The findings and solutions identified in an IR project need to be accepted by the health personnel delivering the health intervention. If these key stakeholders are willing to take up the recommendations suggested by the IR project, then the research will add value and improvement to the health intervention. Without uptake, the IR project has not achieved its intent and its findings will not be used. As discussed earlier in this module, identifying the right people for the IR team is an essential step in this process. This team will work directly with the health personnel throughout the project. The quality and frequency of their interaction will determine how likely the health personnel will utilize the IR project findings and recommendations.
As highlighted throughout the toolkit, the aim of IR is to identify bottlenecks and barriers to implementing health interventions. Data collection in IR investigates why these barriers exist and in its analysis, proposes solutions to address them. Throughout this process, engagement of health personnel who deliver the interventions is key. IR is not 'monitoring and evaluation' of a health intervention, and health personnel should not feel that they are being evaluated while participating in an IR project. This will not encourage the ownership and uptake of the project results by the very people who need to use them.
IR uses an ongoing process of feedback and dialogue between the IR team and health personnel involved in the delivery of the intervention. At the outset of any IR project, this process should be designed so that health personnel understand that they are a critical part of the research and the IR team. Effective feedback should be constructive, tangible, transparent, actionable, user-friendly, specific, timely and ongoing. Feedback can be delivered in various formats: reflection meetings, supportive supervision visits, frequent data review meetings and sharing of research results and updates.
During the process of continuous monitoring, it is possible that adjustments may be made to the health intervention before the IR project has been completed. For example, if education about malaria prevention offered to a cohort of mothers of children <5 years is shown to reduce malaria cases, then the health personnel may decide to offer education to all mothers coming to the health centre at a midpoint in the IR project cycle. Involving the health personnel in the analysis of those early data findings may help them to improve the interventions under study before waiting until the final conclusion of the IR project. Continuous monitoring differentiates IR from other scientific studies, where a researcher traditionally waits until all of the results are compiled and analyzed before providing recommendations. Because IR occurs in real-life settings, the ability to adapt to ongoing findings can have the potential to save lives and improve population health.
Throughout the project cycle, continuous monitoring should be built into the team's activities. These interactions between the research team and the health personnel on the IR team provide opportunities to engage key health personnel in the data collection process, the data analysis and its interpretation. Each of these steps is outlined below.
Health personnel's input into data collection is essential. They often provide most of the local knowledge that the IR team needs prior to starting data collection. For example, what times of the day are best to interview community members? Who are key informants in this locality? What cultural parameters exist in this area that may affect data collection (e.g. women must be interviewed by women, religious holidays, etc.)?
By involving health personnel in the design of the data collection, the IR team creates an expectation of responsibility that continues throughout the project. With this, health personnel will take more ownership of the IR project, even ensuring that their reports are accurate, complete and prompt, thereby improving the quality of the data collected during the project. Their willingness to engage with the information improves if they feel involved in the process. Throughout data collection, the IR team should guarantee the quality of data so that health personnel staff can be confident about its value, thereby increasing their likelihood of them using the information for learning and decision-making. Regular communication during this stage of the IR project will provide an opportunity to address any challenges in the fieldwork and allows the health personnel to participate in the interpretation of some of the early findings, thereby offering the chance to revise the data collection as needed.
During the data analysis and interpretation phase of the IR project, the involvement of the health personnel is critical. By providing opportunities that encourage health personnel to interpret the IR project findings, they are able to identify their own successes, challenges, and solutions to bottlenecks. This dialogue reinforces health personnel ownership rather than forcing "top-down" interpretations and solutions. Furthermore, health personnel provide that important contextual explanation for research findings that the IR team may not be familiar with. As discussed above, at different times throughout the project cycle, the IR findings may be adapted into the existing health intervention.
At the end of the project, when the results are being disseminated to relevant stakeholders, it is important that the IR team work together with the health personnel to identify the best people to deliver messages as well as those people that need to be targeted for knowledge translation. Feedback of this process to the team will be important so that reactions and interpretations of the findings can be understood and where necessary, the message can be adapted. Furthermore, involving key health personnel in the dissemination of the results can be an empowering process.