Collective enquiry and reflective action in research: towards a clarification of the terminology.

Moving from evidence-based medicine through knowledge translation into evidence-based practice presents many challenges. Implementation research requires collaboration of researchers and end users to adapt interventions in response to different contexts. Such research progresses iteratively in response to feedback, reflection and then action, using theory of change and interactive response to diversity. The proliferation of terminology used to describe this research genre requires development of a robust taxonomy to categorize overlapping concepts where engagement of end users in the research process is core. Co-design research redresses past power imbalances where typically research was conducted 'on' not 'with' populations. Ethics committees charged with protecting rights and autonomy of study participants need to recognize that in co-design, participants are not being 'done to' but are engaged and active partners in the study design, and hence relax their requirements for pre-specified study protocol and research documents. Determining which stakeholders should be involved, who can legitimately speak for a group, and how to ensure all have adequate input without being overburdened requires respectful ongoing negotiation. Ultimately, participant engagement is a philosophy not a methodology. Paradigm shift from linear strictly defined processes of traditional 'laboratory' research to dynamic approaches adaptive to changing contextual circumstances requires involvement and engagement of end users. This ensures that the evidence generated is relevant and applicable to intended populations, and facilitates sense of ownership in the new knowledge, maximizing its modification and utilization in diverse contexts. Implementing change in response to new information requires enthusiastic champions-none better than those involved in its creation.