Table 1 Definitions and descriptions of key terms

Researcher/catalyst

Researchers who adopt a PLA approach, techniques and mode of engagement act as catalysts – their primary role and responsibility is to elicit diverse stakeholders’ perspectives and facilitate collaborative inter-stakeholder dialogue/action. The researcher/catalyst facilitates, rather than controls, the direction that stakeholder’s perspectives provide to the research process [60].

PLA ‘mode of engagement’

A PLA ‘mode of engagement’ is the essential attitudinal disposition a researcher/catalyst adopts to promote participation, learning and positive action by and with diverse stakeholder groups; the researcher/catalyst listens, enables, supports stakeholder/inter-stakeholder dialogues, which are ideally reciprocal, mutually respectful, co-operative and productive [19, 31]. Where necessary and appropriate, researchers may act as knowledge-brokers, sharing perspectives and insights that emerge from one stakeholder group with the next, thus ‘brokering’ an educative inter-stakeholder dialogue [19, 20].

PLA research methods and techniques

The broad range of qualitative, participatory activities typical of PLA research which combine the verbal, visual and tangible. Verbal activity includes focus groups, interviews, dialogues, debate and negotiation, story-telling, oral histories, role-play and drama. These are usually combined with visual and tangible activity – generating physical maps, charts, diagrams (e.g., Commentary Charts, Direct Ranking, Seasonal Calendars). Stakeholders’ priorities and perspectives guide this participatory engagement process [19, 20. 31, 55, 60].

Meaningful engagement

We draw from the work of Cornwall and Jewkes, [18] Gaventa [21] and Chambers [22] in defining ‘meaningful engagement’ as an experience of partnership in research that is collegial, inclusive and active for participants, reduces asymmetries of power and enables participants’ authentic perspectives to emerge clearly in research outcomes. A PLA mode of engagement, research methods and techniques are intended to support and facilitate meaningful engagement in inter-stakeholder dialogues.

Stakeholder

Drawing from McMaster Health Forum (2015) we describe a stakeholder as an individual, group or organisation that has an interest in the organisation and delivery of healthcare and will have an interest in the content or outcome of a guideline.

Inter-stakeholder dialogue

Drawing from the work of McMaster [81] regarding ‘stakeholder dialogue’, and Pronk [82] and Ashraf [83] regarding ‘multi-stakeholder dialogue’ we describe inter-stakeholder dialogue as a multi-directional dialogue that occurs between/among diverse stakeholders. Diverse stakeholders may coalesce into a single group, or be dispersed across several groups. Inter-stakeholder dialogues focus on a shared goal (e.g. a health issue or problem all stakeholders have a vested interest in addressing/solving). By learning from each other’s perspectives, stakeholders may develop unique understandings or uncover insights related to the issue or problem at hand, generating creative solutions regarding key implementation considerations. This can only come about when relevant stakeholders who are involved in, or affected by decisions related to the issue, work through it together, charting an agreed course of action towards their shared goal.

Transformative moments

During PLA research, transformative moments can occur when stakeholders (working in a group or across several groups) face a seemingly intractable problem and, through dialogue, some stakeholders make a small leap of generosity towards others, thereby resolving the impasse [65, 84].