In participatory research, researchers share the ideal of democratising knowledge production, on the basis of an expanded understanding of what counts as knowledge and whose knowledge counts. People with knowledge based on their own lived experience take part as co-researchers in processes of co-producing knowledge together with academic researchers. This process of harnessing the knowledge of people with lived experience can make a valuable contribution to the transformation of health and social care practice, as well as to the research field.
Arts-based research methods are often used to draw out the personal knowledge of co-researchers, including the emotional and aesthetic dimensions. But the use of arts-based co-production in participatory research does not easily get rid of the difficulties of putting the principles into practice – due to the tensions that arise between cultivating the collaborative, creative process and generating specific research results.
Health service researchers are plagued by the fear that policy and system-level improvement efforts will ignore or under-utilize research. Consequently, efforts at system improvement that come out of research centers tend to use “research-first” approaches that include protocols, trainings, and coaching sessions around evidence-based programs. But oftentimes the issue is not that a system is unaware of the research, it is uncertainty about how to get something going that fits the local context. This has as much or more to do with local values, personalities, and working relationships as it does with the specifics of a protocol.
Our study finds that engaging a community in a policy codesign process that prioritizes mutual learning, rather than a protocol, not only yielded a high-quality plan but built the relational infrastructure for local collaboration long after the external design facilitators left.
What creative tools can we use to disrupt the status quo and create truly inclusive health and social services? Co-designing evidence and policy change in collaboration with health and social service users and their families is part of an exciting and growing international movement. In our Evidence & Policy article, ‘Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations’, we highlight how our interdisciplinary team of researchers, trainees and lived experience experts engaged in a three-year collaborative process to promote engagement, education, and innovation in equity-based co-design. This article is part of a special issue on creativity and co-production that highlights how collaborative practices, such as co-design and co-production, can be elevated using creative devices and tools (e.g., imagination, storytelling, art etc.) to create a shared language, build relationships, and make meaning.
Co-design approaches take a person-centered perspective, utilizing a design lens to develop solutions to problems in collaboration with lived experience experts. This approach can redistribute power when we meaningfully and effectively engage individuals and communities who experience structural vulnerabilities that affect their health and well-being (e.g., racism, sexism, ableism, colonialism). In other words, how do we ensure that diverse experiences are included and that co-design processes lead to lasting system change?
In our recent Evidence and Policyarticle we provide a detailed description of how a specific creative co-design approach was used to blend academic knowledge with stakeholder knowledge in the development of a complex intervention that addressed a NICE guideline recommendation about information and advice for people with back pain.
In the UK, the National Institute of Clinical Excellence (NICE) produce clinical guidelines based on the best research available in order ensure people receive consistent evidence-based care. However, despite almost universal agreement amongst health professionals that clinical practice should be based on best available evidence, guidelines are routinely not used as specified in decisions relating to individual care.
We know that physical trauma causes psychological problems. The evidence suggests that around 30% of injured adults will develop a psychological problem such as Post Traumatic Stress Disorder within twelve months of injury and these have a significant impact on their recovery. Despite this, NHS management of trauma patients’ psychological needs is generally poor, which leads to under-recognition, delayed treatment, and increased individual, societal and healthcare costs.
The inability of this evidence to directly influence practice is symptomatic of a broader concern about the generation and uptake of research. It goes to the heart of how we perceive human health and healthcare (and the interplay between physical, social, and psychological factors), how we produce knowledge to shape and change it, and how we understand the way knowledge is effectively transmitted in practice. Our study, as published in a recent Special Issue of Evidence & Policy, used innovative methods to address these wider challenges and improve post-injury psychological care.
Creative methods help get evidence and policy into practice
Evaluating 14 healthcare improvement and research projects that used creative methods, we identified three interconnected themes that result in the optimal conditions for getting evidence into practice.
Co-production, co-creation and co-design are increasingly used in healthcare research knowledge mobilisation. These methods have grown in popularity, and the broad range of approaches are often used uncritically. Our recently published Evidence & Policy paper focuses on the creativity component of these approaches, specifically when working with design professionals.
Public debates about history are nothing new, but in recent years – with the convergence of new media platforms and a tumultuous political atmosphere – we have noticed debates centred on duelling historical interpretations are becoming increasingly conspicuous and are engaging the public. In fact, both evidence-based and false, or misleading, historical claims are being brought forth all the time, apparently in efforts to influence key decisions and/or pushing for social change. This drive to mobilise historical knowledge, we also assume, reflects a shared understanding that our history and how we think about it matters – i.e. that different understandings of the past can help us navigate the present, pointing the way to different policies and, perhaps, a more just future.
We understand this strengthening phenomenon as historical knowledge mobilisation, and we set out to better understand its underpinnings, nature and impacts. We drew upon Ward’s (2017) ‘framework for knowledge mobilisers’ to analyse what and whose knowledge is being shared and how and why this is happening. Though we focused primarily on university-based mobilisers (academic historians and history-adjacent scholars), we also observed how non-academics actively inhabit this territory. Indeed, as we revealed, historians and non-historians alike are acting to mobilise the usable past in service of the present. Further, and on a partisan basis, we detect duelling preferences for ‘historical memories’ that either motivate progressive social change or favour policy inaction/reversal.
Embedding researchers in service organisations is the latest in a long line of approaches to better link the worlds of research and practice. Embedded researchers have become particularly popular in the field of healthcare, but can also be found in education and local government. As with any new initiative, one of the big questions on people’s minds is ‘does it work’? The problem, though, is that until now we haven’t had a clear picture of what ‘it’ (i.e. embedded research) is and how those interested in the approach might design an initiative.
To address this, our research team (a diverse group including researchers and healthcare managers) set out to better understand what embedded research initiatives look like in practice and produce a practical framework for anyone involved in designing or cultivating an initiative.
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).
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.