Decision-making of knowledge brokers in moving evidence to action along pathways in global health

Theresa Canova Norton

‘An e-mail never made me change the way I do things’, a colleague once said. Implicit in this statement is the idea that passively receiving information alone is unlikely to motivate change. How might this observation inform the way we approach disseminating the best available evidence? This is what we explore in our Evidence & Policy article, ‘Maybe we can turn the tide’: an explanatory mixed-methods study to understand how knowledge brokers mobilise health evidence in low- and middle-income countries’.

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.

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Four practical steps to increase knowledge exchange between researchers and policymakers

Peter van der Graaf

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.

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Lone cowboys need a posse (and knowledge brokers need to work in teams!)

Lesley Wye

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).

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What types of knowledge do policymakers need to respond to the COVID-19 pandemic?

Claire Bynner and Anna Terje

In a recent article published in Evidence & Policy, we explored the use of Aristotle’s three knowledge types: empirical knowledge, technical knowledge and practical wisdom, in the everyday work and decision-making of frontline public service professionals.  

Our qualitative case study of a Scottish local authority revealed the importance of integrating and recognising the different types of knowledge that are needed to respond to complex policy problems, often referred to as ‘wicked’ problems. Understanding the craft of integrating different types of knowledge, and valuing what can be learnt from frontline workers, is key in achieving impactful evidence-informed policy.

In the current context of a rapidly changing policy landscape resulting from COVID-19, making policy decisions informed by the most appropriate types of evidence is crucial. In this blog, we discuss how Aristotle’s knowledge types can help us understand the types of evidence that should be considered in this ever changing landscape.

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Policy impact is the result of networked approaches to knowledge exchange

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Naomi Nichols, Kaitlin Schwan and Jayne Malenfant

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.

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Focus on the people, not the technology

Senior woman with facial mask,Covid 19.

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.

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Exchanging international perspectives to enhance evidence for policymakers

Tomas van den Broeke

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.

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Knowledge translation opportunities and challenges

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Agnes Black

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.

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Call for papers: Evidence & Policy special issue – The many faces of disability in evidence for policy and practice

By Carol Rivas, David Gough and Ikuko Tomomatsu

This special issue examines the relationship between disability, evidence, and policy. It considers the extent to which the demand for, production, and use of evidence in policy and practice takes account of disability perspectives.  For example, disabled populations, already vulnerable, have been made more so throughout the COVID-19 pandemic, which highlights their disenfranchisement and marginalisation in relevant policy decisions. This outcome has sparked calls to action by disability advocacy groups and coalitions in the Global North and the Global South. These current events and responses provide a window of opportunity to reassess and change some of the entrenched systems that consistently exclude vulnerable groups such as disabled populations.

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Opening the doors of the Machine Room

This blog post is the forth in a series of posts linked to the Evidence & Policy special issue (Volume 16, Issue 2) on Opening up evidence-based policy: exploring citizen and service user expertise. Guest Edited by Ellen Stewart, Jennifer Smith-Merry, and Marc Geddes.

Sarah Carr

Seventeen years ago, Diana Rose wrote that in mental health, user involvement was becoming ‘a technology of legitimation’[1] for reinforcing established powers. Seventeen years later, in examining some of the circuits and processors, Mazanderani and colleagues reveal how complex this ‘technology’ or machinery has become, and is still becoming. As though opening the doors of the machine room, the authors offer us a wealth of important insights and ideas. I’d like to share some thoughts on just a couple of them here.

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