Table 3 Focused ethnography (FE) and integrated knowledge translation (IKT) synergies enacted

Accounting for context

1. Purposive sampling of participants

Immediately before and during data collection

RT, KUs

Purposive sampling strategy requires the RT and KUs to work closely together at the outset of the study in order to suffice inclusion/exclusion criteria, as well as to identify those who have unique knowledge and experience relevant to the study’s investigation

RT and KUs communicated via weekly study update emails (i.e. recruitment status and data collected), bi-monthly in-person clinic meetings to identify new TAVI PPs for purposive sampling, and semi-annual in-person meetings held at research institute to strategise data collection based on aggregated PP characteristics

2. Simultaneous relationship building

Throughout data collection and analyses

RT, KUs, PPs, FCGs

Simultaneous relationship building between the RT with KUs, PPs and FCGs allowed for in-depth understanding of multiple perspectives within this setting

RT gained new insights about the complexity and intersectionality within this context by concurrently engaging with PPs and FCGs (observations and interviews over the course of PP treatment), and positioning these experiences against the health service realities faced by KUs

Bi-monthly in-person clinic meetings, data analyses and semi-annual in-person meetings between RT and KUs permitted the time and collective agreement about arising issues that were then contextualised

High level of engagement

3. Consistent and frequent contact with various groups

Prior to participant recruitment and throughout data collection, analyses, and dissemination and uptake offindings

RT, KUs, PPs, FCGs

Consistent level of communication throughout the study is required in order to form meaningful working partnerships, which then shape the applicability and acceptability of research findings

RT were in weekly contact with KUs in order for decisions to be made collectively around PP and FCG recruitment, processes around data collection by the RT, data analyses, and uptake of key findings into clinic processes meant to support PPs and FCGs in their experiences Similarly, the RT provided additional informational and emotional support to those PPs and FCGs who found the TAVI experience particularly challenging (i.e. additional time to discuss concerns during interviews, development PP informational pamphlet)

Regular meetings meant that these issues were acknowledged and accounted for immediately

Establishing partnerships

4. Effort to flatten knowledge hierarchy

Power dynamics acknowledged and addressed prior to and throughout study processes

RT, KUs

RT and KUs worked to relax restrictive distinctions between researchers and clinicians through continuous engagement in order to establish and maintain a productive partnership

KUs identified gaps in literature and practice to help form relevant research questions Precedent was given to KUs around decisions pertaining to on-going study processes during weekly and bi-weekly meetings

All data generated was made accessible to KUs (once cleaned for personal identifiers) Mentorship of KUs to RT (i.e. research trainees) through sharing of specialised knowledge and skills relevant to clinical settings during data collection

Striving for reciprocity

5. Acknowledging give and take during the research process

Throughout study processes and beyond conclusion of study

RT, KUs, PPs, FCGs

Shared decision-making around all aspects of the research process Continuing to develop further studies and a programme of research based on partnership between researchers and KUs