Knowledge brokers are intermediaries who provide a potentially vital role galvanising change. Studies of knowledge brokers have mostly taken place in high-income countries, so we know much less about knowledge brokers in LMICs. To help address this gap, a global health focused research team conducted three studies following up with knowledge broker participants of international conferences in 2012, 2013 and 2015. The aim was to identify whether evidence from the conferences was shared with others and led to actions such as changes in health policy and practice, and what factors influenced decisions to share and act on evidence.
Keen to have impact with your research but getting lost in all the knowledge exchange frameworks and models that are out there? Based on ten years’ experience working in translational public health for Fuse – The Centre for Translational Research in Public Health, a UK Clinical Research Centre collaboration across five universities in North East England, we identified four practical steps to develop collaborative research and achieve meaningful change in policy and practice.
The challenges of using research to inform policy and practice are well documented, including in public health where the evidence base for interventions or programmes is patchy or contested. In response to these challenges, an abundance of models and frameworks have been developed in recent years that try to define the knowledge exchange process (how research evidence can be used, in combination with other types of knowledge, to change policy and practice). Practitioners and researchers venturing into the field of knowledge exchange are bewildered by the options available, which don’t go beyond the conceptual level and fail to describe in practical terms what research translation on the ground looks like.
You know the story. A lone cowboy (unfortunately never a cowgirl) rides away into the sunset having saved the day. The same expectations are often placed on knowledge brokers who bring together different communities to share knowledge and catalyse change. The lone knowledge broker is supposed to be a hero. But speaking from decades of experience, you just can’t do it alone. A single person does not have all the necessary networks, knowledge, understanding, skills or credibility. To be effective, knowledge brokers need teams.
In a unique experiment from 2013–2016, we set up the Bristol Knowledge Mobilisation team. This was made up of four local healthcare policymakers (called ‘commissioners’) and three primary care academics; all of whom had part-time contracts with both the university and in healthcare commissioning. Our aim was for both communities to draw on each other’s knowledge to create ‘research-informed commissioning’ and ‘commissioning-informed research’ (i.e. research of genuine relevance).
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.
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.
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.
On the understanding that human beings are relational and storytelling animals, who make sense of the world through narrative and dialogue, we developed a story-telling approach to using evidence, which started by developing what has been described as an ‘enriched environment of care and learning’. Within such an environment, everyone involved should gain a sense of security, continuity, belonging, purpose, achievement and significance. To enable this, we started with their priorities and valued their evidence (i.e. practice knowledge, lived experience of older people and carers and organisational knowledge), alongside the research evidence, which we were careful not to impose on them. A challenge for the research team was how to do this.
Accounts of medical professionals performing triage due to the over-burden of healthcare systems during the COVID-19 pandemic are hard to hear. They are a microcosm of dynamics that are occurring globally, where public health authorities and governments are attempting to simultaneously understand and respond to a swiftly moving global pandemic. In this article, the European Centre for Disease Prevention and Control Public Health Emergency team* offer lessons from recent history for decision making during this difficult time.