An evidence synthesis programme commissioned by the UK’s National Institute for Health Research from two academic teams produced a diverse range of outputs and methodological insights in its first three years of operation. The programme was subsequently re-commissioned for two further cycles. Scoping the topic and involving stakeholders were key to its success.
Matthew Johnson, Elliott Johnson, Laura Webber and Kate Pickett
The COVID-19 pandemic has increased interest in Universal Basic Income (UBI) as a means of addressing a range of socio-economic insecurities. While previous trials of cash transfer schemes have often focused on low-level transfers inadequate to satisfy the needs for which the policy was originally developed, emerging pilots are moving toward a position of increasing generosity. Our multidisciplinary project, Examining the Health Case for UBI, has brought together colleagues in behavioural science, public health, epidemiology and economics to establish pathways to health impact outlined in Figure 1 below. Our work suggests the potential for significant health impact and attendant economic benefit via reduced healthcare costs and increased economic activity. The model suggests that elements of impact may only be felt if payment is set at a more generous level. This could create greater return on investment and, ironically, a more cost-effective system.
We have spent much of our academic and professional careers participating in and leading initiatives that are trying to change how organisations, institutions and systems function. The relentless demands of this work mean there is often little opportunity to reflect on the efficacy of our efforts. To address this gap, we conducted more than two years of ethnographic research to learn how community-university-policy partnerships use research and strategic communication to change how youth homelessness is addressed on a pan-Canadian scale. Our intention was to improve our own tactical efforts to ensure our research contributes to the types of changes we want to see (e.g. an end to youth poverty and homelessness).
We learned that networked knowledge exchange is central to ensuring research-to-policy impact.
In this blog post, we suggest three things researchers can do to produce research that addresses persistent social problems.
Sheena Asthana, Rod Sheaff, Ray Jones and Arunangsu Chatterjee
In an article published in Evidence & Policy last year, ‘eHealth technologies and the know-do gap: exploring the role of knowledge mobilisation’, we described the eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC) project, which aims to support the development of a sustainable innovation ecosystem. We found that, in order to build practically useful links between user (and/or carer) groups and those developing new eHealth technologies, the EPIC team had to invest significant resources in knowledge sharing, one-to-one networking, building focused linkages and capacity building; that financial support can play a key role in supply-side dynamics; but that the contextual and organisational barriers to eHealth innovation in England should not be underestimated.
We find that the adoption of evidence-based policies in US states is driven more by Machiavellianism than altruism. Although engagement with evidence-based policymaking (EBP) can produce more efficient and effective government, it can also supply new levers of control to politicians and bureaucrats, which can be used to produce electoral benefits. An appeal to EBP can be used to centralise control of executive functions, as well as to manipulate budgets, that incentivise adoption. Further, the construction, purpose and outcomes of these laws are influenced by the institutions, parties and officeholders who craft them. Our study finds that Democratic governors, Republican legislatures and state innovativeness are significant predictors of EBP adoption in the American states.
Especially in times of crisis, the relationship between evidence and policymaking may change dramatically. The current Covid-19 crisis generated manifestations of ‘evidence informed policymaking’ in an unprecedented way, both nationally and locally. It also showed that the need to use internationally organised, reliable data for effective policy interventions has never been more urgent in times of peace. This information needs to be both profound and directly available.
In the processes of shaping evidence informed policymaking, scientists from all kinds of disciplines play a crucial role to substantiate the development of policies. An international, virtual conference taking place 15–18 December 2020 will treat the outcomes of the current crisis as input for the challenge of professionalising the structured interaction between evidence and policymaking. The current learning processes will be analysed in the context of the existing knowledge infrastructure for policymakers. Instruments for creating evidence for policymakers have recently grown with the introduction of Big Data and the development of algorithms. Another widespread trend is the use of innovative evaluation processes in order to enhance the effectiveness of policy instruments and the growth of new standards for experimental policies.
Complexity in healthcare systems presents knowledge translation (KT) challenges but also opportunities. Our Evidence & Policy article, ‘Connecting knowledge and action in complex health systems: examples from British Columbia, Canada’, illustrates ways we have harnessed complexity to narrow the gap between knowledge and action. We work across different health authorities and funding agencies building strong relationships with those who use research, fostering innovation, supporting evidence-based decision-making and helping people to de-implement obsolete practices. We share a commitment to building strong connections between knowledge and action, and our work is enhanced by embracing the inherent intricacies of the systems in which we work.
We share examples from our practice areas of how we navigate the demands of knowledge translation using responsive solutions and relationship building to support KT that promotes health. While many health systems leaders continue to perceive researchers and research as irrelevant and disconnected from their realities, we have found that when research is undertaken with people who use it, reciprocal and responsive relationships can overcome this barrier and lead to collaborations that support healthcare improvements. Embracing research as a public good requires reimagining the relationships and structures of both research and KT, and we are encouraged by the many ways we’ve seen this happen.
This special issue uses the lens of Creativity and Co-production to explore the meaning of ‘evidence’ and whose meaning counts. It considers what the terms ‘creating’, ‘making’ and ‘production’ mean with regards knowledge creation, sharing and putting into action. It examines the potential role that created artefacts play. For example, what are the values embodied and represented in ‘knowledge artefacts’ and what affordance and agency might they give to human actors?
Areas for discussion include:
What evidence is valid, who produces it, and how was it produced?
What is the process by which ‘evidence’ can be interrogated by others, made sense of, and acted upon?
Not acting on evidence is commonly described as the ‘evidence gap’. Could this be broken down into a series of ‘micro’ gaps between Evidence and Knowledge, Knowledge and Knowing, Knowing and Action?
What role do creative practices, tangible objects, and visual language play in bridging each of these micro gaps?
How do we implement shared decision-making into routine practice? Health systems are struggling with this question worldwide. Instead of simplifying this challenge into barriers and facilitators, what if we embraced its complexity?
In recent years there have been increasing calls for the implementation of shared decision-making in routine clinical care. Shared decision-making is particularly helpful for decisions where there are multiple appropriate options, and the ‘best’ decision rests with the patient’s preferences.
In my work with federal agencies over the last 15 years on violence prevention, social emotional learning, mental health and homelessness, the idea of translating research to practice has become increasingly important. We know there is a gap between what we discover through research and what is applied by practitioners, funders and policymakers.
Over the past decade, federal agencies — and the US Department of Health and Human Services (HHS), in particular — have sought to learn more about the ‘science’ of implementing programmes, practices and policies. They want to invest smartly and do a better job of ensuring the most evidence-based decisions. These are noble goals — especially during this pandemic, when health and human service organizations are being asked to do things they have never done before, with lightning speed. Unfortunately, it gets complicated fast: Each field has its own terminology, frameworks and measures, making it difficult to synthesise information and create a shared body of knowledge across disciplines. So where do we start?