Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16445103995426
L. Phillips, Maria Bee Christensen-Strynø, Lisbeth Frølunde
{"title":"Arts-based co-production in participatory research: harnessing creativity in the tension between process and product","authors":"L. Phillips, Maria Bee Christensen-Strynø, Lisbeth Frølunde","doi":"10.1332/174426421x16445103995426","DOIUrl":"https://doi.org/10.1332/174426421x16445103995426","url":null,"abstract":"Background: In participatory research approaches, co-researchers and university researchers aim to co-produce and disseminate knowledge across difference in order to contribute to social and practice change as well as research. The approaches often employ arts-based research methods to elicit experiential, embodied, affective, aesthetic ways of knowing. The use of arts-based research in co-production in participatory research is embedded in a contested discursive terrain. Here, it is embroiled in political struggles for legitimacy revolving around what counts as knowledge and whose knowledge counts.Aims and objectives: The aim is to present and illustrate the use of a theoretical framework for analysing the complexities of co-production in the nexus between arts and research – with a focus on the overarching tension between cultivating the collaborative, creative process and producing specific research results. The article maps out the contested discursive terrain of arts-based co-production, and illustrates the use of the theoretical framework in analysis of a participatory research project about dance for people with Parkinson’s disease and their spouses.Methods: The theoretical framework combines Bakhtin’s theory of dialogue, Foucault’s theory of power/knowledge and discourse, Wetherell’s theory of affect and emotion, and work in arts-based research on embodied, affective, aesthetic knowing.Results: The analysis shows how arts-based processes of co-production elicit embodied, emotional, aesthetic knowing and with what consequences for the research-based knowledge and other outputs generated.Discussion and conclusions: Trying to contribute to both research and practice entails navigating in a discursive terrain in which criteria for judging results, outputs and impact are often defined across conflicting discourses.Key messagesThere is a dearth of detailed analyses of the potentials and challenges arising in arts-based co-production.The article offers a theoretical framework for analysing the tension between cultivating collaborative, creative processes and generating specific results.It explores how arts-based co-production elicits embodied, emotional, aesthetic knowing, and with what consequences for the results.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"59 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85083384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16388976414615
P. Atkinson, Ha Sheard, A. Martindale, T. Solomon, Aleksandra J. Borek, C. Pilbeam
{"title":"How did UK policymaking in the COVID-19 response use science? Evidence from scientific advisers","authors":"P. Atkinson, Ha Sheard, A. Martindale, T. Solomon, Aleksandra J. Borek, C. Pilbeam","doi":"10.1332/174426421x16388976414615","DOIUrl":"https://doi.org/10.1332/174426421x16388976414615","url":null,"abstract":"Background: Responses to COVID-19 have invested heavily in science. How this science was used is therefore important. Our work extends existing knowledge on the use of science in the pandemic by capturing scientific advisers’ experiences in real time.Aims and objectives: Our aim was to present generalisable messages on key qualifications or difficulties involved in speaking of ‘following the science’.Methods: Ninety-three interviews with UK scientific advisors and government officials captured their activities and perceptions during the pandemic in real time. We also examined Parliamentary Select Committee transcripts and government documents. This material was analysed for thematic content.Findings and discussion: (1) Many scientists sought guidance from policymakers about their goals, yet the COVID-19 response demonstrated the absence of a clear steer, and a tendency to change course quickly; (2) many scientists did not want to offer policy advice, but rather to provide evidence; and (3) a range of knowledge informed the UK’s pandemic response: we examine which kinds were privileged, and demonstrate the absence of clarity on how government synthesised the different forms of evidence being used.Conclusions: Understanding the reasons for a lack of clarity about policy goals would help us better understand the use of science in policy. Realisation that policy goals sometimes alter rapidly would help us better understand the logistics of scientific advice. Many scientists want their evidence to inform policy rather than determine the options selected. Since the process by which evidence leads to decisions is obscure, policy cannot be said to be evidence-based.Key messagesScientific advisors need to know policy goals, but these can be obscure and changeable.Many scientists want their evidence to inform policy rather than determine the policy selected.Evidence feeds into decisions in obscure ways, so policy cannot be said to be evidence-based.‘Evidence-informed’ policy is a more feasible aim than ‘evidence-based’ policy.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"1 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66287357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16420949265777
Alina Potts, Loujine Fattal, Harriet Kolli
{"title":"Engaging refugee women and girls as experts: co-creating evidence on sexual exploitation and abuse in humanitarian crises using creative, participatory methods","authors":"Alina Potts, Loujine Fattal, Harriet Kolli","doi":"10.1332/174426421x16420949265777","DOIUrl":"https://doi.org/10.1332/174426421x16420949265777","url":null,"abstract":"Background: Humanitarian evidence is produced in settings of heightened power imbalances between research stakeholders. Yet evidence production processes often lack explicit reflection of who is shaping the questions asked and making meaning of the answers.Aims and objectives: Empowered Aid is participatory action research that seeks to mitigate sexual exploitation and abuse (SEA) perpetrated by aid actors. Refugee women and girls in Uganda and Lebanon, as experts on SEA risk, are engaged co-researchers in generating evidence on how to make aid distributions safer.Methods: Diverse creative processes are utilised to co-produce knowledge about SEA risks and strategies to reduce them. These same processes are used to reflect on power dynamics within the research process itself, local gender power dynamics, and structural power dynamics between aid actors and those receiving aid.Findings: Fifty-five Syrian and South Sudanese refugee women and girl co-researchers used ethnographic methods to document their and their peers’ lived experiences of SEA risks while accessing humanitarian aid. Creative methods including drawing, drama, storytelling, community mapping, and body mapping were applied during data collection and qualitative analysis, as well as in reflection and action analysis workshops. SEA was reported across all the types of aid studied, and these findings are being used to adapt aid distribution processes.Discussion and conclusions: Creative and participatory practices can address the barriers, such as illiteracy (including computer illiteracy) and lack of training, often cited as limiting researchers’ ability to share power with affected communities, and allow for greater co-production of knowledge and evidence.Key messagesEvidence production processes require reflection on who shapes the questions and participates in answering them.Creative, participatory practices support co-production of knowledge and evidence with marginalised groups.Co-producing knowledge about violence with those most affected by it creates actionable evidence to reduce risks.Refugee women and girls are experts in contextual safeguarding.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"223 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66287711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16436512504633
C. Grindell, T. Sanders, R. Bec, Angela Mary Tod, D. Wolstenholme
{"title":"Improving knowledge mobilisation in healthcare: a qualitative exploration of creative co-design methods","authors":"C. Grindell, T. Sanders, R. Bec, Angela Mary Tod, D. Wolstenholme","doi":"10.1332/174426421x16436512504633","DOIUrl":"https://doi.org/10.1332/174426421x16436512504633","url":null,"abstract":"Background: Co-production, co-creation and co-design are increasingly used in healthcare research knowledge mobilisation. These methods have grown in popularity and the broad range of approaches are often used without any formal evaluation. The challenges to using these approaches are well reported yet there is little evidence on how to overcome them or how they work. This study evaluates ‘creative co-design’, a design-led, solutions-focused process developed specifically as a means to mobilise knowledge in healthcare.Aims and objectives: To investigate the impact of creative co-design on the knowledge mobilisation process. To understand how it impacts on the application of research knowledge in routine clinical practice.Methods: Semi-structured interviews were carried out with 20 participants from 14 projects. Data were analysed using the Framework approach. A workshop involving the first 10 participants was held prior to the final interviews and analysis.Findings: The findings indicate that creative co-design successfully facilitates knowledge mobilisation in healthcare. This is represented by three interconnected themes: creative and visual; design-led; and creating the right conditions.Discussion and conclusions: The themes highlight how the approach supports engagement and creates a safe space for knowledge sharing and synthesis in a non-hierarchical environment. This study contributes important insights into how creative co-design can mobilise knowledge in healthcare. Further evaluation is warranted to help it develop into a recognised and effective method for research implementation and service improvement.Key messagesCreative co-design was perceived to be a successful knowledge mobilisation approach.Creative and visual tools enhanced engagement and innovation.Involving a designer was key and is recommended in co-production projects.Creating a safe space balanced power and voice.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"59 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82081672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16478737939339
Stephen MacGregor, Amanda Cooper, Michelle Searle, T. Kukkonen
{"title":"Co-production and arts-informed inquiry as creative power for knowledge mobilisation","authors":"Stephen MacGregor, Amanda Cooper, Michelle Searle, T. Kukkonen","doi":"10.1332/174426421x16478737939339","DOIUrl":"https://doi.org/10.1332/174426421x16478737939339","url":null,"abstract":"Background: Interest in using arts-informed approaches within research to increase stakeholder engagement is growing; however, there is little work describing how these approaches are operationalised across contexts. This article addresses that gap by exploring the use of arts-informed approaches across three projects.Aims and objectives: We explore how conceptualising research and evaluation as creative endeavours, particularly in arts-informed approaches to co-production, create opportunities to move knowledge into action (knowledge mobilisation). We propose an actionable configuration of context + mechanism = outcome (CMO) to understand the influence of arts-informed approaches to co-production.Methods: Multi-case design and cross-case synthesis was conducted of three studies that used arts-informed approaches. A common focus across our cases was evidence use in the K-12 education sector; however, each engaged with this focus by involving different types of evidence and sets of education stakeholders.Findings: Arts-informed approaches and co-production were influenced by a variety of contextual factors such as relationships between researchers and stakeholders, ethical issues of collaborative research activities, approaches to meaningful stakeholder engagement, co-production of knowledge, capacity-building support and resources, and communication between multi-stakeholder partners. Outcomes included new ways of thinking about research topics based on arts-informed approaches, more positive attitudes about co-production, more relevant and useful research and evaluation findings, and increased openness to future co-productive work.Discussion and conclusions: Four propositions arising from this article include: (1) arts-informed approaches address context specificity and sensitivity; (2) arts-informed approaches promote engagement; (3) arts-informed approaches enhance and intertwine skills; (4) arts-informed approaches broaden thinking about impact.Key messagesArts-informed approaches address context specificity and sensitivity.Arts-informed approaches promote engagement.Arts-informed approaches enhance and intertwine skills.Arts-informed approaches broaden thinking about impact.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"17 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84105954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16448353303856
K. Moerschel, Peter von Philipsborn, B. Hawkins, E. McGill
{"title":"Evidence-related framing in the German debate on sugar taxation: a qualitative framing analysis and international comparison","authors":"K. Moerschel, Peter von Philipsborn, B. Hawkins, E. McGill","doi":"10.1332/174426421x16448353303856","DOIUrl":"https://doi.org/10.1332/174426421x16448353303856","url":null,"abstract":"Background: Taxation of sugar and sugar-sweetened beverages is considered a key policy for improving population-level nutrition. Implementation is influenced by the way evidence is used and framed in public debates. At this time, no sugar tax has been implemented in Germany.Aims and objectives: This study aims to deepen the understanding of the political dynamics that influence the adoption of sugar taxes by analysing the use of evidence in the German media debate on sugar taxation and comparing its findings with analyses from other countries.Methods: In 114 German newspaper articles, published between 01/2018 and 03/2019, we analysed the use and framing of evidence with an abductive thematic analysis approach. We compared our findings with analyses on the framing around sugar taxation from Mexico, the US and the UK.Findings: Evidence was a salient component of the German debate. As in the comparison countries, evidence was used by both tax proponents and opponents but framed differently, for example, regarding problem definitions. However, the German debate relied more strongly on examples from other countries and less on economic arguments.Discussion and conclusions: Our findings suggest that German tax proponents should proactively consider economic arguments and counter spurious arguments made by tax opponents. Researchers should be aware of their work’s potential international spillover effects, and public health advocates should correct expectations regarding the evidence on, and health effects of, isolated measures against obesity. To deepen the understanding of the German policy process, further research should involve social media, public documents and stakeholder networks.Key messagesEvidence was used differently by tax proponents and opponents in the German, Mexican, US and UK sugar tax debates.Economic arguments were less salient in the German debate but should be considered proactively by public health actors.Tax examples from other countries were important in the German debate.Tax advocates should correct expectations on the impact and evidence of isolated measures against obesity.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"129 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85281948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16420918447616
K. Oliver, Anna Hopkins, A. Boaz, S. Guillot-Wright, P. Cairney
{"title":"What works to promote research-policy engagement?","authors":"K. Oliver, Anna Hopkins, A. Boaz, S. Guillot-Wright, P. Cairney","doi":"10.1332/174426421x16420918447616","DOIUrl":"https://doi.org/10.1332/174426421x16420918447616","url":null,"abstract":"Background: To improve the use of evidence in policy and practice, many organisations and individuals seek to promote research-policy engagement activities, but little is known about what works.Aims and objectives: We sought (a) to identify existing research-policy engagement activities, and (b) evidence on impacts of these activities on research and decision making.Methods: We conducted systematic desk-based searches for organisations active in this area (such as funders, practice organisations, and universities) and reviewed websites, strategy documents, published evaluations and relevant research. We used a stakeholder roundtable, and follow-up survey and interviews, with a subset of the sample to check the quality and robustness of our approach.Findings: We identified 1923 initiatives in 513 organisations world-wide. However, we found only 57 organisations had publicly-available evaluations, and only 6% (141/2321) of initiatives were evaluated. Most activities aim to improve research dissemination or create relationships. Existing evaluations offer an often rich and nuanced picture of evidence use in particular settings (such as local government), sectors (such as policing), or by particular providers (such as learned societies), but are extremely scarce.Discussion and conclusions: Funders, research- and decision-making organisations have contributed to a huge expansion in research-policy engagement initiatives. Unfortunately, these initiatives tend not to draw on existing evidence and theory, and are mostly unevaluated. The rudderless mass of activity therefore fails to provide useful lessons for those wishing to improve evidence use, leading to wasted time and resources. Future initiatives should draw on existing evidence about what works, seek to contribute to this evidence base, and respond to a more realistic picture of the decision-making context.Key messagesThere has been a huge expansion in research-policy engagement initiatives.These are mostly poorly described, specified, and evaluated.The lack of strategy may lead to significant harms (for example, increased competition, wasted time and resources).Future initiatives should draw on and build the existing evidence about what works.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"1 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66287832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16426978266831
Christiane Gerblinger
{"title":"Peep show: a framework for watching how evidence is communicated inside policy organisations","authors":"Christiane Gerblinger","doi":"10.1332/174426421x16426978266831","DOIUrl":"https://doi.org/10.1332/174426421x16426978266831","url":null,"abstract":"Background: Seeing how governments formulate decisions on our behalf is a crucial component of their ability to claim democratic legitimacy. This includes being seen to draw on the knowledge and evidence produced by their civil service policy advisers. Yet much of the advice provided to governments is being increasingly withdrawn from public accessibility.Aims and objectives: To counter this diminishing transparency, I propose a framework for observing how evidence is made and used in the political decision-making process. Although my framework is constructed within the Australian context, I hope to encourage its use in other government and policy settings.Methods: Using an example from my own research into the language of rejected policy advice, I construct a framework for locating how policy actors formulate and communicate their evidence. With primary material drawn from Freedom of Information releases, my framework qualitatively examines three impact factors with which to situate policy advice: text, organisational influences and the interplay between the front and back regions of politics and policy. To counter releases’ limitations, they are contextualised with publicly available, contemporaneous statements.Findings: Text displayed excessive detail, inviting multiple interpretations. Organisational influences suggested an insular culture over-reliant on its reputation. Interplay linked to evidence as ostensibly authority-imparting but ultimately adding to the lack of transparency around how political decisions were made.Discussion and conclusions: Even when processes are hidden from public view, they can be found. By connecting an array of impact factors, my framework here illuminated a complex choreography of civil servants communicating with their government about a contentious policy issue and revealed the political affordances they enabled in the process.Key messagesIt is difficult to observe how policy knowledge is constructed and if or how it informs political decision making.Interviews and ethnographic research have been recommended as ways to understand the inner workings of policy organisations – but these are not always possible (or reliable), especially for researchers who want to qualitatively examine politically uncomfortable policy issues.To counter diminishing transparency, I propose a framework for getting closer to watching how evidence is made and used, which includes analyses of texts, organisational culture, and the interplay between policy and politics.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"1 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66287849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16478821515272
Joe Langley, N. Kayes, I. Gwilt, Erna Snelgrove-Clarke, Sarah Smith, C. Craig
{"title":"Exploring the value and role of creative practices in research co-production","authors":"Joe Langley, N. Kayes, I. Gwilt, Erna Snelgrove-Clarke, Sarah Smith, C. Craig","doi":"10.1332/174426421x16478821515272","DOIUrl":"https://doi.org/10.1332/174426421x16478821515272","url":null,"abstract":"<jats:p> </jats:p>","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"1 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76243335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence & PolicyPub Date : 2022-01-01DOI: 10.1332/174426421x16448363973807
Lucia Rocca-Ihenacho, C. Yuill, Ellen Thaels, Nazihah Uddin
{"title":"The Midwifery Unit Self-Assessment (MUSA) Toolkit: embedding stakeholder engagement and co-production of improvement plans in European midwifery units","authors":"Lucia Rocca-Ihenacho, C. Yuill, Ellen Thaels, Nazihah Uddin","doi":"10.1332/174426421x16448363973807","DOIUrl":"https://doi.org/10.1332/174426421x16448363973807","url":null,"abstract":"Background: For women with straightforward pregnancies midwifery units (MUs) are associated with improved maternal outcomes and experiences, similar neonatal outcomes, and lower costs than obstetric units. There is growing interest and promotion of MUs and midwifery-led care among European health policymakers and healthcare systems, and units are being developed and opened in countries for the first time or are increasing in number. To support this implementation, it is crucial that practice guidelines and improvement frameworks are in place, in order to ensure that MUs are and remain well-functioning.Aims and objectives: This project focused on the stakeholder engagement and collaboration with MUs to implement the Midwifery Unit Self-Assessment (MUSA) Tool in European MUs. A rapid participatory appraisal was conducted with midwives and stakeholders from European MUs to explore the clarity and usability of the tool, to understand how it helps MUs identifying areas for further improvement, and to identify the degree of support maternity services need in this process.Key conclusions: Engagement and co-production principles used in the case studies were perceived as empowering by all stakeholders. A fresh-eye view from the external facilitators on dynamics within the MU and its relationship with the obstetric unit was highly valued. However, micro-, meso- and macro-levels of organisational change and their associated stakeholders need to be further represented in the MUSA-Tool. The improvement plans generated from it should also reflect these micro-, meso- and macro-level considerations in order to identify the key actors for further implementation and integration of MUs into European health services.Key messagesEngagement and co-production principles used in the case studies were perceived as empowering by all stakeholders.A fresh-eye view from the external facilitators were highly valued by stakeholders.Micro-meso-macro levels of change need to be further represented in the MUSA-Tool.The high impact actions need to reflect the micro-meso-macro levels to identify the correct players.","PeriodicalId":51652,"journal":{"name":"Evidence & Policy","volume":"25 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90513245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}