Developing and testing a theoretical model to assess and anticipate what factors influence the implementation of research results in humanitarian health responses in conflict-affected settings

Ensuring that research results are implemented is complex. The extended Normalization Process Theory (ENPT) considers the agency that actors have to implement new knowledge in revised practices. In this thesis, I adapted the ENPT to explain constraints met by humanitarian actors when they implement public health responses based on empirical research, in conflict-affected settings. I adapted the ENPT (a-ENPT) in four phases. First, I conducted a scoping review of peer-reviewed papers (n=22). Second, I analysed theoretical approaches cited by authors (n=43) in my initial review. Third, I conducted semi-structed interviews (n=26) with humanitarian practitioners, donors, and academics. Finally, I applied the a-ENPT in two Médecins-Sans-Frontières settings (Pakistan and Guinea) through document review (n=67), social networks analysis (n=2), qualitative interviews (n=20), and a consultative meeting. I present several results. First, most peer-reviewed papers documented mental health interventions (n=15/22) and frontline actors adapted recommendations and negotiated constraints. Second, theoretical approaches (n=43) influenced how frontline actors discussed knowledge and resources distribution. Third, interviewees (n=26) conveyed that frontline actor influenced power imbalances, and that engaging communities meaningfully was challenging. Fourth, field-based research motivated actors and trade-offs were negotiated collectively. Findings from this thesis highlight that frontline actors discuss knowledge, adapt recommendations, negotiate contextual constraints, influence power imbalances, or innovate when they are engaged meaningfully. Using a theoretical approach accounting for their agency is key in conflict-affected settings. My work has several limitations. My scoping review allowed to identify a gap in literature reviewed by peers but does not represent grey literature. My results do not allow for measure of implementation outcomes or cost-effectiveness and are based on data collected within western entities. The a-ENPT should be tested prospectively, within a grassroots organization and in a setting that allows for direct engagement of communities while allowing for improved documentation of outcomes and longer-term economic costs.