A mapping review and critique of the literature on translation, dissemination, and implementation capacity building initiatives for different audiences

Abstract

Background

Capacity building is critical for research and practice as the fields of dissemination, implementation and translation science continue to grow. Some scholars state that capacity building should be grounded in competencies. However, the fields are unclear in determining which competencies are relevant for whom, including the content and appropriate level of information and skills for different roles. The goal of this study was to catalogue competencies across current D&I capacity building initiatives.

Methods

We conducted a mapping review to examine to what extent are theories or frameworks used to guide capacity building, who is being trained, to what extent do capacity building initiatives include a health equity focus, which competencies are being outlined or suggested, how are they being defined, and whether the competencies can be organized along different roles of participants. As a mapping review, we broadly searched for papers using the keywords “training D&I” OR “training implementation” OR “training translation” OR “training dissemination” and included debate and empirical papers about capacity building initiatives in the sample.

Results

A total of 42 articles (from 2011 to 2024) were reviewed, including training development and/or evaluation (n = 25) and conceptual (n = 17) articles. Of the training articles, 13 (52%) specified a framework that guided training. Participants in training included graduate students, researchers, practitioners, and mixed audiences. Fourteen (56%) of the trainings were conducted in the USA, seven (28%) in Canada and other countries. The length of training ranged from two days to two years. Four trainings had an explicit focus on equity. A total of 307 unique competencies were identified and divided into themes: Knowledge, Skills, Engagement with Other Disciplines, Equity, Attitude and Relational Aspects, Capacity Building, Quality Improvement, and Mentorship.

Conclusions

While there are many D&I capacity building initiatives, we found little consistency in competencies that guided training activities for diverse audiences. Few training activities explicitly identified guiding theories or frameworks or tailored competencies toward different levels of interest in D&I research. Even fewer had an explicit focus on health equity. As the fields continue to foster capacity building programs, it will be important to think critically about the types of competencies we are developing for whom, how, and why.

Contributions to the literature

• This study provides a critical step in the dissemination, implementation and translation capacity building literatures by cataloging competencies related to these sciences, and by offering suggestions for capacity building initiatives.

Background

Translation, dissemination, and implementation sciences are rapidly growing fields. All three aim to (1) move research into practice [1], (2) accelerate the uptake of evidence-based interventions, policies, guidelines, and practices into clinical and community settings [2], and (3) examine factors that affect the spread and uptake of knowledge [2]. These three sciences are related, bidirectional, and have similar goals: to identify practices and principles to improve healthcare delivery and health outcomes [1]. In this paper, we will use the dissemination & implementation (D&I) acronym to encompass these three sciences.

Capacity building is critical for research and practice as these fields continue to grow. Some scholars state that capacity building should be grounded in competencies [3, 4] which provide a framework for teaching learners certain skills [5] through knowledge acquisition and practice [6]. The general assumption of a competency-based approach to capacity building is that an occupation “can be broken into smaller elements of defined knowledge and skills (competencies), and that achievement of an accepted level in each of these domains will lead to overall proficiency” [5]. Competency frameworks also help delineate the degree to which knowledge and skills may differ across these three different sciences [3, 7,8,9,10].

Despite advances in capacity building in D&I, gaps remain in outlining various options for building capacity that is most relevant to differing potential groups of trainees. Individuals working in D&I may have different levels, forms of engagement, and experience with the application of fundamental principles. For example, expanding on Tabak et al. [11], we pose at least three phenotypes of people engaged with the D&I fields: 1) the collaborator who is interested in a basic level of knowledge to be able to work effectively with a D&I expert, 2) the scholar who uses D&I science in his/her/their research, and 3) the expert methodologist who seeks to advance the fields of D&I science. In addition to these different levels of research engagement with the science, a person may want to know how to apply the D&I sciences as a practitioner, healthcare leader, public health practitioner, or someone interested in policymaking [12,13,14,15,16,17] Accordingly, scholars have underscored the need for training practitioners, implementation champions, community and healthcare leaders, policymakers, and administrators [15, 18] to generate a D&I workforce. The goal of such a diverse workforce would be to apply translational knowledge responsive to community needs and accelerate the uptake of evidence-based interventions, policies, and practices [19].

The fields of D&I have recently increased their attention to health equity and to healthcare equity [12, 20], with one of the assumptions being that embedding D&I in healthcare settings centered in equity perspectives could promote equity in healthcare practice and research [15, 21]. We define health equity as not only the absence of obstacles to health and well-being for all populations across multiple sectors and societal contexts, but also the presence of quality of life [22]. We define healthcare equity as the just and appropriate access and utilization of healthcare services without variation due to demographic, economic or political factors [23]. To achieve health equity and healthcare equity, we need to address the historical and current systemic factors that affect healthcare delivery practices and policies. We also need to address the non-medical drivers of care that affect access and utilization [15]. Data has shown, however, that even if researchers and practitioners are motivated to engage in equity-oriented D&I research (i.e., research that explicitly and carefully attends to the culture, history, values, assess and needs of the community [20]), there is a lack of capacity building initiatives in this space [24]. As such, one could argue that capacity building initiatives need to have greater attention to the underlying systemic factors that affect the availability and delivery of quality care and their alignment with cultural perspectives, history, assets, and needs of the community served [12, 25,26,27,28,29,30] through the development of a representative workforce. This workforce – including providers, healthcare leaders, and policymakers—needs to be able to generate and apply knowledge that is responsive to community needs and accelerates the implementation of evidence-based practices and guidelines while promoting the delivery and monitoring of equitable healthcare [19].

As more individuals are drawn to learning about D&I sciences, we believe it is essential to: (a) determine which competencies are relevant for whom, including the content and appropriate level of information and skills for different roles; (b) understand and address the intersection between D&I and health equity [12, 15, 31]; and (c) provide opportunities for training those most interested in applying D&I science, including teaching practical skill such as facilitation roles and problem-solving skills during capacity-building initiatives [32,33,34].

We use the term “capacity building” instead of training to reflect the different types of initiatives that may go beyond traditional teaching of D&I competencies. The focus here is on human capacity building and not on resource or infrastructure. While there is no consistent definition on capacity building [35], we conceptualize here the word “capacity” as the ability to carry out a given task, and “building” as the act of developing something. As such, capacity building refers to the development of human competencies to achieve a set goal. The goal of this study was to identify the state of current D&I capacity-building initiatives for expanding dissemination, translation, and implementation research and practice.

Lists of competencies for D&I capacity buildings have been developed using a variety of methods, including card sorting, Delphi methods, concept mapping, and surveys [36]. The challenge with these lists is that they do not necessarily define competencies and do not follow a common lexicon across different initiatives. In fact, since 2020, scholars [8, 36] have asked for standardization of capacity building reporting, including clear outlining of competencies used to train in D&I, to better understand the findings across different contexts and scientific professions. The argument is that, by having clear definitions of competencies using a common lexicon, we can then evaluate which competencies are needed for whom (e.g., practitioners, researchers), at which level (e.g., beginners, advanced) across the different capacity building initiatives. Our study differs from other reviews in that it provides an overarching library of current competencies identified by the authors from different types of capacity building initiatives. It also differs from other reviews in that we are not focused on a specific audience [37, 38]. We do not aim to define further the competencies that we identified; we believe that this is a next step in our work, but rather we present the state of the art of competencies in D&I competencies to increase awareness of the current development of the field and provide recommendations for developers of capacity building initiatives.

Methods

We conducted a mapping review to explore and map the literature available on this topic, and to identify key concepts and gaps in the D&I capacity building literature [39, 40], and to inform future more structured reviews, such as a scoping review [41]. We chose a mapping review because this type of review is meant to answer more deductive questions. Different from scoping reviews, which aim to systematically identify and map the breadth of evidence available on a particular topic, mapping reviews are meant to catalog the evidence gaps in a broader topic area, collate and describe the available evidence relating to the question of interest. In other words, they yield higher level data extraction and give a broader focus of the field by answering the question “what do we know about a topic,” or “what and where does research exist in a particular area” [42]. Mapping reviews, therefore, are meant to be broad and provide an overview of the field [43].

Identifying the research question

Our primary research question was: What is the state of the art – or the most recent stages of development- of current D&I capacity building initiatives? Our secondary questions were: a) to what extent are theories or frameworks used to guide capacity building, (b) who is being trained, (c) what is the length of training, (d) to what extent do capacity building initiatives include a health equity focus, (e) which competencies are being outlined or suggested, and how are they being defined, and (f) can the competencies be organized along different roles of participants.

Identifying and categorizing the articles

AB conducted an initial search in Feb 2021 using GoogleScholar to identify articles related to training in dissemination and implementation using the keywords “training D&I” OR “training implementation” OR “training translation” OR “training dissemination.” The search was updated in June 2022, and newer articles were added based on co-author recommendation until September of 2023. Another search was done in January of 2025 when reviews for the submitted manuscript were received. Because this is a mapping review, we broadly included papers related to capacity building initiatives in D&I, including empirical and conceptual papers. Papers related to other types of trainings (e.g., community engagement) that did not explicitly talk about capacity building initiatives in D&I sciences were not included in the final sample. All papers included in the sample were reviewed in full by both AB and DA.

We categorized articles in two ways: (1) Training development and/or evaluation articles, which were those describing the development of some sort of didactic course (e.g., workshop, training, expert consultation) that was meant to develop capacity of people, papers evaluating training, or papers describing both the development and evaluation trainings, and (2) Conceptual articles, which offered commentaries, perspectives, arguments, or recommendations about D&I capacity building that were not essentially based on empirical research, but were grounded in the literature and expert observations. The conceptual articles also included review articles summarizing capacity-building initiatives.

Charting the data

During the full-text review, we extracted the following data from each article: the theory or framework used to guide the capacity building initiatives, the participants, the length of the training, whether it had an equity focus, and the competencies outlined in the article. AB and DA charted the data; AB compiled the competencies, and DA charted the other components of the articles. AB and DA met bi-monthly to reconcile discrepancies.

Collating, summarizing, and reporting the data

Competencies were compiled from all papers (i.e., training development and debates). They were literally copied and pasted from what the authors wrote in the papers, with no interpretation. Because this is a mapping review, and we had a large and varied sample of papers that yielded many competencies. To organize the discrete competencies, AB used a rapid coding of the competencies and sorted them into bins/themes and all authors provided feedback and further recommendations. Further details about the competencies per paper can be available upon request from the corresponding author. The data about competencies per paper are not publicly available due to its potential sensitive comparisons across capacity initiatives, which is not the goal of the present study.

Competencies were sorted into themes: Knowledge, Skills, Equity, Engagement with Other Disciplines, Attitudes and Relational Aspects, Capacity Building/Infrastructure, Quality Improvement and Mentoring. Competencies were then tallied by frequency in each theme.

Defining the competency themes

The 307 identified competencies were first divided into two large themes: knowledge or skills. A competency was coded in the knowledge theme if the verbs used to describe it were “identify”, “define” or “describe.” A competency was coded in the skill theme if it referred to “use”, “apply”, “employ” or another similar active verb. The rationale for first defining competencies into knowledge and skills was related to the education, medicine, and management literatures that reminds us that knowledge acquisition does not guarantee the successful application of that same knowledge, and as such it is important to also teach skills on how to apply the knowledge [44].

The competencies that did not fit either knowledge or skills themes because they often did not have the verbs outlined above were thematically coded as “Engagement with other disciplines”, “Equity”, “Attitude and Relational Aspects”, “Capacity Building/Infrastructure”, “Quality Improvement” and “Mentoring.” Note that these are subjective themes.

Competencies coded as “Engagement with other disciplines” involved actions related to either collaborating with other disciplines or articulating how other disciplines could foster D&I. Competencies coded in “Equity” broadly involved competencies that exposed participants to methods aimed at engaging community members in the research and implementation process (e.g., engaging stakeholders in identifying outcomes and measures). While one could separate the “Attitude and Relational Aspects” theme into attitude characteristics (e.g., being honest, positive leader) and relational aspects (e.g., being able to work in teams), we posit that these two could also be related: attitudes are affected by context and relational aspects; similarly, relationship dynamics are affected by people’s attitudes [45, 46]. Therefore, we bundled these two constructs in one theme.

Competencies in the “Capacity Building/Infrastructure” involve the ability to build capacity to implement the project/study such as staff training and acquisition of funding. The competencies in “Quality Improvement” are related to using data for monitoring and improving the implementation process, including the development of logic models and an evaluation process. Finally, competencies in the “Mentoring” category involve either receiving and/or providing mentoring.

To gather feedback on these themes, we presented different versions of these groupings to groups of experts who provided further suggestions, including: poster sessions at the 2021 and 2022 Conferences on the Science of Dissemination and Implementation in Health, through internal presentations at our universities, through presentations to the Clinical and Translational Science Award (CTSA) D&I Working Group, and at meetings with our network of D&I research peers in our universities. During these presentations, and among our internal authorship group, we asked for feedback on whether the themes were descriptive of the list of the competencies, and on the rationale for the paper (i.e., the type of review and the value added of this paper compared to the larger literature). Feedback was received in the form of comments during the poster sessions, and during the question-and-answer sections during the presentations. Overall, we received feedback that the categorization of the competencies was useful, that the method (i.e., a mapping review) and this paper added value to the field of D&I capacity building.

Results

A total of 42 articles from 2011 to 2024 were reviewed, including training development and/or evaluation (n = 25) and conceptual articles (n = 17). We focus the results below (frameworks, participants, location & length of trainings, and equity) on only training development and/or evaluation articles, given that our focus was on understanding how trainings are designed. For the competencies section, we include all 42 articles in the result summaries.

Frameworks guiding the trainings

Out of 42 articles reviewed, eighteen (43%) specified a framework that guided training, shown on Table 1. The frameworks were varied, including knowledge translational frameworks and educational frameworks. No two trainings used the same framework.

Table 1 Frameworks that guided the capacity building efforts

Participants

Twenty unique trainings were identified; see Table 2 for details on number and type of participants for each training, as well as additional details on how trainings recruited and selected participants. The majority of trainings (n = 11, 55%) recruited a mix of participants, including some variation of graduate students, researchers, practitioners, public health leaders, policy-makers, decision-makers (including clinicians, healthcare managers, and policy makers), and teaching staff. Five (25%) training programs were only offered to researchers, three (15%) training programs were offered only to students (these were Master’s degrees or Master’s-level courses), and one (5%) training program was offered only to public health nurses.

Table 2 Training characteristics, recruitment, and selection

Location, format, & length of trainings

Table 2 describes the locations, format, and length of trainings. Of the 20 trainings, ten (50%) were conducted in the USA, four (20%) in Canada, and four (20%) in other countries (Japan, Kenya, Germany, and the UK). Two (8%) were massive open online courses available to participants in multiple countries. Five training programs (25%) were short in length, ranging from four 30-min online modules to a 4-week online program, four trainings (20%) were medium length, ranging from a summer long institute to a 9-month program. Nine were long (45%), ranging from an 18-month program to 2-year programs. There were six programs (30%) that were 2-years long, including: the Implementation Research Institute or IRI, a Master’s of Science Program in Germany, the University of Nairobi training program, the Knowledge Translation Challenge in Canada, the Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC), and the Institute for Translational Research Education in Adolescent Drug Abuse (ITRE). Two Massive Open Online Courses did not list the length of the training. Three trainings (15%) were offered in person only, ten (50%) were offered hybrid (with both in person and virtual components), and five (25%) were offered virtually only. Two trainings (10%) did not list the format they were offered in.

Equity focus

Only four trainings (20%) had an explicit focus on integrating equity. The detail about how different trainings conceptualized equity varied. For example, Friedman et al., 2021 noted that health equity was a focus of their CPCRN Scholars Workgroup but did not provide details. Rogal et al. [72] integrated health equity into their training by: 1) presenting a lecture by a health equity expert early in the course, 2) illustrating the Health Equity Implementation Framework as an example of an IS Framework, 3) discussing equity as a crucial aspect of proactive planning and tailoring of the evidence-based practice and implementation strategies for known disparities and barriers in priority populations and implementation contexts, and 4) emphasizing the importance of iterative and ongoing measurement and evaluation of health equity over time as an essential implementation outcome. In their 4-week online course, Rogal et al., “decided a priori to emphasize health equity and human-centered design. As such, we presented a lecture by a health equity expert early in the course and illustrated the Health Equity Implementation Framework [28] as an example of a key IS Framework. We then discussed equity as a crucial aspect of proactive planning and tailoring of the evidence-based practice and implementation strategies for known disparities and barriers (determinants) in priority populations and implementation contexts. Moreover, we emphasized the importance of iterative and ongoing measurement and evaluation of health equity over time as an essential implementation outcome that reflects the quality of sustainability capacity to adapt the “fit” of the evidence-based practice to dynamic context. In our course evaluation, we evaluated the extent to which students felt we had addressed equity.” Vroom, Albizu-Jacob, and Massey (2021) addressed equity by infusing service learning in their curriculum, which they posit is an “ideal vehicle for addressing social justice issues and health disparities because it requires extensive collaboration between academic institutions, students, and the community” [85]. Stevens et al. published monthly newsletters after the completion of the 2-day workshop that include resources on equity in IS [78].

Competencies guiding the trainings

A total of 307 unique competencies were identified across the articles that described them. We could not identify competencies in 10 articles. For the rest of the 32 articles, we catalogued the competencies that were described by the authors. It is important to note that not all competencies were well defined. For example, some authors stated that participants were trained in “adaptation” without defining what about adaptation was being taught. That is, they did not specify whether the training aimed to identify adaptation methods or to use/apply adaptation methods. Additionally, sometimes the competencies did not distinguish between implementation and dissemination and instead were bundled as “D&I” (e.g., knowing about D&I concepts). In these instances, we double-coded the competencies for “implementation” and “dissemination” and marked them with an asterisk in the tables.

Different levels of competencies

Only eight articles (21%) explicitly talked about competencies at different levels of expertise with D&I. Specifically, Padek et al. [3] identified 43 D&I research competencies, which were categorized as: beginner (11 competencies), intermediate (27 competencies), and advanced (5 competencies). Participants selected the list of competencies as beginner, intermediate and advanced as ordinal numbers (i.e., 1.2.3) across four sections: (a) definition, background, and rationale, (b) theories and approaches, (c) design and analysis, and (d) practice-based considerations. To prevent unintended bias by the research team, the authors allowed participants to self-identify their skill, thus did not provide definitions for these skill levels.

Two articles used Padek’s competencies for evaluation [81], and two articles expanded and adapted Padek’s list. Rogal et al. [72] used similar competencies to develop a training program, and Heubschman et al. [7] expanded Padek et al.’s competencies to add eight competencies related to health equity and speed of translation: four competencies in emerging beginners, six intermediate competencies, and two advanced competencies. Friedman et al. [84] also developed competencies for beginner, intermediate, and advanced, and Alonge et al. [88] outlines competencies for basic awareness, beginner, intermediate, advanced, and expert. In a debate article, Mehta et al. [89] refer to the importance of Clinical and Translational Science Award programs in capacity building for early-stage faculty, mentors, consultants, and collaborators but do not specify how these competencies would differ depending on the audience. However, as with Padek et al., Tabak et al. and Mehta et al. allowed participants to self-identify their skill level, rather than providing definitions [3, 79, 89].

Types of competencies

Below, we describe the results from Tables 3, 4, 5, 6, 7, 8, 9, 10 and 11 with competencies grouped by the themes outlined above. Competencies were copied and pasted from the papers to allow for cataloguing (i.e., they are not our interpretation). Because papers often described more than one competency, the number of competencies does not match the sample of papers. The backslash marks a new competency. When a competency had verbs related to knowledge and to skill (see above regarding how these themes were coded), they were double coded and noted with an asterisk.

Table 3 General knowledge competencies

Table 4 Knowledge about D&I research

Table 5 Skills competencies about research in general

Table 6 Skills competencies related to D&I research

Table 7 Competencies related to engaging with other disciplines

Table 8 Competencies related to equity

Table 9 Competencies related to attitudes and relational aspects

Table 10 Competencies related to capacity building

Table 11 Competencies related to quality improvement

We separated knowledge into two main sub-themes: general knowledge (i.e., not specific to D&), and D&I knowledge. Table 3 shows the 28 competencies of general knowledge, divided into: general research (6 competencies), evidence-based practices, policies, guidelines or interventions (7 competencies), context (6 competencies), and health services research (9 competencies). Table 4 shows the 59 competencies related to: knowledge about D&I (11 competencies), theories, models and frameworks (4 competencies), strategies (6 competencies), methods and designs (22 competencies), adaptation and fidelity (7 competencies), dissemination (3 competencies), de-implementation (2 competencies), and ethics (4 competencies).

Table 5 shows the 24 skills competencies not specifically related to D&I, divided into skills about research (20 competencies) and skills about intervention design (4 competencies). Table 6 shows the 79 skills related to D&I: general D&I skills (9 competencies), skills about assessing context (2 competencies), skills related to applying theories, methods and frameworks (2 competencies), skills related to identifying and targeting impactful translational and societal outcomes (17 competencies), skills related to methods and designs (22 competencies), skills related to adaptation science (8 competencies), dissemination (9 competencies), de-implementation (1 competency), sustainability and scale up (6 competencies), and ethics (3 skills). Table 7 outlines the 25 competencies related to “Engagement with other disciplines”, involving actions such as incorporating other fields (e.g., economic evaluation or organizational theories) in D&I research. Table 8 outlines the 24 competencies catalogued in the “Equity” related to engaging the community (9 competencies), methods and approaches (11 competencies), and health literacy and cultural competency (4 competencies). Table 9 outlines the 41 competencies related to “Attitude and Relational Aspects”. Table 10 shows the 13 competencies related to Capacity Building; Table 11 shows the 8 competencies related to “Quality Improvement”; and Table 12 shows the 6 competencies related to Mentoring.

Table 12 Competencies related to mentoring

Table 13 shows that the frequency of the competencies across themes varied: attitudes and relational aspects were the competencies most cited across the papers, with skills about how to apply D&I methods being the second, and knowledge about D&I methods being the third. The least cited competences in the papers reviewed included D&I ethics, knowledge about de-implementation, and intervention design skills. We did not see any trends of competencies across the years.

Table 13 Frequency of competencies

Discussion

This mapping review sought to describe the state of D&I capacity building initiatives. Our data show that, while several initiatives have been published, the literature shows a lack of consistency in the definition of competencies, in the types of competencies used to guide the capacity building initiatives, and in the evaluation of the trainings.

The data in this review show that less than half of the trainings in this study reported using a framework to design their training. The goal of this paper is not to recommend a framework to guide the development and evaluation of capacity building initiatives. We can hypothesize that the absence of a larger framework to guide the different capacity building initiatives reflects how relatively young the field is, and how it is still evolving. However, similar to the argument posed by several scholars about the appropriate selection, adaptation, use and testing of frameworks to guide research in the field of D&I [90], we can argue that frameworks can guide the development and evaluation of capacity building initiatives and provide some alignment in terms of skills and knowledge about the science in the field. Different frameworks can be used to develop a capacity building initiative versus to evaluate it. For example, the Implementation Research Institute used a combination of theoretical perspectives to guide its development, and more recently, the institute has used the Translational Science Benefit Model to evaluate the impact of the work from its alumni [54, 91, 92]. Alternatively, Miyamoto et al. [76] used the Consolidated Framework for Implementation Research to guide content development for their Capacity Development Training Course for Evidence-based Program Implementation (“EPI-TRE”) training [93]. CFIR guided the Implementation Degree Assessment Sheet (IDAS), a teaching aid that then was used as a measure for evaluating their training [94].

The granularity of the competencies used to guide the development and evaluation of the capacity building initiatives may depend on the framework, the audience, the length of training, and the goal of the training. For example, Miyamoto et al. [76] aimed to train their participants in setting up different aspects of readiness to implement the intervention (e.g., availability of resources, leadership engagement, access to knowledge and information), but other trainings simply would refer to this competency as examining contextual factors. While a common framework to guide the development and evaluation of capacity building initiatives is not necessarily an appropriate recommendation (as different initiatives can have different goals depending on their audience and funding), we propose that explicitly outlining which theoretical underpinnings inform the development and evaluation of the different capacity building initiatives can help in the identification of core competencies across initiatives and identify what works for whom as we grow the workforce in the fields of D&I.

Most of the capacity-building initiatives identified in our sample were offered in the United States, and in academic settings. Furthermore, 38% of the trainings were only offered to researchers, and no trainings were offered only to practitioners or lay persons. None of the capacity-building initiatives were in community settings, reducing the accessibility of D&I training for this audience. A discussion about the benefits and challenges of including community members as either community researchers (laypersons employed to conduct research activities in their own communities) [95], as implementers or members of research initiatives [96, 97] is beyond the scope of this study, but one could argue for the importance of engaging community members to inform D&I capacity building to help inform how to connect community with research enterprise and cross-learning. The process by which this type of capacity building would be done, however, is yet to be developed as we did not see any discussion of engaging community members as community advisory boards or as part of the capacity building initiatives in our sample of papers. If we propose that the fields of D&I decrease the quality gap and the science and research gap before they widen [98], we may need to increase the communication and shared skills between researchers, practitioners, intermediaries (i.e., people who translate findings from D&I field to support in the implementation of evidence-based practices), policy makers, educators, and leaders [38, 99]. However, the capacity building initiatives for each of these audiences may have different goals and formats, and much needs to be explored in this space.

Only about 20% (n = 8) of the identified articles referred to different levels of competencies, such as beginning, intermediate, advanced, and expert competencies. While we agree with Padek et al. [3] that pre-defining these learning categories may yield bias from the research team, or those developing capacity-building courses, we feel that there is merit to Alonge et al.’s [88] comment that not defining different competency levels may yield confusion in the fields. It is important to highlight that only five competencies were identified as at the ‘advanced’ level by Padek et al. [3]: describe gaps in D&I measurement and critically evaluate how to fill them; effectively explain and incorporate concepts of de-adoption and de-implementation into D&I study design; incorporate methods of economic evaluation (e.g., implementation costs, cost-effectiveness) in D&I study design; evaluate and refine innovative scale-up and spread methods (e.g., technical assistance, interactive systems, novel incentives, and “pull” strategies); and use evidence to evaluate and adapt D&I strategies for specific populations, settings, contexts, resources, and/or capacities. Recently, seven competencies were added by Heubschman et al. [7], with only two being advanced competencies.

The challenge of doing an in-depth analysis on how these advanced competencies can be addressed in the capacity building initiatives, however, is that these are self-reported classifications and evaluated in initiatives aimed for researchers. One could hypothesize that advanced competencies in D&I are related to the skills of applying the knowledge in either developing a research protocol and/or applying the knowledge in the field implementing an intervention, program, policy or guideline. To foster advanced competencies, variables such as: participants’ background knowledge of D&I and of research, the goal of the training, and the length of the capacity building initiative (e.g., one day workshop, two years) may be variables that developers of capacity building programs may need to consider. Additionally, as the fields mature, we will need to examine whether capacity-building programs identify more advanced competencies. Different audiences (e.g., researcher, practitioners, public health, healthcare leaders) could then position themselves in this continuum of competencies, depending on their goal and level of engagement with the D&I fields.

One potential proposal for the D&I fields is to conceptualize the types of competencies for the different audiences based on knowledge, skills, and other activities that their roles will require. For example, recently the medical field has advocated for developing a curriculum based not only on competencies but also on entrustable professional activities (EPAs), which are “units of professional practice (tasks or bundles of tasks) that can be fully entrusted to an individual, once they have demonstrated the necessary competence to execute them unsupervised” [100, 101] We could speculate that, if we return to the potential different levels of engagement with the D&I fields articulated in the introduction, the scientific collaborator interested in a basic level of knowledge may only need to foster knowledge competencies, the scientist who uses D&I in his/her/their research will need knowledge and skills competencies, and the expert methodologist who seeks to advance the D&I fields would strive for entrustable professional skills. That is, the scientist using D&I would be focused more on the translational aspect of D&I (translate findings from their own research into clinical or community settings), and the expert methodologist would focus on advancing the methodology. We did not find such discussion in the papers from our sample.

Our review demonstrated a lack of clarity in the definition of competencies, with three main issues. First, usually the competencies referred to implementing (or de-implementing, or developing) an evidence-based intervention within healthcare settings. Because the fields of D&I are broader than implementing only interventions in healthcare, we advocate that competencies should include attention to implementing evidence-based practices, policies, guidelines and practices in settings outside health care. Our review was unable to determine whether capacity-building programs are extending these competencies to innovations beyond the healthcare system. Second, there was inconsistent use of verbs (i.e., actions required to demonstrate the competency) in the description of the competencies. To move the fields forward, we propose that capacity building leaders be clear about the intention of the competencies. For example, if competencies are related to building knowledge, verbs such as “characterizing” or “identifying” should be used. If, however, the training aims to foster skill competencies, we suggest using the verbs “employ” or “apply”. Third, the competencies were often bundled (e.g., “learn D&I principles”). As the fields of translational, dissemination, and implementation research continue to grow, it may be important to disentangle these competencies to clarify the training goals more precisely. As we advance the science of these themes (e.g., identify mechanisms of implementation strategies or advance the science of adaptation), we could hypothesize that competencies may need to be further described as scholars become methodological experts in these areas.

Interestingly, some capacity-building programs fostered competencies related to research in general. We decided to report the competencies around general research knowledge and skills here because, depending on the goal of the capacity-building program, training in these foundational research skills may be important. For example, trainings such as IRI, MT-DIRC, and TIDHR select participants who have pre-requisite experience and funding in research [49, 54, 81]. Other capacity-building initiatives, however, especially those in graduate programs may not have an audience with expertise in general research (e.g., grant writing). Here, there would be (at least) three paths. One is to train the audience in general research skills in other courses so that – if the goal is to apply D&I science in research – they are well-equipped to do so. Second, if the training is aimed towards practitioners, for example, they may not necessarily need to be well-versed in general research skills. A third path is what may be happening in contexts where consultants sometimes provide mentoring/consultation in both research skills and D&I projects [8, 102]. As the fields of D&I grows and we develop different capacity-building opportunities, it will be important to think critically about which competencies are needed for diverse audiences (e.g., researcher, practitioners, graduate students, policy makers, public health practitioners) and which path is relevant for the type of engagement with the fields.

Several competencies were coded “Attitudes and Relational Aspects.” The literature on D&I practitioners has recognized the importance of attitudes and relational aspects [103, 104] for these professionals’ applied work. While recognizing attitudes and relationships has been more prominent in the practitioner literature, scholars have also identified the importance of relationships, self-reflection, and humility in the research space [105]. Another theme that emerged was the importance of “Engaging with Other Disciplines”. Here, there seems to be at least a three-way approach: for D&I scholars to learn from other fields (e.g., learn how to do cost analysis from economists), to apply D&I in other fields (e.g., how to use D&I methods to increase uptake of cancer guidelines), and/or to create bi-directional learnings between fields (e.g., how the cultural adaptation field can learn from implementation science and vice versa).

While the D&I fields have recently given more attention to health equity [12, 15, 106, 107], only four trainings had an explicit focus on integrating equity. As capacity-building initiatives start to incorporate more equity considerations in their trainings, it would be important to learn from and incorporate the expertise that race scholars, healthcare and social justice scholars, and psychologists who have been developing cultural competency and other trainings to incorporate attention to social justice and equity [108,109,110]. There were few competencies identified in “Capacity Building” and in “Mentoring.” Knowing how to gather funding to support the sustainment of initiatives and how to foster capacity building in community settings are skills that could perhaps be more explicit in capacity training initiatives. Similarly, mentoring is a key aspect of trainees’ success and should not be undervalued, as is shown in the evaluation of capacity building initiatives [54, 81].

Challenges related to competency-based initiatives

This paper illuminates the challenges in basing D&I capacity building on competencies without a well-defined method and theory to inform capacity building efforts. We are at a pivotal moment as the fields continues to build capacity building initiatives for different audiences and for different levels of engagement with the sciences.

This study was developed with the assumption that competencies can provide a map to inform initiatives for capacity-building in D&I, as outlining competencies can inform the goals, process and evaluation of capacity building initiatives. However, it is important to note that scholars from other disciplines (e.g., psychology, education, organization) have offered critiques of capacity-building initiatives. For example, in the context of competency training in the linguistic field, Park [111] cautions on the potential colonization of competency-based trainings and encourages “fundamentally questioning competency-based trainings’ overwhelming emphasis on positivist analysis of linguistic knowledge and practice,” to decrease the risk of contributing to reproducing inequalities.

There are at least three related points about competency-based initiatives for the D&I fields to reflect on. First, not every researcher who does work that could be conceptualized as D&I self-identifies as D&I researcher [10, 112]. We do not want to exclude investigators in the fields simply because they do not have specific D&I competencies. In other words, we do not want to increase the silo that limits collaboration between D&I experts and other scholars. Second, the competencies identified in this study were created with Western, North American, and European perspectives, and as such, they may perpetuate colonizers’ theories and views [113]. As we continue to develop capacity-building initiatives, we need to pay attention to issues of power, marginalization, and oppression, and include reflexivity in the trainings [15, 105, 113,114,115]. We need to critically examine how we can collaboratively develop capacity building initiatives with community members, healthcare leaders, and policy makers [15] to decrease the gap between researcher and practice globally [32]. Third, competencies can be tied to “meritocracy,” which could have a negative effect on the development of the fields. Meritocracy places judgement on people’s knowledge, skills and ability to accomplish certain tasks. A challenge in such a system is identifying who has ownership of defining the ability of others, as this has consequences around hiring and retention in the workforce. The fields are in an early stage of developing competencies for different individuals working with the D&I science, and we hope that leaders can attend to the above cautionary points as they foster D&I capacity buildings.

Recommendations

The fields of D&I have an incredible opportunity to make fundamental changes from within the science and the walls of academia to truly decrease the quality gap. Based on the data from this study, we propose that the D&I fields could benefit from:

• (1) clear consensus-based definition of competencies,

• (2) further development of capacity-building initiatives for various audiences, including researchers, practitioners, and operational leaders,

• (3) comparing and contrasting learner competencies for research and practice, and

• (4) critical thinking about how to embed equity in capacity building initiatives.

Limitations

First, we did not conduct a systematic review and therefore may have missed important publications about capacity building in D&I, but this mapping review can inform the strengths and gaps in the fields. Second, the articles identified were in English, and therefore we could have missed other relevant literature. Third, we recognize that not all capacity-building initiatives in D&I are being published, or published in gray literature, and therefore the sample in this study is biased. Fourth, the search was conducted using only one database and could be strengthened by using a more systematic approach. Nonetheless, we have identified important points for discussion and enhancement in the D&I capacity building initiatives in our sample.

Conclusion

Overall, we found that the competencies currently articulated in D&I capacity building initiatives infrequently differentiate by desired level of expertise, commonly focus on training researchers-only to the exclusion of practitioners, and infrequently and inconsistently incorporate critical areas such as equity and collaboration with other disciplines. As the fields continues to foster capacity-building programs, it will be important to think critically about the types of competencies we are developing for whom, how, and why.