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Adjust your own oxygen mask before helping those around you: an autoethnography of participatory research

Implementation Science volume 15, Article number: 70 (2020) Cite this article

Abstract

Background

There is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature of participatory approaches complicates application of implementation theories, methods, and strategies which do not address researchers’ situatedness within participatory processes. As an implementation scientist, addressing one’s own situatedness through critical reflection is important to unearth how conscious and unconscious approaches, including ontological and epistemological underpinnings, influence the participatory context, process, and outcomes. Therefore, the aim of this exploratory work is to investigate the heretofore blind spot toward the lived experience of implementation researchers within the participatory process.

Methods

We developed an integrated research-practice partnership (IRPP) to inform the implementation of a gestational weight gain (GWG) control program. Within this IRPP, one investigator conducted a 12-month autoethnography. Data collection and triangulation included field notes, cultural artifacts, and systematic timeline tracking. Data analysis included ethnographic-theoretical dialogue and restorying to synthesize key events and epiphanies into a narrative.

Results

Analysis revealed the unpredicted evolution of the GWG program into a maternal health fair and three themes within the researchers’ lived experience: (1) permeable work boundaries, (2) individual and collective blind spots toward the ontological and epistemological underpinnings of implementation paradigms, and (3) maladaptive behaviors seemingly reinforced by the research culture. These themes contributed to the chaos of implementation and to researchers’ experience of inadequate recovery from cognitive, emotional, and practical demands. These themes also demonstrated the importance of contextual factors, subjectivity, and value-based judgments within implementation research.

Conclusion

Building on extant qualitative research guidelines, we suggest that researchers anchor their approach to implementation in reflexivity, intentionally and iteratively reflecting on their own situatedness. Through this autoethnography, we have elucidated several strategies based on critical reflection including examining philosophical underpinnings of research, adopting restorative practices that align with one’s values, and embracing personal presence as a foundation of scientific productivity. Within the predominant (post-) positivism paradigms, autoethnography may be criticized as unscientifically subjective or self-indulgent. However, this work demonstrates that autoethnography is a vehicle for third-person observation and first-person critical reflection that is transformative in understanding and optimizing implementation contexts, processes, and outcomes.

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Background

In translating research findings to real-world benefit, participatory research [1,2,3,4] purportedly embodies the spirit of a quote often attributed to cultural anthropologist Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it is the only thing that ever has” [5] (p. 111). As a vehicle for change, participatory research is characterized by active collaboration between researchers and diverse stakeholders [1]. This collaboration is intended to empower stakeholders—specifically those who are underrepresented in research decision-making—to shape all aspects of research, ultimately optimizing how a program or policy works within stakeholders’ unique lives and communities [4, 6]. Overall, participatory research holds promise as the backbone of pragmatic [7] implementation [8] to promote feasible, user-friendly applications of research findings to the daily lives of community members.

However, as participatory research has become more common, experts have uncovered a “dark side” to this collaborative model with practical, personal, and professional costs to researchers, as well as costs to stakeholders, the research itself, and research as a profession [9]. Ample evidence suggests that participatory research poses people-oriented, emotionally charged challenges plus complicated logistics and scheduling barriers in constant flux [10,11,12,13,14]. Exemplifying the emotional dimension of these challenges, researchers in recent focus groups described pursuing dissemination and implementation (D&I) science as “intimidating” and “career suicide” [15]. Furthermore, within participatory processes, researchers may have to navigate conflict and tension related to organizational change and feedback loops, particularly when there are power differentials between stakeholders (e.g., physician and patient) [10]. The unpredictable nuances of working within complex human environments can be chaotic [10], challenging the usability of current implementation theories, methods, and strategies [16, 17] that do not specifically acknowledge researchers’ roles or intrapersonal resources to initiate and maintain participatory processes [18].

In addition, the uncontrollable, value-laden nature of a participatory approach [19, 20] seems incommensurable [21, 22] with positivist or post-positivist paradigms reflected in mechanistic implementation advancements such as quantification of discrete implementation activities [23] and calls for deductive qualitative research [24]. In general, (post-) positivist paradigms emphasize systematic a priori hypothesis testing, experimental control, elimination of bias, generalizable predictions, and research quality determined by conventional internal and external validity aimed at explanation. In contrast, constructivist (sometimes called interpretive) paradigms emphasize the subjective nature of knowledge, naturalistic inquiry with participant voice, reflexivity, iterative theorizing, and research quality determined by trustworthiness aimed at understanding meaning [19, 25, 26]. For additional description of scientific paradigms, see Table 1 in Greenhalgh et al. [26] or Table 6.2 in Guba and Lincoln [19].

Table 1 Results of the ethnographic-theoretical dialogue
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Indicating an opportunity to look beyond (post-) positivist paradigms, emergent research suggests that mundane, hidden tasks fuel the implementation process [90]. However, there has been a blind spot to the effect of researchers’ “situatedness,” including intrapersonal resources, values, and ideologies [91, 92], within this hidden dimension of implementation. Moreover, current literature does not include day-to-day, concrete strategies that researchers can use to acknowledge and leverage their situatedness and, therefore, optimally cope with professional and personal challenges within participatory approaches [9]. There is a need to critically investigate the ground-level work within the lived experience of participatory research [11] in order to unpack the black box of implementation [93], including how our own conscious or unconscious situatedness as researchers influences the implementation process.

Therefore, the aim of this research was to explore and analyze what happened in 1 year of a participatory research project dedicated to maternal well-being. For this exploration, researchers employed a novel autoethnographic approach. Autoethnography appears to be a relatively untapped methodology in implementation science [10] and offers a fluid, qualitative approach to capturing the nuanced, inter- and intra-personal micro-processes of how a participatory effort unfolds within an unpredictable real-world, community context [24, 25, 94]. We argue that autoethnography is an appropriate method to investigate current implementation blind spots such as researchers’ situatedness. In combining first-person and third-person perspectives, autoethnography may capture the impact of blind spots and situatedness on all aspects of research from stakeholder interactions to data analysis and interpretation

In exploring nuanced processes, autoethnography combines two central components of science—observation and critical thinking [93, 95]. What autoethnography lacks in conventional control and a priori systemization is made up for by ongoing, interdisciplinary, theoretical dialogue, and critical reflection. Critical reflection [96,97,98] has not been explicitly explored as a method of implementation inquiry above and beyond the standard integration of reflexivity within qualitative studies. However, in fields such as education and cognitive science, critical reflection is practiced and studied as a process “that allows us a rigorous approach to the scientific work…because it enhances the capability of the mind to go in depth in its life” [98] (p. 7). Intentionally embracing such a subjective method within implementation science poses various limitations, particularly within dominant (post-) positivist paradigms. Therefore, the discussion section includes an assessment of credibility, transferability, dependability, and confirmability as measures of trustworthiness [24, 99, 100].

This work is significant for three primary reasons. First, it dives beneath the current mechanistic understanding of participatory research by attempting to capture and narrate the complete story and lived experience of implementation, including cognitive-social-emotional phenomena that may elude quantitative methods and current paradigms. Second, the autoethnographic approach may be replicated in other implementation investigations as a rigorous and meaningful method for studying contexts, processes, and outcomes, as depicted in Fig. 1. Third, this work informs actionable strategies for personal stability and empirical depth within the chaos of implementation.

Fig. 1
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Autoethnography: informing implementation processes and capturing implementation outcomes [101, 102]

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Methods

An integrated research-practice partnership (IRPP) is a strategic collaboration of stakeholders and researchers to plan, implement, evaluate, and sustain local evidence-based programs [103,104,105,106]. In 2009, when the primary investigator (PI, the senior author) was a graduate research assistant learning a specific IRPP approach, she established an IRPP in Southwest Virginia (see Fig. 1) to support the development, delivery, and evaluation of a gestational weight gain (GWG) control program [107]. However, due to high turnover among IRPP members and the departure of the PI who accepted an international postdoctoral position, progress on implementing the GWG control intervention came to a halt. This reflects the common phenomenon of “parachute” research [108, 109] in which researchers disappear from a community setting when empirical work is complete or academic demands arise.

From 2014 to 2018, after completing the postdoctoral fellowship, the PI re-established her community connections and conducted foundational collaborative work on preconception weight management. In 2018, the PI recommitted to prenatal health interventions, pursuing her passion for disseminating evidence-based health information and self-compassion practices to individuals within the gestational period. The graduate research assistant (GRA) whom she hired to manage and evaluate a new IRPP is the first author of this manuscript and conducted autoethnography of her experience implementing the IRPP from July 2018 to July 2019.

In conducting autoethnography, the GRA served as a participant observer [94, 110] simultaneously leading and studying the IRPP. The GRA recorded real-time observations of meetings, interactions, and events as “jottings” which she subsequently expanded into field notes [111]. The GRA wrote field notes for a minimum of 10 min after IRPP-related meetings and events. The GRA also collected cultural artifacts such as meeting agenda, meeting minutes, flyers, and emails [24, 93, 111] and systematically tracked attendance at meetings, start/end times of meetings, adherence to meeting agenda, adherence to communication protocols, and a detailed timeline to measure temporality of implementation efforts and strategies [23].

To capture her own cognitive-social-emotional experience within the work, the GRA wrote general field notes for at least 1 h per week as a process of critical reflection and self-inquiry in which she “play[ed] at the same time the role of subject who reflects and object who is reflected” [98] (p. 1). True to theoretically informed ethnography [110], she iteratively integrated evidence-based concepts and classical theories from other fields [112] so that the fieldnotes were simultaneously data collection and data analysis. This ongoing interdisciplinary [113], “ethnographic-theoretical dialog” [110] is rooted in qualitative research paradigms that emphasize the value-laden, fluid nature of reality (ontology), and knowledge (epistemology) [19, 20, 25].

To capture her own cognitive-social-emotional experience within the work, the GRA wrote general field notes for at least 1 h per week as a process of critical reflection and self-inquiry in which she “play[ed] at the same time the role of subject who reflects and object who is reflected” [99] (p. 1). True to theoretically informed ethnography [110], she iteratively integrated evidence-based concepts and classical theories from other fields [112] so that the fieldnotes were simultaneously data collection and data analysis. This ongoing interdisciplinary [113], “ethnographic-theoretical dialog” [110] is rooted in qualitative research paradigms that emphasize the value-laden, fluid nature of reality (ontology), and knowledge (epistemology) [19, 20, 25].

To organize and further analyze the ethnographic-theoretical dialog, investigators (i.e., the PI and GRA) used a chronological approach called restorying [94] to identify epiphanies or key events within the data and synthesize them into a narrative with the five elements of literature—characters, setting, conflict, plot/action, and resolution. From these elements, investigators generated, interpreted, and presented themes and practical implications of the narrative.

The investigators obtained consent from all IRPP members and protocol approval from the university Institutional Review Board. The GRA’s approach to this work reflects her Master’s of Public Health, academic training in journalism and human development, 15 years of leadership experience as a collegiate swim coach, and ongoing study of yoga. An experienced yoga teacher and practitioner, the PI’s approach to this work incorporates her empirical and practical expertise in pragmatic methods, group dynamics, community-based physical activity, and implementation science. Both investigators were full, active members of the IRPP and neither investigator is a parent; therefore, the investigators simultaneously managed “insider” and “outsider” roles [46, 109, 114] within this participatory project aimed at maternal well-being.

Results

The presentation of autoethnographic results is a result in and of itself and evidence of the difficulty operationalizing novel methods within current scientific norms such as the common format of peer-reviewed journals. In this project, separating data and interpretation may dilute the reflective, iterative nature of ethnographic-theoretical dialogue. Therefore, investigators suggest that readers iteratively refer to Table 1 throughout the “Results” and “Discussion” sections to experience the visceral-intellectual rhythm of autoethnography and critical reflection. In Table 1, investigators present results of the ethnographic-theoretical dialogue, and in the subsections below, investigators report the results of restorying, including plot, setting, characters, conflicts, themes, and resolution.

Restorying: plot and setting

The IRPP’s narrative is set in Southwest Virginia where the connection between a public land-grant university and local health care system developed over more than a decade. As depicted in Fig. 2, the IRPP’s “plot” within this setting dramatically shifted from July 2018 to July 2019. In July 2018, the IRPP convened to plan a randomized controlled study (RCT) of a GWG control program. Investigators aimed for the study to be a systematic step in “scaling out” [115] the program by delivering it through videoconference. To adapt the program, the GRA intended to develop a community advisory board as an additional arm of the IRPP. As the investigators worked with local women to film prenatal physical activity videos, the plans for a community advisory board morphed into free prenatal yoga classes. Attendees of the prenatal yoga classes suggested the idea of a 1-day, family-friendly event for local women. This idea developed into the planning, implementation, and pragmatic evaluation of a maternal health fair to empower, educate, and connect local mothers in July 2019. The event featured 23 local educators including a lawyer, physical therapist, music therapist, and neuroscientist, who presented interactive workshops including “Self-Advocacy at Home, Work, and Your Doctor’s Office,” “Pelvic Floor Exercises for Pregnancy and Postpartum,” “Music for Labor Through the Early Years,” and “Mommy Mind” (manuscript under review). See Fig. 3 for the structure and composition of the IRPP in the year leading to the maternal health fair.

Fig. 2
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Restorying the plot and setting of the IRPP, July 2018–July 2019

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Fig. 3
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IRPP model, member description, and process

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Within data collection and analysis, it was apparent that understanding the IRPP’s “plot” required looking beyond the 12-month autoethnography: “The IRPP isn’t in a petri dish. [The PI] has been working on [the GWG program] since she was a graduate student and there’s already discussion about how this is just the first Mom Expo [the maternal health fair], just one step toward better connections for pregnant and postpartum women. When I get caught up in the 12-month time frame of the protocol, I forget that the IRPP actually exists on a continuum of time and life with all sorts of inputs and outputs. It’s not like a carefully prepared sterile slide under a microscope” (field notes, June 6, 2019). In other words, what led to this IRPP and what stems from it extends before and after the empirical, researcher-established boundaries of a project (see preamble and epilogue in Fig. 2).

Within this unbounded “setting,” seemingly mundane interpersonal interactions rippled into long-term effects. For example, the GRA established a connection with a local community member who attended a single prenatal yoga class in March 2018. That community member provided an introduction to a leader of an existent local non-profit organization who agreed to host the first event of the new non-profit organization that developed from the maternal health fair that originated in the yoga classes. In other words, a single interpersonal relationship that developed within a prenatal yoga class that was not part of the initial IRPP plan contributed to the significant, unpredicted long-term community benefit of a non-profit organization for holistic maternal well-being. Likewise, other interpersonal connections the GRA developed within the community led to promotional spots on local television stations and reduced financial costs for hosting the maternal health fair. “This whole thing is like the butterfly effect: I don’t know how or when I meet someone will lead to something else later down the road” (field notes, July 28, 2019). The butterfly effect, first demonstrated by Edward Lorenz in mathematical models of weather predictions, describes how seemingly inconsequential events eventually contribute to significant outcomes in a later state [116], as in the flapping of a butterfly’s wings in Brazil causing a tornado in Texas [117]. The butterfly effect provides a metaphor for the dynamic, unpredicted effects of spending time with community members within informal settings that belie conventional scientific protocol.

Based on the GRA’s initial D&I science training in a graduate course, she expected “what happens in an IRPP” to be a slow but steady, systematic but iterative flow. “The language about implementation frameworks, theories, and processes from D&I class implies a slow but continuous spread: diffusion [italics included] of innovations, 17 years to move through the traditional pipeline from basic science to uptake in the real world, iterative and ongoing balance of fidelity and adaptation. It sounds very Darwinian—gradual evolution, survival of the fittest. Even the language of a diffusion ‘champion’ conjures up an image of the ‘fittest’” (field notes, December 9, 2019). However, in terms of metaphors from natural science, the full IRPP story resembles punctuated equilibrium (PE) [118]. PE is a model of evolution that describes change patterns in nature as occurring through periods of relative stability suddenly punctuated by rapid adaptation [118]. Social science researchers have recently used this evolutionary model to describe the delayed benefits of coaching when a certain event triggers an epiphany that catalyzes an individual to suddenly enact what he or she previously learned in coaching [119]. Likewise, evaluation scientists have highlighted “evolutionary epistemology” and posited that the natural selection of what knowledge survives and spreads in the real-world is not a “foreordained” process but takes place in “fits and starts” [120] (p. 4). These fits and start are evident in the full story of the IRPP which spans chunks of “latent” time punctuated by blocks of intense activity in 2008–2009, 2011, 2014, and 2018–2019. Even within 2018–2019, there was a distinct shift in pace (i.e., a punctuation) when the prenatal yoga classes catalyzed action toward the maternal health fair. The catalysts for the action were not the mechanistic operations of the IRPP, but the characters and conflicts within the story.

Restorying: characters, conflicts, and themes

On the surface, the PE pattern of IRPP-related work was contingent upon investigators’ situatedness as graduate students: The highest intensity blocks occurred during 2008–2009 when the PI initiated the GWG program and community partnerships as a graduate student, and during 2018–2019 when the GRA managed the IRPP and founded the health fair. Graduate education resources such as predoctoral fellowships, protected time, and supervision from experienced advisors enabled intense empirical and practical activity: The investigators’ “situatedness” [29] as graduate students set the stage for generating ideas, completing time-intensive research, and establishing extensive personal networks through a participatory approach.

Beneath the concrete academic resources, the investigators’ lived experience demonstrated their situatedness as human beings [109] with ever-present emotions, deep values, limited time, and finite energy making them vulnerable to strain [121] from work demands. For example, the GRA experienced emotional exhaustion and ego depletion [72, 73] stemming from a complicated web of her own associative thinking [71], maladaptive perfectionism [69, 122], and perseverative cognition [50, 51] that was exacerbated by a publish or perish research culture [74, 123] rooted in extrinsic motivation [75, 76] and performance achievement orientation [124]: “All year I’ve felt like I’m on a wild-goose chase or playing some Alice-in-Wonderland version of dominoes, balancing what a dissertation committee values as science with what prenatal yoga women value as life, all while keeping up a can-do attitude and A+ quality amidst the constant topple of…’let’s change the name for [the GWG program]’…’actually, let’s not do the [GWG program]’…’you have to have a research question’” (field notes, March 25, 2019). The autoethnographic process itself helped the GRA recognize how her own cognitive patterns contributed to her exhaustion, and subsequently, she was able to reshape maladaptive rumination and over-analysis into insightful reflection [125, 126].

Critical reflection within this research design illuminated dissonance between the investigators’ professional, conventionally scientific roles and their person-centered participatory roles. The difficult decision to pivot away from an RCT epitomized this conflict: In implementing a pragmatic maternal health fair instead of an intervention RCT, the investigators intentionally chose to prioritize participatory input over traditional a priori empirical processes: “I can’t truly empower people in the spirit of participatory research if the only way to achieve ‘rigor’ is to march steadily forward on a pre-fixed, ‘systematic’ path based on a priori research questions, not on the destination women really seek” (field notes, March 13, 2019). In addition, this shift manifested investigators’ epiphany that GWG was not local mothers’ central need: “…we get caught up in creating band aids, not treating wounds. Bandaids are kind of like packageable, tidy interventions for narrow health outcomes, like GWG, that are important but not the real source of suffering, not the central thing that heals the core issue or fuels all-around well-being…To achieve something sustainable that people want to maintain with fidelity, we have to get at the underlying root issue and what really matters to people, even if it’s hard to measure.” (field notes, February 24, 2019).

With this epiphany, the GRA’s work expanded from leading structured IRPP meetings to spending one-on-one time with stakeholders out in the community in non-academic, non-clinical settings such as coffee shops and libraries. From July to March, the IRPP had inched toward launching the RCT as investigators grappled with organizational red tape and convoluted procedures within the clinical system: “Busyness gets in the way of business. There’s tons of horizontal movement—as in digital horizontal movement as emailsemailsemails gobble up the day—but no vertical progress toward the mountain peak” (field notes, October 14, 2019). In contrast, progress toward the health fair was rapid, including partnerships with an existing family-oriented organization and local library, as well as commitments from nearly 40 individuals to volunteer their service, expertise, and energy at the health fair. “I get so much more input from one-on-one get-togethers out in the community then when I run IRPP meetings with agenda and minutes and action items. The IRPP meetings are systematic and trackable; but for all the organization (i.e. replicable processes worth publishing in a journal), they don’t seem nearly as authentic as the one-on-one meetings with women out in their community…where I’m making traction, where I feel like I’m gaining insight into community dynamics, where relationship-building doesn’t feel like a mercenary research task” (field notes, April 12, 2019).

In living out these epiphanies and conflicts, investigators identified three themes: (1) permeable work boundaries [127], (2) individual and collective blind spots toward the ontological and epistemological underpinnings of implementation paradigms, and (3) maladaptive behaviors seemingly reinforced by the research culture. See Fig. 4 for a diagram of the themes and Table 1 for subthemes, ethnographic evidence, theoretical/literature dialogue, and untapped opportunities for progress.

Fig. 4
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Themes of the researcher lived experience

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One lens for interpreting these intertwined themes is structuration theory [128] which “refers to the idea that rules, policies, and structures are only made ‘valid’ when individuals follow them and make decisions based upon them” (p. 59) [25]. In other words, the GRA’s own behaviors—her individual “micro-practices”—reinforced the publish or perish culture and (post-) positivist paradigms that may hamper participatory research and well-being. For example, in the first 6 months of the project, the GRA’s drive for achievement reinforced her situatedness in a culture of workism [127]: “I was tossing deep thinking out the window so that I could keep driving forward as fast as possible…my ambition to be more ‘productive’ devoured my responsibility for self-care” (field notes, December 27, 2018). But as the IRPP work turned to relationship building in the second 6 months, the GRA found some traction by distinguishing between presence and productivity: “I cannot control all of the variables that go into scientific productivity, but I can control where and how I choose to focus my energy…the depth and deliberateness of my presence in each and every conversation even if I cannot control an editor’s or committee member’s reaction to a paper I write” (field notes, March 21, 2018). This distinction did not lead to a mindful panacea of constant ease. Instead, it has led to unease knowing that challenging the prevalent implementation structure may lead to conflict and rejection within the field.

The field has made significant advancements in developing toolkits to clarify empirical outcomes of implementation [101], establish skill-based mentoring [48], and promote qualitative methods that capture nuanced micro-processes [24]. Furthermore, at the 2018 and 2019 Annual Conferences of the Science of Dissemination and Implementation in Health, there were calls to acquire “soft” skills. However, we have yet to appropriately operationalize these calls and advancements by determining what roles an implementation scientist should or could realistically play within participatory research [18] based on their unique skills, training, personality, values, and time—in other words, based on their situatedness and finite human capacity [73]. The lack of awareness or reticence to recognize personal situatedness and limits of human capacity [73] may be a result of traditional scientific paradigms that dominate health research: The structure of grant writing [58], system of tenure (cultural artifact, university tenure guidelines), emphasis on outcomes [102], and alignment with conventional benchmarks of rigor such as objectivity and internal/external validity [7, 129, 130] indicate dominance of (post-) positivism [19, 20, 25]. Likewise, the general style of reporting results in peer-reviewed journals reflects a paradigm of value-free objectivity. Researchers generally write methods sections in a passive voice (e.g., “data was collected…”); avoid the subjective pronouns I, we, and you; and describe procedures that are measurable and replicable. Minimizing attention to the inherent role of their own five senses and cognition, researchers often un-situate themselves as an indication of unbiased validity and reliability. This paradigm of projecting machine-like expertise seems incommensurable with both reflective practice [96, 97] and participatory research which hinges on researchers’ moral drive to make a difference in the real-world and their ability to build trust with stakeholders [131]. Building trust is a human—not scientific—venture, and this ethnographic-theoretical dialogue suggests that researchers’ humanness—for example, being “too tired to inspire” [64]—is a critical component of the black box of implementation. Furthermore, researchers’ deep philosophical views and scientific training may limit their perspective on novel ways to open that black box. For example, authors of a recent implementation autoethnography observed an “underlying tension between the production and use of generalizable knowledge” caused by conflicting scientific paradigms [10] (p. 6). This paper avoids that trap by elucidating strategies to uncover paradigm conflicts that reduce the usability of findings (see the “Conclusion” section).

Fields such as education and mindfulness have embraced debates on the ontological and epistemological foundations of research and practice [97, 98, 132,133,134], and the emerging idea of value-based medicine [135, 136] emphasizes philosophical underpinnings and patient empowerment [20]. However, implementation dialogue focuses on the methodological level of what constitutes credible evidence, not philosophical viewpoints of reality and knowledge [55]. The lack of clarity on these ontological and epistemological levels may contribute to the chaos [17] and lexicological quagmire [8, 112, 113, 137] often described within implementation science. A firm footing in the field’s beliefs about science may provide a foundation to stabilize at least some of the chaos: “Time and time again, I’ve seen that the swimmers who consistently win aren’t always the ones with the most efficient stroke or highest V02 max—it’s often the ones who had the strongest why, the clearest perspective of what a race meant, a purpose beyond the numbers on the record board…” (field note, February 2, 2019). Paradoxically, the coaches and athletes who win the most are often the ones who anchor their focus on a purpose beyond winning, beyond tangible outcomes measured by a stopwatch or counted in a win-loss record [138, 139]. In contrast, the GRA observed an overemphasis on outcomes over process and methods over philosophy within the IRPP, implementation literature, and academic research environment. It was through the process of autoethnography that the GRA unearthed her own ontological and epistemological assumptions; she experienced the effectiveness of reflective practice to clarify her own philosophy as a stabilizing point within the messiness of implementation.

Restorying: resolution

The resolution of the 12-month study indicates empirical, practical, personal, and philosophical evolution. On the empirical level, the GWG control intervention evaluated through RCT evolved into a health fair evaluated through the pragmatic application of the RE-AIM framework [140] (manuscript under review). On the practical level, the GRA’s work evolved from leading an IRPP in a systematic way to meeting community members for coffee and “walk and talks.”

On the personal level, continuous reflection through this methodological approach prompted the investigators to intentionally shift their behaviors and micro-practices to optimize their own situatedness including well-being and creativity: The PI practiced delegation and “allowed” the IRPP, health fair, and non-profit to form organically, adjusted research focus in order to avoid emotional triggers, committed to eating lunch before 3 pm, crafted a value-laden mission statement for the lab, and carved out time away from email. The GRA re-vamped her morning breathing meditation practice, thwarted work-related rumination by listening to unrelated podcasts during her commute, and stepped away from the computer to hug her husband whenever he arrived home. In line with the Conservation of Resources theory [120, 141] from industrial and organizational psychology, these shifts helped optimize situatedness by conserving and refueling researchers’ intrapersonal energy and interpersonal resources to meet the demands of participatory implementation research.

Finally, at the philosophical level, the GRA evolved from focusing on novel methodologies to grappling with deeper ontologies and epistemologies that influence or limit implementation science and participatory research. Paradoxically, the use of a novel methodology (i.e., autoethnography) is what revealed that novel methodologies are not enough: There is a need to examine and align underlying ontological and epistemological foundations of implementation science, including the roles of subjectivity and values within participatory research. PE paleontologists Eldredge and Gould embraced subjectivity within the scientific process when they wrote, “We do not encounter facts as data (literally “given”) discovered objectively. All observation is colored by theory and expectation” [118] (p. 85). With a similar nod toward embracing bias, the investigators report the trustworthiness of this study in Table 2. In this paper, we have transparently presented our own vulnerabilities and biases as examples of how researcher situatedness may impact participatory approaches to implementation. In addition, we have leveraged interdisciplinarity to interpret these vulnerabilities as untapped opportunities to advance the field of implementation science.

Table 2 Reporting trustworthiness of qualitative data based on Guba and Lincoln’s criteria [142]
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Discussion

Based on this study, we propose that implementation researcher situatedness influences all aspects of participatory research from planning to dissemination. Situatedness is multifaceted with personal (i.e., the researcher), interpersonal (i.e., the researcher + IRPP), and cultural (i.e., the researcher + implementation science) dimensions that include conscious and unconscious, adaptive and maladaptive drivers. It stands to reason that these drivers influence many manifestations of implementation science, not just participatory research. Therefore, the implications of this work are applicable to all implementation scientists.

This work indicates that autoethnography is a thought-provoking, action-inspiring method to leverage researcher situatedness through critical reflection, capturing empirical aspects of implementation while enhancing the practice of implementation including researchers’ own influence on the process. As shown in Figs. 1 and 5, the reflective nature of autoethnography can deepen researchers’ understanding of implementation contexts, processes, and outcomes [101, 102] and generate questions within radiating frames of reference. In addition, autoethnography brings interdisciplinary [113] work to life by facilitating the identification and application of theories from other fields, particularly social science [143] where researchers have grappled with real-world messiness for years [144]. Future work in implementation science is needed to distinguish between empirical autoethnography and “mere anecdotes” [97] (p. 198) and to develop strategies for disseminating the breadth and depth of data captured in this time- and energy-intensive method.

Fig. 5
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Frames of reflection within the autoethnography

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Findings in this explicitly reflective work suggest that there are gaps in acknowledging our own humanness and in investigating “invisible” drivers such as deep ontological and epistemological foundations of implementation science. Without deeper recognition of the ontological and epistemological components of the current implementation paradigm, new methodologies will fall flat; we will not be able to clear the research-real world pipeline that we inadvertently clog through our own attachment to traditional views of what matters and what is. Furthermore, we may exacerbate gaps and blind spots by unintentionally behaving in maladaptive ways that reinforce the culture of workism, demonstrable productivity, and chaos. Within this chaos, we suggest several strategies to optimize situatedness.

First, we suggest incorporating ontological and epistemological inquiry into academic training, team science, and efforts to advance the implementation field. Diving beneath the current focus on matching methods to a research question, researchers should reflect on personal philosophies that underscore or contradict paradigms of what evidence counts [55]. See Table 3 for potential benefits of acknowledging philosophical underpinnings.

Table 3 Potential benefits of recognizing and clarifying ontological and epistemological paradigms
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Second, we suggest that researchers adopt evidence-based restorative practices that align with one’s own values, similar to how elite athletes prioritize recovery in their training regimens [146, 147]. Potential practices include microbreaks [148, 149], meaningful off-job experiences [150], slow deep breathing [151, 152], and breaks from digital communication [153].

Third, to promote presence, we suggest that researchers focus their senses, intellect, and emotions on the people present in a specific time and place: Acknowledge the potential of “n-of-1” participatory research in which individual, authentic relationships can spiral into unpredicted community benefit in a butterfly effect pattern. Embrace personal presence as a valuable experience in and of itself in addition to being a vehicle for relevant empirical productivity.

Conclusion

Each of these strategies incorporates reflective practice and values as stabilizing mechanisms within the chaos of implementation: Clarity through the chaos of implementation starts with clarity within the researcher—as a situated human being viscerally and cerebrally experiencing life. We may not be able to control dynamic, real-world variables and unpredictable external contexts, but we can choose to maximize our humanness and presence. In leveraging our own situatedness through critical reflection, we can apply implementation-related constructs to ourselves: scale inward, facilitate one’s own capacity, protect personal sustainability, seek fidelity to values, and embrace the present context of moment-to-moment time and space. Ultimately, through this critical reflection, implementation scientists may epitomize what Margaret Mead meant by thoughtful citizens changing the world.

Availability of data and materials

Publicly sharing all autoethnographic data, including all field notes and cultural artifacts, may compromise personal privacy. Table 1 and the extensive integration of field notes throughout the manuscript provide the minimal data needed to interpret, replicate, and build upon findings reported in this article.

Abbreviations

D&I:

Dissemination and implementation

GRA:

Graduate research assistant

GWG:

Gestational weight gain

IRPP:

Integrated research practice partnership

PE:

Punctuated equilibrium

PI:

Principal investigator

RCT:

Randomized controlled trial

RE-AIM:

Reach, effectiveness, adoption, implementation, maintenance

V02 max:

Volume of oxygen consumption during maximal exercise

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Acknowledgements

The authors are grateful to the many individuals who fueled the evolution of this project over the last 13 years. This research and community work would not have been possible without their engagement.

Funding

In 2019, the first author received a Margaret C. Hepler Summer Research Fellowship to conduct participatory research and autoethnography. This fellowship provides graduate students with funding to continue their research projects over the summer months but does not take an explicit role in collecting, interpreting, or analyzing data. The Virginia Tech Open Access Subvention Fund provided funding to publish this article.

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Authors and Affiliations

  1. Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, Room 1032, Blacksburg, VA, 24060, USA

    Abby M. Steketee & Samantha M. Harden

  2. Department of Agricultural, Leadership, and Community Education, Virginia Tech, 284 Litton-Reaves Hall, Mail Code 0343, Blacksburg, VA, 24061, USA

    Thomas G. Archibald

Authors
  1. Abby M. Steketee
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  3. Samantha M. Harden
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Contributions

AS conducted the autoethnography, wrote the original draft of this paper, and designed the figures and tables. SMH developed the initial concept for this project, was a major contributor to the ethnographic-theoretical dialogue throughout data collection and analysis, and provided vital feedback in the content and design of the manuscript and figures. TA contributed expertise and creativity to incorporating interdisciplinary theories and concepts, as well as interpreting results and crafting the conclusion. All authors read and approved the manuscript.

Corresponding author

Correspondence to Abby M. Steketee.

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Ethics approval and consent to participate

The Virginia Tech Institutional Review Board approved this project, IRB 18-935.

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The authors declare that they have no competing interests.

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Steketee, A.M., Archibald, T.G. & Harden, S.M. Adjust your own oxygen mask before helping those around you: an autoethnography of participatory research. Implementation Sci 15, 70 (2020). https://doi.org/10.1186/s13012-020-01002-1

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Keywords

Implementation Science

ISSN: 1748-5908