Engaging stakeholders in the development of a mixed method systematic review in the domain of humanitarian aid

Background and objectives: In order to improve handwashing and sanitation practices in low and middle income countries (LMICs), a range of programs to promote behaviour change have been designed. It is not always clear to policy makers which of these approaches is the most effective on learning outcomes, behaviour change and health outcomes, and a mixed methods systematic review (MMSR) was initiated (funded by 3ie/WSSCC). Since this subject is important to policy makers, program developers and end-users, it is very relevant to engage these different stakeholders throughout the different steps of the MMSR, so that context is taken into account as much as possible. We organized discussion groups with a heterogeneous group of stakeholders to develop a theoretical model, as part of the MMSR process, to try and understand how the interventions under study would work out in practice and what the potential mechanisms are that may influence the causal chain developed. Methods: The research team is composed of methodological experts (systematic review, qualitative research) and a topical expert in WASH (Water, Sanitation and Hygiene) behaviour change. In addition to the team members, an Advisory Group was composed by recruiting relevant stakeholders with the following profile: a methodologist (experienced in program implementation in vulnerable populations), WASH experts, a policy maker, end users, and a representative of the donor community. The majority of topical experts and end-users were from LMICs, i.e. Sub-Saharan Africa and South Asia. In order to engage stakeholders in the different steps of the MMSR, we organized discussion groups as part of the mixed methods methodology. Stakeholders were consulted throughout the different steps of the MMSR, via electronic means and through two face-to-face meetings, including one in the preparatory phase (protocol development), and one (future meeting) in the final phase of the project (data interpretation + formulating recommendations based on evidence gathered from the MMSR). Results: The qualitative findings generated from the first face-to-face stakeholder meeting resulted in agreed definitions that are relevant for practice, a refined Theory of Change model sensitive to our target group, and improved research questions and selection criteria. This led to an improved version of the MMSR protocol, , which was initially drafted by researchers with a methodological focus, and now contains greater awareness of the context (http://www.campbellcollaboration.org/lib/project/366/). The second stakeholder meeting aims to translate the findings of the SR into practical implications for policy. Conclusion and discussion: Discussion with the different stakeholders throughout our review process resulted in a review that is more sensitive to the needs of those involved in delivering and financing promotional interventions. Involving stakeholders in the development of the MMSR also created a sense of ownership and stakeholder buy-in, which is important from the point of view of promoting our (future) findings among their network and to facilitate capacity building. Keywords: mixed methods systematic review, stakeholder consultationstatus: publishe