Implementation and sustainability of hospital-based harm reduction delivery: a qualitative analysis.

Research triangulation is a process in which multiple sources of different evidence addressing the same question are integrated through collection, examination, comparison, and interpretation []. Triangulation can be used to test hypotheses and understand phenomena with increased rigor than can be achieved by considering a single source [–]. The triangulation process evaluates the potential biases and their direction in each evidence strand, and, if biases are unrelated to each other, weaves the evidence strands to reach a conclusion []. Triangulation has been successfully used in social sciences and education research, with several examples from the public health field and epidemiology [, ]. Although much research entails some sort of evidence triangulation, the process is often informal, not sufficiently structured, nor is it fully transparent or clearly documented. Previous attempts to structure the triangulation processes have described it as a stepwise approach that includes (up to) 12 steps grouped broadly into three main categories: (a) planning the triangulation process, (b) conducting the triangulation of evidence and analysing the data, and (c) communicating the results or action points [, ]. The process may also include a “triangulation meeting”, where stakeholders involved in the process present and evaluate the whole body of evidence, alter, or modify the starting research hypotheses and identify the need for additional data []. The role of a triangulation meeting shares elements with meetings to develop clinical recommendations. There is a lot of guidance about the development of clinical recommendations, with clear instructions about how to structure and hold meetings [–] and generate quality checklists and reviews [, ]. However, detailed theoretical, methodological, and operational guidance on how to plan, conduct, and evaluate triangulation is still lacking [, ]. We aim to fill this gap as part of our collective research endeavours of the GALENOS project (Global Alliance for Living Evidence on aNxiety, depressiOn and pSychosis) []. GALENOS is a Wellcome-funded project that carries out a series of living systematic reviews (LSRs) on the mechanisms, prevention, and treatment of anxiety, depression, and psychosis []. People with lived experience of mental health issues are involved in all steps of GALENOS, and the project aims to inform priority setting for research conducted to develop new treatments or diagnostic approaches []. In our experience, the involvement of people with lived experience makes a critical contribution to the success of, and value which can be derived from, the process of research priority setting that meets identified unmet needs. All GALENOS LSRs aim to include different types of evidence, including data human and non-human animal studies (referred to from now on as “animal studies” for brevity). Triangulation of these two evidence theses, and consideration of their different biases, as well as the integration of lived experience, leads to recommendations for future research []. The proof-of-concept approach, GATE (GALENOS Approach to Triangulating Evidence), has been developed in the first three years of the project. It describes the collection, evaluation and integration of different types of evidence using a multi-disciplinary and co-produced approach. More details on GATE can be found elsewhere [].