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Table 2 Considerations for REM

From: Ripple effects mapping: capturing the wider impacts of systems change efforts in public health

Practical considerations when using Ripple Effects Mapping

Preparation

• Spend time working with project staff / implementers to understand the logic by which the intervention is anticipated to work. Seek to understand the broader context that the project is situated within.

• Carefully consider the probing questions for the workshop. These probes will help to gather data that is pertinent to the research question, as well as providing structure for workshop participants.

• Consider who would be most appropriate to facilitate the workshops and to analyse the data; this could be an independent research team, an embedded research team, or members of the implementation team. There are strengths and limitations to each of these approaches.

• It may, or may not, be desirable to have a formal presentation at the beginning of the workshop. Researchers should work with implementers to determine what the preferred / most accessible format is likely to be.

Recruitment

• Work with implementers to invite a broad range of stakeholders (community members, differing sectors, organisations, and levels of seniority) who have been involved in / or affected by the project.

• Use REM outputs to help identify additional wider stakeholders and work with implementers to invite them to future sessions.

• Researchers / workshop facilitators may wish to speak directly with prospective participants to familiarise them with the method prior to their workshop attendance.

• If wider stakeholders are not able to attend, consider using a semi-structured interview to ascertain similar information. This information can then be added to the developing REM output.

Initial REM workshop

• The role of the researcher in the mapping activity is to guide the conversation and to uncover further activities and impacts. This will be a similar role to that of facilitating a focus group discussion.

• It would be useful to have several researchers present in the workshop to facilitate the group-based discussions (i.e., a facilitator per sub-group), especially at the beginning of the mapping when more queries are likely. Facilitators could also be members of the implementation team (e.g., Active Gloucestershire) if provided with sufficient training.

• The initial session could also be completed in an online format dependent on researcher and group preferences or circumstances. If using a face-to-face format, Dictaphones could be used to capture some of the conversation being had whilst stakeholders are creating and discussing the REM output.

Follow up REM workshops

• Identify a mechanism for workshop attendees to record activities and impacts between REM sessions. These notes can then be drawn upon in the REM workshops and ensures key information is not overlooked / forgotten.

• Re-familiarise with the REM output and create a set of questions to elicit further information from participants in the follow up workshop(s).

• Allow the previous REM output to form the basis of the follow up workshop. Seek to update and expand upon this. Ask for updates across all aspects of the REM output to understand which aspects have led to further ripple effects and those which have not.

• Ask to record the workshop if using video-conferencing software (e.g., Microsoft Teams, Zoom, Skype etc.…). This will enable the researcher to revisit the video recording to bolster the REM outputs.

Analysis

• When identifying impact pathways, remember that their purpose is to assist the subsequent analysis. It is likely that the identified pathways may differ between researchers.

• A deductive approach may be useful if a particular theoretical or conceptual framework would help to answer the research questions.