CHAPTER 1
Introduction

Anita Kothari, Jo Rycroft-Malone, Chris McCutcheon, and Ian D. Graham

BACKGROUND: WHAT IS THIS BOOK ABOUT?

Research coproduction is a collaborative way to plan and implement healthcare research. Instead of the researcher working alone, driven by academic curiosity, those who will use the research - called knowledge users - are part of the research team. A researcher or a knowledge user can initiate the research project. The idea is that multiple perspectives about a research problem will result in research that is more relevant to programs, policies, practice, patients, and communities. The findings will be more feasible to implement, eventually resulting in better health services and improved health and wellness. In this book we define research coproduction as a model of collaborative research that explicitly responds to knowledge user needs in order to produce research findings that are useful, useable, and used. Collaboration in coproduction research is characterized by shared decision-making between knowledge users and researchers, mutual learning, and respect.

This emerging approach is receiving strong attention in healthcare for a number of reasons. One motivation is the indicators that research findings are not finding their way into practice, programs, or policy, suggesting a lag time between research findings and their application (Health Economics Research Group et al. 2008). This gap in implementation of research results has been noticed by governments and research funders, who need to demonstrate a return on investment. Historically and theoretically, the problem has been called the two-community problem, characterized by differences in timelines, jargon, and performance rewards between the researcher and knowledge user communities (Dunn 1980). Two solutions have been presented for this lag time in research application. First, knowledge transfer strategies have focused on improved tailoring and dissemination efforts of research findings for knowledge users, starting from the assumption that knowing and practice are two separate epistemologies; in this worldview, using research findings to make healthcare decisions is seen as rational behavior. The second solution is about a different way to generate knowledge, a collaborative way that assumes knowledge and practice are linked, and hence coproduction approaches will result in research findings that are more feasible and relevant for practice (Greenhalgh and Wieringa 2011). In this book, we spotlight the latter approach to knowledge generation. The assumption is that research coproduction will result in research that is relevant and usable in particular (practice/policy/patients/community) contexts, thus accelerating the application of research findings to solve real-world problems.

Another motivation for research coproduction is the conceptual shift, from patient to consumer of healthcare, which has led to the recognition from healthcare organizations for patient, caregiver, and public involvement in research. Endeavors such as the INVOLVE initiative (INVOLVE 2012), Patient-Centred Outcomes Research Initiative (PCORI) (Selby 2013), and Strategy for Patient Oriented Research (SPOR) (Canadian Institutes of Health Research 2014) were created, and they aligned with the patient and consumer activism movement in research, often termed patient and public engagement or involvement. Major funders, like the UK's National Institute of Health Research and PCORI in the USA, signaled their support for this partnered approach by requiring patient or public participation in research projects from the outset. In shifting from patients to consumers, this movement acknowledges patient/public agency and power in health and social care processes.

The broader societal shift around re-defining "the expert" and democratizing science also motivates the turn to research coproduction. This agenda has a broad focus, whether that be related to institutions (through which knowledge production is supported) (Hutchinson et al. Chapter 3.5), decision-making (for which research findings are considered along with lay persons' knowledge) (Ludwig and Banner Chapter 3.2), or determining scientific impact (where societal outcomes are counted along with contributions to science) (McLean et al. Chapter 4.3). The important lesson is that this agenda, which is complementary to the consumerism movement, strives to rebalance the privileging of science. Research coproduction is a way to give power to citizens and their values by creating an inclusive and deliberative knowledge-generation process with equal contributions from multiple types of knowledge (Ritter et al. 2018).

Often there is ambiguity in the broader literature about exactly who the stakeholders are in contrast to knowledge users (McGrath and Whitty 2017). We define stakeholders as all individuals and groups who might be interested in, or affected by, the research findings, such as funders or managers in the wider healthcare community. Knowledge users are a special set of stakeholders who use research findings to make healthcare or system decisions over which they have control; these knowledge users are sometimes called "decision makers." They include, but are not limited to, policy makers, clinicians, health system managers, the public, patients, and researchers from different fields or industries. A second group of stakeholders is not in a position to make decisions but is affected by the decisions that knowledge users make, and by the research. The third group of stakeholders does not make decisions and is not directly impacted, but is generally interested in research findings.

In terms of their role within a research team, knowledge users are considered research partners (essentially, co-investigators or research team members on research projects or research programs); they are necessary for research coproduction. Stakeholders from groups two (affected by the research findings) or three (interested in the findings) could be included as research partners, but often they are not. Stakeholders from any of the three groups could also be included as advisors (advisory committee members to projects or individuals consulted by the research team to elicit their unique perspectives) to the research process or the dissemination of project findings (McCutcheon et al. Chapter 4.2). As advisors, they might provide guidance to the research team at key decision points about methodology, dissemination, or implementation, but they are not as closely integrated with the research process as the knowledge user partners, nor are they considered equal partners with researchers on the team. Figure 1.1 depicts these possible different groups, where stakeholders operating as knowledge user partners is a necessary condition for research coproduction.

FIGURE 1.1 The coproduction research team and stakeholders.

* could include knowledge users and other stakeholders who are impacted and/or interested in the research findings. Adapted from: Reszel J, Sprague AE, Darling EK, on behalf of the Ontario Birth Centre Demonstration project evaluation team. An integrated knowledge translation approach to evaluate the first year of operations of two new freestanding, midwifery-led birth centers in Ontario. In: McCutcheon C, Reszel J, Kothari A, Graham ID, editors. How We Work Together: The Integrated Knowledge Translation Research Network Casebook. Volume 4. Ottawa, ON: Integrated Knowledge Translation Research Network. 2021; 11-15.

Understanding these distinctions among knowledge user partners, knowledge user advisors, and stakeholders can be extremely useful in understanding the different perspectives each brings to the coproduction process. Armed with this understanding, coproduction research teams can consider the possible need for different levels of involvement depending on the stage of the research process. For example, some stakeholders might be engaged broadly through surveys or workshops, but the team might decide that stakeholders also need to be aware of ongoing project findings throughout the research, using tailored dissemination strategies. We encourage the coproduction team to attend to each category of involvement and engagement by thinking about what to measure, engagement processes and related barriers, information and dissemination needs, and sustainability issues.

FOCUS OF THE CHAPTER: WHAT DO WE MEAN BY RESEARCH COPRODUCTION?

This book focuses on coproduction during the research endeavor (a model of collaborative research that explicitly responds to knowledge user needs in order to produce research findings that are useful, useable, and used). Research coproduction is an approach that can be superimposed on any study design or research methodology and associated method (e.g., see Baumbusch et al. (2018) for an account of research coproduction and ethnography). Therefore, we position it as a lens but not quite yet as a philosophy accompanied by a particular epistemology, as others have defined partnered research (Frank et al. 2020). This lens can be layered on top of other paradigms and ontologies. Research coproduction can be characterized as taking up a problem and using deliberative processes to turn it into a question that is useful for, or derived from, the practice/policy field and from gaps in knowledge. Research coproduction adopts a participatory approach. Team members - researchers and knowledge users - are equal partners with respect to research and dissemination decisions, drawing on everyone's expertise. Research coproduction...