Identity, Psychological Safety and Social Capital: A mixed methods examination of their influence on knowledge use in the context of LEARN Communities of Practice

There is a strong push in public health for multi-faceted partnerships to develop practice-relevant evidence that effectively address complex risk factors like tobacco use. Consequently, new partnership structures that cross-cut different social groups are emerging to harness their distinct knowledge and generate actionable breakthroughs. Little is known about these structures, particularly informal ones that hinge on voluntary group membership like Communities of Practice (CoPs). Specifically, little is known about the factors/processes that enable people representing different social groups to translate their knowledge across group boundaries and co-create knowledge that informs action in these informal structures. Calls to develop/test theories, frameworks, and models are made to enlighten these gaps. This study responded to these calls by developing and testing a conceptual framework. The framework asserts that a shared identity, member identification / sense of belonging, social capital and psychological safety contribute to diverse people cohering into a collective, which was deemed important to enable knowledge to translate across group boundaries. The study examined how each factor influenced and inter-related to influence the use of CoP-related knowledge and its different types (with an emphasis on conceptual and instrumental uses). The study also examined what factors contributed to or detracted from these relationships in the context of the Program Training and Consultation Centre’s tobacco control specific Learning through Evidence and Action Reflection Network (LEARN) Community of Practice (CoP) project. Following a pragmatist orientation, a two-phased quant-QUAL sequential, explanatory mixed-methods embedded case study design was employed. The LEARN CoP project formed the case study and two CoPs that comprised that project formed the embedded units. Phase I of the study involved a quantitative survey that was completed by 35 of 58 eligible LEARN CoP members. The Phase II dominant qualitative study involved ~90 minute audio-recorded telephone interviews of 14 LEARN CoP members (seven per embedded unit) who comprised a subset of Phase I survey respondents (nested sampling approach). CoP documents (meeting minutes, audio-recorded meetings, Community Charters and Learning Agendas, WebEx™ discussion posts) served as supplementary data sources. Phase I quantitative analyses examined whether each factor of interest predicted knowledge use using simple and multiple linear regression, tested an analytic model that proposed shared identity led to knowledge use via the mediators member identification, social capital and psychological safety using Baron & Kenny’s (1986) mediation approach and Goodman’s Test (1960) for confirmation. As a prelude to the Phase II qualitative study, descriptive statistics, t-tests and ANOVA were conducted to discern how the LEARN CoP and more specifically each of its embedded units (CoP A and CoP B) were developing with respect to the factors of interest and what differences existed between the two communities. Phase I findings loosely informed the focus of the Phase II qualitative study and data were coded and analysed using open, axial and selective coding procedures (Strauss & Corbin, 1990). Phase I and Phase II data were compared and contrasted in the discussion, with greater emphasis placed on the qualitative findings. Overall findings revealed that in the LEARN CoP case, each factor in the conceptual framework influenced how members used knowledge gained in the CoP. These factors also inter-related in ways that helped diverse members to cohere in ways that influenced knowledge use. Shared identity, member identification / sense of belonging and psychological safety were related to conceptual types of knowledge use (increased awareness, learning as a result of CoP knowledge). Social capital was the only factor that was related to both conceptual and instrumental types of CoP knowledge use (e.g., knowledge gained from the CoP was used to inform decision making or applied in some fashion in practice). However, member identification / sense of belonging emerged as an important theme that motivated members to interact and build social capital which in turn led to instrumental types of knowledge use. A superordinate identity (shaped by a common and actionable purpose) helped members to jel together despite representing different social groups by serving as an anchor point for member identification / sense of belonging. The CoP’s ‘alignment’ with the philosophies, culture and priorities of important entity’s that shaped the CoP’s work (e.g., government and the organizations that members represented) also influenced the use of CoP knowledge. Other factors including relevant knowledge, leadership (including member roles), and a variety of mechanisms that enabled interaction (i.e., in-person meetings, WebEx, teleconferences, structured time for practice sharing, working groups) contributed to or detracted from the relationships found in the study. Solving complex problems like tobacco-related chronic diseases necessitates building multi-faceted partnership structures that connect different configurations of an existing or desired system and their respective knowledge. This is not an easy task because it requires bringing together people representing potentially different social identities that possess their own ways of thinking and doing, which can limit knowledge use. This study sought to understand how factors that help diverse people to cohere into a collective enhance knowledge use. The study highlights the need to understand identity-based issues at play when people from different social groups are brought together in partnership structures like the formally instituted, voluntary CoP examined. Cultivating a shared identity and sense of belonging can bridge silos and motivate people to engage in behaviours that build rich pools of social capital. These factors together can enhance the co-creation and use of evidence and collective action that can save lives

Governing Antimicrobial Resistance (AMR) in a Changing Climate: A Participatory Scenario Planning Approach Applied to Sweden in 2050

Background: Antimicrobial resistance (AMR) is a growing global crisis with long-term and unpredictable health, social and economic impacts, with which climate change is likely to interact. Understanding how to govern AMR amidst evolving climatic changes is critical. Scenario planning offers a suitable approach. By envisioning alternative futures, stakeholders more effectively can identify consequences, anticipate problems, and better determine how to intervene. This study explored future worlds and actions that may successfully address AMR in a changing climate in a high-income country, using Sweden as the case.Methods: We conducted online scenario-building workshops and interviews with eight experts who explored: (1) how promising interventions (taxation of antimicrobials at point of sale, and infection prevention measures) could each combat AMR in 2050 in Sweden given our changing climate; and (2) actions to take starting in 2030 to ensure success in 2050. Transcripts were thematically analyzed to produce a narrative of participant validated alternative futures.Results: Recognizing AMR to be a global problem requiring global solutions, participants looked beyond Sweden to construct three alternative futures: (1) “Tax Burn Out” revealed taxation of antimicrobials as a low-impact intervention that creates inequities and thus would fail to address AMR without other interventions, such as infection prevention measures. (2) “Addressing the Basics” identified infection prevention measures as highly impactful at containing AMR in 2050 because they would contribute to achieving the Sustainable Development Goals (SDGs), which would be essential to tackling inequities underpinning AMR and climate change, and help to stabilize climate-induced mass migration and conflicts; and (3) ”Siloed Nations” described a movement toward nationalism and protectionism that would derail the “Addressing the Basics” scenario, threatening health and wellbeing of all. Several urgent actions were identified to combat AMR long-term regardless which future un-folds, such as global collaboration, and a holistic approach where AMR and climate change are addressed as interlinked issues.Conclusion: Our participatory scenario planning approach enabled participants from different sectors to create shared future visions and identify urgent actions to take that hinge on global collaboration, addressing AMR and climate change together, and achieving the SDGs to combat AMR under a changing climate

Factors influencing antimicrobial resistance in the European food system and potential leverage points for intervention: A participatory, One Health study

Introduction Antimicrobial resistance (AMR) is a global crisis that evolves from a complex system of factors. Understanding what factors interact is key to finding solutions. Our objective was to identify the factors influencing AMR in the European food system and places to intervene. Materials and methods We conducted two workshops involving participants with diverse perspectives to identify the factors influencing AMR and leverage points (places) to target interventions. Transcripts were open coded for factors and connections, then transcribed into Vensim 8.0.4 to develop a causal loop diagram (CLD) and compute the number of feedback loops. Thematic analysis followed to describe AMR dynamics in Europe’s food system and places for intervention. The CLD and themes were confirmed via participant feedback. Results Seventeen participants representing human, animal and agricultural sectors identified 91 CLD factors and 331 connections. Seven themes (e.g., social and economic conditions) describing AMR dynamics in Europe’s food system, five ‘overarching factors’ that impact the entire CLD system (e.g., leadership) and fourteen places for intervention (e.g., consumer demand) emerged from workshop discussions. Most leverage points fell on highly networked feedback loops suggesting that intervening at these places may create unpredictable consequences. Conclusions Our study produced a CLD of factors influencing AMR in Europe’s food system that implicates sectors across the One Health spectrum. The high connectivity between the CLD factors described by participants and our finding that factors are connected with many feedback mechanisms underscores the complexity of the AMR problem and the challenge with finding long-term solutions. Identifying factors and feedbacks helped identify relevant leverage points in the system. Some actions, such as government’s setting AMU standards may be easier to implement. These actions in turn can support multi-pronged actions that can help redefine the vision, values and goals of the system to sustainably tackle AMR

Factors influencing antimicrobial resistance in food systems & recommendations for long-term governance under à changing climate - Research brief

▪ AMR development, spread and impact are driven by a complex web of factors that span, human, animal, agriculture, and environment sectors. ▪ Reducing AMR and AMR impacts requires multi-pronged interventions that target human, animal, agriculture, and environment sectors and planning for unintended health, social or economic consequences. ▪ Interventions that address AMR and climate change together, achieve the Sustainable Development Goals and are underpinned by multistakeholder participation and global collaboration are essential to mitigating AMR. ▪ An urgent need to act NOW or the fight against AMR will be lost

Factors impacting antimicrobial resistance in the South East Asian food system and potential places to intervene: A participatory, one health study

Background With AMU projected to increase, South East Asia (SEA) is at high risk of experiencing disproportionate health, social, and economic burdens due to antimicrobial resistance (AMR). Our objective was to identify factors influencing AMR in SEA’s food system and places for intervention by integrating the perspectives of experts from the region to inform policy and management decisions. Materials and methods We conducted two 6.5 h workshops and two 90-min interviews involving 18 AMR and other disciplinary experts from human, animal, and environment sectors who brainstormed the factors influencing AMR and identified leverage points (places) for intervention. Transcripts and workshop materials were coded for factors and their connections and transcribed into a causal loop diagram (CLD). Thematic analysis described AMR dynamics in SEA’s food system and leverage points for intervention. The CLD and themes were confirmed via participant feedback. Results Participants constructed a CLD of AMR in the SEA food system that contained 98 factors interlinked by 362 connections. CLD factors reflected eight sub-areas of the SEA food system (e.g., government). Seven themes [e.g., antimicrobial and pesticide use and AMR spread ( n = 40 quotes)], six “overarching factors” that impact the entire AMR system [e.g., the drive to survive ( n = 12 quotes)], and 10 places for intervention that target CLD factors ( n = 5) and overarching factors ( n = 2) emerged from workshop discussions. Conclusion The participant derived CLD of factors influencing AMR in the SEA food system demonstrates that AMR is a product of numerous interlinked actions taken across the One Health spectrum and that finding solutions is no simple task. Developing the model enabled the identification of potentially promising leverage points across human, animal, and environment sectors that, if comprehensively targeted using multi-pronged interventions, could evoke system wide changes that mitigate AMR. Even targeting some leverage points for intervention, such as increasing investments in research and capacity building, and setting and enforcing regulations to control antimicrobial supply, demand, and use could, in turn, shift mindsets that lead to changes in more difficult to alter leverage points, such as redefining the profit-driven intent that drives system behavior in ways that transform AMU and sustainably mitigate AMR.</p

Governing Antimicrobial Resistance (AMR) in a Changing Climate: A Participatory Scenario Planning Approach Applied to Sweden in 2050

Background Antimicrobial resistance (AMR) is a growing global crisis with long-term and unpredictable health, social and economic impacts, with which climate change is likely to interact. Understanding how to govern AMR amidst evolving climatic changes is critical. Scenario planning offers a suitable approach. By envisioning alternative futures, stakeholders more effectively can identify consequences, anticipate problems, and better determine how to intervene. This study explored future worlds and actions that may successfully address AMR in a changing climate in a high-income country, using Sweden as the case. Methods We conducted online scenario-building workshops and interviews with eight experts who explored: (1) how promising interventions ( taxation of antimicrobials at point of sale , and infection prevention measures ) could each combat AMR in 2050 in Sweden given our changing climate; and (2) actions to take starting in 2030 to ensure success in 2050. Transcripts were thematically analyzed to produce a narrative of participant validated alternative futures. Results Recognizing AMR to be a global problem requiring global solutions, participants looked beyond Sweden to construct three alternative futures: (1) “Tax Burn Out” revealed taxation of antimicrobials as a low-impact intervention that creates inequities and thus would fail to address AMR without other interventions, such as infection prevention measures. (2) “Addressing the Basics” identified infection prevention measures as highly impactful at containing AMR in 2050 because they would contribute to achieving the Sustainable Development Goals (SDGs), which would be essential to tackling inequities underpinning AMR and climate change, and help to stabilize climate-induced mass migration and conflicts; and (3) ”Siloed Nations” described a movement toward nationalism and protectionism that would derail the “Addressing the Basics” scenario, threatening health and wellbeing of all. Several urgent actions were identified to combat AMR long-term regardless which future un-folds, such as global collaboration, and a holistic approach where AMR and climate change are addressed as interlinked issues. Conclusion Our participatory scenario planning approach enabled participants from different sectors to create shared future visions and identify urgent actions to take that hinge on global collaboration, addressing AMR and climate change together, and achieving the SDGs to combat AMR under a changing climate.</p