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Table 1 Results of the ethnographic-theoretical dialogue

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

Theme #1: Permeable Work Boundaries: “As I left [coffee shop], I realized that I’d just added another person into my internal carousel of thinking and feeling. I put myself in a position to be more responsive to more people. It’s increasingly difficult to protect uninterrupted time to do my ‘intellectual’ academic and research work from the boundless work of caring about something. And then it gets harder and harder to stop the intellectual work of figuring something out from flowing into dinner with Steve, walking with Bo, going to sleep. There’s not an on/off switch for these intangible dimensions of cognition and emotion” (May 15, 2019).
Constant digital connectivity: The GRA’s use of email blurred the lines between work and home.

Opportunity for Progress:
Intentional email and social media use
• “It’s the third time this week that I’ve let an email that arrives late in the afternoon become a cascade of things to work on and send back and forth through dinner and reading for class. So, now I’m amped up, like I just finished an interval workout on the treadmill. Steve is already asleep, but I’m wired: First, I might get another follow-up email that “needs” to be answered. Second, I’m adrenalized from what feels like “firefighting.” Third, I’m unsettled since I didn’t do the neuro reading. Fourth, I’m mad at myself for getting caught up in the frenzy, blowing things out of proportion, and not regulating my own perspective and reaction. All because of my conscientiousness—or should I say guilt, obsessiveness, drive—toward answering email 24-7” (February 19, 2019). • Individuals in academic and creative roles may experience emails as disruptive, exacerbating stressful perceptions of lack-of-control [27].
• Email can contribute to stress and overload [28, 29], the sensation of doing more things without actually getting anything done.
• Email may prompt multi-tasking which is antithetical to performance and productivity [30, 31], as well as to deliberate, uninterrupted concentration needed to master challenging tasks [32,33,34].
Determination and burnout: Despite years of coaching elite athletes on the importance of recovery, the GRA realized that she was sacrificing her own well-being and work capacity as the research-academic culture that flaunts busy-ness fanned her inner fire to succeed in producing high-quality work deemed significant by faculty, the implementation field, and the real-world.

Opportunity for Progress:
Strategic recovery to prevent burnout and emotional exhaustion.
• “If I post this video of me practicing sun salutations, are people going to think that I’m not working hard? Even though I know it’s ridiculous to feel guilty over not posting something about ‘only 2.5 hours of sleep, Starbucks, and Altoids,’ here I am—feeling like an impostor in this research/grad school life” (October 20, 2018).
• “Just look at Tom Brady and Under Armor pajamas: In elite athletics, recovery is a big deal. When I was coach, getting the most determined swimmers to take time away from the pool was one of my biggest challenge. But here in academia, no one is coaching graduate students or co-workers to stay sharp by incorporating recovery. No one is even encouraging them to stay home when they’re sick. My advisor told me that one of her colleagues—or maybe it was one of her professors—said that she didn’t care what the personal excuse was, the work still had to get it done” (November 16, 2018).
• Attending the 11th Annual D&I Conference: “I didn’t need a randomized controlled trial based on an intricate framework to conclude that quite a few health researchers aren’t that healthy. Talking about the next glass of red wine, glancing between a laptop and cell phone propped on their knees during a keynote lecture, feeling guilty about missing a lecture to squeeze in a spinning class. Are our minds so full to do innovative, respected work that we can’t be mindful of our own health?” (December 8, 2018).
• There’s no literature on burnout among implementation researchers, but in two studies published in 2019, more than one-third of scientists in health-related fields reported burnout [35, 36].
• Long hours characterize academia and research [37, 38], even though meta-analysis indicates that working more than 55 hours per work is associated with an increase in the risk of incident coronary heart disease and incident stroke compared to working 35-40 hours per week [39].
• The Effort-Recovery Model (ERM) from industrial and organizational psychology suggests that inadequate recovery from work demands may deplete an individuals’ psychological and physiological resources to accomplish what has to be done in a certain place within a specific time frame [40]. Recovery is an essential process to restore one’s capacity to meet work demands [41,42,43]. See below for additional dialogue related to recovery.
Emotional work: The GRA’s personal connection to IRPP members, prenatal yoga attendees, and maternal health expo volunteers included an emotional dimension with authentic trust and empathy that led to both laughter and heartache within the lived experience.

Opportunity for Progress:
Expanded D&I competencies that include social-cognitive dimensions
• After learning about the loss of community member’s partner: “I usually smile at the viridescence of the moss finding its way through the gray cement blocks. But today it’s garish. The moss is living, but KK’s wife is not” (June 6, 2019).
• After the parents of an IRPP member suffered a series of health events: “I woke up thinking about how SM will feel moving her parents into the retirement home…that shift from your parents taking care of you to you taking care of your parents…reminds me of the first time I realized that when Pops and I walked into the ocean holding hands, I was stabilizing him, preventing him from getting knocked over by the waves, not him holding up me anymore” (July 11, 2019).
• Qualitative researchers in various fields acknowledge the impact of compassion stress [44], empathy [45], and emotional labor [46, 47] as participant-researcher relationships develop.
• To the investigators’ knowledge, accounts of participatory research in D&I science have not explored this emotional component of researchers’ positionality as an insider in the implementation process.
• Demonstrating our current blind spot toward the emotional dimension of our work, fellows who enrolled in the Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC) program ranked emotional support as their lowest priority for mentoring [48]. In addition, published educational competencies for D&I science do not include any social-cognitive dimensions, even under practice-based considerations [49].
• Emotional and psychological processes erode recovery. Replaying a stressful event in one’s mind—“perseverative cognition”—affects the cardiovascular, immune, endocrine, and neurovisceral systems even if a person is physically separated from the stressor [50, 51].
• For example, work-related rumination (i.e. thinking about an element of one’s job during off-hours) is associated with reduced cognitive functioning [52] and co-worker related helping behaviors [53].
Theme #2: Blind spots or conflicts within scientific paradigm: “It seems that D&I scientists can experiment with a different wavelength of thinking that transcends the replicable methods, visible research process, and generalizable frameworks. Something deeper, something that takes courage, something like that adage about ‘a ship is safe at shore, but that’s not what ships are built for’” (December 27, 2018).
Feasibility of pragmatic methods with positivist/postpostivist underpinnings: The GRA’s academic classes did not delve into philosophical underpinnings of scientific methods. Sensing that something was missing, she independently read about the ontological and epistemological foundations of various scientific paradigms. In her interpretation, the positivist/postpositivist evidence preferred by the implementation field is at odds with calls for actionable, stakeholder-centered approaches.

Opportunity for Progress:
Reflexivity of how philosophical underpinnings may curtail novel approaches
• After a seminar: “Putting meta-analyses and systematic reviews at the top of the evidence hierarchy applies to a conventional scientific paradigm of generalizable quantification across the translational spectrum. Perhaps a meta-analysis is the best thing for clarifying a cause-effect relationship between bone density and vitamin D supplementation, something that has a literal dose. But using meta-analysis to pinpoint the effects of a community advisory board would be like showing someone the electromagnetic spectrum to describe the taste of the cold orange I ate at hour 28 of the dance marathon” (October 13, 2018)
• Applying lessons from the D&I class to writing a methods section for a community advisory board: “If the main criteria for judging the significance of a finding is its internal and external validity, then what’s the point of community work that inspires change or empowers people or embraces subjective experience? The potentially expansive impact of pragmatic community work challenges narrow definitions—or perhaps purposes—of science” (November 14, 2018).
• Calls for pragmatic approaches entail research methods and outcomes that matter to stakeholders in real-world settings [7, 54]. Yet, qualitative research within implementation science is “positivist and deductive in nature, with their use increasingly guided by theories and organized by one or more implementation models or frameworks” p. 4 [24]. There seems to be a tug-of-war between finding out what stakeholders value through genuine participatory research versus employing a methodology that is rapid and geared to specific issues determined a priori.
• In other words, it seems that we are trying to employ seemingly value-free methods to achieve real-world value.
• Scientific paradigms are human constructions [19, 54]. Paradoxically, our deeply-held values as scientists influence our drive to be objective and value-free.
• Examination of the ontological (what is the nature of reality?) and epistemological (what is the nature of knowledge) foundations of the evidence that we’re willing to accept as credible [19, 25, 55, 56] may facilitate our ability to be truly pragmatic and stakeholder-centered, acknowledging the role of values in capturing what really matters to stakeholders.
• Overall, it may not be feasible to simultaneously achieve scientific rigor characterized by systematic objectivity and real-world relevance characterized by practical meaning [8, 57]. Participatory research that strives to accomplish both may actually accomplish neither, having tepid significance scientifically, practically, and personally.
Incongruence of a prior/systematic design within participatory process: The GRA grappled with the need for detailed a priori methods sections for grant applications and dissertation proposals, even when investigators intend the direction of the research—including outcomes—to truly develop from IRPP input within a participatory approach.

Opportunity for Progress:
Funding avenues for the invisible relational work in participatory research
• Trying describe her method for finding community members to teach seminars at the Mom Expo: “I’m trying to write down how I will systematically go about ‘recruiting’ educators for the Mom Expo so that the process could be replicated. The general action of genuinely listening to a person in an environment in which she is comfortable can be replicated on some level, but there’s not an objective, systematic equation for building true trust. Just like recruiting collegiate swimmers, connecting with community members takes time and emotional energy but it can’t be distilled into something objective and traditionally ‘scientific.’ The distilled part, the replicable part is love and “humbition” and I don’t think that’s going to fly in the methods section” (February 13, 2019). • Successful D&I grant writing requires well-reasoned clarity with pre-established collaborators and benchmarks [58]. In addition, grant writing for the National Institutes of Health (NIH) requires “strict application of the scientific method to ensure robust and unbiased experimental design, methodology, analysis, interpretation, and reporting” (NIH Grant Writing handbook, page 16).
• These descriptions of what it takes to win a grant suggest that participatory research is not fundable—at least not participatory research that leaves room for naturalistic networking, authentic exploration, and iterative enactment of what stakeholders—like pregnant women—really value.
• Currently, the networking and relationship-building inherent in participatory research appears to be “invisible work”—time consuming but unrecognized [59,60,61]
Lack of researcher reflexivity/situatedness/positionality: In leading the IRPP, the GRA found that what she had learned in various leadership trainings was not common in implementation science. There appeared to be no training, guidelines, or frameworks about how to leverage her own leadership style and personality to optimize the participatory approach. Other implementation researchers she met through the year were also directly leading participatory efforts involving stakeholders but had received no leadership training or instruction about the importance of intrapersonal capacity.

Opportunity for Progress:
Leveraging researchers’ personality strengths and honing leadership skills
• “There were mentions of soft skills at D&I [11th Annual Conference], but the D&I competencies from the [D&I graduate school] class syllabus don’t reflect how those soft skills might really matter” (December 8, 2018).
• “The first thing we did in the Energizing People for Performance Executive Education program [at Northwestern University’s Kellogg School of Business] was take various assessments to understand our own behaviors, communication, and personality as a centerpiece to effective leadership. My teams swam much better after I realized that my intense focus was unintentionally intimidating to my athletes and that my analytical, perfectionistic tendencies slow down the process of doing anything” (December 27, 2018).
• “Suddenly [in running labs, collaborating in team science, leading meetings with stakeholders], researchers who have grown up (in school, etc.) being praised for accuracy, analytical skills, depth of knowledge, and ability to navigate peer-reviewed literature have to build spontaneity and easy-going attitudes that work for relationship-building and navigating real-time personal situations. It’s like when I needed to switch from the athlete mindset of staring at the line in the bottom the pool to the coaching mindset of connecting with people. I didn’t have to fundamentally change my core self, I just had to develop awareness of my ingrained focused and working style” (February 22, 2019).
• After listening to a podcast of Graham Duncan describing how our greatest strengths are adjacent to our greatest dysfunctions: “So now I’m feeling like an Aristotelian tragic hero: Just call me Oedipus Rex, Phd wannabe implementation extraordinaire. The determination that that earns me praise and the very GRA position that I currently hold is the same determination that causes this eye twitch from standing in front of the computer long after I’ve lost the edge of creativity and insight” (March 16, 2019).
Personality traits are related to leadership styles [62, 63] and leadership styles influence [64] team performance including communication and cohesion [62, 65,66,67].
• The influence of researchers’ leadership styles and personalities on team science [68] and participatory research have not been studied, even though both approaches are advocated. We know little about implementation researchers’ leadership styles and personalities, including their effects on the participatory process.
• However, research indicates that scientists—like all humans—have adaptive and maladaptive personality facets such as self-critical perfectionism related to perseverative cognition and inadequate recovery [69].
• On the adaptive side, researchers may also have high levels of openness which is the capacity for change, variety, and novelty [70]. Openness is positively associated with creativity, number of citations, and h-index but not number of publications [71]. (See discussion of publish or perish below.)
• Understanding their own personalities and strengths could help researchers prevent fatigue and burnout by offsetting the ego depletion that occurs when we reach the end of our willpower [72, 73]. In other words, constantly keeping natural personality traits in check or extending into areas that don’t suit our personal values could deplete intrapersonal resources related to cognitive performance (e.g. attention) and general quality of life.
Theme #3: Research/Academia Culture: “I’m constantly reinforcing the very culture that stresses me out and slows the translational process by working toward peer-reviewed publication. In other words, the assignments I receive and the assignments I strive to do as a D&I grad student undermine dissemination; pouring my time into crafting information for journals and grad committees is necessary to earn my degree and paycheck, but it’s an energy suck away from actually getting information to the public” (February 23, 2019).
Pressure to “publish or perish”: The GRA felt torn between reinforcing the current paradigms of productivity versus pursuing transformational dissemination by bucking the current focus on journals and repositories.

Opportunity for Progress:
Optimize motivation and achievement orientation to improve research quality and impact, instead of overemphasizing publication quantity
• “One reason I left elite athletics was to get away from the obsession with outcomes. But with the language here—bean counting, line on the CV—I feel submerged in a culture that quantifies personal worth in productivity stats like number of publications. If I hadn’t spent years disentangling my self-worth from the time on a stopwatch, I would be probably be unconsciously engrossed in this system of constantly proving I’m enough by publishing something” (April 30, 2019).
• “It’s clear through all of the discussions at [prenatal] yoga that women don’t want to be a research subject; they don’t want the mom expo to feel like an experiment. So I’ve got this choiceprioritize their values OR prioritize peer-reviewed journal values. They’re not mutually exclusive, but designing a study for people who don’t want to be in a study is different from designing a study for people who publish journals and approve dissertations…I need to distinguish between a service mindset and manuscript obsession” (February 26, 2019).
• The ubiquitous pressure to publish or perish has been called a perverse incentive, influencing funding, professional advancement, and even scientific trustworthiness [74]
• On the spectrum from extrinsic to intrinsic motivation, pressure to publish may foster “controlled” types of motivation associated with burnout, poorer performance, and overall well-being [75,76,77,78,79].
• Pressure to publish also reflects a “performance” achievement orientation that is based on proving one’s competence in comparison to others, as opposed to a “learning” or “mastery” achievement orientation that is based on personal growth regardless of comparison to others [80,81,82].
Norms of multiple roles and responsibilities: The GRA observed her professors juggling teaching, research, and service responsibilities and learned about PhD career trajectories. She also read many online bios of implementation researchers and noticed the extensive email signatures. Even though her dissertation committee encouraged her to commit to one deep line of research inquiry for the dissertation, she felt that academia, implementation science, and participatory research demand individuals to spread themselves across multiple domains and responsibilities.

Opportunity for Progress:
Streamline responsibilities and time commitments to reducing competing demands
• After reading guidelines for earning tenure: “It’s as if tenure-track faculty are expected to be the coach, be the swimmer, and be the referee all at one time” (February 20, 2019).
• Reflecting on email signatures: “So. Many. Positions. (And acronyms). It’s the opposite of athletics. In athletics, individuals get more and more specialized in one sport or one position in a sport as they become more elite: They channel their energy and invest their training time into specific sports which is why it’s so rare to have multi-sport Olympians or even Division I athletes. But in academia, it seems that the road toward ‘eliteness’ requires individuals to take on responsibilities in broader and broader realms—to survive doing as many things as possible as opposed to doing one or two things really, really well” (May 15, 2019).
• “It’s hard to take the reins of a new project when your hands are already full” (scribbled in my notebook, didn’t write the date).
• Research suggests that burnout is associated with spending less than 20% of one’s time on the activity that is most meaningful to him or her [83].
The Challenge-Hindrance Framework from psychology posits that not all “stress” is bad: Demanding activities that are perceived as fulfilling (“challenges”) are associated with beneficial outcomes and life satisfaction while demanding activities that are perceived as time-consuming but meaningless (“hindrances”) are associated with negative outcomes and low life satisfaction [84,85,86,87].
“Attentional residue” between switching focus from one job demand to another suggests that multi-tasking may erode work quality [31, 88, 89].
• In the illuminating article Are Academics Irrelevant?, Randy Stoecker argues that community-engaged researchers cannot and should not expect or be expected to have all the requisite skills to fill all of the necessary roles, such as animator and community organizer [18]. To be relevant and genuinely helpful to a community, Stoecker suggests that researchers should fill only the roles that reflect their skills.