A tool for exploring the dynamics of innovative interventions for public health: the critical event card.

OBJECTIVES: Public health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions' evolution, based on critical events. METHODS: Drawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-to-face interviews and focus groups. RESULTS: Analytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions. CONCLUSIONS: The CEC provides a tool to analyze and represent intersectoral internvetions' complex and dynamic evolution.

[Partnership-based research as a space to support innovation]. / La recherche partenariale comme espace de soutien a l'innovation.

The process of joint evaluation involving several actors is criss-crossed by a process of negotiation and adjustment between different concerns, responsibilities and interests. How can we encourage a dialogue between knowledge from expertise and knowledge from experience, in order to produce knowledge that is scientifically based and useful for those who are involved in the programs? Far from being a mechanical process, this involves the delicate task of striking a balance, which relies on a negotiated partnership framework. The implementation of an advisory committee, organized by an interface function between the stakeholders of the intervention under study, has increasingly become recognized as a necessary condition for success in partnership-based research. These conditions enable the deployment of a reflexive system that can support social innovation--when the formulation of the problem and its resulting actions become enriched, as knowledge about the intervention develops.

Structuring an inter-sector research partnership: a negotiated zone.

OBJECTIVES: To document and analyze the initial steps in building a health research partnership. To enable a greater appreciation of what these processes entail and also to provide guidance in negotiating the inevitable tensions between parties with different aims and objectives. METHODS: This case study is based on participant-observation and document analysis. It employed three general analytic strategies: developing a case description, relying on theoretical propositions and thinking about rival explanations. RESULTS: The development of a research partnership framework entails a complex negotiation process marked by tensions: one of representing the interests of the various parties; and one establishing the basis for collaboration. Some factors can facilitate these processes: acknowledging the specific interests and organizational culture of the various organizations involved; designating a mediator to develop a climate of trust; and mitigating the inequalities among partners, in a process which requires considerable efforts over a rather long period of time. CONCLUSION: The process of structuring the relations among the associated partners does not end with negotiating a partnership accord. Denying this would be tantamount to denying the political nature of a research partnership, and denying those involved any autonomy in future research projects.