Integrating research evidence in humanitarian health responses: Analysing power and knowledge negotiation using the adapted Extended Normalization Process Theory

Background: People living in settings affected by conflicts face insecurity and live in fragmented social systems. Conducting research in these settings is essential, however integrating results into practices is complex. Implementation science tools are not used often in such environments. In this paper we explore how a convenience sample of interviewees experienced implementation in these settings, through the lens of the adapted Extended Normalization Process Theory (a-ENPT). Methods: We conducted in-depth interviews with 26 participants (donors, academics, and humanitarian actors). We assessed what key issues interviewees met and how they negotiated them. We combined an inductive thematic analysis to identify implementation issues, and we applied the a-ENPT deductively to question power imbalances, engaging a group of humanitarian actors as co-authors along the way. Results: The main challenges met by interviewees related to a) engaging frontline actors to produce knowledge; b) discussing the results critically; c) integrating research results in constrained learning spaces; and d) managing contextual instabilities in settings affected by conflicts. Interviewees negotiated these constraints through an early involvement of frontline actors, an institutional support, a meaningful engagement of communities, and balanced partnerships. Based on these findings we propose a tool to anticipate the power imbalances embedded in the implementation of research results in settings affected by conflicts, rooted in the a-ENPT constructs. Conclusion: We identified mechanisms that allowed for the negotiation of important challenges and power imbalances, through an implementation science tool. Further research should focus on the perspectives of communities affected themselves.