Integrating Research, Practice, and Policy: What We See Depends on Where We Stand

Kerner, J. F. (2008). Integrating research, practice, and policy: What we see depends on where we stand. Journal of Public Health Management Practice, 14(2), 193-198.
In this special issue of the Journal of Public Health Management and Practice, the editors have taken on the important challenge of characterizing the current landscape of knowledge translation research and practice in public health. This includes the diffusion of scientific and program evaluation evidence into public health practice and policy, the dissemination and implementation of evidence-based interventions in public health practice, and the complex issues associated with the meaning and methods of dissemination and implementation research. Three of the most important challenges for moving the field of dissemination and implementation science and research dissemination and implementation practice forward are the confusion of terminology, the meaning of evidence, and partnerships across the research, practice, and policy divides. Because many in the research, practicKe, and policy-making sectors do not see their role in closing the gap among research, practice, and policy, new and expanded incentives need to be put in place to encourage these collaborations. Partnerships between research, practice, and policy can help inform decisions in all three sectors to help achieve a better balance between evidence based on science and evidence based on personal experience.
The paper is published in a public health journal so it comes from the perspective of health but these considerations are likely present in many other disciplines regularly writing and thinking about knowledge mobilization including (but not limited to) education, social work, international development, agriculture, criminal justice and the environment.
This is not a new paper but it is interesting to look back six years to see what, if anything has changed. This paper investigates three primary barriers to dissemination and implementation science:

  • the confusion of terminology
  • the meaning of evidence
  • partnerships across the research, practice, and policy divides

What’s in a name? « The terms translational and translation research, knowledge translation and transfer, dissemination, diffusion and implementation (to name but a few) are used interchangeably to mean sometimes similar and sometimes different things in the literature. »
This statement, if true for health, is certainly compounded by terms used in other disciplines such as agriculture which has a history of « extension » that dates back to the late 1800s and the establishment of the US land grant universities. The author believes this statement to be true and it likely was in 2008 but is it still true today? The practices of K-something have become more common in 2014 and many academic researchers and therefore their research partners are embracing a common practice if not sharing a common terminology.
I think terminology matters to academics. I think results matter more to our practice and policy partners. So long as you define what it is you’re talking about and are clear on anticipated results our partners will more readily considering engaging with you.
The K* (K star) initiative attempts to move beyond terminology and focus on practice.
However, for those truly geeky on terminology check out the What is KT wiki. There are terms for KT science, KT interventions, KT tools and methods, standardized KT terms and the « never know what you’re going to get » category of miscellaneous KT terms.
I think that in 2014 terminology is less important than results.
Is evidence, like beauty, in the eye of the beholder? This section reads along the same lines as the PARIHS framework which made its debut also in 2008 so this is another example of convergent thinking (a post about PARIHS in this journal club has received about 3 times more views than the next most popular post). The author points out that evidence is context specific (context, along with evidence and facilitation are the three elements of the PARISH framework).  The author speaks of five key questions that policy makers face when considering evidence: (1) which program or intervention approach has the strongest evidence of efficacy and effectiveness? (2) Which program or approach has the best fit for the service delivery context in which we are operating? (3) Which program or approach can most easily be adapted to improve the fit in our service delivery context or to meet the needs of our target populations? (4) How much flexibility do we have to adapt the program or the approach without seriously undermining the impact on outcomes? (5) Which program or intervention approach can we afford to implement within the resource base of our service delivery context?
Aligning with the PARIHS framework we get:

  1.  = evidence
  2.  = context (fit)
  3.  = facilitation (adaptation)
  4.  = facilitation (flexibility
  5.  = context

I think these elements are still important to the effective implementation of evidence into practice. This paper presents them as barriers. I think they are still barriers; however, in 2014 we have a greater understanding of how to work to address these barriers. We have seen a rise in the practice of knowledge brokering, a greater understanding of contextual factors and an awareness that co-produced evidence has the greatest potential to inform practice and policy decisions.
I would characterize these elements as important but no longer barriers if well addressed.
Partnerships: Who will work with whom?  « New and expanded resources are needed to create and support these research-practice partnership and to develop communities of evidence-based practice. » The principle of supporting research-practice/policy collaborations is as critically important today as it was in 2008. In contrast to 2008 we now have many funding programs that support these collaborations across the Canadian research funding landscape: SSHRC Partnership Grants, CIHR Partnerships for Health Service Improvement, NSERC Collaborative Research & Development, NCEs, Genome Canada and many provincial funding opportunities that purposefully fund collaborative research and training. This is an important development in the last few years although it is not uncontested by the academic research establishment that prefers to have a focus on traditional scholarship.
We also have new structures and organizations with a sole purpose to create collaborations and facilitate the movement of research into policy and practice settings. Organizations like Institute for Work and Health, Canadian Partnerships Against Cancer, Canadian Mental Health Commission, Knowledge Network for Applied Education and Research, Evidence Exchange Network (CAMH) plus every Network of Centres of Excellence are just a few examples of organizations with an explicit K-something mandate.
How far we have come is illustrated by comparing 2014 to part of the author’s conclusion in 2008. « As long as the majority of scientists and scientific funding agencies do not see that they not only are stakeholders in the dissemination and implementation of evidence-based interventions and policy approaches but can also increase the number of research applications and funding of science to inform research dissemination, the slow pace of translating research into practice will continue to suppress the return on our Nation’s investment in health research. »
Questions for brokers – only one question this month:

  1. What are your top three barriers to effective implementation of evidence into policy and practice?

RIR is producing this journal club series as a way to make the evidence and research on KMb more accessible to knowledge brokers and to create on line discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. If you are a community partner speak to someone at your local university to obtain this article. Read it. Then come back to this post and join the journal club by posting your comments.