Table 1 Themes, subthemes and descriptions of critical factors influencing the process of workbook development

Having well-placed and credible champions

- People promoting ideas (Ideas)

- People devoting their time/resources to completing the work (Work)

Champions were people who helped move ideas forward and/or who devoted their time and other resources to complete the work. Without their commitment and persistence, the work may not have occurred. Champions could have different levels of involvement, and someone who is a champion at one stage of the process may not be a champion at another.

Creating and capitalising on opportunities

- Creating opportunities (Creating)

- Capitalising on opportunities (Capitalising)

- Missed opportunities (Missed)

- Potential opportunities (Potential)

The champion(s) either sought out or created opportunities to move the work forward, or other actors presented opportunities to the champion(s) who then capitalised on these opportunities. There were times when the work could have moved forward, but it did not, resulting in missed opportunities. Lastly, there are potential opportunities that could be capitalised upon to move the work even further in the future.

Finding the right language to engage various actors and obtain buy-in

- Building understanding by using common terminology (Building understanding)

- Using persuasive language to ‘sell’ an idea (Persuading)

- Following standards (e.g. use of scientific language, page length for publishing) (Standardising)

The champion(s) used persuasive language to gain buy-in from those who were involved in and could have created barriers in the process. However, a more subtle way to help obtain buy-in was to first build a shared understanding of the concepts or issues by using common terminology that resonated with the target audience. This level of shared understanding was seen as especially useful for trying to communicate the relevance of or how to apply the work. Following standards for language could be a facilitator when working with specific audiences, such as WHO’s Guideline Review Committee, which requires specific formatting and the use of academic language, but this can be a barrier to other audiences, such as policy-makers, who may not be familiar with scientific or academic language. Poor communication could act as a barrier.

Obtaining and maintaining meaningful buy-in

- Obtaining buy-in (Obtaining)

- Maintaining buy-in for the current work (Maintaining)

- Institutionalising the process or work (Institutionalising)

First, one needed to obtain buy-in and then buy-in needed to be maintained. Institutionalisation can be seen as a type of ‘permanent buy-in’ by an institution. Unless a process is institutionalised, a change in leadership could result in previous buy-in being lost. Therefore, either continuous communication with new leadership is required to secure meaningful buy-in from new leadership, or institutionalising a process by one group or leader could bypass the future need to obtain buy-in. The difficult part can be knowing if there is meaningful buy-in or if the buy-in is for a secondary purpose (e.g. advancing other work). This could manifest itself as appearing to have meaningful buy-in at one stage of the process but not having buy-in at another. However, ascertaining this level of information could require immense transparency on the part of the actors involved as it seems it would be unlikely for people to be open about secondary motives. Also, this problem could be difficult to distinguish from a separate problem of lacking resources (e.g. buy-in from one group of people may not secure resources from other groups of people).

Ensuring access to human, financial and other resources

- (Human resources)

- (Motivation)

- (Knowledge)

- (Finances)

- (Time)

- (Technology)

Resources were used in carrying out the work and included human resources, finances, time, motivation, knowledge and technology. Without these resources, the work was likely to be abandoned. Human resources include the people involved in doing the work. Further attributes of these individuals, which arose from the data, include motivation and knowledge. Motivation to work on a particular topic is necessary when there are competing demands on an individual or on an agency. This can be seen as prioritising specific work. Knowledge can come from existing knowledge of the individuals involved in the work or can be found through searches for information. So, this attribute can be intrinsic (e.g. expertise) or extrinsic (e.g. library resources). Finances include salaries or payments for those carrying out the work, funding for traveling and funding to secure supplies. Time is required for individuals to do the work, and individuals and agencies have timelines for getting the work done. Technology can also support or be a barrier in advancing the work.