Introduction
Engaging key partners as equal members of a research team stimulates collaboration and enhances the overall impact of research. Key partner engagement, defined as “the meaningful involvement of patients, caregivers, and other healthcare stakeholders through the entire research process,” is both a moral imperative and a strategic approach that fosters reciprocal relationships, co-learning, transparency, and trust [1,Reference Sheridan, Schrandt, Forsythe, Hilliard and Paez2]. This engagement strengthens partnerships and broadens the scope of research to be more inclusive and effective. We define key partners as “…a person or group of persons, who are influenced by or able to influence the project” [Reference Freeman3]. By adopting this terminology instead of “stakeholders,” we aim to contribute to the decolonization of research and move beyond language that contradicts the principles of community engagement [Reference Reed and Rudman4]. Our team will be utilizing the term “key partners” to refer to our “stakeholders” and “stakeholder groups.” We will continue to use the term “stakeholder” when referring to referenced works, tools, or frameworks where the term is used (e.g., stakeholder analysis, stakeholder theory, etc.). Effective key partner engagement enhances the quality and sustainability of community-engaged research projects, supports strong partnerships, expands knowledge, and ultimately improves health programs and policies for thriving communities [Reference Silberberg and Martinez-Bianchi5–Reference Aguilar-Gaxiola, Ahmed and Anise7].
Although heterogeneous in its application, key partner engagement must abide by the principles of community engagement and strive for the highest level of engagement to yield the greatest impact [Reference Maurer, Mangrum and Hilliard-Boone8,Reference McCloskey, Akintobi, Bonham, Cook and Coyne-Beasley9]. The nine principles of community engagement described by the Clinical and Translational Science Award Consortium Community Engagement Key Functions Committee Task Force on the Principles of Community Engagement are outlined in Table 1. These principles are incorporated in Figure 1 to demonstrate levels of engagement [Reference McCloskey, Akintobi, Bonham, Cook and Coyne-Beasley9].
Figure 1. Community engagement continuum.
Table 1. Nine principles of community engagement
A stakeholder analysis is a commonly used process for increasing engagement that identifies key partners and provides a better understanding of their positionality surrounding a given project, policy, or topic. This process can be used to enhance key partner engagement and community-engaged research through a deeper understanding of key partners’ perceptions, values, and needs surrounding a project [Reference Jepsen and Eskerod10,Reference Chapleo and Simms11].
Stakeholder analyses have been used since Freeman introduced the subject in 1984 [Reference Freeman3]. Freeman’s stakeholder theory expanded the understanding of key partners to include anyone affected by a given company and its workings, suggesting that success is wider than simply capitalistic profit [Reference Freeman3]. By identifying and understanding the perspectives and interests of different key partner groups, organizations can enhance decision-making, foster collaboration, and mitigate potential conflicts.
Stakeholder analyses can be broken down into four general steps: 1) brainstorming for key partner groups, 2) identifying categories of key partners and understanding why they are important, 3) prioritizing key partners, and 4) understanding your key partners [12]. When identifying key partners, the PESTLE model can be a helpful tool to utilize through the brainstorming process [12]. The PESTLE model recognizes Political, Economic, Sociological, Technological, Legal, and Environmental influences of power [13]. After a list of key partners has been identified, it’s important to consider how each person or group relates to your project via their specific interests, be it positive or negative [12]. The third step of stakeholder analysis proceeds to prioritize key partners in relation to “their importance and influence” [12]. Key partners with higher levels of influence or interest can help to push project progress along faster when included earlier in the project timeline. The final step of the stakeholder analysis process collates the information collected across the preceding steps to create a more well-rounded understanding of key partner interests, impacts, and risks pertaining to a given project [12].
The stakeholder analysis approach has historically been top-down rather than collaborative with key partners, due to the goal of gaining insight into the interests, power, and positionality of key partners surrounding a goal pertaining to a project or policy [Reference Brugha and Varvasovszky14]. However, this approach poses challenges for key partner engagement and community-engaged research, which aims to incorporate partners throughout the project. Limitations of the traditional approach include marginalizing key partners’ voices and relying on assumptions rather than real-time community input [Reference Brugha and Varvasovszky14,Reference Hardy, Wickham and Gretzel15].
The literature on community engagement and stakeholder analysis outside the context of organized projects is limited. However, evidence suggests that re-centering the research to focus on key partners can enhance the sustainability of community engagement and ongoing relationships [Reference Ramachandra, Naha Abu Mansor, Duckworth and Jonathan Tummons16,Reference Savage, Dunkin and Ford17]. By integrating community engagement principles into stakeholder analyses, a more participatory, holistic process can emerge, providing a well-rounded understanding of key partners and strategies for improving engagement and integration [Reference McCloskey, Akintobi, Bonham, Cook and Coyne-Beasley9]. Through a discourse analysis, this paper aims to qualitatively examine the value of community-engaged research for diverse partners to increase collaboration, strengthen partnerships, and enhance impact, ultimately driving key partner engagement.
Materials and methods
Interview guide
To accomplish our stated aim, the research team, comprised of the Community Engagement Network (CEN) at a Midwest Academic Medical Center, reviewed existing literature on key partner, patient, and community engagement in research to understand the value of diverse participation in research as it relates to contexts, processes, and outcomes. Based on the findings of the literature, we generated 3–6 value propositions for our identified key partner groups, described in “Interviewee Selection,” around principles of knowledge, capacity, trust, decision-making, social progress, personal development, and collaboration [Reference Luger, Hamilton and True18–Reference Ballantyne, Frow, Varey and Payne21]. These value propositions incorporate the principles of community engagement, described in Table 1. A value proposition is “a clear, simple statement of the benefits, both tangible and intangible, that the evidence-based program/intervention will provide to a particular key partner, along with a recognition of the approximate financial, time, implementation, and other costs associated with the benefits” [Reference Aaker22]. The value propositions can be found in Table 2.
Table 2. Value proposition statements
In addition to the value propositions, the interview guide assessed three content areas: 1) perceived value and/or benefit of participating in community-engaged research, 2) perceived barriers to participating in community-engaged research, and 3) ways to improve the impact of community-engaged research for key partners. General demographic information, including key partners’ occupation, organization of employment, and how they currently participate in community-engaged research was also gathered. In total, the interview guide consisted of 14 open-ended questions, followed by 4–7 value proposition statements, resulting in interviews lasting 20–45 minutes.
Interviewee selection
To mirror the first step of a traditional stakeholder analysis, we generated a purposive sample of key partner groups that play an integral role in community-engaged research. The key partner groups identified for desired perspectives included community members, community organizations, Practice-Based Research Network members, researchers, research administration, university administration, and potential funders. Members of the CEN then generated a list of potential interviewees that represented each key partner group, based on preexisting partnerships. Once the key partner list was created, five names were randomly selected from each key partner group, using the website random.org, to ensure each key partner had an equal chance to be selected and to prevent selection bias from the CEN members. We believe this approach would generate a more robust and representative sample in each key partner group. A total of 40 individuals were invited to participate in the key partner interviews, 38 interviews were completed, and 2 individuals did not respond to the invitation to participate. Table 3 displays the distribution of interviewees across key partner categories.
Table 3. Distribution of interviewees across key partner categories
Conducting interviews
Interviewers were affiliated with the Community Engagement and Outreach Core of the Great Plains IDeA Clinical and Translational Research Network (n = 4), Community Outreach and Engagement Core of the Fred and Pamela Buffett Cancer Center (n = 1), and the university’s Office of Community Engagement (n = 2). Informal interviews were conducted virtually between November 2021 and February 2022, using the Zoom web conferencing platform. The use of Zoom met HIPAA Compliance standards. Interviews were conducted using the interview protocol described above and recorded with the interviewees’ permission. Data saturation was established when no novel insights were uncovered in the interview. All interviews were transcribed into Research Electronic Data Capture (REDCap) upon completion. The interviewers brought diverse community engagement perspectives and experiences to the research team through their educational backgrounds, previous experience, and intersectional identities, leading to unique and valuable bias throughout the interview process. Personal characteristics of interviewers can be found in Table 4.
Table 4. Research team and reflexivity
Community Engagement Network (CEN) Affiliation: UNMC OCE-University of Nebraska Medical Center Office of Community Engagement; CTR CEO-Great Plains IDeA-CTR Community Engagement and Outreach; BCC COE-Buffett Cancer Center Community Outreach and Engagement.
Modified from the Consolidation Criteria for Reporting Qualitative Studies (COREQ)[Reference Tong, Sainsbury and Craig23].
The Office of Regulatory Affairs at the University of Nebraska Medical Center determined that this project did not constitute human subjects research as defined by 45CFR46.102 and was therefore not subject to federal regulations.
Data analysis
Members of the CEN, comprising the data analysis team, developed an etic codebook using an inductive approach prior to completing our coding analysis of the interview notes. We utilized this approach to allow for themes to emerge. We summarized the themes that emerged from our coding tree in Table 5. Two research team members coded the interview notes independently. Their coding results had a high level of agreement, indicating consistency across the coding process. When there was a coding disagreement, the team discussed it until general consensus was reached. After the coding was completed, the research team pulled illustrative quotes that aligned with the themes. The CEN team reviewed the results for accuracy and completeness.
Table 5. Interview themes and subthemes
CER-Community-Engaged Research.
The analysis aimed to contribute to the ongoing discussion on key partner engagement by demonstrating the value of qualitative data in enriching the stakeholder analysis process. The findings are projected to inform both theoretical frameworks and practical strategies for key partner engagement, ultimately enhancing the effectiveness of organizational strategies and initiatives reliant on stakeholder analyses or other engagement tools.
Results
A total of 38 interviews were conducted. The analysis of these interviews yielded three overarching themes: 1) fostering community buy-in, 2) enhancing communication and dissemination strategies, and 3) building capacity and ensuring sustainability. The themes and subthemes are available alongside their illustrative quotations in Table 5.
Theme 1: Fostering community buy-in
Within community engagement initiatives, fostering community buy-in emerges as a pivotal theme, essential for nurturing trust and genuine commitment from key partners across projects. This not only revolves around authentically representing diverse community perspectives and identities but also cultivating inclusive and collaborative partnerships. These subthemes underscore the imperativeness of creating spaces where all voices are heard, respected, and actively engaged, ultimately contributing to the co-creation of impactful solutions that resonate with the community’s needs, goals, and aspirations.
Authentic representation of community perspectives and identities
Partners expressed that authentic representation is fundamental to the success of any community engagement effort. It underscores the significance of genuinely valuing and incorporating diverse perspectives and identities within communities. In discussions with partners, the importance of this aspect was consistently highlighted:
“…would value [community engaged research] that reflects the diversity of the community where that community [engaged research] is being done.”
This concept transcends mere acknowledgment; it involves intentional incorporation of a comprehensive process that emphasizes meaningful community engagement in decision-making processes. According to scholarly literature, authentic representation is best defined as a multifaceted approach that seeks to involve community members in shaping policies, programs, and initiatives that directly impact them [Reference Sheridan, Schrandt, Forsythe, Hilliard and Paez2].
Recognizing and respecting the richness of community perspectives plays a pivotal role in enhancing innovation, building and maintaining trust, fostering a sense of belonging, and ultimately securing genuine buy-in for research initiatives. By actively involving community members in the decision-making process, organizations can demonstrate their commitment to inclusivity and ensure that their efforts are truly reflective of the community’s needs and aspirations. One participant further emphasized this point:
“The relationships to do [community engaged research] is extremely important because without them you don’t have buy-in.”
Inclusivity and collaborative partnerships
Partners believed these types of partnerships further reinforced the importance of dedicated relationship-building prior to research activities. Incorporating collaboration throughout the research timeline fosters a sense of shared ownership and responsibility. Successful research initiatives are characterized by a collective, participatory approach that actively involves community members in decision-making processes. This was conveyed by one participant who shared that relationships are crucial in community-engaged research, as they facilitate buy-in from community members who not only want to participate but also receive feedback on their involvement:
“Community members want to participate AND receive the feedback.”
Theme 2: Enhancing communication & dissemination
Partners expressed the significance of enhancing communication and dissemination efforts within the context of community-engaged research. Effective communication not only facilitates engagement but also ensures that research findings reach diverse audiences, fostering greater trust, understanding, and impact within the community. This theme unfolds through four significant subthemes: 1) continuity through past research updates, 2) sustaining ongoing engagement, 3) community-centered dissemination, and 4) balancing research and action.
Continuity through past research updates
Ensuring continuity through past research updates is essential for fostering community engagement and trust. Partners expressed a desire to be informed about previous research outcomes, emphasizing the value of building on past efforts by maintaining a continuous flow of updates. Consistent and accessible information regarding the progression of research initiatives not only contributes to building a sense of transparency and knowledge sharing but also acknowledges and incorporates historical context. Past research informs and enriches current strategies, providing a foundation for ongoing collaboration and improvement.
“…update about the past studies that the [Citizen Advisory] board approved – to see where things are at.”
Sustaining ongoing engagement
Sustaining ongoing engagement requires dynamic communication that goes beyond one-time interactions. Partners emphasized the importance of effective, iterative communication to ensure that all key partners involved in the work are informed and connected. They highlighted the need for regular opportunities to connect and share updates, particularly in contexts where multiple individual efforts may create confusion for community members. One participant stated:
“Finding opportunities to connect regularly to ensure all involved in this work know what others are doing. So many individual efforts make it confusing for community members.”
Community-centered dissemination
Community-centered dissemination strategies are crucial for ensuring that research findings resonate with, and are accessible to, the community. This involves tailoring communication materials, formats, and channels to align with community values, language, and preferences. Effective dissemination efforts must incorporate community members to ensure relevance and accessibility, which provides a platform for sharing research results and facilitating meaningful dialogue as a couple of participants pointed out:
“Give a platform to share results of research. …communities need to know.”
“…some way to share data seamlessly without much pain from the community side and our side.”
Balancing research and action
Partners expressed that this sub-theme is paramount, as research is not only about gathering and conveying knowledge but also mobilizing towards collaborative and impactful actions. Partners emphasized the importance of using strategies that clearly convey research findings to inspire tangible, community-driven actions. They stressed the need to focus on addressing health disparities and finding solutions within the community, thus showcasing interventions that lead to measurable improvements and advocating for effective sustainable strategies that can be scaled up. One participant stated:
“…Goes back [to] health disparities – the only way to find solutions is to do this work in the community. We need to do this research to find solutions to the problems.”
Another participant further described why it is important to involve community in research and the positive impact it can produce on sustainability:
“Are we working on the right problems [that are] meaningful to the community-which speaks to measuring. What are we measuring and can we show it’s getting better? It [is] not just about a paper or grant but we show that an intervention increased X or Y in a community and how to scale it up. Strategies we devise and how sustainable they are in the community.”
Theme 3: Building capacity and ensuring sustainability
Participants expressed the importance of building capacity to conduct community-engaged research not just for researchers, but also for community. In addition, many of the participants discussed the importance of universities and other academic collaborators committing to a long-term investment in sustaining community partnerships beyond the scope of a grant period. As a result, we identified two key subthemes: 1) continuous learning for key partners and 2) long-term investments.
Continuous learning for key partners
Participants emphasized how essential continuous learning is for fostering effective community engagement and collaboration. Some participants emphasized the importance of ongoing education and skill development across research teams, therefore leveling the playing field among community and academic partners. Spreading awareness of community-engaged research and fostering research environments conducive to continuous learning are vital. This may involve integrating training programs, workshops, and knowledge-sharing dissemination platforms to empower all key partners and enhance their capacity for meaningful participation. Key partners have expressed the need for training in best practices in community engagement, recognizing the value it brings to both the community and students involved in research endeavors:
“Training best practices in community engagement. Value community engagement that can also benefit students.”
“More training in community-engaged research.”
Long-term investments
Participants expressed that long-term investments are crucial for sustaining authentic community partnerships and ensuring the sustainability of community-engaged research efforts. However, there were several challenges described by participants related to funding and the sustainability of relationships at the conclusion of a project, which can disrupt community partnerships and key partner engagement if not adequately addressed. Recognizing the time commitment involved in community-engaged research, there is a call for long-term investment strategies that diversify the community members engaged across various levels. A forward-looking approach that extends beyond the grant or research timeline is necessary to cultivate stability and capacity-building within the community. This approach circles back to the notion of fostering a sense of ownership and empowerment among community leaders, key partners, and participants. Key partners emphasized the importance of grassroots work, which provides direct engagement with the community, and the need for ongoing evolution and adaptation of research efforts to meet community needs and sustain meaningful engagement:
“More grassroots work working directly with the community, not just the leaders.”
“We need to continue to evolve the work, not just stop it and leave the community hanging.”
“Capacity. More time to do things and learn to understand; have more time to do engagement.”
Discussion
Our study qualitatively examined the value of community-engaged research for diverse partners to increase collaboration, strengthen partnerships, and enhance impact, ultimately driving key partner engagement. We explored key partners’ perceptions and reactions to stakeholder analyses by specifically assessing their perceived value, barriers, and improvement strategies for community-engaged research with value proposition statements. We analyzed the data by reading the interview notes several times looking for illustrative statements of the perceptions that key partners held when asked about proposition statements related to traditional stakeholder analyses and community-engaged research. Our analysis revealed three main themes that, we believe, will enhance key partner engagement by increasing collaboration, partnerships, and impact.
To our knowledge, there is no peer-reviewed literature describing the integration of community into a traditional stakeholder analysis framework. Therefore, the significance of this study lies in its methodological approach, which emphasizes the importance of incorporating community engagement principles into the stakeholder analysis process to increase key partner engagement in subsequent community-engaged research projects. By directly engaging key partners and creating space for them to express their perceived value of community-engaged research based on their experience, this research seeks to provide insights that are not only contextually grounded but also reflective of the complex realities that key partners navigate across the community engagement continuum.
Our findings highlight the critical importance of fostering community buy-in for the success of community-engaged research. Authentic representation of community perspectives emerged as a fundamental requirement. Participants emphasized that community engagement efforts must genuinely value and incorporate diverse perspectives and identities within communities. This aligns with existing literature which underscores that genuine community representation enhances innovation, trust, and a sense of belonging, characteristics that are commonly missing from traditional research [24]. Our study extends this understanding by demonstrating that inclusive and collaborative partnerships are not merely beneficial, but essential for gaining and maintaining community commitment. These insights suggest that institutions must prioritize building and nurturing authentic relationships with community members throughout a research timeline to ensure effective engagement.
Effective communication and dissemination strategies were identified as pivotal for sustaining ongoing engagement and ensuring that research findings resonate with and are accessible to the community. Key partners expressed a strong desire for continuity through regular updates on past research, which builds transparency and trust. This finding supports the idea that community members are not passive recipients of information but active partners who seek continuous engagement [Reference Frank, Morton and Guise20]. Furthermore, community-centered dissemination strategies, which tailor communication to align with community values and preferences, were deemed crucial. These strategies not only facilitate better understanding and impact but also empower communities to engage in meaningful dialog about research findings. This approach highlights the importance of balancing research and actionable outcomes, ensuring that research initiatives lead to tangible, community-driven actions. It also provides insights about how to meaningfully strategize the engagement of key partners when conducting a stakeholder analysis.
Building capacity and ensuring sustainability were also highlighted as essential for the long-term success of community-engaged research. Continuous learning opportunities for both researchers and community members were seen as vital for fostering effective engagement and collaboration. Participants stressed the need for ongoing education and skill development, which supports the notion that capacity-building efforts are crucial for leveling the playing field between community and academic partners [Reference Luger, Hamilton and True18]. Additionally, long-term investments in community partnerships were deemed necessary to sustain engagement beyond the scope of individual projects or grant periods. This finding underscores the importance of a forward-looking approach that extends beyond immediate research goals to cultivate stable and enduring community relationships that are necessary to consider in the stakeholder analysis process.
The insights gained from this study have significant implications for both practice and future research. Practitioners should prioritize community engagement as part of the stakeholder analysis process because it can result in authentic representation and inclusive partnerships in their engagement strategies. Effective communication and dissemination efforts must be community-centered, ensuring that research findings are accessible and actionable. Capacity-building initiatives should focus on continuous learning for all key partners involved, fostering a collaborative research environment.
This study’s use of purposive sampling limited the captured perspectives of interviewees to those who already had a relationship with a member of the research team. This approach likely excluded individuals who are not typically involved in research or who are not in an active partnership or study. Additionally, the development of the interview guide relied heavily on existing literature available on stakeholder analyses which typically rely on an etic approach. This limits the emic insights we were able to glean from our data analysis. Future research should explore community engagement in stakeholder analyses to establish increased long-term impact of sustained community engagement on research outcomes and community well-being. Additionally, there is a need to develop standardized methods for participatory stakeholder analyses that can be integrated with traditional approaches to provide a comprehensive understanding of key partner dynamics through both an etic and emic lens.
This study underscores the value of incorporating qualitative insights into stakeholder analyses to enhance collaboration, strengthen partnerships, and improve the impact of community-engaged research. By engaging key partners directly and allowing them to express their views, this research provides contextually grounded insights that are crucial for the success of key partner engagement strategies. The findings offer valuable insight for institutional transformation and implementation of effective stakeholder analyses and engagement tools, ultimately enhancing the effectiveness of research strategies and initiatives. Best practices in community-engaged research suggest the need to decolonize the language surrounding engagement by incorporating strategies that are inclusive of key partners’ backgrounds, experiences, and assets [Reference Reed and Rudman4]. We strongly encourage our peers in the field to adopt the term “key partners” to further this effort. This work demonstrates valuable strategies for integrating the principles of community engagement in qualitative methodologies.
Acknowledgments
This work would not have been possible without the valuable contributions of our key partners. We express our immense gratitude for their ongoing partnership and collaboration.
Study data were collected and managed using REDCap. REDCap is a secure, web-based application designed to support data capture for research studies. REDCap at UNMC is supported by the Research IT Office funded by the Vice Chancellor for Research (VCR). This publication’s contents are the sole responsibility of the authors and do not necessarily represent the official views of UNMC or the VCR.
Author contributions
Casey Allen, Emily Frankel, Shinobu Watanabe-Galloway, Heidi Keeler, Dave Palm, Brooke Fitzpatrick, Paul Estabrooks, and Keyonna King all contributed to this work. Casey Allen: conduct and interpretation of analysis, contribution of analysis tools and expertise, and drafting the manuscript (takes responsibility for the manuscript as a whole). Emily Frankel: conception and design of the work, collection of data, conduct and interpretation of analysis, contribution of analysis tools and expertise, and drafting of the manuscript. Shinobu Watanabe-Galloway: conception and design of the work and collection of data. Heidi Keeler: conception and design of the work and collection of data. Dave Palm: conception and design of the work and collection of data. Brooke Fitzpatrick: collection of data. Paul Estabrooks: conception and design of the work, collection of data, contributions of expertise. Keyonna King: conception and design of the work, collection of data, and contributions of expertise.
Funding statement
The project described is supported by the National Institute of General Medical Sciences, U54 GM115458, which funds the Great Plains IDeA-CTR Network. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
The project described is supported by the National Cancer Institute Buffett Cancer Center, P30 CA036727.
Competing interests
The authors declare none.
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