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health & medical marketing
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Around the Traps: what works for knowledge translation?

Introduction by Croakey: Academic journals must engage in activism to help address some of the big picture challenges facing the world, according to presentations to the recent Academic Publishing in Europe conference.

Dr Richard Horton, editor-in-chief of The Lancet, is cited in a Times Higher Education report of the conference urging journals to seek to “change the direction of society” rather than “passively waiting” for manuscripts.

He says they should gather the very best scientific evidence, and “then think strategically about how that evidence fits within the overall trajectory of scientific and political policy in the world”.

Conference participants also heard how the Nature journals are trying to help achieve the Sustainable Development Goals by publishing one-page “policy briefs” explaining the implications of academic papers to policymakers.

The publisher has also hosted events, such as the Science and Sustainable City Summit, to bring together academics, city leaders and policymakers, according to Elisa de Ranieri, editor-in-chief of Nature Communications.

What else might help to ensure knowledge translation that has meaningful, real-world impact?

Dr Tahna Pettman, a member of the Australian Public Health Consultant’s Network, scopes some of the options in the latest edition of Around the Traps, an irregular column provided by members of the Network.


Tahna Pettman writes:

As public health practitioners, there is a risk that we forget evidence in the day-to-day pressures of decision-making. Among other impacts, ignoring the evidence may cause harm as a result of implementing well-intentioned ideas without underpinning theory. 

A classic example is the juvenile awareness program ‘Scared Straight” which was designed to deter young people from criminal offending. This involved organised visits to prisons using confrontational approaches and education sessions. These programs once proliferated in many countries from the 1970s – 90s, being low-cost and easy to implement.

A systematic review of research evaluating their impacts showed that ‘Scared Straight’ interventions are actually more harmful than doing nothing, worsening delinquency and relapse into crime among those who participated. Eventually, policy caught up with the science – but this is not always the case.

In Australian healthcare, people generally receive evidence-based care in only 57 percent of encounters, and only 14 percent of research evidence is ever translated to practice.

Of course we wouldn’t advocate that practitioners and policy actors blindly follow research evidence – the hallmark of evidence-informed practice is that context, and community and stakeholder preferences are also paramount, together with resources, values, ethics, and pragmatics. Research evidence is but one piece of a decision-making puzzle.

Challenges and gaps

Rebecca Zosel, a public health consultant, agrees that using evidence is a challenge. Zosel describes a “gap between what is known to work and what is being implemented: obesity prevention, alcohol pricing and availability policy, and climate change are three (of many) areas where the evidence in favour of action exceeds current efforts and investment”.

An example of this gap is in the national policy inertia on unhealthy food marketing targeting children. Research consistently shows the negative impacts on children including TV advertising, digital media content, sports sponsorship, product packaging (and those pesky plastic collectible toys!).

Another view on this issue is that given that so much research is poor quality, it may not be a problem that so much is not influencing decision-making and practice.  

Still to ensure accountability and return on investment, researchers are under the proverbial microscope with the recent introduction of research impact assessments, which assess the societal benefits of research beyond academic publications (for example, Australia’s Engagement and Impact Assessment, and the UK’s Research Excellence Framework.

So research is going to waste, and is often created without practitioner, policymaker or community stakeholders’ input.

Knowledge translation aims to step in here, to build bridges between research and policy/practice, and to bring together a range of stakeholders (for example, policy actors, practitioners, community members) at the beginning of the research cycle – this can increase co-production of research, making it more likely to be useful, and used in decision-making.

For decades, the question of how research is used in policy and practice has captured the attention of researchers and practitioners – particularly in medicine and public health. Many other terms may sound more familiar – research utilisation, and ‘know-do-gap’ are some examples.

While you’d think that people doing research on research would have a united voice, over 100 different terms are used across disciplines to describe knowledge translation. 

Call it what you will, essentially knowledge translation is both a science and a practice, and is about methods to get researchers to connect with stakeholders, and get research used in decision-making.

A widely accepted definition of knowledge translation is:

a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the health care system”.

Don’t be fooled by the unidirectional terminology of ‘translation’, by the way – knowledge translation goes beyond communication, and exchange is implied in this definition from the Lowitja Institute:

A series of interactions that connect research evidence to changes in policy and practice.”

What does knowledge translation look like?

For thousands of years, Indigenous communities have practised coming together to share thinking, long before knowledge translation was defined in Western published literature.

Internationally there are pockets of great expertise about this field; the mechanics of evidence generation and use for decision-making(for example, Transforming evidence collaboration, Alliance for useful evidence, National Collaborating Centre for Methods and Tools).

While not all knowledge translation strategies have been tested, we know that traditional ‘push’ information efforts (such as didactic presentations) are seldom effective on their own – but more so when tailored and targeted. There are mixed effects for dissemination activities like conferences and opinion leaders.

More interactive strategies (“integrated knowledge translation”) like participatory research, academic detailing and electronic reminder systems tend to be mostly effective.

Then there is the emerging role of ‘knowledge brokers’. They are common in Canada and the UK, but very few such roles exist in Australia.

However, with shifts in the public health workforce, consultants are well placed to facilitate the use of research evidence, and by nature of their work, help to create multi-directional exchanges between research users and producers (and other stakeholders).

This begins to address the challenges in both involving stakeholders in research, and in using research evidence in decision-making – by brokering knowledge derived from research for decision-making, and, by accelerating the translation of evidence into policy impact.

Examples from the frontlines

I asked around the traps for examples of research evidence use in practice and of knowledge translation success.

Kristy Schirmer from Zockmelon describes acting as knowledge broker between current practice in social media, academic evidence and the end-user (public health practitioners). She utilises electronic reminders with Google Scholar to alert her to newly-published evidence on specific search terms, and reaches out to authors where required.

Matt Healey from First Person Consulting describes deliberate engagement with specific research collaborators, and a reliance on partnerships to ensure that evidence guides his work for clients (decision-makers and policy organisations). This is a planned process that he dedicates time to before commencing new projects, and throughout, for example by monthly meetings.

Schirmer noted that for some areas of policy and society, such as social media, changes far exceed the speed of academic publishing. However, she encourages clients (practitioners) to publish or present their outcomes to contribute to the evidence base.

Similarly, Healey reflects on current work with the Victorian Responsible Gambling Foundation’s  Prevention Partnerships Program – in this community-based initiative, public health evidence helped to inform program purpose in the area of gambling-harm prevention, where evidence of effectiveness was very limited. This highlighted the need for testing ideas (working in the evidence gaps), emphasising importance of evaluation and publishing outcomes where feasible.

Links between practitioners, evaluators, decision-maker organisations and a facilitator or broker,  are a common thread in the experiences of Schirmer and Healey, and this is consistent with the knowledge translation science.

Other strategies may include partnership research projects (including stakeholder advisory committees), deliberative processes between evidence producers and policy actors to jointly establish research priorities, evidence reminder systems in organisational processes (such as strategic planning), and workplace co-locations between research and practice.

Where to with knowledge translation?

It takes decades for evidence to make it all the way to policy or practice, and even longer to produce measurable benefits for people and communities.

Partnerships and collaborations between researchers and policy actors are one way forward, moving across disciplines and sectoral boundaries.

Consideration must be given to the diverse range of stakeholders in both research and policy processes – this will challenge the questions being asked and solutions being proposed. For example, in the evaluation of South Australia’s Health in All Policies, a cross-Government policy advisory committee was established to co-design research questions and oversee processes. High-level input was provided by multiple public sector departments, local government, and non-government organisations such as Health Justice Australia and South Australian Council of Social Service (SACOSS).

In addition to regular meetings between policy actors and academics, and ‘policy club’ seminars to invite deliberations and debate from public sector staff and NGO stakeholders, the research project manager was co-located in government departments throughout the evaluation. Together, these exchange strategies shaped research questions and outputs beyond academic interests to ensure policy relevance.

By seeking to understand what evidence is needed to answer policy and practice challenges, research processes and outcomes will address what sort of evidence is useful for the decision-maker – not for the researcher.

Political context critical

We also must engage with the political context: even when expertise and partnerships are available to support evidence-informed practice, scientific evidence may get trumped by politics or ideology at any turn of decision-making.

Policy decision-making is determined by many factors and events, and is dependent on the relationships between those involved. Evidence has a long history of being misused and cherry-picked.

Political scientists are generating theory about the complex nature of decision-making, and the political nature of knowledge and policy entrepreneurship. Hopefully this can be applied to improve future research funding and design, and evaluation of research impact.

More flexible funding arrangements, better systems and infrastructure are all needed to advance evidence-informed policy and produce more useful research – such as joint research priority setting, and strategic research investments.

In the meantime we can pursue practical strategies like research-practice partnerships, staff co-locations between research and policy, stakeholder advisory committees on research projects, and evidence reminder systems in organisational processes.

We also need brokers – evidence champions, opinion leaders, role models (evidence entrepreneurs?).

Ultimately, we need systems to hardwire evidence into everyday decisions, and, better research infrastructure to enable coproduction with stakeholders.

Together, this may help to reduce research waste, and get evidence used and generated in real-world policy and practice.

• Dr Tahna Pettman is an academic, consultant and advocate who is passionate about evidence-informed decision-making, research impact, public health policy, equity and social justice. Highlights of her career so far include co-developing and delivering researcher training in knowledge translation, practitioner and decision-maker training in evidence-informed public health, postgraduate teaching and topic coordination in public health leadership, consultancy projects with state government departments and non-government organisations, and contributing to research impact assessment processes.

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