Proliferating interest in Life Course Intervention Research (LCIR) has led to an increasing need to train researchers to incorporate life course-focused thinking, skills, and methodologies into their intervention studies. To do so, it is necessary to identify the knowledge, skills, tools, relational capacities, and values (ie, core competencies) required for LCIR. The purpose of the current paper is to describe the process and results of an iterative and collaborative methodology for developing the LCIR competencies. The resulting 29 competencies are organized across 5 domains, each representing a different stage of the LCIR process: (1) understanding Life Course Health Development and LCIR; (2) developing LCIR questions and standards of scientific evidence; (3) designing life course interventions (LCIs); (4) implementing and evaluating LCIs; and (5) disseminating, translating, and promoting scalability and sustainability of LCIs. We also discuss 12 competencies that comprise 3 crosscutting themes that are applicable to all the aforementioned domains. The breadth and depth of competences required to undertake this work suggests the need for a team-based approach. We report the results of a Modified Delphi approach for gauging initial expert support for the competencies (n = 28). Next steps for continuing to advance these competencies are also discussed.
There has been a surge of research in the past decade emphasizing the importance of life course intervention research (LCIR) for health-promotion, research, and policy. As a result, there is a need to develop core life course competencies for intervention researchers. These developments will spur the next generation of LCIR scientists, practitioners, and educators.
LCIR is a rapidly evolving discipline, developed out of the fields of life course health science and Life Course Health Development (LCHD).1 Life course health science integrates the extensive literature on early brain development, childhood trauma and adversity, epigenetics, developmental psychology, mental health, and other health-related disciplines. The life course health sciences field acknowledges that early development is critical for adult health outcomes (ie, development origins of adult disease [DoAD]), but also emphasizes the continuous nature of development. The discipline of life course health sciences has led to the increased need for theoretical frameworks to organize and guide our increasingly complex and nuanced understanding of development.2
In response, over the past 2 decades, a model for LCHD has been proposed.2–4 This model represents a conceptual framework for organizing the role of multilevel risk and protective factors in influencing health trajectories. Burgeoning interest in applying these frameworks has paved the way for the field of LCIR.
LCIR is grounded in several core tenets. First, LCIR is focused on altering life course trajectories, rather than short-term outcomes, related to health, development, and well-being. LCIR centers on identifying strategies for manipulating risk and protective factors across levels, including systems, families, individuals, and generations. Second, LCIR emphasizes the importance of the timing of exposure to risk and protective factors. It also prioritizes the role of transitions and turning points across the life course. As a result, LCIR seeks to identify the most impactful leverage opportunities for interventions. Third, LCIR prioritizes the critical importance of contextual factors in research, which facilitates the promotion of equity and stakeholder-researcher collaborations. Finally, the field of LCIR has a strong applied focus, emphasizing the application of these tenets for developing, implementing, evaluating, scaling, and disseminating research on health-promoting interventions.5,6 Given the complex and multifaceted nature of LCIR, there is a need to develop LCIR-focused training and educational frameworks.
The Current Paper
The current paper seeks to outline LCIR knowledge, skills and tools, relational capacities, and values (core competencies) that should be emphasized in LCIR training. This work will inform the development of training opportunities and educational materials for the next generation of LCI researchers. The current paper will describe an iterative and collaborative methodology for developing the competencies and present the competencies, with the broader goal of laying the foundation for training and education. The competencies outlined here will continue to evolve along with the field.
Methods
Funded by the Health Resources and Services Administration, Maternal and Child Health Bureau, the Life Course Intervention Research Network (LCIRN) is a collaborative national research network that seeks to identify opportunities for developing, implementing, and evaluating new approaches to interventions that can create disruptive and transformational change in health outcomes.
Sample
The LCIRN is comprised of the following entities. The National Coordinating Center (NCC), based at the University of Los Angeles, which includes researchers, clinicians, and administrators with expertise in LCIR, as well as in medicine, developmental psychology, education, and public health. The NCC coordinates activities across the Network, which includes a steering committee, an advisory committee, and network members.
The steering committee is comprised of a strategically selected group of experts who are actively involved in the development and function of the network by overseeing collaborative working groups focused on key areas of LCIR (research nodes). The advisory committee is comprised of a diverse group of content experts, including researchers, practitioners, policymakers, methodologists, and parent and family representatives, who provide subject-matter expertise to the network. Network members are researchers, practitioners, and other individuals across the United States who are invested in the field of LCIR. Each of these entities was involved in the LCIRN competency development process. In the current study, we engaged a subsample of the 70 individuals from across these entities (n = 28) to provide initial input on the competencies.
Procedure
The LCIR competency development process included 3 key methodological steps: (1) ideation and design; (2) literature review and synthesis; and (3) network engagement.
Ideation and Design
First, the NCC extracted key ideas from the Life Course Health Development Handbook, focusing on foundational principles of LCHD and LCIR, to inform the first draft of the competencies.2 Using these principles as a foundation for generating conversation, the NCC engaged the steering committee in virtual collaborative brainstorming and ideation sessions. This step aimed to solicit expert input regarding the key knowledge, tools and skills, relationship capacities, and values that are important for the field of LCIR. The NCC organized this information into an outline of initial competencies and expanded the outline via the literature review and synthesis phase.
Literature Review and Synthesis
Building from the initial competencies, the NCC conducted a targeted literature review and environmental scan to identify synergistic frameworks that would continue to advance the competencies. Such frameworks included other competency frameworks, such as the learning health system competencies, which outlined 7 domains: (1) systems science; (2) research questions and standards of scientific evidence; (3) research methods; (4) informatics; (5) ethics of research implementation in health systems; (6) improvement and implementation science; and (7) engagement, leadership, and research management.7 Another framework that was instrumental to the development process was the doctoral student health system researcher competencies that emphasized the importance of mastering bundles of competencies, rather than specific, piecemeal, individual competencies.8
The NCC also reviewed a range of interdisciplinary training resources. These included dissemination and implementation research training resources that emphasized the integration of researcher and practitioner perspectives9 and the Maternal and Child Health Leadership Competencies (Version 4.0) that outlined the knowledge, skills, personal characteristics, and values to improve the health of vulnerable populations.10
Given the vast array of competencies gleaned up to this point, it became clear that individuals are unlikely to possess all of the knowledge, tools, skills, relationships, and values required for carrying out complex and multifaceted research. Rather, it was evident that we needed to conceptualize the competencies as capacities available within teams or working groups. As a result, the NCC also reviewed toolkits focused on the importance of diverse interdisciplinary and transdisciplinary teams11 ; the competencies for effective interdisciplinary team functioning12 ; and other key ideas from team science.13
Network Engagement
Based on the competencies identified from the first 2 steps, the NCC subsequently engaged with the full LCIRN membership, including the steering committee, the advisory committee, and the network members. This process involved an abbreviated Modified Delphi process, meant to gauge initial support for the competencies among 70 network members. Network members were asked to participate in Qualtrics surveys to rate the extent to which the competencies are impactful, comprehensive, and have the potential to address health disparities. There were 28 responses, generating a response rate of 40%.
Results
Data gathered through our methods led to the development of 29 core competencies organized by 5 domains, each representing a different stage of the LCIR process (Table 1): (1) understanding LCHD and LCIR; (2) developing LCIR questions and standards of scientific evidence; (3) designing LCIs; (4) implementing and evaluating LCIs; and (5) disseminating, translating, and promoting scalability and sustainability of LCIs. There are also 12 competencies that reflect crosscutting themes that apply across all 5 competency domains (Table 2). The participant characteristics for the LCIRN subsample (n = 28) who provided initial feedback on the competencies are presented in Table 3. The findings from the Modified Delphi process with this subsample are presented in Table 4.
LCIRN Competencies
| Domain | Competency |
| 1 Understanding LCHD | Knowledge and comprehension of LCHD–in theory, research, and practice |
| 1.1 | Demonstrate knowledge and comprehension of the principles of LCHD, (ie, health development, unfolding, complexity, timing, plasticity, thriving, and harmony) and related frameworks |
| 1.2 | Demonstrate the capacity to integrate conceptual frameworks from a range of related and complementary disciplines (eg, developmental psychology, economics, systems science, medical anthropology etc) |
| 1.3 | Demonstrate familiarity with large, longitudinal, and/or population-level datasets as a means to gain an understanding of development and intergenerational cycles of risk and protective factor transmission |
| 1.4 | Demonstrate an understanding of systems (health care, social services, education, etc.), including how systems function, the current research and practice gaps, and opportunities to address these gaps |
| 2 LCIR Questions and standards of scientific evidence | The capacity to generate research questions relevant to diverse stakeholders and evaluate the usefulness of scientific evidence and insights |
| 2.1 | Demonstrate the ability to develop research questions that address timing, transitions, and turning points across the lifespan |
| 2.2 | Demonstrate the ability to develop and prioritize research questions in collaboration with relevant stakeholders (individuals, families, clinicians, communities, policy makers) |
| 2.3 | Demonstrate the ability to critically analyze and assess the strength of available scientific evidence to craft well-informed research questions |
| 2.3a | To be able to identify gaps in the literature to identify potential opportunities for life course intervention research |
| 2.3b | To be able to identify promising existing interventions that could be adapted to scale or bundled for greater impact |
| 3 Designing LCIs | The capacity to design intervention research in accordance with life course principles utilizing collaborative methods, strong project management strategies, and robust measurement approaches |
| 3.1 | Demonstrate the ability to apply theory and conceptual models in the design of life course intervention research |
| 3.1a | Demonstrate the capacity to design interventions that consider the timing of measurement, transitions, and turning points |
| 3.1b | Demonstrate the ability to consider optimal scale and sustainability, taking into account limitations on resources, funding, and capacity |
| 3.2 | Demonstrate the capacity to engage in stakeholder codesign and consensus building |
| 3.3 | Demonstrate key abilities pertaining to project management, including the capacity to foresight, vision-set, and identify aspirational goals for proposed interventions |
| 3.4 | Demonstrate the ability to develop theories of change and logic models |
| 3.5 | Demonstrate knowledge and comprehension of research methods, particularly those that are conducive to life course intervention research, including longitudinal research methods, experimental, and quasi-experimental design, and mixed methods research |
| 3.5a | Demonstrate the capacity to use, create, and refine novel holistic developmental measures and population-level tools |
| 4 Implementing and evaluating LCIs | The capacity to conduct, implement, and evaluate life course intervention research studies and apply implementation and improvement science theory and methods |
| 4.1 | Demonstrate knowledge and comprehension and the capacity to apply principles of improvement and implementation science to understanding and addressing systems-level challenges |
| 4.2 | Demonstrate the ability to implement research methods conducive to life course intervention research, including mixed methods approaches, longitudinal design, and experimental, and quasi-experimental design |
| 4.2a | Demonstrate the capacity to build in process-oriented performance measures to evaluate the codesign process |
| 4.2b | Demonstrate the ability to use existing databases to track complex life course trajectories over time |
| 4.3 | Demonstrate the capacity to use life course-oriented data analytic methods, including modeling longitudinal change that captures intra and interindividual trajectories, appropriate missing data protocols, and latent variable approaches |
| 4.4 | Demonstrate the capacity to implement and evaluate intervention research across multiple academic and/or community institutions |
| 4.5 | Demonstrate the capacity to promote scalability and sustainability by developing approaches that reflect the needs and priorities of the population and the nuances and complexities of the system in which the intervention is embedded. This includes stakeholder codesign and human-centered design |
| 5 Disseminating, translating, and promoting scalability and sustainability | The capacity to disseminate LCI research findings to diverse audiences and identify strategies to scale them into population-level interventions and practices across disciplines |
| 5.1 | Demonstrate the capacity to translate LCIR findings into actionable recommendations |
| 5.1a | Demonstrate the ability to translate LCI findings with transparency—that is, to document and report on the intervention design process to support other researchers in furthering this work |
| 5.2 | Demonstrate the ability to communicate research findings to cross boundaries in terms of recognizing crossdisciplinary implications from research studies and communicating with diverse audiences (eg, clinical, research, lay person, etc) |
| 5.2a | Demonstrate the ability to use diverse mediums to communicate findings (eg, written, verbal, etc) |
| 5.3 | Demonstrate the capacity to identify opportunities to scale or bundle previously tested interventions or intervention studies to enhance the scalability and sustainability of these approaches |
| Domain | Competency |
| 1 Understanding LCHD | Knowledge and comprehension of LCHD–in theory, research, and practice |
| 1.1 | Demonstrate knowledge and comprehension of the principles of LCHD, (ie, health development, unfolding, complexity, timing, plasticity, thriving, and harmony) and related frameworks |
| 1.2 | Demonstrate the capacity to integrate conceptual frameworks from a range of related and complementary disciplines (eg, developmental psychology, economics, systems science, medical anthropology etc) |
| 1.3 | Demonstrate familiarity with large, longitudinal, and/or population-level datasets as a means to gain an understanding of development and intergenerational cycles of risk and protective factor transmission |
| 1.4 | Demonstrate an understanding of systems (health care, social services, education, etc.), including how systems function, the current research and practice gaps, and opportunities to address these gaps |
| 2 LCIR Questions and standards of scientific evidence | The capacity to generate research questions relevant to diverse stakeholders and evaluate the usefulness of scientific evidence and insights |
| 2.1 | Demonstrate the ability to develop research questions that address timing, transitions, and turning points across the lifespan |
| 2.2 | Demonstrate the ability to develop and prioritize research questions in collaboration with relevant stakeholders (individuals, families, clinicians, communities, policy makers) |
| 2.3 | Demonstrate the ability to critically analyze and assess the strength of available scientific evidence to craft well-informed research questions |
| 2.3a | To be able to identify gaps in the literature to identify potential opportunities for life course intervention research |
| 2.3b | To be able to identify promising existing interventions that could be adapted to scale or bundled for greater impact |
| 3 Designing LCIs | The capacity to design intervention research in accordance with life course principles utilizing collaborative methods, strong project management strategies, and robust measurement approaches |
| 3.1 | Demonstrate the ability to apply theory and conceptual models in the design of life course intervention research |
| 3.1a | Demonstrate the capacity to design interventions that consider the timing of measurement, transitions, and turning points |
| 3.1b | Demonstrate the ability to consider optimal scale and sustainability, taking into account limitations on resources, funding, and capacity |
| 3.2 | Demonstrate the capacity to engage in stakeholder codesign and consensus building |
| 3.3 | Demonstrate key abilities pertaining to project management, including the capacity to foresight, vision-set, and identify aspirational goals for proposed interventions |
| 3.4 | Demonstrate the ability to develop theories of change and logic models |
| 3.5 | Demonstrate knowledge and comprehension of research methods, particularly those that are conducive to life course intervention research, including longitudinal research methods, experimental, and quasi-experimental design, and mixed methods research |
| 3.5a | Demonstrate the capacity to use, create, and refine novel holistic developmental measures and population-level tools |
| 4 Implementing and evaluating LCIs | The capacity to conduct, implement, and evaluate life course intervention research studies and apply implementation and improvement science theory and methods |
| 4.1 | Demonstrate knowledge and comprehension and the capacity to apply principles of improvement and implementation science to understanding and addressing systems-level challenges |
| 4.2 | Demonstrate the ability to implement research methods conducive to life course intervention research, including mixed methods approaches, longitudinal design, and experimental, and quasi-experimental design |
| 4.2a | Demonstrate the capacity to build in process-oriented performance measures to evaluate the codesign process |
| 4.2b | Demonstrate the ability to use existing databases to track complex life course trajectories over time |
| 4.3 | Demonstrate the capacity to use life course-oriented data analytic methods, including modeling longitudinal change that captures intra and interindividual trajectories, appropriate missing data protocols, and latent variable approaches |
| 4.4 | Demonstrate the capacity to implement and evaluate intervention research across multiple academic and/or community institutions |
| 4.5 | Demonstrate the capacity to promote scalability and sustainability by developing approaches that reflect the needs and priorities of the population and the nuances and complexities of the system in which the intervention is embedded. This includes stakeholder codesign and human-centered design |
| 5 Disseminating, translating, and promoting scalability and sustainability | The capacity to disseminate LCI research findings to diverse audiences and identify strategies to scale them into population-level interventions and practices across disciplines |
| 5.1 | Demonstrate the capacity to translate LCIR findings into actionable recommendations |
| 5.1a | Demonstrate the ability to translate LCI findings with transparency—that is, to document and report on the intervention design process to support other researchers in furthering this work |
| 5.2 | Demonstrate the ability to communicate research findings to cross boundaries in terms of recognizing crossdisciplinary implications from research studies and communicating with diverse audiences (eg, clinical, research, lay person, etc) |
| 5.2a | Demonstrate the ability to use diverse mediums to communicate findings (eg, written, verbal, etc) |
| 5.3 | Demonstrate the capacity to identify opportunities to scale or bundle previously tested interventions or intervention studies to enhance the scalability and sustainability of these approaches |
Cross Cutting Themes
| Theme | Competency |
| 1 Applying ethical principles of research | The capacity to ensure that research adheres to the highest ethical standards |
| 6a.1 | Demonstrate knowledge and comprehension of ethics pertaining to intervention research design |
| 6a.2 | Demonstrate knowledge of how to ethically conduct research with vulnerable populations |
| 6a.3 | Demonstrate the ability to conduct applied, community-based, and/or participatory research |
| 6a.4 | Demonstrate the capacity to integrate ethical principles of research in measure development, including considerations of vulnerable populations in item and domain development |
| 2 Leveraging Transdisciplinary Team Science | The capacity to work efficiently with transdisciplinary teams of researchers |
| 6b.2 | Demonstrate the ability to lead or actively participate in a transdisciplinary team and promote a diverse team culture |
| 6b.2 | Demonstrate an understanding of the importance of collaboration and be able to engage in collaborative decision-making and effective team processes |
| 3 Antiracist and antiopressive research domain | The capacity to engage in human-centered intervention research that critically analyzes how racism and other structural forces shape and determine life course trajectories and uses a strengths-based approach to meet the needs of communities |
| 6c.1 | Demonstrate an ability to critically analyze structural inequities and racism and their impacts on life course trajectories |
| 6c.2 | Demonstrate the ability to conduct a structural power analysis to understand different sources of power, the way power is exercised, and where power lies to create institutional system change (Griffith et al, Came and Griffith) |
| 6c.3 | Demonstrate the ability to use human-centered design and implementation as an antioppressive research tool (Sinha et al) by shifting the locus of power from academics to participants (Potts and Brown 2005) |
| 6c.4 | Demonstrate the ability to decolonize and apply critical race theory and other frameworks to data collection, analysis, and interpretation (sense-making) |
| 6c.5 | Demonstrate the ability to build diverse and integrated research teams and community partnerships |
| 6c.6 | Demonstrate the ability to approach intervention research from a strengths-based framework that recognizes the strengths, assets, and opportunities in minoritized communities |
| Theme | Competency |
| 1 Applying ethical principles of research | The capacity to ensure that research adheres to the highest ethical standards |
| 6a.1 | Demonstrate knowledge and comprehension of ethics pertaining to intervention research design |
| 6a.2 | Demonstrate knowledge of how to ethically conduct research with vulnerable populations |
| 6a.3 | Demonstrate the ability to conduct applied, community-based, and/or participatory research |
| 6a.4 | Demonstrate the capacity to integrate ethical principles of research in measure development, including considerations of vulnerable populations in item and domain development |
| 2 Leveraging Transdisciplinary Team Science | The capacity to work efficiently with transdisciplinary teams of researchers |
| 6b.2 | Demonstrate the ability to lead or actively participate in a transdisciplinary team and promote a diverse team culture |
| 6b.2 | Demonstrate an understanding of the importance of collaboration and be able to engage in collaborative decision-making and effective team processes |
| 3 Antiracist and antiopressive research domain | The capacity to engage in human-centered intervention research that critically analyzes how racism and other structural forces shape and determine life course trajectories and uses a strengths-based approach to meet the needs of communities |
| 6c.1 | Demonstrate an ability to critically analyze structural inequities and racism and their impacts on life course trajectories |
| 6c.2 | Demonstrate the ability to conduct a structural power analysis to understand different sources of power, the way power is exercised, and where power lies to create institutional system change (Griffith et al, Came and Griffith) |
| 6c.3 | Demonstrate the ability to use human-centered design and implementation as an antioppressive research tool (Sinha et al) by shifting the locus of power from academics to participants (Potts and Brown 2005) |
| 6c.4 | Demonstrate the ability to decolonize and apply critical race theory and other frameworks to data collection, analysis, and interpretation (sense-making) |
| 6c.5 | Demonstrate the ability to build diverse and integrated research teams and community partnerships |
| 6c.6 | Demonstrate the ability to approach intervention research from a strengths-based framework that recognizes the strengths, assets, and opportunities in minoritized communities |
Modified Delphi Participant Characteristics (N = 28)
| Participant Characteristics . | n (%) . |
|---|---|
| Resident in US | 24 (86) |
| Female | 17 (61) |
| Race | |
| White | 18 (64) |
| Black or African American | 2 (7) |
| American Indian or Alaska Native | 0 (0) |
| Asian | 2 (7) |
| Native American or Pacific Islander | 0 (0) |
| Other | 3 (11) |
| Hispanic | 5 (18) |
| Education or training | |
| Master’s degree | 3 (11) |
| Professional degree beyond a bachelor’s degree (eg, MD, DDS, DVM, LLB, JD) | 8 (29) |
| Doctorate degree (eg, PhD, EdD) | 15 (54) |
| Participant Characteristics . | n (%) . |
|---|---|
| Resident in US | 24 (86) |
| Female | 17 (61) |
| Race | |
| White | 18 (64) |
| Black or African American | 2 (7) |
| American Indian or Alaska Native | 0 (0) |
| Asian | 2 (7) |
| Native American or Pacific Islander | 0 (0) |
| Other | 3 (11) |
| Hispanic | 5 (18) |
| Education or training | |
| Master’s degree | 3 (11) |
| Professional degree beyond a bachelor’s degree (eg, MD, DDS, DVM, LLB, JD) | 8 (29) |
| Doctorate degree (eg, PhD, EdD) | 15 (54) |
Modified Delphi Results
| . | The Competencies are Impactful, n (%) . | The Competencies are Comprehensive, n(%) . | The Competencies Have the Potential to Address Health Disparities, n(%) . |
|---|---|---|---|
| Domain | |||
| 1 | 25 (89) | 21 (75) | 21 (75) |
| 2 | 24 (86) | 22 (79) | 23 (82) |
| 3 | 23 (82) | 20 (71) | 21 (75) |
| 4 | 20 (71) | 18 (64) | 17 (61) |
| 5 | 23 (82) | 19 (68) | 19 (68) |
| Cross-Cutting Themes | |||
| 1 | 25 (89) | 22 (79) | 26 (93) |
| 2 | 25 (89) | 23 (82) | 25 (89) |
| 3 | 26 (93) | 24 (86) | 26 (93) |
| . | The Competencies are Impactful, n (%) . | The Competencies are Comprehensive, n(%) . | The Competencies Have the Potential to Address Health Disparities, n(%) . |
|---|---|---|---|
| Domain | |||
| 1 | 25 (89) | 21 (75) | 21 (75) |
| 2 | 24 (86) | 22 (79) | 23 (82) |
| 3 | 23 (82) | 20 (71) | 21 (75) |
| 4 | 20 (71) | 18 (64) | 17 (61) |
| 5 | 23 (82) | 19 (68) | 19 (68) |
| Cross-Cutting Themes | |||
| 1 | 25 (89) | 22 (79) | 26 (93) |
| 2 | 25 (89) | 23 (82) | 25 (89) |
| 3 | 26 (93) | 24 (86) | 26 (93) |
N and % reflect responses of Strongly Agree or Agree.
Domain 1: Understanding LCHD and LCIR
Domain 1 focuses on knowledge and comprehension of LCHD and LCIR. In recognition of the complexities underlying this framework, this domain promotes a foundational understanding of developmental psychology, medical, public health, and other social science frameworks, with the goal of eventually cultivating an integrative and holistic perspective on health development. In addition, this domain promotes an understanding of intervention research more broadly.
Gaining an understanding of the distinct theoretical underpinnings of LCIR and how they are complementary can facilitate the development of novel approaches to understanding and addressing issues and challenges. For example, listening to communities experiencing racial and ethnic disparities in birth outcomes and utilizing frameworks from critical race theory, health policy, and economics sets the stage for developing novel approaches to prevent racialized disparities.14 Understanding the intersections of social policy and health facilitates the development of policy recommendations that reflect educational, health, and social factors.15 Finally, an integrative understanding can spur training in methodological approaches that align with this perspective. For example, the utilization of secondary analysis of large, longitudinal datasets can illuminate complex and adaptive processes that speak to LCHD. This work can provide key insights into life course trajectories, intergenerational patterns, and opportunities for intervention. The majority of the network member subsample supported this domain as impactful (89%), comprehensive (75%), and endorsed it as having the potential to address health disparities (75%).
Domain 2: Developing Research Questions and Evaluating Research
Domain 2, developing LCIR questions and evaluating standards of scientific evidence, reflects the application of research skills and knowledge. This includes the capacity to craft meaningful research questions and evaluate the usefulness of scientific evidence that align with an LCIR orientation. LCIR requires researchers to compose feasible and timely research questions and hypotheses for particularly complex research topics. It is usually necessary to develop research questions with stakeholders’ involvement to ensure that research questions are relevant, feasible, and acceptable for the target population, as well as potentially scalable if successfully implemented. Researchers should consider exploratory research questions, in addition to hypothesis-driven research questions, to generate knowledge that can facilitate innovation and novel approaches to intervention research. In the face of research funding constraints, researchers should prioritize addressing research questions that are solution-driven, rather than research questions that seek to document problems. Researchers may also need to collaborate with other teams to maximize resources.
Domain 2 also includes the capacity to critically analyze and assess available scientific evidence, including evidence available in sources beyond peer-reviewed journal articles, such as policy reports and other “gray literature” that are oftentimes excluded from literature reviews. These avenues may shed light on local and/or regional trends, the impact of specific policies on individuals and populations, and other key insights that are not typically available in research studies that are often important for LCIR. Domain 2 also acknowledges the necessity to develop research questions that address timing, transitions, and turning points across the lifespan. In effect, Domain 2 capacities often require research skills and knowledge beyond those traditionally taught in research methods courses. The majority of the subsample endorsed this domain as impactful (86%), comprehensive (79%), and having the potential to address health disparities (82%).
Domain 3: Designing LCIs
Domain 3, designing LCIs, reflects the methodological skills and knowledge needed to address complex and adaptive challenges. For example, LCIR needs to account for the timing of the intervention, including its duration and sustainability, and the capacity to evaluate meaningful longitudinal change. LCIs, by their nature and intent, will play out over extended periods of time during which they will be affected by many intervening variables. Consequently, intervention design also requires an understanding of the multiple levels and systems (eg, families, health care systems, communities, etc) in which the intervention will operate and how the intervention will align, engage, and positively or negatively interact with these systems.
Domain 3 also recognizes the importance of the capacity to foresight, vision-set, and identify aspirational goals. These capacities are particularly important given the emphasis on changing long-term outcomes and trajectories in LCIR. This should include consideration of how a successful intervention could be designed to scale at the population level and how it might be spread and sustained via appropriate and often innovative financing arrangements. Due to these and other logistics that need to be considered for intervention design, capacities related to project management, team building, and communication skills, including consensus-building techniques and managing conflict, are also essential for this competency.
In addition to these capacities, there is a corresponding need to adapt an entrepreneurial mindset, that is, the capacity to design an optimal intervention with environmental and resource constraints in mind. This is important because it can be challenging to ensure that an intervention is relevant, acceptable, and easily implemented in applied contexts. In particular, the development of interventions with real-world impact is often impeded by the realities of resource-limited health contexts; prespecified research funder priorities or limited funding; a reluctance to deviate from grant application protocols; and the randomized clinical trial as a marker of intervention effectiveness.16 Researchers and funders should recognize the complementary roles of participatory or community-based approaches and randomized clinical trials. Research based in participatory approaches ensures that methodologically rigorous studies speak to the needs of the populations they seek to serve; randomized clinical trial research can generate additional research questions that require stakeholder collaboration and feedback. In light of funding or other constraints, LCI researchers are tasked with identifying priorities for specific studies and collaborating with other teams to maximize available resources.
LCIR design also necessitates continuous and iterative stakeholder collaboration and codesign to ensure that the aims, methods, and outcomes reflect the needs, experiences, and priorities of the target population. This will involve collaboration with youth, families, practitioners, policymakers, and other stakeholders. There are several steps researchers can take to facilitate opportunities for families and communities to initiate and maintain partnerships with researchers. Generally speaking, research funders should prioritize supporting studies that are based in stakeholder collaboration and feedback at all stages of the research process. This will ensure that stakeholder engagement is built into research protocols before beginning their research. This approach will promote stakeholder engagement strategies that are well-planned and adequately supported. When carrying out the stakeholder engagement strategies, researchers should use multiple modes of communication, including virtual and in-person approaches. Researchers should ensure that all recruitment or engagement approaches are transparent, culturally tailored, and accessible. This is critical from both a value-based perspective as well as a dissemination, sustainability, and scalability perspective. Along these lines, it is important that researchers are able to comprehensively describe and measure the codesign process so that knowledge and insights gleaned from this research can be explained, disseminated, and replicated.
Finally, designing LCIR often requires the development of specific methodological tools, including holistic developmental measures and population-level tools. These capacities pertain to not only the capacity to apply basic principles of psychometrics and measurement, but also the capacity to devise a measurement plan that aligns with complex research questions and diverse populations. The majority of the subsample supported that these competencies are impactful (82%), comprehensive (71%), and have the potential to address health disparities (75%).
Domain 4: Implementing and Evaluating LCIR
Domain 4, implementing and evaluating LCIs, focuses on the capacity to apply systems, quality improvement, and implementation science principles toward implementing, optimizing, and evaluating interventions. The continuous and iterative nature of quality improvement science is conducive to promoting change within complex, adaptive systems, ensuring continuous methodological accuracy and relevance, promoting human-centered design, and catalyzing scalable and sustainable change through LCIR. Importantly, there is a distinction between traditional process and outcome evaluation versus how to enable the intervention to work optimally in different contexts and conditions. The first methodology is comparative, and the second is collaborative. This process of enabling an intervention to work best in different contexts falls at the intersection of implementation science and quality improvement and presents methodological challenges in that flexibility is required in the somewhat formative process of adapting interventions for different populations, while at the same time continued evaluation is required to determine if those adaptive processes have been successful. Domain 4 speaks to the collaborative methodology required for LCIR. Given this, in LCIR implementation and evaluation efforts, it will be beneficial to also develop the capacities to collaborate across multiple academic institutions, and across academic, community, and other institutions to create and develop the new types of research methodology needed for these implementation studies. These collaborations are needed to maximize implementation efforts, and to ensure that the whole population benefits from effective interventions.
In addition to these capacities, there is a continued need to ensure robust tracking of process-oriented performance measures as well as short- and long-term outcomes. This tracking may require the development of new databases and/or the refinement of existing databases to track complex life course trajectories over time. While there are concerns that comprehensive tracking could produce very large amounts of data for analysis, time new methodologies for interpreting “big data” mean that the more parsimonious approaches to data collection in traditional research methodologies may in fact not be superior to a more comprehensive approach. There are also a range of data analysis capacities necessary for evaluating LCIR, including modeling longitudinal change that captures intra and interindividual trajectories, appropriate missing data protocols, and latent variable approaches. The majority of the subsample identified Domain 4 as impactful (71%), comprehensive (68%), and as having the potential to address health disparities (61%).
Domain 5: Disseminating and Translating LCIR
Domain 5, disseminating, translating, and promoting the scalability and sustainability of LCIs, speaks to the importance of translating LCIR into actionable recommendations for clinical practice, system design and operations, public policy, and future research. To do this, it is essential to consider translation at the beginning of the research process. This means, for example, conceptualizing research so that outcome variables are directly relevant to practice and/or policy. The National Center for Advancing Translational Sciences emphasizes the critical need for translational scientists who have the capacity to discover, develop, and disseminate science and technology to improve health outcomes. Indeed, translational research uniquely fosters transdisciplinary research and has the potential for maximal public benefit.17
A current barrier to translational research is an overall under-reporting of the process of developing the intervention.18 Researchers have posited a range of reasons why the development of interventions is often under-reported, including funding and publishing priorities and pressures. Failure to adequately describe how interventions are developed impedes the development of future interventions. Given this, a key competency in this domain relates to the ability to track, document, and report on the LCI development process. The majority of the subsample supported that this domain was impactful (82%), comprehensive (68%), and has the potential to address health disparities (68%).
Crosscutting Themes
Theme 1: Ethical Principles of Research
The first crosscutting theme pertains to ethical principles of research. While these principles apply to research universally, these are principles that are particularly relevant for LCIR. These principles include ethics pertaining to research design19 ; research with vulnerable populations20 ; conducting applied, community-based, and/or participatory research21 ; and maintaining a critical eye toward ethics as new and novel measurement and design strategies are developed. The majority of the subsample supported this theme as impactful (89%), comprehensive (79%), and as having the potential to address health disparities (93%).
Theme 2: Transdisciplinary Team Science
The second crosscutting theme pertains to team science. Recognizing that individuals are unlikely to possess all of the knowledge bases, tools and skills, relationships, and values required for carrying out complex and multifaceted research, team science has increasingly been recognized as a key capacity in 21st century research training. Team science recognizes the importance of interdisciplinary teams that have diverse areas of expertise. Transdisciplinary team members aim to integrate their expertise, rather than offer discrete contributions. Transdisciplinary teams are well-positioned to engage in innovative problem-solving. They also have leaders who are particularly attuned to promoting a diverse team culture and emphasize collaborative decision-making and effective team processes.12,13 The majority of the subsample supported this theme as impactful (89%), comprehensive (82%), and as having the potential to address health disparities (89%).
Theme 3: Anti-racist and Anti-oppressive Research
The final crosscutting theme is the capacity to conduct antiracist and antioppressive research. MCHB has emphasized the importance of cultural competence in research, that is, the ability to engage with diverse communities respectfully and with an awareness of implicit bias and assumptions held by research organizations. This capacity is particularly important for LCIR in light of the American Academy of Pediatrics’ 2019 policy statement on the impact of racism on child and adolescent health, noting that the “failure to address racism will continue to undermine health equity for all children, adolescents, emerging adults, and their families.”22
Antiracist and antioppressive researchers have the capacity to also engage in human-centered design and other research methods that shift the locus of power from academics to participants. They are able to critically examine the structural forces that determine life course trajectories and identify leverage points for systems change, while recognizing their privilege, building diverse and integrated research teams, and building upon the assets and strengths of communities that have been historically marginalized. An antiracist and antioppressive focus will facilitate the development of diverse new investigators moving forward. The majority of the subsample endorsed this theme as impactful (93%), comprehensive (86%), and as having the potential to address health disparities (93%).
Discussion
Life course intervention research (LCIR) requires multifaceted knowledge, skills and tools, relational capacities, and values. In recognition of this necessity, the Health Resources and Services Administration, Maternal and Child Health Bureau Life Course Intervention Research Network (LCIRN) developed a set of core competencies that, if present, can support equitable and impactful research. The collaborative and iterative competency development process yielded 5 domains and 3 crosscutting themes. A subsample of experts endorsed the competencies as impactful, comprehensive, and as having the potential to address health disparities. In effect, the competencies presented in the current paper can be used to create a training program or set of curricula for the next generation of LCI researchers. Given the dynamic and rapidly evolving nature of LCIR, we anticipate that this inaugural version of LCIR competencies will require regular updating as the field advances.
Moving forward, we will undertake the following next steps related to the competencies. First, we will incorporate an iterative vetting process through key informant and expert interviews. This process will yield in-depth qualitative suggestions and feedback for revisions to the competencies. We will make a concerted effort to survey and interview LCIR stakeholders across the country; this sample will be more diverse with respect to race and ethnicity, training background, and other characteristics than the current sample, which lacked heterogeneity in these areas.
There will also be a need to continually revisit competencies for social and cultural relevance and contribution to the field. For example, the COVID-19 pandemic and concurrent social and economic tumult required researchers to quickly pivot their areas of focus to develop necessary supports and interventions. Thus, there is a need to consider dynamic competencies, evolving categories of knowledge, skills and tools, relational capacities, and values, that are strategically aligned with current and emergent trends and priorities. These competencies would be continually revised and reassessed to reflect these trends and priorities.
Finally, we will need to design the practical applications of these competencies. In particular, there is a need to align competencies with educational and training curricula, which may require additional iterative revisions. Taken together, our goal is for the competencies outlined in the current paper to guide or be integrated into training, education, and other opportunities for the next generation of LCIR scholars. We look forward to continuing to advance these competencies and build this burgeoning field that holds great promise for promoting health development.
Acknowledgments
We gratefully acknowledge the guidance of Christopher Forrest in the early stages of developing these competencies.
Dr Hotez led the development of this manuscript; Ms Berghaus and Drs Verbiest and Russ supported the development of this manuscript; Dr Halfon provided guidance and expert consultation to this manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: This project is supported by the Health Resources and Services Administration of the US Department of Health and Human Services under the Life Course Intervention Research Network grant, UA6MC32492. The information, content and/or conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by Health Resources and Services Administration, US department of Health and Human Services or the US Government.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.
This paper describes the process and results of an iterative and collaborative methodology for developing the Life Course Intervention Researcher competencies.
Comments