Consensus Building Research Articles

The PERMIT guidelines for designing and implementing all stages of personalised medicine research.

Personalised medicine (PM) research programmes represent the modern paradigm of complex cross-disciplinary research, integrating innovative methodologies and technologies. Methodological research is required to ensure that these programmes generate robust and reproducible evidence. The PERMIT project developed methodological recommendations for each stage of the PM research pipeline. A common methodology was applied to develop the recommendations in collaboration with relevant stakeholders. Each stage was addressed by a dedicated working group, specializing in the subject matter. A series of scoping reviews that mapped the methods used in PM research and a gap analysis were followed by working sessions and workshops where field experts analyzed the gaps and developed recommendations. Through collaborative writing and consensus building exercises, the final recommendations were defined. They provide guidance for the design, implementation and evaluation of PM research, from patient and omics data collection and sample size calculation to the selection of the most appropriate stratification approach, including machine learning modeling, the development and application of reliable preclinical models, and the selection and implementation of the most appropriate clinical trial design. The dissemination and implementation of these recommendations by all stakeholders can improve the quality of PM research, enhance the robustness of evidence, and improve patient care.

Community-based development and indigenous evaluation in Africa: insights from Ghana

ABSTRACT Community-based development (CBD) evaluation is often rooted in mainstream evaluation theories and methods to the detriment of Afrocentric evaluation philosophies and practices. Afrocentric values, grounded in cultural ideals and relational patterns, are the foundation of the search for new knowledge. The notion is that indigenous evaluation values and assumptions could aid in developing alternative concepts, approaches, and practices for assessing CBD initiatives. Employing a thematic analysis approach rooted in indigenously responsive evaluation (IRE), this paper identified tangible and intangible notions such as social networks, relational stakeholders, social accountability, mutual respect, community participation, community spirit, relational feedback, and consensus building as some of the key concepts embedded in social and development activities that have the potential for effective CBD and evaluation activities. This paper outlined cultural evaluation components that Ghana and Africa at large may effectively include in contemporary evaluation frameworks to ensure the sustainability of CBD and evaluation initiatives.

Decompensated Liver Cirrhosis Research Network (UK-CLIF): Building consensus for hepatology trials in the UK

Liver disease is a major, and increasing, cause of death in the UK. The UK Chronic Liver Failure network (UK-CLIF) was developed as a multi-stakeholder network with the aim to advance cirrhosis research, with emphasis on geographical areas of high disease prevalence or limited research activity. The process involved network development through dissemination and snowball sampling techniques, with monitoring of network development and connections between participants, developed over two online meetings. Network membership included representatives from patients, carers, clinicians, researchers, R&D professionals, industry representatives, and the third sector. Subsequently, two facilitated in-person workshops were conducted with network participants. World Café methodology and participant dot voting was used to develop areas of priority and consensus in: (i) research infrastructure for cirrhosis clinical trials, (ii) clinical factors affecting research delivery, and (iii) research priorities for future trials. Thematic analysis demonstrated that the need for patient-centric trial materials, a lack of resource for clinicians to participate in research, and variability in the standard of inpatient care for cirrhosis, were barriers for cirrhosis clinical trials. Future activities for UK-CLIF include participation in a process of quality standard setting for inpatient care for cirrhosis, and coordination of a James Lind Alliance Priority Setting Partnership to develop research questions for liver cirrhosis.

A generalized TODIM approach based on information measurement and consensus building model in probabilistic hesitant fuzzy environment

Information measurement and decision-making methods are two important aspects in the application of probabilistic hesitant fuzzy elements (PHFEs), and these issues are crucial for improving decision quality and enhancing the applicability of PHFSs. This paper focuses on the entropy measure and score function of PHFEs, and then proposes a generalized TOIDM method based on information measurement and consensus building. In this contribution, we develop a novel non-probabilistic entropy measure by two non-fuzzy elements and a novel score function based on sigmoid function. The novel non-probabilistic entropy of PHFEs can comprehensively reflect the dynamic changes of fuzzy uncertainty and hesitant uncertainty, and provide a new axiomatic framework. The novel score function of PHFEs can synthesize multiple information effectively with strong integrity. In the sequel, the two proposed information measurement methods are compared with existing methods to further verify the validity of the developed methods. Eventually a consensus building model is constructed based on the proposed information measurement method, and then a generalized TODIM approach based on information measurement and consensus building is proposed for probabilistic hesitant fuzzy environment. The developed approach is demonstrated with an emergency rescue planning decision-making problem. Sensitivity analysis and comparative analysis are employed to verify the validity and stability of the approach and information measures proposed in this paper. Based on the findings of this study, we conclude that the proposed methods effectively enrich the existing information measurement methods and decision-making methods in the field of probabilistic hesitant fuzzy.

Minimum deviation distribution ranking model and fairness concern-based consensus building for group decision-making

Minimum deviation distribution ranking model and fairness concern-based consensus building for group decision-making

The many facets of perceived bladder health in women: Absence of symptoms and presence of healthy behaviors across the life course

Purpose:Qualitative studies exploring bladder health are rare compared to research focusing on lower urinary tract symptoms (LUTS). Our aim was to explore adolescent and adult women’s perceptions about what constitutes a healthy bladder. Methods:We conducted a 7-site focus group study of bladder health with adolescent and adult women across six age categories (11–14 to 65+ years). Transcripts were analyzed using transdisciplinary, directed content analysis and an iterative interpretive consensus building approach to identify key constructs, focusing on “healthy bladder” and “unhealthy bladder” codes. Results:Forty-four focus groups with 360 participants were completed. Three thematic categories were identified: (1) concept of a healthy bladder (conceptual abstraction); (2) experience of a healthy bladder (subjective experience); and (3) lifestyle and life course considerations (bladder health in context). Participants struggled to define the unfamiliar concept of healthy bladder and relied on contextualized experiences and behaviors for characterizing bladder health. They described the concept of a healthy bladder as something that you did not need to think about but did require attention to healthy habits to maintain. Other features of a healthy bladder discussed include having bladder control despite urgency and environmental constraints on voiding, normal voiding frequency, and qualities of urine and urination. Participants struggled with lack of information about healthy bladder habits and noted absence of routine bladder health screening. Discussion:Findings identify need to promote public education and information sharing in health care visits about bladder health. Further they can inform bladder health promotion and clinical research on LUTS prevention.

Mobilising in the face of large-scale urban change: a conversation between two community organisers from Johannesburg and London

Large-scale and long-term urban development projects often cause sizeable transformations in the built and social fabric, raising questions about the impacts on existing neighbourhoods and communities, and how they might try to shape the development. There are significant challenges to achieving community-based engagement at a large scale involving mobilising a wide range of stakeholders with different positionalities, agendas and priorities across multiple and diverse areas of a city. In this interview, two experienced organisers reflect together on their different but resonant experiences in building community networks to engage with large-scale developments. Between 2016 and 2018, the research project ‘Governing the Future City’ explored the governance of large-scale developments in three urban areas—London, Johannesburg and Shanghai. In Johannesburg and London, the research process directly funded and supported community-based organising in relation to the planning and implementation of the developments. The organisers and researchers worked with existing community-based organisations to try to influence the planning process, drawing together a wide range of affected community and neighbourhood groups. During the course of the research project, the two community coordinators, Mike Makwela (Planact, Johannesburg), focusing on the Corridors of Freedom project, and Sharon Hayward (London Tenants Federation and Grand Union Alliance), working on the Old Oak Park Royal development, visited the other city to explore possibilities to learn from each other’s experiences and contexts. In 2017, while Sharon was in Johannesburg, project researcher Romain Dittgen interviewed them together, twice, on 18 and 20 July, about their experiences of organising and mobilising in their respective cities, specifically in relation to large-scale development projects and in the context of highly diverse communities. Key issues that emerged concerned shared values of community self-organising, the benefits of building consensus or working with different views, and different approaches to relations with government officials and elected representatives. In parallel, they also reflected about working and collaborating with academics, as well as about possibilities for critical analysis of the developments and mutual learning across the two cases.

A Strategic Leadership Approach To Conflict Resolution In Papua

This study, titled "Strategic Leadership Approaches in Conflict Resolution in Papua," aims to explore how strategic leadership can contribute to resolving conflicts in Papua. The research focuses on two main areas: the impact of strategic leadership competencies on conflict resolution and the application of strategic leadership guidelines within organizational culture. First, the study examines the influence of strategic leadership competencies on the effectiveness of conflict resolution in Papua. These competencies include the ability to plan, implement, and evaluate strategies, as well as adapt to changing situations. The research evaluates how leaders with strong strategic competencies can facilitate dialogue, build consensus, and design sustainable solutions for long-standing conflicts. Second, the study assesses the application of strategic leadership guidelines within the context of organizational culture. Understanding the local culture and applying leadership principles that align with the organizational culture are central to this analysis. The research investigates how formal procedures and strategic control are used to manage and resolve conflicts effectively within organizations operating in Papua. The findings indicate that effective strategic leadership requires a deep understanding of the local context and skills in designing and implementing adaptive strategies. Integrating cultural values with leadership principles is crucial for building harmonious relationships and resolving conflicts. This research provides practical insights for leaders in designing more inclusive and responsive approaches to conflict resolution in Papua.

Development of a core predictor set of weaning in critically ill patients: a Delphi-based study protocol.

Prolonged mechanical ventilation in intensive care units (ICUs) leads to increased morbidity, higher mortality rates, and elevated healthcare costs. Predicting successful weaning from mechanical ventilation with accuracy is essential for optimizing resource use and improving patient outcomes. The International Classification of Functioning, Disability and Health (ICF) framework offers a holistic perspective on health conditions and can be adapted to identify key predictors of weaning readiness. This study aims to develop a Delphi-based core predictor set for weaning in critically ill patients, utilizing the ICF model. The core predictor set development comprises three steps: (1) Literature review and expert consultation to gather weaning predictors, (2) Predictor alignment with ICF categories per established rules, and (3) Three-round Delphi survey with a multidisciplinary team. A systematic review across major databases will be conducted to identify predictors related to weaning predictors in critically ill adults from cohort studies, trials, and reviews. Predictors will then be categorized within ICF domains. A multidisciplinary expert panel will evaluate the relevance of each predictor using a 9-point Likert scale to achieve consensus. This study will contribute to the development of a standardized, evidence-based predictor set for weaning readiness in critically ill patients. Using the ICF framework, this study aims to encompass the complex factors that influence weaning, thereby enabling personalized care plans and improving weaning outcomes. The Delphi methodology guarantees a thorough, iterative process for building consensus by integrating diverse clinical perspectives. The proposed Delphi-based study protocol aims to establish a core set of predictors for weaning in the ICU setting, guided by the ICF model. Successful implementation of this predictor set could enhance decision-making around weaning trials, reduce unnecessary ventilation days, and ultimately improve patient outcomes and healthcare efficiency. Future validation and implementation studies will be essential to confirm the utility and generalizability of this predictor set in clinical practice.

Large scale public health system transformation: Germany

Abstract The COVID-19 pandemic was a stress test for public health services in Germany. Decision making was complex (party lengthy and inconsistent) due to the divided responsibilities within the federal system. Some improvements on the public health system were already enacted during the pandemic. A “pandemic radar” was established to bundle up relevant infectious disease indicators with indicators of health services use. The national electronic notification and information system for infectious diseases was extended. Digital improvements were made in the public health offices. Laboratory capacity was strengthened, so was inter-science modelling to forecast pathogen spread. A nation-wide collaborative mechanism, the cloverleaf system, was introduced between regions to avoid the overburdening of hospitals. It is now established for times of excess need for inpatient services. In 2020, a 4 billion euros investment program, the “Pact of Public Health Services”, was adopted to strengthen and modernize the German public health service institutions. The pact is implemented until 2026. The human resources component is the largest. Further priorities include digitalization, improvement of the infrastructure (of designated ports and airports) for the implementation of the International Health Regulations, research and the creation of agile and resilient public health structures. Outputs so far include the establishment of more than 4800 new public health positions, the appointment of new professorships for public health services, the initiation of several research projects, and the roll-out of more than 300 digitalization projects. A new federal institute for prevention is planned. It aims to foster networking between public health services, strengthen health communication, data use, and evidence for public health services. In this process, WHO advised the federal ministry e.g. on behavioral insights; heat health action; prevention on noncommunicable diseases and others. Many public health actors have provided opinions. However, consensus building on how Germany can overcome fragmentation in public health is ongoing.

Infrastructure first principles for the Anthropocene

Abstract There appears to be a growing decoupling between the conditions that infrastructures were designed for and today’s rapidly changing environments. Infrastructures today are largely predicated on the technologies, goals, and governance structures from a century ago. While infrastructures continue to deliver untold value, there is growing evidence that these critical, basic, and lifeline systems appear ill-equipped to confront the volatility, uncertainty, accelerating conditions, and complexity that define them and their changing environments. Innovative and disruptive first principles are needed to guide infrastructures in the Anthropocene. Drawing from emerging infrastructure research and disciplines that appear better able to confront disruption and change, a novel set of first principles are identified: (1) Plan for complex conditions and surprise; (2) Recouple with agility and flexibility; (3) Govern for exploration and instability; (4) Build consensus as control decentralizes; (5) Restructure to engage with porous boundaries; and, (6) Cyberthreat planning is now mission critical. These principles should guide infrastructure planning recognizing the changing nature and increasingly obsolete boundaries that have defined engineered systems in the modern era.

The process of developing a framework for code of ethics

Abstract Issue/Problem The World Health Organisation (WHO) and Association of Schools of Public Health in the European Region (ASPHER) roadmap for the professionalisation of the public health workforce has noted ethics as a pillar for professionalisation. It also highlights the need for code of ethics and professional conduct for all public health professionals and institutions. The Global Network for Academic Public Health (GNAPH), in collaboration with EUPHA, ASPHER, and the UK Faculty of Public Health has been working together for a code of ethics. Description of the problem The WHO/ASPHER group asked for a framework to be developed by the expert group as part of the rollout of the professionalisation agenda. The objective of this work was to develop a guide that is applicable to different countries within Europe to develop their own of code of ethics and conduct. A modified Delphi approach to building consensus amongst professionals in ethics included law, academia, and public health professionals. The questions sought to be answered were what and how to develop a framework and what should be included in the guide for creating a public health code of ethics. Results Throughout this method we developed five values, and twelve principles that are essential for the development of a code of ethics through a consensus building exercise. This framework was the first of its kind as part of the professionalisation agenda for different regions. There will be ongoing work piloting this framework in practice with various professional groups and institutions. Lessons Throughout this process, the need and demand across the public health community for ethical education and development of code of ethics was made evident. Collaboration between academics, ethicist, lawyers, and public health professionals and policy makers were key in developing a public health code of ethics. Identifying the challenges with monitoring and evaluating of its implementation a public health code of ethics. Key messages • Ethics, and a code of ethics are an essential component of the professionalisation agenda of the public health workforce. • There is need for continued collaboration and partnership with public health professionals and institutions in enacting its implementation and evaluation.

Developing an Evidence-Based Primary Cancer Prevention Repository: insights from the PIECES project

Abstract Introduction Up to 40% of cancer cases could be avoided through effective primary prevention. However, cancer prevention tends to be fragmented across Europe, leading to geographical health differences. The dissemination and scale-up of effective primary cancer prevention interventions may address this. Although effective cancer prevention programs exist, finding them and their materials (especially regarding implementation) can be challenging. Repositories of evidence-based interventions provide insight into “what is out there” and can support dissemination within and across national borders. The PIECES project aims to develop and disseminate a repository of evidence-based primary cancer prevention programs adaptable to European contexts, with information to aid adaptation and implementation across countries. Methods The development of the PIECES repository has been informed by established repositories such as NCI’s Evidence-Based Cancer Control Programs. The project team developed a scoring sheet with a selection of items that could be included in the repository. All participants rated each item on relevance and applicability and provided comments and suggestions. A final framework, including a set of minimal requirement items, was agreed upon during three online consensus building meetings. Results We created a repository of evidence-based primary cancer prevention interventions targeting modifiable risk factors suitable for implementation in European healthcare settings. This 22-item repository provides information about an intervention’s logic model, implementation practices, and appraisal of published evidence of effectiveness. Conclusions This repository is innovative as it includes practical information and tools to facilitate implementation. While initially built to serve the PIECES project, the repository is designed to be a valuable tool for European policymakers, researchers, and implementers. Lessons learned from this process will inform future developers. Key messages • A comprehensive cancer prevention intervention repository avoids “reinventing the wheel” and allows for more efficient use of existing interventions by building upon the best available evidence. • The ongoing efforts of the PIECES project represent a significant contribution to reduce cancer prevention disparities and to facilitate the adoption of evidence-based interventions in Europe.

Whose forest, whose values? Planning for Atlanta’s “South River Forest”

ABSTRACT Atlanta, Georgia's (USA) proposed South River Forest (SRF) is a 3,500-acre area straddling southeast Atlanta and parts of neighboring DeKalb County that would include non-contiguous greenspace and developed land uses. Catalyzed by the 2017 Atlanta City Design process, the SRF concept recognizes the ecologically rich, urban forest patches in this predominantly African American part of the metro area. SRF advocates point to the climate and environmental equity benefits of green space conservation for underserved communities and the personal benefits of having wildland-like outdoor recreation areas within the city. To gauge public perceptions of the SRF, promoters conducted the South River Forest Consensus Building & Stakeholder Engagement process in 2022, which included an online survey querying respondents' interactions with and personal relationship to the SRF. The findings showed overwhelming support for the preservation effort; however, eighty percent of respondents identified as white and just nine percent as black. This composition contrasts sharply with most SRF neighborhoods, which question whether black ways of being in nature were captured by the engagement process. Our analysis also brings attention to an alternative, black-led vision for the area that was not reflected in the engagement process and the implications of this erasure for recognition justice.

Letter From the Co-Editor: Yes, “Shit’s Got to Change.” But How? A Call for a Deep Scholarship Social Movement

This letter from the editor is in response to Benjamin et al.'s (2024) call to action surrounding the structures and systems of the tourism academy. It recommends a social movements approach as a possible framework for taking next steps. This Deep Scholarship Movement suggests (1) identifying and assembling key leadership change agents with diverse viewpoints, (2) enhancing self-efficacy, increasing consciousness-raising, and maximizing resource mobilization, the three primary components of successful social movements, and using them to work toward (3) community consensus building. These are challenging and daunting recommendations. This letter argues, however, that this or some other systemic, organized approach is necessary for those of us in varying aspects of leadership to clear the way and establish deeper, richer, more inclusive and less oppressive environments for our early-and mid-career colleagues.

Hybridity as a governmental technique for designing and delivering NAPLAN in Australian schools

AbstractThis paper explores the utility of hybrid governance as an analytical lens for understanding policy design and delivery in Australian schooling reform. Using the National Assessment Program in Literacy and Numeracy (NAPLAN) as a case study, we argue that its design and delivery processes exemplify hybridity in myriad dimensions. In a federal system in which national schooling reform relies upon negotiation and consensus building amongst a multiplicity of government and non‐government stakeholders, we argue that NAPLAN's hybridity serves as a governmental technique for managing and sustaining collaborative governance arrangements. Hybridity also supports the standardised implementation of the assessment across diverse schooling systems and sectors. While NAPLAN's hybridity generates strategic benefits for Australian governments, it also produces risks. A challenge for policymakers is to harness its benefits while ensuring transparent decision‐making and clear responsibilities and accountabilities. To address risks and leverage opportunities, we argue there are benefits to having a convening agency with authority to manage and sustain hybrid networks at the national scale.Points for practitioners Hybrid governance offers productive insights into how Australian governments work collaboratively to design and deliver national schooling reforms. The National Assessment Program in Literacy and Numeracy (NAPLAN) is an exemplary case study for examining hybrid governance in the Australian federation. Hybrid governance serves as a technique for managing and sustaining collaborative governance arrangements at the national scale and for ensuring NAPLAN's implementation is standardised across Australia's diverse subnational schooling systems and sectors. Hybridity creates risks and opportunities. A challenge for policymakers is to harness its benefits while ensuring transparent decision‐making and clear responsibilities and accountabilities. There are benefits to having a convening agency with authority to manage and sustain hybrid networks at the national scale.

A stakeholder perspective on contested urban heritage and heritage tourism

While there is consensus among researchers that stakeholder participation is critical for heritage development, conflicts between stakeholders can exist and create an arena of contestation. Limited studies have addressed the issue of contested heritage and conflict mitigation in heritage tourism. Examining contested urban heritage in Dalian, China, this study investigates stakeholder conflict using means-end-chain analysis to reveal conflicting perspectives and visions. Furthermore, it uses tourisation theory to assess the tourism potential of each identified development scenario. Findings reveal how a focus on functional adaptation can help to achieve compromise between “dismantler” and “preservationist” polarities to gain agreement between stakeholders. This study enhances the understanding of stakeholder conflict related to contested heritage and contributes to stakeholder theory by addressing conflict mitigation and consensus building. By highlighting the heterogeneity within traditionally defined stakeholder groups, the study suggests using attitudinal groups as a strategy for stakeholder categorization and identification of common ground. It further demonstrates how a value-based approach can help to understand the shaping of stakeholders’ views and foster consensus, laying the foundation for collaborative planning in urban heritage tourism.

Engaging Diverse African American/Black and Latine Youth and Emerging Adults Living with HIV into Research: Description of Recruitment Strategies and Lessons Learned.

Improving engagement along the HIV care continuum and reducing racial/ethnic disparities are necessary to end the HIV epidemic. Research on African American/Black and Latine (AABL) younger people living with HIV (LWH) is essential to this goal. However, a number of key subgroups are challenging to locate and engage, and are therefore under-represented in research. Primary among these are persons with non-suppressed HIV viral load, severe socioeconomic disadvantage, transgender/gender expansive identities, and refugee/migrant/immigrant populations. Research in community settings is needed to complement studies conducted in medical institutions. The present study describes the efficiency of recruitment strategies used in the community to enroll AABL young and emerging adults LWH ages 19-28 years. Strategies were designed to be culturally responsive and structurally salient. They were: peer-to-peer, social media, classified advertisements (newspaper, craigslist), subway ads, dating apps (Jack'd, Positive Singles), and direct recruitment in community-based organizations. Data were analyzed using mainly descriptive statistics and interpreted using a consensus building approach. We screened 575 individuals in a first step, 409 were eligible (71%), of these 297 presented to the second screening step (73%), but 112 were lost. Almost all presenting at the second step were eligible (98%, 291/297) and 94% enrolled (274/291). Peer-to-peer, dating app (Jack'd), direct recruitment, and craigslist were the most efficient strategies. Recruitment on dating apps was superior to the peer-to-peer approach in yielding eligible participants (OR = 1.5; 95% CI: 0.98-2.3; p = 0.06). The sample enrolled was diverse with respect to HIV viral suppression, gender identify, sexual orientation, immigration status, and barriers to HIV care engagement. We discuss the advantages and disadvantages of each strategy. Recruitment is a vital aspect of research and warrants attention in the empirical literature.

Consensus-Building Processes for Implementing Perioperative Care Pathways in Common Elective Surgeries: A Systematic Review.

To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries. Systematic review. Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023. Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions. The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions. Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented. Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals. These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. No patient or public contribution. CRD42023413817.

Building alliances and consensus around social-ecological rewilding in Chile

We provide a case study of how we position our rewilding project in central Chile in order to find scientific and social support and build alliances, collaborations, and consensus. Our core vision focuses on reintroducing guanacos (Lama guanicoe) to central Chile in order to provide natural restoration and ecosystem processes in espinal woodlands dominated by the native tree Vachellia [Acacia] caven. We envision a scenario of “social-ecological rewilding” with widespread guanaco browsing in woodlands and guanaco migration across the region, coexisting with multiple human uses of the landscape. Guanacos would ideally be managed by regional collectives who could benefit from guanaco tourism, sustainable harvest of their fiber (wool), and regulated hunting. Our wider vision for reintroductions and integrated conservation management extends to a set of other species that may have coexisted with guanacos and V. caven at various points in the past, but more research is necessary to establish and gain support for evidence-based baselines. Our strategy is to inspire actors with greater resources (land, money, influence) to share our vision and implement it, in collaboration with the NGO that we have formed to support our projects. Over ten years, circulating alternate interpretations and a novel imaginary of how central Chile was in the past and could be in the future, along with developing and testing scientific hypotheses, has moved our vision from an idea shared by two people to one that a wide variety of actors publicly embrace.