Trust in the conduct of health and implementation research in conflict-induced humanitarian settings: a narrative literature review and preliminary theoretical framework

Abstract

Conducting research in settings marked by violence is essential for generating credible knowledge to improve humanitarian responses. While its importance is widely acknowledged, the practice of health research, and implementation research in particular, is rarely itself a focus of research endeavors, limiting the understanding of the complexities of research conduct in conflict-induced humanitarian settings. This narrative review aims to synthesize and conceptualize the literature reflecting on research conduct in such settings through an analytical lens of trust, adopted after an initial synthesis of the literature, and offers a preliminary theoretical framework to guide researchers’ efforts in conflict-affected settings. We conducted a systematic search of Google Scholar, Scopus, PubMed, and Web of Science to identify studies reflecting on the research conduct process in conflict-induced humanitarian settings, focusing on implementation research and the broader health-related field. Twenty-seven studies were included. The data were synthesized thematically through the lens of trust. The included studies covered eight world regions and diverse conflict-affected settings, fragile and conflict-affected states, displacement and refugee situations, and complex humanitarian crises. Nearly half reflected on the research conduct process, while others focused on specific interventions; the methodologies were largely qualitative, and six of the included papers were identified as having implementation research characteristics. We identified nine key constructs of research practice in such settings, organized into relational, systemic, and societal aspects of trust. We examined the relationships and interactions of these constructs with the research process, illustrated them in a conceptual model, and presented an epistemological dilemma: trust operates both as a precondition enabling research initiation and as a result of the research practice, continuously shaped through researchers’ engagement, interaction, and decision-making within a given context. The findings underscore the importance of reflexive researcher positioning, attention to power dynamics, and collaborative, context-sensitive, inclusive approaches to support ethical and credible knowledge production. This review demonstrates that trust plays a central and dynamic role in conducting research, including implementation research, in conflict-induced humanitarian settings. A preliminary theoretical framework, developed as an outcome of this review, requires further refinement to guide meta-implementation research to support research practices in adverse settings.