Co-production, or what?

Over the last year, I’ve had the privilege to be part of an amazing project called MH2K, putting young people at the heart of mental health policy in Oldham, Greater Manchester.

Briefly, the project was this:

  • First, twenty Citizen Researchers from very different backgrounds volunteered to interrogate mental health facts and figures, research and views to identify the top five mental health challenges facing young people in Oldham;
  • Then, they designed and led 42 roadshows focused on these challenges and their potential solutions, comprised of quizzes, multimedia, discussions and debates, deliberating with nearly 600 other young people from all walks of Oldham life;
  • They synthesised their findings and worked on an equal footing with MH2K’s advisors – people whose jobs are in mental health service delivery, policy, research and engagement – to come up with joint recommendations for the future of mental health in Oldham;
  • Finally, they presented their work to a group of 85 people from 27 organisations at a big celebration event (and many more, beyond, online).

You can read all about the project’s methods, outcomes, recommendations and evaluation here.

Here, I want to focus on why I think the project was so successful (and yes, I’m biased). Here’s a clue: it’s all about the people.

Agents of change, changing agencies
Creating Citizen Researchers as agents of change was a pivotal part of MH2K’s success. A little apprehensive and nervous to begin with, these young researchers flourished because of the project: they learnt more about mental health, they put their faith in some of their ideas about how to combat issues such as stigma, they grew in confidence; with guidance, they developed presentation, listening and basic research skills. Some found that the project helped their recovery following a mental health challenge; others chose to pursue a career in mental health care because of the project. All of them enjoyed themselves; all of them became agents of change.

Importantly, now that MH2K is over, Citizen Researchers will not be left disappear into the ether, nor to teeter on the edge of change. At the outset, Citizen Researchers expressed high expectations for tangible change to occur and for continued involvement beyond the end of the project. MH2K listened: some Researchers will continue to work with Oldham policy-making, charitable and civic organisations, to drive MH2K’s recommendations forward and to shift the ways of Oldham’s agencies to become more inclusive of, and led by, youth.

Diverse young people talking to diverse young people
MH2K’s Citizen Researchers were a truly mixed bunch of 14-25 year olds: Muslim, Christian and atheist, of diverse ethnic heritage, sexualities, learning abilities, and mental health experiences. All shared enquiring minds and a passion for mental health. Young people who took part in the roadshows learnt about mental health and felt listened to too; some changed their beliefs. They opened up to the Citizen Researchers because of who they were: young, their peers, from similar backgrounds. Conversation was informed, frank, and free. Such honesty can be hard to come by when we try to engage people about a difficult topic in a relatively short space of time. But MH2K’s Citizen Researchers nailed it. And Oldham’s mental health horizon is now all the better for it.

Not just diverse young people working together
MH2K assembled a pretty impressive panel of people from varied civic, charitable, healthcare and research organisations to act as advisors for the project and to work hand in hand with the project team and the young people. Because of this process, MH2K’s resulting recommendations benefit from strong buy-in and being approached from all angles. The professional partners in the project report stronger existing collaborations as a result of MH2K, as well as new connections.

A brilliant team
Guided by thinking and methods in youth work, youth leadership and deliberative democracy, the project team were thorough and inclusive from beginning to end. They instilled trust and respect; they worked with empathy, gave space and encouraged expression from others. Importantly, they were able to do so because they planned and appropriately budgeted for a detailed process. Having the commensurate investment of time and energy, as well as knowledge and skills to facilitate engagement was crucial to MH2K’s success.

Co-production or what?
I’ve been asked if MH2K was a co-production project and whether it empowered people. Judge for yourselves. What we did might be called co-creation, co-production, participatory policy-making, participatory decision-making, experience-based co-design, peer-to-peer communication, empowerment. For me, it reinforced the value of lots of different people working together towards a clear and relevant common goal. I’m so proud of the project and all the people involved in it, whether it’s co-production or not.

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Some of MH2K’s Citizen Researchers at work
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Packing punch

This is a guest blog for Invisible Grail whose mission is to bring inspiration, creativity and authenticity to writing and communication for those who work in higher education. Invisible Grail’s passion is nurturing extraordinary professional writing believing that writing could, and should, have a greater impact for everyone in universities – to influence, persuade, negotiate, engage and connect.

Packing a punch

The Medical Director of a Very Important Healthcare Organisation speaks with emphasis, gravitas and lots of clever diagrams. We’re talking health, science, innovation, evidence, data, patient benefit, public trust. Big words, big concepts.

The room feels heavy under the weight of expectation and yet another PowerPoint presentation. The temperamental projector puts pressure on speakers to perform.

My turn next. A dry swallow as I step up to the imposing podium: “I don’t need the projector, thanks.”

An almost imperceptible reaction: the corner of a mouth smirks surreptitiously, a furtive ocular roll strains microscopic tendons, a guttural clearing rises above huddled heads.

My colleague winks.

A pause, then:

My voice quivers,
In rhythmic semi-quavers,
My hand shakes lightly,
I’m sweating ever so slightly,
The words come flowing,
As I recite my poem.

Another pause, then:

A rumble of thunder drums the air, a round of applause rolls in my ears (the first of the day, might I add). My words oxygenate the room; we are revived, inspired (not my words). There’s even an involuntary tear in one eye (not mine).

I’m relieved, of course, that my poem packs a punch. Although maybe I shouldn’t be: it’s my job, after all, to connect academia and people. “Public Engagement” and “Patient and Public Involvement” with health research, is what I do. These non-descript phrases come with equally helpful acronyms: PE and PPI. Are you thinking sweaty gym kits and dodgy payment insurance? I am.

In reality, I’m a scientist and a lover of the written and spoken word. My team and I work daily to creatively plan, design and explain health research hand in hand with patients, communities and marginalised groups. We use writing, poetry, performance, the art of conversation. Even grime.

Except sometimes, I don’t always practice what I preach. I’ve lapsed into buzzword bingo and strategy-speak with the best of them. Reciting my poem is part of a conscious effort to resist relapse. I’ve recently been reminded that metaphors bridge the known and the unknown, the unimaginable and the imaginable; that they are “as necessary to science, as to poetry*”. Important too for our understanding of science: use a blueprint metaphor to teach the complexity of genetics and school students come away with a more deterministic view than if you use a recipe metaphor**.

Poetry and science are fertile cross-pollinators of one another. The magnificent Ada Lovelace, the world’s first computer programmer, discovered the powerful potential of a calculating engine through ‘poetical science’. Both mould themselves with uncertainty running through their veins; they offer surgical insights into the heart of the matter (whatever that might be). Perhaps they achieve this through a shared precision; perhaps my poem acted as a pacemaker to the room because it transfused abstract concepts with detail, human relationships and the relatable world.

In any case, over lunch, the Medical Director of the Very Important Healthcare Organisation, and several others, ask me if they can share my poem with their colleagues, patients, friends, family.

“Yes, yes, yes, please do,” I answer. “But better still, write your own.”

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*Jacob Bronowski, Science and Human Values. 1956
**Heijkoop MEA, The meaning secondary school students ascribe to genomic metaphors. 2013

 

Don’t talk to me (an evidence-based poem)

Don’t talk to me (an evidence-based poem)

Don’t talk to me about facts and figures,
In a way that gives me medical jitters.

I understand evidence, really I do,
But you don’t make it easy, do you?

A bit less, please, jargonese,
And legalese, in PILs and SPCs*.

On paper so transparently thin,
It’s easily thrown into the bin.

Where’s the benefit information?
A risky business, this medication.

I don’t mean to poo poo your peer review,
It’s just… I don’t trust you.

Especially if you’re big pharma,
Face it: you’ve got bad karma.

Help us to talk to you,
We’ve much to offer, too.

Our words are woven,
With experiences, human.

Medical proof can only get better,
Working together, boxing clever.

Don’t talk to me, without my family,
They’re part of my thinking alchemy.

My brother, my sister, by blood or by water,
My mother, my lover, next door’s daughter.

That queue behind me?
I trust them, implicitly, even when we disagree.

And if I’m in a minority,
The queue is much much longer than three.

Don’t talk at me, speak to me,
Tell me a symptomatic story,

Alive with compassion and care,
Some science too, with creative flair,

One proven in life’s laboratory,
Not given to flights of fantasy.

“The plural of stories is culture”;
Testimonies lend us structure,

Narrative data to inform,
Metaphorical and evidential brainstorms.

Don’t tell me: drugs are the only medicine,
Fine fettle is more than a regular regimen.

A roof over my head, a warm comfy bed,
An honest job, that won’t make me sob.

Food in my bowl,
Food for my soul.

Perhaps most importantly?
My other humans in relation to me.

*PILs are Patient Information Leaflets and SPCs are Summary of Product Characteristics, both found in the sheets contained in packets of medicine.

Why I wrote this poem

In response to my week last week, including:

  • Reading the Academy of Medical Sciences‘s report: “Enhancing the use of scientific evidence”. The report highlighted that: only about a third (37%) of the public trust evidence from medical research, compared to approximately two-thirds (65%) who trust the experiences of their friends and family; people are highly sceptical of the role of the pharmaceutical industry in medical research; communication of evidence, including in patient information leaflets, and reference to risk:benefit ratios of medicines, should be clearer and more accessible; patient involvement in medical research should be significantly strengthened. And related blogs from Simon Denegri & the British Medical Journal.
  • Following the #EvidenceLive conference on Twitter, particularly threads relating to patient stories in healthcare and medical research.
  • Reading a peer-reviewed paper focused on how women rely on their social networks to make healthcare decisions when newly diagnosed with breast cancer.
  • Attending an arts and health event, focused on tackling health inequalities through creative collaborations.
  • Reading an interview with Duncan Selbie, Chief Executive of Public Health England
  • Being reminded of Elspeth Murray’s fabulous poem: This is Bad Enough. Read it too.

Top ten tips: diversity and inclusion in public involvement in health research

“A diverse and inclusive public involvement community is essential if research is relevant to population needs and provides better health outcomes for all. We have been struck by the degree to which researchers and public contributors have encountered barriers when trying to work with different communities and populations.”

NIHR Going the Extra Mile

Diversity and Inclusion is the name of the game at the moment – in both public involvement and engagement spheres. And rightly so. My train speeds me towards a meeting addressing the above. Usually (and sensibly) meetings such as these result in requests for practical advice targeted at researchers and engagement practitioners. So, in preparation, I’m reflecting on my experiences and mentally composing my Top Ten Tips:

1. Check your power. First and foremost, acknowledge that engagement and involvement in research operate in a historical and current context of (imbalanced) power relationships between people and research. Even more so if your aim is to work with vulnerable, marginalised groups or those who might not currently engage. My mantra? “Check your privilege & balance fairness” was an inspiring provocation by the philosopher Mark Kingwell at a recent conference I attended. Do what you can to understand the politics of power and authority within your engagement context, your role within that context and how to operate sensitively accordingly.

The reasons for doing engagement and involvement might also be influenced by shifting power dynamics between, for example, funders, researchers, public engagement practitioners and institutions. In my view, engagement activities should seek to positively challenge power imbalances; if they are in danger of being swayed by different power players: clarify, question, challenge the ethics of engagement.

2. “Listen and seek agreement”, Mark Kingwell went on to say. The Wellcome Trust‘s recent #ExpertDebate on Twitter revealed that listening is a vital feature of public engagement. For anyone who subscribes to engagement as dialogue and exchange, this is not new. Dialogue simply does not happen without listening: active listening. We have all experienced the situation where people listen, but carry on regardless. Listen carefully. Then act on what you have heard.

3. Consider the politics of place. Where you engage needs careful consideration. I was reminded of this by a recent passionate discussion online, about whether engagement physically located in institutional settings (in this case, on campus) acts as a barrier to participation. Whilst some consider this a myth, citing productive engagement with various groups in campus settings, campus environments can also be unfamiliar, daunting, territorial, sometimes physically inaccessible and expressions of power dynamics (asking someone to ‘come to you’ being an exertion of authority). Emily Dawson has published widely on how architecture and setting can stop some people from feeling like activities are ‘for them’, and thus limiting the diversity of potential audiences. Agreement focused on the need to work with your target audiences to define where and when activities would be most successful. Universities, hospitals, science centres, libraries, community centres, arts venues, the street, online, social media – the list of places to engage is limited only by your imagination.

Moreover, when engaging with research in the complex health sphere, place-based approaches become attractive by focusing on the social and physical environments of communities rather than on the problems or ‘deficits’ faced by individuals. Typically used in areas of deprivation or need, place-based approaches are bottom-up and asset-based, enabling communities to participate, lead and own activities to address complex issues. The relevance and richness of such approaches may yet challenge the orthodoxy of ‘one size fits all’ engagement.

4. Get from A to B, perhaps via Z. Your engagement objectives may be clearly defined, usually around health-related research content. Yet ‘science’ and ‘health and health research’ are often already emotionally laden and exclusive terms; patients with conditions may prefer not to know. Find another way in, one that builds on social identities or interests unrelated to science or research, and curate some conversations (see point 5). Be prepared not to start where you think is the beginning. Be prepared to have some (perhaps uncomfortable) discussions about the weather, poverty, race, discrimination. Find the common ground and then move forwards. Meander like the rivers I see through my train window: stimulate their source, feed their tributaries and let them flow in the knowledge they will reach their destinations.

5. Collaborate. A rich plethora of creative, community, cultural, charitable, civil society and other organisations exist to engage and have a huge amount of knowledge and expertise. Some specialise in working with particular groups. Find them, work with them to mutual benefit, invest in partnerships. Don’t know where to start? That’s where people like me – and other public engagement practitioners can help. I particularly value working with arts-led organisations. Creative methodologies can be particularly helpful to nurture genuine expression, subvert power and catalyse discussion.

6. Invest in people, Part 1: the people you want to work with, to engage. Understand who they are, their hopes, their fears, their likes, their dislikes and why they might not readily get involved in health. Luckily, there are tools out there to help you, like the British Science Association’s Mosaic and Audience Spectrum research and the Arts Council’s Audience Finder tool). Understand that they might already have negative experiences of (not necessarily health) research and that they might already be over-researched. Or that they might have within them existing or undiscovered passions and talents. Take the time to invest in relationships with people and communities.

7. Invest in People, Part 2: public engagement practitioners, leads and facilitators. There are over 200 of us in the NIHR and many more in Universities, other organisations and working freelance. Two meetings of this workforce at the end of 2017 demonstrated what I knew already: first, that we are incredible polymaths; second, that we are also mostly white, female, and often ex-researchers. Is a “fluffy, human” engagement career what women do when they have “failed” at science (not my words)? And what happens when you Google images of science presenters, or examine the gender balance of senior organisational public engagement roles? We know that representations of women and men in science, engineering and technology largely reproduce dominant gender discourses; what about representations in science communication and public involvement?

If you are in a position to:

  • At the very least, invest in diversity and inclusion, and unconscious bias training for all who engage
  • Seek out and support researchers from diverse backgrounds to engage and involve
  • Curate and savour the mix of your wider public involvement team and stakeholders
  • Avoid the disincentive of short-term contracts for public involvement posts or ‘add-on’ responsibilities to existing posts
  • Think creatively about where your talent could come from next. For the past year, I have had the privilege of working with young adults with creative talents from challenging socioeconomic and health backgrounds. I hope to embed their refreshing ideas and perspectives, and offer them real career prospects by embedding (paid) internships for the most promising of them in our team. Others are doing similar work.

8. Evidence, evaluate, reflect. I’m finding that Theory of Change approaches work well here: as much for evaluation as for strategic planning and stakeholder engagement.

9. Act small, think big. It can be daunting to change the world but a small change can make a big difference. Social change can be effected through small acts of kindness. That transformation in confidence, learning and skills that you have nurtured through your engagement, those more diverse voices that you have supported to be heard in health research, within an individual or groups, can lead to further agency of change.

10. Be values based, socially innovate. The risk with Diversity and Inclusion as an agenda for public involvement is that it becomes (yet another) box-ticking exercise. Working within a values-driven framework may help, as could including the principles of social innovation in our work.

Pills, potions and pongs

Young people want to be involved in clinical research and they have valuable contributions to make. Significant efforts have been made to work with older children in medicines research and development, and initiatives such as GenerationR reach children as young as 8; generally speaking though, few resources and initiatives target younger children.

imageProfessor Hallux’s Miraculous Medicines, a new series of seven 3-minute podcasts produced by me and Fun Kids Radio (with advice from GenerationR, Nuffield Council on Bioethics, young people and scientists), addresses this gap, inspiring 7-12 year olds and their families to think about clinical research. The podcasts explore the what, how and why behind medicines research, and the importance of inclusive conversations. Featuring pills, potions and pongs, journeying via Ancient Egypt, Rome and the modern day, Professor Hallux, Nurse NanoBot and Body set about finding a new medicine for Body’s tummy ache. Fun and informative, the podcasts are broadcast nationally and are free to download to listen at home, in the classroom, healthcare settings and as part of informal learning activities.

We hope that the podcasts stand alone as entertaining listening for children and their families. We’re also particularly interested in how they might be used to support the active involvement of children in clinical research. For example, my local Children’s Clinical Research Facility already has an impressive portfolio of activities to engage younger children with research, including dedicated play specialists to help understand what’s going on, information sheets about each study written specifically for younger age groups, a whole raft of trust- and relationship-building activities; not to mention brand-spanking new treatment and chill-out rooms, co-designed with young people, and featuring their artwork and a ‘roof garden’ with changeable lighting. Currently, however, there is no formal way of actively involving young people and children in designing, planning and carrying out research. We are committed to changing that, as part of the Facility’s future plans, and hope to use the Fun Kids Radio podcasts as stimuli for conversations and collaborations with young people and children.

What’s clear already, is that listening audiences are incredibly interested in young children and research. In the first two weeks of broadcast, Professor Hallux’s podcasts have been viewed over 3,000 times – this is about 25% more than average views for other Fun Kids pages in a similar time period. My colleagues at Fun Kids nearly fell off their chairs at this number (unfortunately, I wasn’t quick-witted enough to record this for comedy sound effects). And over 600 parents have opted in to being contacted by us in the future about children and clinical research.

Please listen to the podcasts here. Please spread the word about them. I would be delighted to know what you think about them – good or bad! – as well as whether they might be useful to you and how. You can drop me a line below or at bella.starling@cmft.nhs.uk.

Happy Listening!

 

 

Science engagement – going global

One of my proudest career achievements was persuading the Wellcome Trust to support biomedical ethics and public engagement internationally*, mainly in low to middle income countries. Arguing the ethical imperative for public engagement as a component of sound research, and the need for equity in public engagement practice across the nations and populations where Wellcome has a research presence, I also strongly believed (and still do) that we, in the UK, have much to learn from public engagement practices in diverse global settings.

I was therefore delighted to re-engage with this international community of practice at the Global Health Ethics and Engagement Network meeting in Kenya in September 2016. Led by the Ethox Centre, the network comprises inspirational ethics and engagement practitioners and researchers from across the globe, including (but not limited to) Wellcome’s global health research centres: Africa Health Research InstituteMahidol Oxford Tropical Research Unit; KEMRI-Wellcome Trust Research Programme; Malawi-Liverpoool-Wellcome Trust Clinical Research Programme; Wellcome Trust Brighton and Sussex Centre for Global Health Research; Oxford University Clinical Research Unit. No less than 60 countries were represented at the meeting.

The meeting explored several themes:

Using as a stimulus the Nuffield Council on Bioethics’s work on Children and Clinical Research, involving young people in research highlighted:

  • The development of a young person’s advisory group to the main research hospital in Cambodia;
  • Ethnographic and social scientific research into children’s understandings of clinical research in Myanmar and Malawi;
  • The extensive schools engagement carried out by KEMRI-Wellcome in Kenya and many other global health research programmes;
  • Research into Kenyan views on if, when and how children should (or shouldn’t) be actively involved in research.

Using contexts from Kenya, Thailand, Vietnam, Malawi and the UK, including examples of engagement with migrant populations, female sex workers, rural communities and undernourished children, the vulnerability theme explored:

  • What constitutes vulnerability in research engagement?
  • What are our moral obligations in terms of engaging vulnerable groups?
  • Are children automatically a vulnerable population?
  • Who is vulnerable? Clearly, some of the people we engage, but also the fieldworkers, engagement practitioners and researchers?
  • Are there transferable ethical and/or practical approaches to engage with vulnerable groups?

Consent is an enduring ethical complexity for both research and engagement practice. Presentations from New Zealand, Uganda, South Africa, Ethiopia, Rwanda and Thailand addressed:

  • What constitutes valid consent and how does engagement contribute to and/or inform the process? For whom (eg. Research Ethics Committees, participants, families and friends, frontline workers, funders, principal investigators)?
  • What are consent and engagement considerations in large-scale health surveillance studies?
  • How do we strengthen the processes for explaining and translating research terminologies and concepts (eg. Placebo, randomisation)?
  • Factors affecting consent to surgical research;
  • Challenges for engagement and consent related to complex research (eg. HIV, genomics);
  • Navigating rumours, stigma and jealousy;
  • Data sharing policies and implications for consent and engagement;
  • Consent and engagement in pragmatic clinical trials (trials that evaluate the effectiveness of interventions in real-life routine practice conditions rather than in ‘optimal’ conditions).

Finally, discussions moved from engagement as an essential part of the ethical conduct of research towards approaches that broaden scientific literacy, promote participatory conversations and ultimately influence research. This included – in both urban and rural areas – the use of science cafes, community debates, film shows, participatory community theatre, spiral walking, radio, puppetry and visual art; the important role played by frontline workers (fieldworkers, engagement practitioners) and their capacity development needs; working with Community Advisory Boards; and much much more.

Witnessing the incredible range and creativity of engagement approaches, often in challenging circumstances was humbling and addressed the spectrum of engagement:

  • Engagement as an essential component of ethical research: for example the Community Advisory Boards that are an integral part of many of global health research groups;
  • Engagement to promote scientific communication, literacy and critical thinking: for example, KEMRI-Wellcome’s extensive schools engagement programme;
  • Science as culture: for example, the creative use of participatory theatre to explore scientific research in rural and urban communities in South East Asia;
  • Engagement informing research: for example, AHRI’s participatory spiral transect walking, listening to communities to inform research programmes before they start.

Reflecting on the meeting, common themes, many with resonance in the UK, also emerged:

  • Engagement and involvement of people in research, with diverse audiences and a variety of methods, is alive and well, globally (though it is by no means common practice everywhere);
  • Some engagement practices across different contexts are similar and/or transferable; others unique to specific settings;
  • The interdisciplinary and thoughtful approach, often evidence-based, ethically and social scientifically informed, taken to engagement in many international settings;
  • There is a growing and thriving community of engagement practice, globally, with whom we, in the UK, should be engaging more.

Nevertheless, common challenges remain, including (again, many with resonance in the UK):

  • How to strategically link the various aspects of engagement across its spectrum of audiences, aims and practices (eg. linking study-specific engagement with, for example, wider cultural initiatives);
  • Securing buy-in from institutional and wider stakeholders about the value of engagement, in all its guises;
  • Active involvement of communities in early and late stages of the research cycle (eg. Setting research agendas, feeding back research results to participants and communities);
  • How to balance making science ‘fun’ and engaging, and taking steps to ensure social responsibility and social justice within engagement with research;
  • Engagement practitioners (eg. Research fieldworkers and creative practitioners) are often in a unique position with multiple responsibilities that require thoughtful management;
  • How to recognise engagement activities, and the learning derived from them, is difficult. Publishing is one option – perhaps, via this blog piece, I can persuade the journals Research for All or Research Engagement and Involvement to consider a special issue in this area? Notwithstanding that it is also important to publish engagement pieces in scientific journals, are there also other alternative ways of recognising value, aside from publication?
  • Engagement can include elements of ‘being a good neighbour’ eg. As an employer and often a healthcare provider within a geographic area, offering ‘collateral’ benefits to local communities such as training courses not directly related to research outputs.

If you want to find out more about engagement with research in low to middle income countries, I encourage you to visit Ethics & Engagement Across the Wellcome Trust Major Overseas Programmes and MeSH – the global health community engagement network, and other online communities (eg. Science Communication Africa’s Facebook page)

Coming to this meeting was undoubtedly one of the highlights of 2016 for me. It also felt like coming home. Thank you for inviting me.

*In 2002, the Wellcome Trust Biomedical Ethics in Developing Countries funding scheme was launched, followed in 2005 by the International Engagement Awards. Funding for international ethics and public engagement activities can now be sought as part of the Humanities and Social Science funding, Public Engagement Fund and Public Engagement within Research grants.

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Junju dispensary, Kilifi District, Kenya. Site of many KEMRI-Wellcome research projects with active community involvement.

 

Engagement & complexity

Complexity seems to be a hot topic right now. The inherent complexity of modern science, complex interventions in healthcare, complex conditions, the complexities of interdisciplinary research.

So, how to engage with complexity? And is engagement complex in itself?

A bit of head scratching, a decent understanding and a lot of creativity helps when engaging with complex science. Narrative, metaphor, visualisation, participation, jelly babies, immersive theatre and making, are just some of the approaches I’ve used and believe to be effective when dealing with complex science. Developing and using such approaches, often in partnership with others, nevertheless requires an understanding of their theoretical and practical complexities (OK, perhaps not for the jelly babies).

And it’s not just the science that’s complex. Engaging with complex science often means dealing with other, equally complex disciplines and perspectives. Take genomics: effective engagement with genomics often marries complex science, with complex social scientific and ethics research.

“Know your audience” is often the first mantra of public engagement. Well, there’s “nowt as strange as folk”. And nowt as complex either. Think inclusively and be ready for people to do things completely differently.

Working across disciplines, practices, audiences and organisations invokes all kinds of expectations, power relationships, agendas, hopes, fears and frustrations. Hopefully, we mediate and adapt, and juggle all these emotional and political balls to create some great engagement. Relationships change, evolve and sometimes can go wrong. Sometimes then, the juggler can be re-cast as the jester.

As public engagement practitioners, we use our inquisitive, analytical and creative minds and skills to understand and navigate all these areas of complexity.

So yes, engagement is also complex. But it’s so worth it!

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Image credit: Centre for Complexity Science, Imperial College London