary statement from the review of an overlapping new (A0) or resubmission (A1) application.
• A resubmission (A1) application that is submitted before issuance of the summary statement from the review of the previous new (A0) application.
• An application that has substantial overlap with another application pending appeal of initial peer review (see 2.3.9.4 Similar, Essentially Identical, or Identical Applications ).

Only one application per institution (normally identified by having a unique UEI number or NIH IPF number) is allowed.

Section IV. Application and Submission Information

1. Requesting an Application Package

The application forms package specific to this opportunity must be accessed through ASSIST, Grants.gov Workspace or an institutional system-to-system solution. Links to apply using ASSIST or Grants.gov Workspace are available in Part 1 of this NOFO. See your administrative office for instructions if you plan to use an institutional system-to-system solution.

2. Content and Form of Application Submission

It is critical that applicants follow the instructions in the Research (R) Instructions in the SF424 (R&R) Application Guide except where instructed in this notice of funding opportunity to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.

Letter of Intent

Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows IC staff to estimate the potential review workload and plan the review.

By the date listed in Part 1. Overview Information , prospective applicants are asked to submit a letter of intent that includes the following information:

• Descriptive title of proposed activity
• Name(s), address(es), and telephone number(s) of the PD(s)/PI(s)
• Names of other key personnel
• Participating institution(s)
• Number and title of this funding opportunity

The letter of intent should be sent to:

Yujing Liu, MD, PhD National Institute on Minority Health and Health Disparities (NIMHD) Telephone: 301-827-7815 Email: [email protected]

Page Limitations

All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.

The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this NOFO.

SF424(R&R) Cover

All instructions in the SF424 (R&R) Application Guide must be followed.

SF424(R&R) Project/Performance Site Locations

SF424(R&R) Other Project Information

SF424(R&R) Senior/Key Person Profile

All instructions in the SF424 (R&R) Application Guide must be followed, with the following additional instructions:

Travel costs for attending any in-person meetings and STRONG Executive Steering Committee (SESC) meetings must be included.

Funds may not be used for:

• Research infrastructure (such as laboratory supplies, laboratory equipment)
• Alterations or renovations
• Research projects or pilot projects

R&R Subaward Budget

PHS 398 Cover Page Supplement

PHS 398 Research Plan

Research Strategy:

Significance

Explain the needs for institutional research capacity and importance of the problem or critical barrier to progress that the proposed project addresses. Describe the benefits if the proposed aims are achieved with respect to enhanced biomedical research capacity.

Applicants should address the innovative aspects of the proposed needs assessment plans for research capacity. For this program, innovation is considered the use of existing products, tools or processes or creating or adapting evidence-based tools to fit the context and needs of the institutions.

A. Institutional Needs-Assessment for research capacity section describe:

• Physical research facility, research faculty support from institution, faculty teaching workload, human resources, Sponsored program
• Applicant must describe current methods of measuring student/faculty outcomes to take into consideration institutional missions, faculty investment, student populations, student needs, and institutional resource constraints.
• Tools and instruments for needs assessment, monitoring and evaluation of health research capacity development activities at the individual and organizational level
• The types of research facilities available for biomedical research and research training.
• The needs for research infrastructure to conduct biomedical, behavioral or clinical research, potential and current scientific research areas of interest.
• List and describe the outcomes of any capacity-building or infrastructure grants the institution has received over the past ten years, including the source and total costs of each award.
• The investigative team and their relevant expertise in conducting a needs assessment
• Student enrollment in the biomedical areas, including the number and percentage of undergraduate and graduate students, and the enrollment of students who are Pell-grant eligible (for LRA applications); and
• The current level of student and faculty participation in research.
• Describe the sponsored programs administration and how it will inform the needs assessment. The types of services provided by the existing sponsored projects administration (or similar entity). Current levels of sponsored programs productivity (e.g., number of applications submitted, number of applications funded, number of subcontracts).

Describe the approaches for developing an Institutional Action Plan after completing needs assessment for research capacity. The Institutional Action Plan for research capacity is intended to serve as a roadmap for enhancing the infrastructure and capacity at the applicant institution. This section of the application should describe steps that will be undertaken to ensure identified needs assessment activities lead to action plans for the long-term strengthening of research capacity. It must include an institutional commitment to achieving the goals and objectives of the proposed project and activities signed by institutional leadership (e.g., President, Provost, and Deans (see Letters of Support).

C. Governance and structure of steering committees

The Steering Committee (SC) will serve as the primary governing and oversight board for the cooperative agreement funded under this NOFO.

• Describe the composition and the activities of the steering committee. Describe the desired expertise of its members. Include the frequency of meetings and any other relevant information.
• The membership of the SC consists of the PD(s)/PI(s), the NIH Project Coordinator, and any additional stake holders deemed necessary.

Timeline and Milestones:

Describe the timeline for the needs assessment and action plan activities. The timeline should be realistic given the time needed to develop the approaches/tools and collect the proposed data. Describe how the program goals/aims will be aligned with milestones and metrics.

Letters of Support: Provide letters of support for the proposed needs assessment activities following instructions in the SF424 Application Guide.

A. Institutional Eligibility Letter (1-page maximum). S ubmit a letter from the Provost or similar official with institution-wide responsibility that certify that the applicant organization qualifies as one of the following two categories of research active RLI specified in this NOFO:

A mission to serve historically underrepresented populations may be demonstrated by a documented historical and current mission to educate students from underrepresented populations in biomedical research.

The two categories of research active RLIs are:

1) Low Research Active (LRA): An RLI that is an undergraduate or graduate degree granting institution, with at least 35% of undergraduate students supported by Pell grants, and that has had less than six million dollars in NIH research project grant (RPG) support per year in three of the last five years.

2) High Research Active (HRA): An RLI that grants doctoral degrees and has had less than 25 million dollars in NIH RPG support in three of the last five years.

B. Institutional Commitment Letter. The application must include an Institutional Commitment Letter from the President or designated high-ranking official such as the Provost, Vice President or Dean. Describe how the proposed project aligns with the broad institutional vision for enhancing biomedical research. The letter should include a commitment to achieving the goals and objectives of the proposed project and activities.

The letters of support must be included with the application. Applications which lack this letter will be considered incomplete and will be withdrawn and will not be reviewed.

Resource Sharing Plan : Individuals are required to comply with the instructions for the Resource Sharing Plans as provided in the SF424 (R&R) Application Guide.

The following modifications also apply:

Generally, Resource Sharing Plans are expected, but they are not applicable for this FOA.

• A Data Management and Sharing Plan is not applicable for this NOFO.

Appendix: Only limited Appendix materials are allowed. Follow all instructions for the Appendix as described in the SF424 (R&R) Application Guide.

• No publications or other material, with the exception of blank questionnaires or blank surveys, may be included in the Appendix.

PHS Human Subjects and Clinical Trials Information

When involving human subjects research, clinical research, and/or NIH-defined clinical trials (and when applicable, clinical trials research experience) follow all instructions for the PHS Human Subjects and Clinical Trials Information form in the SF424 (R&R) Application Guide, with the following additional instructions:

If you answered Yes to the question Are Human Subjects Involved? on the R&R Other Project Information form, you must include at least one human subjects study record using the Study Record: PHS Human Subjects and Clinical Trials Information form or Delayed Onset Study record.

Study Record: PHS Human Subjects and Clinical Trials Information

Delayed Onset Study

Note: Delayed onset does NOT apply to a study that can be described but will not start immediately (i.e., delayed start).All instructions in the SF424 (R&R) Application Guide must be followed.

PHS Assignment Request Form

3. Unique Entity Identifier and System for Award Management (SAM)

See Part 1. Section III.1 for information regarding the requirement for obtaining a unique entity identifier and for completing and maintaining active registrations in System for Award Management (SAM), NATO Commercial and Government Entity (NCAGE) Code (if applicable), eRA Commons, and Grants.gov

4. Submission Dates and Times

Part I. Overview Information contains information about Key Dates and times. Applicants are encouraged to submit applications before the due date to ensure they have time to make any application corrections that might be necessary for successful submission. When a submission date falls on a weekend or Federal holiday , the application deadline is automatically extended to the next business day.

Organizations must submit applications to Grants.gov (the online portal to find and apply for grants across all Federal agencies). Applicants must then complete the submission process by tracking the status of the application in the eRA Commons , NIH’s electronic system for grants administration. NIH and Grants.gov systems check the application against many of the application instructions upon submission. Errors must be corrected and a changed/corrected application must be submitted to Grants.gov on or before the application due date and time. If a Changed/Corrected application is submitted after the deadline, the application will be considered late. Applications that miss the due date and time are subjected to the NIH Policy on Late Application Submission.

Applicants are responsible for viewing their application before the due date in the eRA Commons to ensure accurate and successful submission.

Information on the submission process and a definition of on-time submission are provided in the SF424 (R&R) Application Guide.

5. Intergovernmental Review (E.O. 12372)

This initiative is not subject to intergovernmental review.

6. Funding Restrictions

All NIH awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement .

Pre-award costs are allowable only as described in the NIH Grants Policy Statement .

7. Other Submission Requirements and Information

Applications must be submitted electronically following the instructions described in the SF424 (R&R) Application Guide. Paper applications will not be accepted.

Applicants must complete all required registrations before the application due date. Section III. Eligibility Information contains information about registration.

For assistance with your electronic application or for more information on the electronic submission process, visit How to Apply Application Guide . If you encounter a system issue beyond your control that threatens your ability to complete the submission process on-time, you must follow the Dealing with System Issues guidance. For assistance with application submission, contact the Application Submission Contacts in Section VII.

Important reminders:

All PD(s)/PI(s) must include their eRA Commons ID in the Credential field of the Senior/Key Person Profile form . Failure to register in the Commons and to include a valid PD/PI Commons ID in the credential field will prevent the successful submission of an electronic application to NIH. See Section III of this NOFO for information on registration requirements.

The applicant organization must ensure that the unique entity identifier provided on the application is the same identifier used in the organization’s profile in the eRA Commons and for the System for Award Management. Additional information may be found in the SF424 (R&R) Application Guide.

See more tips for avoiding common errors.

Upon receipt, applications will be evaluated for completeness and compliance with application instructions by the Center for Scientific Review, NIH. Applications that are incomplete or non-compliant will not be reviewed.

In order to expedite review, applicants are requested to notify the NIMHD Referral Office by email at [email protected] when the application has been submitted. Please include the NOFO number and title, PD/PI name, and title of the application.

Post Submission Materials

Applicants are required to follow the instructions for post-submission materials, as described in the policy

Section V. Application Review Information

1. Criteria

Only the review criteria described below will be considered in the review process. Applications submitted to the NIH in support of the NIH mission are evaluated for scientific and technical merit through the NIH peer review system.

Reviewers will provide an overall impact score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following review criteria and additional review criteria (as applicable for the project proposed).

Reviewers will consider each of the review criteria below in the determination of scientific merit and give a separate score for each. An application does not need to be strong in all categories to be judged likely to have major scientific impact. For example, a project that by its nature is not innovative may be essential to advance a field.

Does the project address an important problem or a critical barrier to progress in the field? Is the prior research that serves as the key support for the proposed project rigorous? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field?

In addition, specific to this NOFO:

How well does the application provide a vision for how the project will serve as a foundation for future research capacity building? To what degree the application describes clear pathways between the need assessment and action plan development research activities and future research efforts? To what extent is the proposed project likely to enhance institutional research capacity to conduct biomedical research?

Are the PD(s)/PI(s), collaborators, and other researchers well suited to the project? If Early Stage Investigators or those in the early stages of independent careers, do they have appropriate experience and training? If established, have they demonstrated an ongoing record of accomplishments that have advanced their field(s)? If the project is collaborative or multi-PD/PI, do the investigators have complementary and integrated expertise; are their leadership approach, governance, and organizational structure appropriate for the project?

To what extent do the PDs/PIs have the appropriate expertise to conduct the needs assessment, implement the proposed project, analyze the outcomes, and develop action plans?

Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation, or interventions proposed?

How well does the applicant create approaches to fit their context and needs? Does the application employ novel approaches or methods to fulfill its purpose?

Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Have the investigators included plans to address weaknesses in the rigor of prior research that serves as the key support for the proposed project? Have the investigators presented strategies to ensure a robust and unbiased approach, as appropriate for the work proposed? Are potential problems, alternative strategies, and benchmarks for success presented? If the project is in the early stages of development, will the strategy establish feasibility and will particularly risky aspects be managed? Have the investigators presented adequate plans to address relevant biological variables, such as sex, for studies in vertebrate animals or human subjects?

If the project involves human subjects and/or NIH-defined clinical research, are the plans to address 1) the protection of human subjects from research risks, and 2) inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion or exclusion of individuals of all ages (including children and older adults), justified in terms of the scientific goals and research strategy proposed?

To what extent does the applicant describe the tools and instruments for needs assessment, monitoring and evaluation of research capacity development activities? To what degree does the applicant identify metrics and indicators of success that will be used to assess the anticipated outcomes? Is the duration of the initial needs assessment stage adequate to develop action plans for short-term goals? To what degree isthe structure and governance plan likely to lead to implementation of the proposed plan? Are these goals feasible and well developed on the timeline of the award? How well are the program goals/aims aligned with yearly milestones and are the details provided adequate?

Will the scientific environment in which the work will be done contribute to the probability of success? Are the institutional support, equipment, and other physical resources available to the investigators adequate for the project proposed? Will the project benefit from unique features of the scientific environment, subject populations, or collaborative arrangements?

How strong is the level of institutional commitment to the project, including administrative and scientific support, to ensure the success of the project?

How well do the letters of support demonstrate a strong commitment to the proposed activities?

As applicable for the project proposed, reviewers will evaluate the following additional items while determining scientific and technical merit, and in providing an overall impact score, but will not give separate scores for these items.

For research that involves human subjects but does not involve one of the categories of research that are exempt under 45 CFR Part 46, the committee will evaluate the justification for involvement of human subjects and the proposed protections from research risk relating to their participation according to the following five review criteria: 1) risk to subjects, 2) adequacy of protection against risks, 3) potential benefits to the subjects and others, 4) importance of the knowledge to be gained, and 5) data and safety monitoring for clinical trials.

For research that involves human subjects and meets the criteria for one or more of the categories of research that are exempt under 45 CFR Part 46, the committee will evaluate: 1) the justification for the exemption, 2) human subjects involvement and characteristics, and 3) sources of materials. For additional information on review of the Human Subjects section, please refer to the Guidelines for the Review of Human Subjects .

When the proposed project involves human subjects and/or NIH-defined clinical research, the committee will evaluate the proposed plans for the inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion (or exclusion) of individuals of all ages (including children and older adults) to determine if it is justified in terms of the scientific goals and research strategy proposed. For additional information on review of the Inclusion section, please refer to the Guidelines for the Review of Inclusion in Clinical Research .

The committee will evaluate the involvement of live vertebrate animals as part of the scientific assessment according to the following criteria: (1) description of proposed procedures involving animals, including species, strains, ages, sex, and total number to be used; (2) justifications for the use of animals versus alternative models and for the appropriateness of the species proposed; (3) interventions to minimize discomfort, distress, pain and injury; and (4) justification for euthanasia method if NOT consistent with the AVMA Guidelines for the Euthanasia of Animals. Reviewers will assess the use of chimpanzees as they would any other application proposing the use of vertebrate animals. For additional information on review of the Vertebrate Animals section, please refer to the Worksheet for Review of the Vertebrate Animals Section .

Reviewers will assess whether materials or procedures proposed are potentially hazardous to research personnel and/or the environment, and if needed, determine whether adequate protection is proposed.

For Resubmissions, the committee will evaluate the application as now presented, taking into consideration the responses to comments from the previous scientific review group and changes made to the project.

Not applicable

As applicable for the project proposed, reviewers will consider each of the following items, but will not give scores for these items, and should not consider them in providing an overall impact score.

Reviewers will assess whether the project presents special opportunities for furthering research programs through the use of unusual talent, resources, populations, or environmental conditions that exist in other countries and either are not readily available in the United States or augment existing U.S. resources.

Reviewers will assess the information provided in this section of the application, including 1) the Select Agent(s) to be used in the proposed research, 2) the registration status of all entities where Select Agent(s) will be used, 3) the procedures that will be used to monitor possession use and transfer of Select Agent(s), and 4) plans for appropriate biosafety, biocontainment, and security of the Select Agent(s).

Reviewers will comment on whether the Resource Sharing Plan(s) (e.g., Sharing Model Organisms ) or the rationale for not sharing the resources, is reasonable.

For projects involving key biological and/or chemical resources, reviewers will comment on the brief plans proposed for identifying and ensuring the validity of those resources.

Reviewers will consider whether the budget and the requested period of support are fully justified and reasonable in relation to the proposed research.

2. Review and Selection Process

Applications will be evaluated for scientific and technical merit by (an) appropriate Scientific Review Group(s) convened by NIMHD, in accordance with NIH peer review policy and procedures , using the stated review criteria . Assignment to a Scientific Review Group will be shown in the eRA Commons.

As part of the scientific peer review, all applications will receive a written critique.

Applications may undergo a selection process in which only those applications deemed to have the highest scientific and technical merit (generally the top half of applications under review) will be discussed and assigned an overall impact score.

Applications will be assigned on the basis of established PHS referral guidelines to the appropriate NIH Institute or Center. Applications will compete for available funds with all other recommended applications . Following initial peer review, recommended applications will receive a second level of review by the appropriate national Advisory Council or Board. The following will be considered in making funding decisions:

• Scientific and technical merit of the proposed project as determined by scientific peer review.
• Availability of funds.
• Relevance of the proposed project to program priorities.
• Geographical distribution of the portfolio
• Balance between HRA and LRA awards

3. Anticipated Announcement and Award Dates

After the peer review of the application is completed, the PD/PI will be able to access his or her Summary Statement (written critique) via the eRA Commons . Refer to Part 1 for dates for peer review, advisory council review, and earliest start date.

Information regarding the disposition of applications is available in the NIH Grants Policy Statement .

Section VI. Award Administration Information

1. Award Notices

If the application is under consideration for funding, NIH will request "just-in-time" information from the applicant as described in the NIH Grants Policy Statement .

A formal notification in the form of a Notice of Award (NoA) will be provided to the applicant organization for successful applications. The NoA signed by the grants management officer is the authorizing document and will be sent via email to the recipient's business official.

Recipients must comply with any funding restrictions described in Section IV.6. Funding Restrictions. Selection of an application for award is not an authorization to begin performance. Any costs incurred before receipt of the NoA are at the recipient's risk. These costs may be reimbursed only to the extent considered allowable pre-award costs.

Any application awarded in response to this NOFO will be subject to terms and conditions found on the Award Conditions and Information for NIH Grants website. This includes any recent legislation and policy applicable to awards that is highlighted on this website.

Institutional Review Board or Independent Ethics Committee Approval: Recipient institutions must ensure that protocols are reviewed by their IRB or IEC. To help ensure the safety of participants enrolled in NIH-funded studies, the recipient must provide NIH copies of documents related to all major changes in the status of ongoing protocols.

2. Administrative and National Policy Requirements

All NIH grant and cooperative agreement awards include the NIH Grants Policy Statement as part of the NoA. For these terms of award, see the NIH Grants Policy Statement Part II: Terms and Conditions of NIH Grant Awards, Subpart A: General and Part II: Terms and Conditions of NIH Grant Awards, Subpart B: Terms and Conditions for Specific Types of Grants, Recipients, and Activities , including of note, but not limited to:

• Federal wide Research Terms and Conditions
• Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment
• Acknowledgment of Federal Funding

If a recipient is successful and receives a Notice of Award, in accepting the award, the recipient agrees that any activities under the award are subject to all provisions currently in effect or implemented during the period of the award, other Department regulations and policies in effect at the time of the award, and applicable statutory provisions.

Should the applicant organization successfully compete for an award, recipients of federal financial assistance (FFA) from HHS will be required to complete an HHS Assurance of Compliance form (HHS 690) in which the recipient agrees, as a term and condition of receiving the grant, to administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, age, sex and disability, and agreeing to comply with federal conscience laws, where applicable. This includes ensuring that entities take meaningful steps to provide meaningful access to persons with limited English proficiency; and ensuring effective communication with persons with disabilities. Where applicable, Title XI and Section 1557 prohibit discrimination on the basis of sexual orientation, and gender identity. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. Please see https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html and https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html

HHS recognizes that research projects are often limited in scope for many reasons that are nondiscriminatory, such as the principal investigator’s scientific interest, funding limitations, recruitment requirements, and other considerations. Thus, criteria in research protocols that target or exclude certain populations are warranted where nondiscriminatory justifications establish that such criteria are appropriate with respect to the health or safety of the subjects, the scientific study design, or the purpose of the research. For additional guidance regarding how the provisions apply to NIH grant programs, please contact the Scientific/Research Contact that is identified in Section VII under Agency Contacts of this NOFO.

• Recipients of FFA must ensure that their programs are accessible to persons with limited English proficiency. For guidance on meeting the legal obligation to take reasonable steps to ensure meaningful access to programs or activities by limited English proficient individuals see https://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html and https://www.lep.gov .
• For information on an institution’s specific legal obligations for serving qualified individuals with disabilities, including providing program access, reasonable modifications, and to provide effective communication, see https://www.hhs.gov/civil-rights/for-individuals/disability/index.html .
• HHS funded health and education programs must be administered in an environment free of sexual harassment, see https://www.hhs.gov/civil-rights/for-individuals/sex-discrimination/index.html . For information about NIH's commitment to supporting a safe and respectful work environment, who to contact with questions or concerns, and what NIH's expectations are for institutions and the individuals supported on NIH-funded awards, please see https://grants.nih.gov/grants/policy/harassment.htm .
• For guidance on administering programs in compliance with applicable federal religious nondiscrimination laws and applicable federal conscience protection and associated anti-discrimination laws see https://www.hhs.gov/conscience/conscience-protections/index.html and https://www.hhs.gov/conscience/religious-freedom/index.html .

Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under federal civil rights laws at https://www.hhs.gov/ocr/about-us/contact-us/index.html or call 1-800-368-1019 or TDD 1-800-537-7697.

In accordance with the statutory provisions contained in Section 872 of the Duncan Hunter National Defense Authorization Act of Fiscal Year 2009 (Public Law 110-417), NIH awards will be subject to the Federal Awardee Performance and Integrity Information System (FAPIIS) requirements. FAPIIS requires Federal award making officials to review and consider information about an applicant in the designated integrity and performance system (currently FAPIIS) prior to making an award. An applicant, at its option, may review information in the designated integrity and performance systems accessible through FAPIIS and comment on any information about itself that a federal agency previously entered and is currently in FAPIIS. The Federal awarding agency will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgement about the applicant’s integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR Part 75.205 and 2 CFR Part 200.206 Federal awarding agency review of risk posed by applicants. This provision will apply to all NIH grants and cooperative agreements except fellowships.

The following special terms of award are in addition to, and not in lieu of, otherwise applicable U.S. Office of Management and Budget (OMB) administrative guidelines, U.S. Department of Health and Human Services (DHHS) grant administration regulations at 45 CFR Part 75 and 2 CFR Part 200, and other HHS, PHS, and NIH grant administration policies. The administrative and funding instrument used for this program will continue as a cooperative agreement, an "assistance" mechanism (rather than an "acquisition" mechanism), in which substantial NIH programmatic involvement with the recipients is anticipated during the performance of the activities. Under the cooperative agreement, the NIH purpose is to support and stimulate the recipients' activities by involvement in and otherwise working jointly with the award recipients in a partnership role; it is not to assume direction, prime responsibility, or a dominant role in the activities. Consistent with this concept, the dominant role and prime responsibility resides with the recipients for the project as a whole, although specific tasks and activities may be shared among the recipients and the NIH as defined below.

The individual STRONG-RLI recipients will establish steering committees at their institutions with defined roles.

In addition, the PIs of the STRONG-RLI awards and involved NIH staff, and others as needed (ex-officio), will form a STRONG-RLI Executive Steering Committee (SESC) which will oversee the activities of the STRONG-RLI program recipients. There will be a yearly rotating chair of the SESC who will be nominated and selected from the PIs of the awards.

The PDs/PIs will have the primary responsibility for:

• Plan, organize, coordinate, and administer the described activities of the program, including setting project milestones with specific timelines and criteria for Institutional needs assessment and developing action plans.
• Establish Steering Committee, organize, and coordinate SESC meetings
• Ensure compliance with the applicable mandatory NIH regulations and policies
• Participate in the STRONG SESC meetings is a requirement for the PI/PDs.The purpose of the meeting is to share progress, best practices, and address common challenges.
• Work closely with the NIH Program Official and Project Coordinator (see below) in project coordination and management.
• Establish a separate site specific steering committee that will comprise of PI, institute leadership and NIH staff
• Evaluate progress using defined milestones and metrics. Recipients will provide NIH with progress reports at regular intervals as requested.
• Share needs assessment and action plan with the NIH during the award period.
• Recipients will retain custody of and have primary rights to the data and software developed under these awards, subject to Government rights of access consistent with current DHHS, PHS, and NIH policies.

NIH staff will have substantial programmatic involvement that is above and beyond the normal stewardship role in awards, as described below:

The NIH Project Coordinator will :

Work closely with individual PIs and NIH program officials (POs) to facilitate collaborations.

• Interact with each recipient, help coordinate approaches, and contribute to the adjustment of projects/programs or approaches as warranted.
• Advise the recipient in performing project activities (e.g., coordination among RLI recipients for needs assessments; provide access to NIH supported resources; identify other resources for the project);
• Facilitate, not direct, activities.
• Participate on the Steering Committee (see below) or in other functions to help guide the course of the program (e.g., Annual Program Meeting and other Program related meetings).
• Ensure that the directions taken are consistent with the NIH missions and goals.

The Project Coordinator will not participate in the oversight of the funding opportunity announcement, application review, or programmatic and budgetary stewardship of the award.

The Program Official will be responsible for the normal programmatic stewardship of the award, including funding decisions, and will be named in the award notice. The Program Official will not serve as a voting member of the Steering Committee or partake of the duties of the Project Coordinator.

Areas of joint responsibility

The SECS is the governing and oversight body for the Program. Members, who are appointed by the PDs/PIs of the award, will be comprised of the following:

• The PI of each award will serve as the SESC member.
• NIH Project Coordinators.
• Additional members from the NIH may be appointed, but the total number of NIH votes may not exceed 1/3 of the Executive Steering Committee voting membership. Other government staff may attend the Steering Committee meetings, if their expertise is required for specific discussions.
• Each recipient must plan regular meetings (no less frequently than monthly) to discuss the progress and direction of its activities and to ensure that the necessary interactions are taking place. Recipients will be expected to participate in STRONG RLI program-wide meetings. These meetings may be in the form of phone teleconferencing, videoconferencing, and/or web conferencing, as well as face-to-face meetings. Unwillingness or a consistent inability of a PD/PI to attend may be the basis for administrative action including termination of the award.

The SESC will:

• Serve as the primary steering and oversight board for the awards funded under this NOFO.
• Decide on the schedule of regular and annual meetings. The Executive Steering Committee may also call meetings to address urgent needs and will participate in network meetings and teleconferences as needed.
• Contribute to the development of a cohesive and sustainable program.
• Provide advice on key issues such as needs assessment administration, approaches, and tools for research capacity, and opportunities for growth.
• Ensure that the implementation of the Institutional Needs Assessments and Development of Sustainable Action Plan is occurring on schedule and continues to align with the applicant institution's strategic vision for biomedical research and/or research training.
• Alert NIH to emerging needs and impediments.
• Prepare concise (1-2 page) summaries of the Executive Steering Committee recommendations, which will be delivered to the PDs/PIs and members of the group within 30 days after each meeting.

Dispute Resolution:

Any disagreements that may arise in scientific or programmatic matters (within the scope of the award) between award recipients and the NIH may be brought to dispute resolution. A Dispute Resolution Panel composed of three members will be convened. The three members will be a designee of the STRONG Executive Steering Committee chosen without NIH staff voting, one NIH designee, and a third designee with expertise in the relevant area who is chosen by the other two. In the case of individual disagreement, the first member may be chosen by the individual recipient. This special dispute resolution procedure does not alter the recipient's right to appeal an adverse action that is otherwise appealable in accordance with PHS regulation 42 CFR Part 50, Subpart D and DHHS regulation 45 CFR Part 16.

The NIH reserves the right to withhold funding or curtail the program (of an individual award) in accordance with NIH policy.

3. Data Management and Sharing

Note: The NIH Policy for Data Management and Sharing is effective for due dates on or after January 25, 2023.

Consistent with the NIH Policy for Data Management and Sharing, when data management and sharing is applicable to the award, recipients will be required to adhere to the Data Management and Sharing requirements as outlined in the NIH Grants Policy Statement . Upon the approval of a Data Management and Sharing Plan, it is required for recipients to implement the plan as described.

4. Reporting

When multiple years are involved, recipients will be required to submit the Research Performance Progress Report (RPPR) annually and financial statements as required in the NIH Grants Policy Statement.

A final RPPR, invention statement, and the expenditure data portion of the Federal Financial Report are required for closeout of an award, as described in the NIH Grants Policy Statement . NIH NOFOs outline intended research goals and objectives. Post award, NIH will review and measure performance based on the details and outcomes that are shared within the RPPR, as described at 45 CFR Part 75.301 and 2 CFR Part 200.301.

The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for recipients of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later. All recipients of applicable NIH grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at www.fsrs.gov on all subawards over the threshold. See the NIH Grants Policy Statement for additional information on this reporting requirement.

In accordance with the regulatory requirements provided at 45 CFR 75.113 and 2 CFR Part 200.113 and Appendix XII to 45 CFR Part 75 and 2 CFR Part 200, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts from all Federal awarding agencies with a cumulative total value greater than $10,000,000 for any period of time during the period of performance of a Federal award, must report and maintain the currency of information reported in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period. The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently FAPIIS). This is a statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313). As required by section 3010 of Public Law 111-212, all information posted in the designated integrity and performance system on or after April 15, 2011, except past performance reviews required for Federal procurement contracts, will be publicly available. Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75 and 2 CFR Part 200 Award Term and Condition for Recipient Integrity and Performance Matters.

Section VII. Agency Contacts

We encourage inquiries concerning this funding opportunity and welcome the opportunity to answer questions from potential applicants.

eRA Service Desk (Questions regarding ASSIST, eRA Commons, application errors and warnings, documenting system problems that threaten submission by the due date, and post-submission issues)

Finding Help Online: https://www.era.nih.gov/need-help (preferred method of contact) Telephone: 301-402-7469 or 866-504-9552 (Toll Free)

General Grants Information (Questions regarding application instructions, application processes, and NIH grant resources) Email: [email protected] (preferred method of contact) Telephone: 301-480-7075

Grants.gov Customer Support (Questions regarding Grants.gov registration and Workspace) Contact Center Telephone: 800-518-4726 Email: [email protected]

Brett Miller, PhD Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Telephone: 301-496-9849 Email: [email protected]

Rina Das, PhD. National Institute on Minority Health and Health Disparities (NIMHD) Telephone: 301-496-3996 Email: [email protected]

Behrous Davani, PhD. National Cancer Institute (NCI) Telephone: 240-276-6170 Email: [email protected]

Olga Kovbasnjuk, Ph.D. National Institutes of General Medical Sciences (NIGMS) E-mail: [email protected]

Kristopher Bough, PhD National Institute of Nursing Research (NINR) Telephone: 301-337-1372 Email: [email protected]

Anissa F Brown, PhD NIDCR - NATIONAL INSTITUTE OF DENTAL & CRANIOFACIAL RESEARCH Phone: 301-594-5006 E-mail: [email protected]

Melissa C. Green Parker, Ph.D. Office of Disease Prevention (ODP) Phone: 301-480-1161 E-mail: [email protected]

Erica K Rosemond NCATS - NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES Phone: (301) 594-8927 E-mail: [email protected]

Kristy M. Nicks, PhD National Institute of Arthritis and Musculoskeletal and Skin Diseases Tel: 301-594-5055 Email: [email protected]

Carol Shreffler, PhD National Institute of Environmental Health Sciences (NIEHS) Phone: 984-287-3322 E-mail: s [email protected]

Aria Crump NIDA - NATIONAL INSTITUTE ON DRUG ABUSE Phone: 301-443-6504 E-mail: [email protected]

Diane Adger-Johnson, MPH Office of Research Training and Special Programs (ORTSP) National Institute of Allergy and Infectious Diseases (NIAID) Telephone: 301-594-5945 Email: [email protected]

Damiya Eve Whitaker, PsyD, MA ORWH - Office of Research on Women's Health Phone: 301-451-8206 E-mail: [email protected]

Damali Martin, Ph.D., MPH NATIONAL INSTITUTE ON AGING (NIA) Division of Neuroscience (DN) Phone: 301-402-8310 E-mail: [email protected]

Judith Cooper NIDCD - NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS Phone: (301) 496-5061 E-mail: [email protected]

Xinzhi Zhang, M.D. National Heart, Lung, and Blood Institute Phone: 301-435-6865 Email: [email protected]

Brittany Haynes, Ph.D. National Institute of Mental Health (NIMH) Telephone: 301-496-2767 Email: [email protected]

Beda Jean-Francois, Ph.D. National Center for Complementary & Integrative Health (NCCIH) Phone: 202-313-2144 Email: [email protected]

Elizabeth Powell, PhD National Institute on Alcoholism and Alcohol Abuse ( NIAAA ) Telephone: 301-443-0786 Email: [email protected]

Margaret Young Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Telephone: 301-642-4552 Email: [email protected]

Priscilla Grant, JD National Institute on Minority Health and Health Disparities (NIMHD) Telephone: 301-594-8412 Email: [email protected]

Alania Foster NIGMS - NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES E-mail: [email protected]

Randi Freundlich National Institute of Nursing Research (NINR) Telephone: 301-594-5974 Email: [email protected]

Gabriel Hidalgo, MBA NIDCR - NATIONAL INSTITUTE OF DENTAL & CRANIOFACIAL RESEARCH Phone: 301-827-4630 E-mail: [email protected]

Leslie Le NCATS - NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES Phone: (301) 435-0856 E-mail: [email protected]

Jenny L Greer NIEHS - NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES Phone: 984.287.3332 E-mail: [email protected]

Pamela G Fleming NIDA - NATIONAL INSTITUTE ON DRUG ABUSE Phone: 301-480-1159 E-mail: [email protected]

Samuel Ashe National Institute of Allergy and Infectious Diseases ( NIAID ) Telephone: 301-435-4799 Email: [email protected]

Jeni Smits NATIONAL INSTITUTE ON AGING (NIA) E-mail: [email protected]

Anthony Agresti NHLBI - NATIONAL HEART, LUNG, AND BLOOD INSTITUTE Phone: 301-827-8014 E-mail: [email protected]

Tamara Kees National Institute of Mental Health (NIMH) Telephone: 301-443-8811 Email: [email protected]

Debbie Chen, Ph.D. National Center for Complementary and Integrative Health (NCCIH) Telephone: 301-594-3788 Email: [email protected]

Judy Fox National Institute on Alcoholism and Alcohol Abuse (NIAAA) Telephone: 301-443-4704 Email: [email protected]

Section VIII. Other Information

Recently issued trans-NIH policy notices may affect your application submission. A full list of policy notices published by NIH is provided in the NIH Guide for Grants and Contracts . All awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement .

Awards are made under the authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and under Federal Regulations 42 CFR Part 52 and 45 CFR Part 75 and 2 CFR Part 200.

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