A systematic review of peer-reviewed literature was conducted using LionSearch from Penn State University. LionSearch searches hundreds of databases simultaneously at Penn State University Libraries (including, for example, PubMed, PsychINFO, and Ebsco electronic books). A full list of the databases included in LionSearch is available at: https://www.libraries.psu.edu/psul/databases.html#. We limited the search to articles published from 2000 through 2012, and conducted a general search using terms for stakeholder education (e.g. partnership, collaboration, education, awareness), and public health (e.g. public health, community health, adolescent health, teen pregnancy) to focus results on relevant public health-related efforts (see the Appendix). In an effort to improve specificity of our search, we conducted additional, distinct searches for four priority audiences: 1) faith-based community, 2) parents, 3) staff or administrators within child welfare/foster care organizations, and 4) staff or administrators from post-secondary institutions or colleges (see the Appendix). During the first two years of the initiatives, these four audiences emerged as key priorities for stakeholder education in the funded communities based on two factors: 1) their key roles in building community support for adolescent health, and 2) their access to underserved and high-risk populations (such as youth in foster care or teens aged 18–19). Secondary schools and community-based organizations are the entities most often engaged in teen pregnancy prevention efforts, yet child welfare and foster care organizations and post-secondary institutions, which often serve teen populations at higher risk of pregnancy, are less frequently engaged and were the focus of this review (Dworsky, 2010 and Bradburn, 2002). Corresponding search terms for each of the respective audiences included: 1) faith leaders, faith organizations, faith communities, faith-based; 2) parent, trusted adult, guardian, mother, father; 3) foster care, case workers, social workers; and 4) college, post-secondary, technical school, vocational school, community college. Search terms looked for keywords, title, and abstract. If a term appeared in any form, it pulled similar terms. For example, by including “parent” this would also allow us to see stepparent, foster parent, etc. A full matrix of the search terms can be found in Appendix 1.

The search results yielded a total of 410 articles for title and abstract review. Authors and team members from the national organization responsible for the stakeholder education component reviewed the initial titles and abstracts and applied retrieval criteria. We did not retrieve a full article if it involved work outside of the United States or was written in a language other than English. For example, we did not retrieve an article titled Engaging Italian and Australian Social Workers in Evaluation. We retrieved full articles that appeared to meet these criteria: addressing general stakeholder education strategies in public health initiatives or discussing strategies for specifically engaging one of the four priority audiences in public-health related initiatives. We identified 106 of the 410 for full-article review. After full-article review, we applied inclusion criteria. We excluded articles that focused on why partnerships were important instead of providing strategies for how to engage stakeholders. We also excluded articles that focused on an intervention without mention of strategies to build partnerships, education, or awareness or of lessons learned. For example an article titled Improving Understanding and Collaboration between Campus Ministers and College Counseling Center Personnel. Journal of College Counseling, focused exclusively on intra-college relationships and did not offer additional strategies for stakeholder education, thus was excluded. The term “strategies” here is defined as a plan, method, or series of activities for obtaining a specific goal or result, i.e. educated or engaged stakeholders; the phrase “lessons learned” is defined as knowledge shared that has been gained through experience. The authors determined whether each article met the inclusion criteria; two additional subject matter experts reviewed the reasons for inclusion and exclusion. Final decisions were made when all reviewers reached consensus. More specifically, all reviewers held at least one meeting to discuss until full agreement was reached for inclusion/exclusion.

To reduce the chance of missing valuable articles, we also conducted the same search using Google and GoogleScholar, applied the same inclusion criteria described above (focus on how to engage stakeholders and specific strategies or lessons learned), and the criterion that any non-peer reviewed papers must be from reputable organizations such as government agencies at the federal and state level, along with national nonprofit organizations with expertise in the topic. While Google Scholar was included in LionSearch, we re-ran this search to ensure we did not miss any articles. We did not find any new peer-reviewed articles from this search. Google was used with the aim of finding non-peer reviewed resources from the field. The Google search did discover non-peer reviewed articles which we separately reviewed for inclusion in this literature review as described above.

From the articles, we extracted strategies and lessons learned for educating or engaging stakeholders. Strategies and lessons were then grouped according to theme and organized into a step-wise process that could be practically followed and implemented.

We found a focus on identifying key stakeholders and their values as well as understanding the community’s needs and resources; this theme was underscored in 25 of the 59 articles reviewed. Strategies in this theme included keeping stakeholders in mind when conducting needs and resource assessments, gathering information about key stakeholder groups to have a better understanding of their interests and influence, and identifying language and concepts that can be used to build partnerships and establish a two-way dialogue and knowledge exchange. For example, one project, which focused on engaging faith communities to address health, determined that assessment of the community at the beginning of the project was critical. In particular, assessments to determine the norms and values of the faith-based organizations and the communities they serve and to identify common ground on which to build a partnership were important for authentic engagement from the beginning (Corbie-Smith, Goldmon, Isler, Washington, Ammerman & Bunton, 2010). Another study, which explored facilitators and barriers to effective public and private partnership, found that trust was lower and communication more challenging when local health departments engaged community members in the planning process, but then made their own decisions without explaining how the input of key stakeholders was or was not used to inform those decisions (Stajura, et al., 2012).

We found that developing a plan for stakeholder education and/or including stakeholder education as a component of the overall project plan was important to a project’s success. Thirty-one of the 59 articles included strategies related to this theme. Multiple articles discussed planning, setting key goals, and implementing project activities according to timelines. Articles also cited the importance of delineating measureable outcomes and providing adequate resources to the stakeholder education activities. For example, a project in New York that was designed to develop effective community partnerships to address youth development found that allocating sufficient time and resources to establish collaboration was critical, as was engaging partners in the visioning and planning process, so that partners and stakeholders were invested in the outcomes (Dotterweich, 2006). Another study found that including strategies that are already familiar to the stakeholder group, such as prayer and music, could be included in programmatic strategies to better engage the faith community (Adkinson-Bradley, Johnson, Sanders, Duncan, Holcomb-McCoy, 2005).

The use of clear, tailored, and compelling messages that addresses the audience’s needs was another theme mentioned. Seven of the 59 articles reviewed provided insight related to this theme. Articles discussed the importance of using knowledge gained from audience assessment to ensure that the message resonates with that particular audience. We also found emphasis on educational processes with stakeholders that are interactive, encouraging, responsive, reciprocal, objective, inclusive, and flexible. For example, Parvanta and colleagues suggest that when exploring the potential for social marketing to reach particular individuals, a thorough understanding of the other messages provided to the same target audience is helpful for developing a communications campaign that will be noticed (Parvanta, Nelson, Parvanta, & Harner, 2010). Successful stakeholder engagement activities involve communicating in ways that are clear, culturally relevant, ongoing, frequent, transparent, and respectful.

This review identified several implementation strategies when executing a plan to engage stakeholders. Twenty-six of the 59 articles reviewed mentioned activities related to this implementation theme. Allowing for flexibility and change, enlisting stakeholders for support in the implementation phase were found to be important. For example, one study in North Carolina found that pastors were very willing to share messages to help reduce stigma related to HIV/AIDS. The pastors benefited from training about how to talk about HIV/AIDS and from materials and resources that were developed for them to easily disseminate (Moore, Onsomu, Timmons, Abuya, Moore, 2012). Other articles indicated that continuous and active dissemination of materials and resources was essential to keep funders and other key stakeholders engaged (Dötterweich, 2006; Jeffery, 2009; The Finance Project, 2002).

Our review also indicated that strategies and lessons learned were guided by several predominant behavioral theories, including the Stages of Change/Transtheoretical Model of Change, Health Marketing Theory, and the Ecological Model. The Stages of Change model relates to anticipating and understanding a particular stakeholder’s “stage of readiness” and meeting the stakeholder where they are, including tailoring the message to fit the stakeholder’s stage of readiness (Edberg, 2007). Health Marketing Theory involves “creating, communicating, and delivering health information and interventions using consumer-centered and science-based strategies to protect and promote the health of diverse populations,” as defined by CDC (Bernhardt, 2006). The Ecological Model approaches teen pregnancy prevention using a multi-level approach that considers the influence of and interactions among environmental, societal, organizational, policy, and individual factors (including predisposing, reinforcing, and enabling factors) (Parvanta et al., 2010). Implicit in these behavioral theories is a natural connection between and among efforts to promote stakeholder education, community mobilization, and working with diverse communities, and these theories provide the backbone for the strategies listed in this guide.

To synthesize the numerous strategies, we identified the aforementioned themes. To make this information more readily usable for practitioners engaging in similar public health efforts, we translated these themes into four steps, each with certain strategies (Figure 1).