Fafard, P., and Hoffman, S.J. (2020) Rethinking knowledge translation for public health policy. Evidence and Policy. 16(1): 165-175. https://doi.org/10.1332/174426418X15212871808802
There is continuing interest in using the best available research evidence to inform public health policy. However, all too often efforts to do so rely on mechanistic and unrealistic views of the process by which public policy is made. As a result, traditional dyadic knowledge translation (KT) approaches may not be particularly effective when applied to public policy decision making. However, using examples drawn from public health policy, it is clear that work in political science on multiplicity, hierarchy and networks can offer some insight into what effective KT might look like for informing public policy. To be effective, KT approaches must be more appropriately tailored depending on the audience size, audience breadth, the policy context, and the dominant policy instrument.
Steven Hoffman is the Scientific Director of the CIHR Institute for Population and Public Health and, along with Patrick Fafard (Associate Director), is the Director of the Global Strategy Lab with a mandate to “advise the world’s governments and public health organizations on how to design laws, policies and institutions that address transnational health threats and make the world a healthier place for everyone.” Hoffman has been in the media 28 times between Jan 21-April 1 speaking on COVID-19 (scroll down the page here). Hoffman and Fafard know what they’re talking about when they are talking about KT to inform public health policy.
The paper opens with the problem he is addressing. “Within the health sector, much success has been achieved and celebrated in developing a science of KT to inform health professionals’ clinical practices (Straus et al, 2011), design healthcare programmes (Lavis, 2006), and implement health promotion campaigns (Dobbins et al, 2009). But the same kind of success has not yet been achieved for informing the development of public health policy.”
The article interestingly distinguishes KT from research use. They don’t delve deep into it, but my research impact brain went down a little impact rabbit hole thinking about this. The co-produced pathway to impact clearly has the use of evidence in the hands of co-production partners who are using the evidence to inform policies, practices and products but I see the whole pathway to be KT, as opposed to the discrete dissemination (or end of grant) practices that *try* to get evidence into the hands of those who can use it. So, while I can see a distinction between KT and research use if KT is limited to dissemination, I don’t see such a distinction when working in a co-produced paradigm. Work the question below if you are down the rabbit hole I am in.
Now back to the substance of the article…
The essence of the gap between public health research and public health policy is a failure by researchers and intermediaries to understand the policy process. Policy making is a political process that is resistant to dyadic methods of KT (dyadic = between two parties = researcher → policy maker = dissemination). There is no single “policy maker” as there can be a single clinician seeking to use research evidence in clinical practice. In contrast, “Policy-related decision-making authority is diffused and involves complex and variable institutional hierarchies and policy networks.” The article proceeds to dig deeper into each of these: diffused decision making, institutional hierarchies and policy networks.
Importantly there are policy advisory systems made up of a variety of actors inside and outside of governments. The authors quote John Lavis advising that “when thinking about knowledge brokering the traditional focus on individuals should perhaps give way to knowledge-brokering structures or KT platforms, that is, organisational entities devoted to fostering the use of research evidence in policymaking.”
Bottom line: dyadic (=dissemination between individuals) methods of KT will not likely inform decisions about public policy. Networked approaches (i.e. becoming an expert advisor in a policy advisory system) are needed. Once again, the advice of Sandra Nutley (Using Evidence, 2007) from 13 years ago continues to resonate. I paraphrase her extensive work to mean that dissemination is necessary but not sufficient to inform change. Co-produced methods (i.e. networks and research collaborations) of KT are more successful but appear to be required in policy contexts.
Returning to John Lavis’ advice about organization entities devoted to fostering use of evidence in policy making. Check out last month’s journal club post about the KE Team in the UK Parliament. There is an opportunity to study their structures to see if they are moving the needle on research informed policy making in the UK.
Questions for brokers:
- Go down that impact rabbit hole. What is the difference between KT and research use and does this change in dissemination vs co-produced contexts?
- I suspect that traditional models of KT in health care practice will similarly benefit from networked approached. Is there evidence for this?
- Does anyone really understand the political nature of policy making? How can we find them and what can we do to connect them to our KT practices?
Research Impact Canada is producing this journal club series to make evidence on KMb more accessible to knowledge brokers and to create online discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Read this open access article. Then come back to this post and join the journal club by posting your comments