More controversially, my article argues that this would be a better way to reform research funding than lotteries, which others’ research indicates would be better than current norms. Norms are changing though – one of the things I’ve learnt more about since publishing this article is how the Health Research Council of New Zealand has been using a lottery to allocate some grants. They have been doing that for long enough to publish a peer-reviewed paper about it.
Behaviour change policies, known as nudges, have been used by governments across the world to get people to behave in pro-social ways, such as making healthier lifestyle choices or reducing their environmental footprints. Nudges use behavioural insights to steer people into doing the right thing, while also giving them the choice. Critics argue that traditional nudge policies are top-down, manipulative and un-transparent. Nudge policies seem to expect the worse in people, and are easy to caricature as a technocratic approaches to policy design.
However, a new kind of nudge – ‘nudge plus’ – has started to spring up. Nudge plus tackles the risks of paternalism in traditional approaches through the participation of those being nudged. If nudges are going to be even more ‘bottom-up’, how can such behavioural public policies be developed?
The COVID-19 pandemic has sparked a major debate about the role of experts in policymaking and the capacity of politicians to ‘follow the science’. The trend we have seen, where expert advisers have increasingly become the public face of the pandemic, raises questions about the evolving role of experts in other public policy challenges – including challenges where the scientific base is arguably far clearer about effective policy responses. If politicians are willing to ‘follow the science’ with such diligence in relation to COVID-19, why does the same principle not apply to other public health challenges?
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.
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.
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.
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?
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.
Our university-policy maker partnership produces ‘fake’ abstracts of articles we’ve not written yet (on results we frankly don’t even know we’ve got) to loosen up thinking. It helps the team visualise pathways for policy action.
Ours is a tricky situation, politically-speaking. A health department is undertaking Australia’s largest ever scale-up of evidence-based childhood obesity programs into every school and childcare centre across the state. It costs $45m. They have an electronic data monitoring system in place. It’s already telling them that targets are being met. But rather than just rest on their success, they invite a team of researchers to do a behind-the-scenes, no-holds-barred ethnography. It could reveal the ‘real’ story of what’s goes on at the ground level.