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Increasing the use of evidence in health policy: practice and views of policy makers and researchers

Increasing the use of evidence in health policy: practice and views of policy makers and researchers Background: Better communication is often suggested as fundamental to increasing the use of research evidence in policy, but little is known about how researchers and policy makers work together or about barriers to exchange. This study explored the views and practice of policy makers and researchers regarding the use of evidence in policy, including: (i) current use of research to inform policy; (ii) dissemination of and access to research findings for policy; (iii) communication and exchange between researchers and policy makers; and (iv) incentives for increasing the use of research in policy. Methods: Separate but similar interview schedules were developed for policy makers and researchers. Senior policy makers from NSW Health and senior researchers from public health and health service research groups in NSW were invited to participate. Consenting participants were interviewed by an independent research company. Results: Thirty eight policy makers (79% response rate) and 41 researchers (82% response rate) completed interviews. Policy makers reported rarely using research to inform policy agendas or to evaluate the impact of policy; research was used more commonly to inform policy content. Most researchers reported that their research had informed local policy, mainly by increasing awareness of an issue. Policy makers reported difficulty in accessing useful research syntheses, and only a third of researchers reported developing targeted strategies to inform policy makers of their findings. Both policy makers and researchers wanted more exchange and saw this as important for increasing the use of research evidence in policy; however, both groups reported a high level of involvement by policy makers in research. Conclusion: Policy makers and researchers recognise the potential of research to contribute to policy and are making significant attempts to integrate research into the policy process. These findings suggest four strategies to assist in increasing the use of research in policy: making research findings more accessible to policy makers; increasing opportunities for interaction between policy makers and researchers; addressing structural barriers such as research receptivity in policy agencies and a lack of incentives for academics to link with policy; and increasing the relevance of research to policy. Page 1 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 and promotion within the higher education system Background Evidence from research can enhance policy development depends on publication in peer-reviewed journals as by identifying new issues for the policy agenda, informing opposed to broader knowledge transfer activities, and decisions about policy content and direction, or by evalu- there is a general lack of administrative and monetary sup- ating the impact of policy [1-5]. Although evidence from port for translation-oriented work. research is only one of the many factors considered in pol- icy development, there is an increasing recognition of its There are very few studies of engagement between potential value. In a recent speech to senior public serv- researchers and policy makers in Australia. In 1995, Ross ants, the Australian Prime Minister identified seven key examined the use of economic evaluations by senior pol- aspects of policy making, one of which was the use of evi- icy makers (n = 34) from the New South Wales (NSW) dence; he went on to emphasise the importance of evi- Health Department and the Commonwealth Health dence-based policy making as part of a robust culture of Department and found that only 38% of the policy mak- policy contestability [6]. ers had ever used economic evaluations to inform policy development [19]. A survey of population health staff in However, it is evident that many opportunities to use evi- an Area Health Service in NSW found that most felt that dence from research in policy are currently missed [7-10], there was a lack of evidence on which to base policy and with some authors suggesting that the consideration of that an evidence based approach would improve practice evidence by policy makers is 'haphazard' at best [3,11-14]. [20]; relatively few reported using a web-based portal, the Grol and Grimshaw conclude, for example, that "one of the Clinical Information Access Program, to access evidence most consistent findings in research of health services is the gap about population health interventions [21]. between evidence and practice" (p. 1225) [15]. A recent study of reports from completed projects funded A lack of communication, exchange and understanding through National Health and Medical Research Council between researchers and policy makers is often regarded (NHMRC) grants found that only 14% of principal inves- as a major contributor to the failure to consider the rele- tigators felt their research had influenced public health vant evidence. This has been well described by Lomas who practice, and only nine percent believed their work had noted that "efforts by researchers and by decision makers seem made any impact on health policy [22]. An earlier survey to proceed largely independently. Both have their own (often of NHMRC grant recipients asked about the potential misplaced) ideas about the other's environment. Opportunities value of different approaches to enhancing research dis- for ongoing exchange and communication are few. ...It is like semination [23]. The most highly rated suggestions two people trying to assemble a jigsaw puzzle, each with half the included encouraging greater demand for research find- pieces but each working in a separate room" (p. 439) [16]. ings and better skills at judging 'good' research among policy makers, encouraging policy makers to become Relatively little is known about the ways in which involved in research, better infrastructure support for pub- researchers and policy makers work together or about bar- lic health research, and more research funded by health riers to increasing exchange. A systematic review of 24 organisations. studies of health policy makers' perceptions indicated that the most important facilitator of research use was per- This study aimed to explore the views and current practice sonal two-way communication between researchers and of both policy makers and researchers about the use of policy makers [3]. Research suggests that evidence is more evidence in policy. Specifically, the study aimed to: likely to be used to inform policy if it is relevant and acces- sible [14,17] and there are incentives supporting its con- i. Describe the extent to which policy makers and sideration [3,14]. However, past studies in this field are researchers believed that research is currently used to mostly surveys of opinions rather than accounts of current inform policy use, communication or exchange. ii. Investigate current practice in relation to the dissemina- Even less is known about the views of researchers about tion of and access to research findings for policy factors that might increase their participation in policy rel- evant research and engagement with policy makers. Only iii. Explore the extent of communication and exchange one study exploring the views of health researchers was between researchers and policy makers and located; it reported that researchers were concerned about the risks posed to an academic career by spending time on iv. Examine incentives for increasing the use of research in engagement with policy agencies [18]. In Australia, tenure policy Page 2 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 ice Development and of Population Health from each of Methods Setting the Area Health Services were sent a letter of invitation The Sax Institute was established in 2002 with core fund- from the NSW Chief Health Officer (n = 54). ing from the NSW Department of Health. The Institute is a unique organisation in Australia that aims to build Interview schedule excellent policy- and practice-focused health research and The interview schedule included both closed and open- increase the impact of this research on health policy, pro- ended questions and asked about respondents' involve- grams and services. The Institute is an independent, not- ment in policy development, access to and use of research for-profit organisation structured as a coalition of mem- findings, and involvement in research activities and net- ber organisations. Membership is open to Universities, works. Participants were asked to think broadly about pol- Schools and research groups with programs in public icy and to include in their answers policy in the form of health and health services research. At the time of the small-scale local plans or operational issues through to study the Institute's members included 34 research groups large-scale programs or system-wide directions, and relat- (six Universities and 28 Schools/research centres) of ing to a variety of issues including resource allocation, national and international standing, representing most of service patterns, or the delivery of health care or public the Universities and research groups that undertake public health programs. In responding to questions about health and health services research in NSW. A full list of research, participants were asked to include any kind of members and details about membership are available on formal or systematic process of collecting and analysing the Sax Institute's website http://www.saxinstitute.org.au. data, including stand-alone studies, studies that form part of a broad thematic program of research, and research Procedure reviews. The study was designed as a quality assurance exercise to Interviews with researchers assess, and inform the further development of, the Sax Institute's programs for improving links between research Participants and policy. The study complied with the definition of a Sixty senior population health and health services quality assurance activity as set out in the relevant researchers were invited to participate through a letter sent National Health and Medical Research Council guidelines from the Chief Executive Officer of the Sax Institute. [24]. Specifically, participants were being interviewed in Invitees included nominated representatives from the their professional capacity to describe their current prac- Institute's member Universities (n = 6), nominated mem- tice; the interviews were undertaken with the informed bers from the Institute's member Schools and research consent of participants; participants were unlikely to suf- centres (n = 28), and one additional nominee from each fer burden or harm; and no personal details or identifying member School and research centre currently employing information were collected. Accordingly, the approval of two or more senior researchers (n = 26). a human research ethics committee was not sought. Interview schedules Separate interview schedules were prepared for research- The structured interview schedule included both closed ers and policy makers and samples identified as described and open-ended questions and asked about respondents' below. The procedure for administering both sets of inter- involvement in policy development, dissemination of views was the same. Structured telephone interviews were their research and its impact on policy, and degree of conducted by trained interviewers from an independent involvement of policy makers in their research. The research company. Potential participants were initially descriptions of the terms 'policy' and 'research' were the contacted by telephone and asked to identify a suitable same as those provided in the interviews with policy mak- interview time; a minimum of six follow-up call attempts ers. were made to establish contact. Participants were informed that their responses would be fully de-identi- Results fied. Interviews took an average of 30 minutes to com- Sample Policy makers plete. The interviews were not recorded, but responses to open-ended questions were handwritten verbatim and Of the 54 people approached, six people were on subsequently coded using thematic analysis to identify extended leave or had transferred from their area. Of the common categories. remaining 48 potential participants, 10 did not respond to the letter of invitation. The final sample consisted of 38 Interviews with policy makers interviewees (79% response rate). Participants All members of the NSW Department of Health Policy The 38 policy makers interviewed were employed at sen- Development Committee and all directors of Health Serv- ior levels of the NSW Department of Health (n = 14) and Page 3 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 the Area Health Services (n = 24). Over half (58%) had ting issues onto the policy agenda, informing policy con- worked in their current position for more than two years. tent and direction, and evaluating the implementation or All participants had been involved in policy development the impact of a policy. in the last 12 months, with 71% having developed more than five policies and 84% having approved policies Respondents were asked to estimate, for those policies developed by other staff. Respondents were involved in that they had developed or approved, whether research developing a range of policies relating to population was used to inform: (a) none of these policies; (b) less health (eg state wide immunisation strategy, Area-level than a quarter; (c) between a quarter and a half; (d) public health plan), health service provision (eg cancer between half and three quarters; or (e) more than three services plan), governance and administration (eg patient quarters. The majority of respondents used research only information privacy), and clinical care (eg collection of infrequently to inform policy agendas. Sixty six percent of urine samples for testing). respondents used research in agenda setting on less than a quarter of occasions in the previous year; this included Researchers two participants who had never used research to inform Of the 60 researchers approached, six were unavailable policy agendas. Most participants also used research infre- during the study period and four no longer held a sub- quently to evaluate the implementation or impact of pol- stantive research position. Of the remaining 50 potential icies: 60% had used research to evaluate policies on less participants, five opted out of the study and four could than a quarter of occasions in the previous year. This not be contacted. Forty-one researchers completed an included three participants who had never used research interview (82% response rate). The 41 researchers inter- to evaluate policies. viewed were drawn from 29 of the Sax Institute's member organisations across NSW. All but one respondent (98%) Use of research to inform policy content or direction was had worked in an academic research environment for more common. All respondents had used research to eight or more years (range 3 to 40 years, mean 19 years). inform policy content at some time in the previous year, Interviewees identified their primary research areas as and only 11% reported using research on less than a quar- public health (56%), health services (51%), clinical and ter of policies. Nevertheless, only a minority of partici- medical sciences (27%), and equity (12%). pants (29%) used research to inform content on more than three-quarters of policies. Is research currently used to inform policy? Policy makers Researchers Respondents were asked to indicate how much of a need Eighty five percent of respondents perceived a high need there is to increase the use of research in policy making to increase research use by policy makers (rated 4 or 5) using a five point scale. Sixty three percent of respondents and the remainder believed that there was a moderate felt that there was a high need to increase the use of need (rated 3). research (rated 4 or 5) and a further 24% believed that there was a medium need (rated 3). Table 1 shows researchers' reports of the impact of their research on policy. Two thirds of the respondents reported Figure 1 shows respondents' reports of their use of that findings from their research had been used to inform research in policy in the past 12 months in terms of get- health policy or practice within NSW, and 69% agreed that a research review they had undertaken in the previous two years had impacted on policy in some way. Thirty nine percent could identify findings from their research that they believed should have been used to inform local policy or practice, but which had not been used. When asked to describe how their research had influenced health policy or practice, respondents most often felt that their research or reviews had increased policy makers' aware- ness of an issue. Are research findings accessible and useful? Policy makers Policy makers' views about the p evaluation Figure 1 olicy agenda setting; (b) policy conten impact of research on: t/direction; and (c) (a) Respondents were asked whether the health research Policy makers' views about the impact of research undertaken by researchers in NSW was relevant to policy on: (a) policy agenda setting; (b) policy content/direc- and program development. Over one third of respondents tion; and (c) evaluation. (39%) felt that local research was relevant, but most of Page 4 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 Table 1: Researchers' views about the impact of research on policy or practice and reported dissemination Research findings Research review (n = 41) (n = 29) IMPACT OF RESEARCH ON POLICY n % n % Own research or reviews have been used to inform policy or practice 27 66 20 69 Had findings that were not used by policy but were potentially important 16 39 NA NA Own research increased policy makers' awareness of the issue 24 59 19 66 Own research helped to get the issue on the policy agenda 20 49 13 45 Own research assisted policy makers in formulating the policy issue 19 46 14 48 Own research helped policy makers to identify policy alternatives 17 41 11 38 Own research helped policy makers to choose the preferred policy option 20 49 9 31 Own research used to justify the final policy 20 49 12 41 DISSEMINATION Published in peer review journal 36 88 9 31 Published in report for funding agency 27 66 16 55 Published in report for stakeholders 22 54 10 34 Presented at conference 37 90 10 34 Presented to policy makers 21 51 13 45 Presented to practitioners 26 63 8 28 Researchers who had contributed to a review in the previous two years Most recent research paper or review these (87%) believed that the research was not presented terms of decision making. Summaries of local data were in a useful way. In total, only 5% of the interviewees felt rated as highly useful by 78% of these respondents, with that local research was both relevant and presented in a 72% rating brief research summaries and 64% rating sys- useful way. tematic reviews as highly useful respectively. Researchers Figure 2 shows participants' reports about their use of three different types of research syntheses over the past 12 Respondents were asked how often they had used various months. It is evident that policy makers needed all three strategies to communicate their research findings in the types of synthesis, but had difficulty finding brief research previous two years. Twenty three (56%) reported that they summaries and systematic reviews when they were often identified the policy or practice implications of their needed. Policy makers who accessed research syntheses research findings, but only 14 (34%) regularly developed reported that these were almost always of some use in explicit policy recommendations or summaries from their research for policy makers. Sixteen (39%) respondents had frequently developed targeted strategies for commu- nicating their research to non-academic audiences, and 18 (44%) often wrote reports or papers about their research for non-academics. Table 1 shows respondents' reports of dissemination in relation to the most recent research study or review in which they had been involved. Although the most com- mon dissemination strategies were conference papers and peer review papers, half reported a presentation of find- ings to policy makers. How much communication and exchange is there between researchers and policy makers? Pol pr Figure 2 ev icy makers' ious 12 m need f onths or and use of research syntheses in the Policy makers Policy makers' need for and use of research synthe- Most policy makers (n = 28, 74%) had wanted to contact ses in the previous 12 months. a researcher during the past 12 months to sound out an Page 5 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 issue. Of those who had wanted to discuss ideas with a of research questions, or assisted with the dissemination researcher in the previous year, 57% (42% of the total of research results. Half of the interviewees reported active sample) were easily able to contact a relevant researcher participation in a research team. However, fewer had been when needed. involved in the sorts of activities that are likely to facilitate communication and application of research, such as par- Table 2 shows policy makers' communication and ticipating in the analysis, writing up and publication of exchange with researchers in the past 12 months. Most the research results. Eighteen percent of the sample had respondents had attended forums to hear research find- collaborated on a successful competitive research grant. ings and about half of the respondents had actively invited researchers to participate in the policy process by Researchers providing a research perspective or joining a policy devel- Table 2 also shows researchers' reports about communica- opment committee. tion with policy makers in the last two years. Almost all had presented their research findings at a conference or More than two-thirds of the policy makers had acted in an forum where state- or Area-level policy makers were likely advisory role in research, participated in the development to have been present, but only half had presented their Table 2: Exchange between researchers and policy makers POLICY MAKERS' REPORTED EXCHANGE WITH RESEARCHERS Links with researchers in the previous 12 months (and reports that these links were useful ) (n = 38) n% Attended forums with researchers and policy makers to hear about research findings 33 (12) 87 (32) Invited researchers to give a research perspective in an area of policy development 22 (15) 58 (39) Invited researchers to be an active member of a policy development committee 18 (14) 47 (37) Regularly used research contacts as a sounding board for policy work 28 (20) 74 (53) Contracted a research group or individual to conduct a research review or study 20 (15) 53 (39) Involvement in research in the previous 12 months (n = 38) n% Acted in an advisory capacity to a research team 26 68 Contributed to the development of research questions 28 74 Collaborated on a successful competitive research grant 7 18 Active member of a research team 18 47 Collaborated in analysis and writing up of findings 16 42 Authored or co-authored a research publication 12 32 Assisted in dissemination 25 66 RESEARCHERS' REPORTED EXCHANGE WITH POLICY MAKERS Involvement in policy activities in the previous two years (n = 41) n% Presented research findings at a forum where NSW policy makers likely to have been present 32 78 Presented research findings at a forum organised specifically for NSW policy makers 21 51 Actively participated on a health policy development committee 23 56 Used as a 'sounding board' by a policy maker to provide a research perspective 27 66 Funded by NSW policy agency to conduct a review of research 12 29 Funded by NSW policy agency to conduct a research project 21 51 Involvement of policy makers in research in the previous two years (and reports that this involvement was n% useful ) (n = 41) Acted in an advisory capacity to a research team 28 (16) 68 (39) Discussed ideas for research questions 29 (16) 71 (39) Collaborated on a competitive research grant 25 (13) 61 (32) Active member of a research team 20 (8) 49 (20) Collaborated on analysis or writing up of results 18 (5) 44 (12) Co-authored research publication 17 (7) 41 (17) Assisted in disseminating results 18 (15) 44 (37) Rated 4 or 5 on a 5-point scale Page 6 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 research findings to a forum specifically for policy makers. quality and credibility of the research (33%); a receptive Two thirds had been approached informally to provide a policy environment the 'right research at the right time' research perspective on a policy issue, half had been (33%); and research that was designed specifically to funded by a local policy agency to conduct research, and address policy priorities (19%). The 16 researchers who a third had been funded to undertake a research review. felt that their research should have been but was not used to inform policy reported that the use of their research was Eighty percent of interviewees had wanted to involve a impeded by: research findings that were politically sensi- policy maker in their research at some time in the previ- tive or inconsistent with policy directions (38%); the ous two years. Of these, 58% (46% of the total) were eas- importance of other policy drivers, such as politics or ily able to find a policy maker to contribute when needed, media (31%); and practical constraints to the implemen- but 27% found it difficult to contact a policy maker and tation of findings, such as financial implications (25%). 15% could not find an appropriate person. For those Respondents' suggestions for improving the impact of interviewees who did find a policy maker to contribute to their research on policy and practice included: encourag- their research, this was almost always (79%) based on an ing a better understanding of the importance of research existing relationship. among policy makers and politicians (31%); more oppor- tunities for dialogue and interaction with policy makers Table 2 summarises the ways in which respondents had (25%); and more research and funding (19%). involved policy makers in their research in the previous two years. Policy makers were most often approached by Respondents indicated that none of the policy making, researchers to sound out ideas for research questions or research funding or academic sectors provided significant act in an advisory capacity to a research team, such as incentives to increase research uptake (Table 3). Thirty through a steering committee. Respondents felt that these eight percent of respondents felt that the NSW Depart- were the most useful roles for policy makers in terms of ment of Health placed a high value (rated 4 or 5 on a five influencing the direction, implementation, interpretation point scale) on policy being supported by research. Most or dissemination of their research. respondents believed that funding bodies did not value academics' achievements in research transfer when evalu- What could be done to increase the use of research in ating their track record, and that Universities did not value policy? these achievements when considering promotion. Policy makers In response to an open question, the most common rea- Discussion sons for not using research in policy were: the absence of This paper reports findings from interviews with both sen- appropriate and/or relevant research (29%); a lack of ior policy makers and researchers in NSW. While the sam- skills or capacity to access or acquire relevant research ples were small, this reflects the size of the relevant (24%); the need to consider local agendas and other pol- research and policy communities in NSW, and the icy drivers (24%); and time pressures (21%). The most response rates were good. frequently nominated strategy for improving the use of research in respondents' organisations was improved Policy makers and researchers recognise the potential of access to research and researchers (32%). Participants' research to contribute to policy and are making significant suggestions included: "building bridging systems between attempts to integrate research into the policy process. researchers and policy makers" and "standing arrangement Most policy makers reported having needed data and with key research groups and key research people who can read- reviews in the past 12 months, having commissioned ily assist in policy making". research or reviews during this period, and having used evidence to contribute to the content of policy. The rates Fifty five percent of the respondents were not aware of a of use of evidence by policy makers appear to be some- NSW Health guideline that required evidence to be what higher than those reported in previous Australian checked during policy development. Forty two percent of surveys (eg [19]). Similarly, over the past 12 months, most the sample perceived that NSW Health placed a high value researchers felt that their work had had a policy impact; in (rated 4 or 5 on a five point scale) on policy being sup- particular, they felt that their research had contributed to ported by research. raising awareness of issues and to setting policy agendas. Researchers However, policy makers and researchers agreed that much Of the 27 researchers who reported that their research had more could be done to increase the use of research in pol- been used in policy, the most commonly cited facilitators icy. Reports of current practice indicated that only around identified in response to an open question were: existing half of the researchers thought their research had been relationships and networks with policy makers (33%); the used to get issues on the policy agenda or select preferred Page 7 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 Table 3: Researchers' views about incentives and motivation to improve research uptake 1 2 3 None/little Medium High n% n % n % Perceived value placed by NSW Health on policy being supported by research (n = 39) 15 38 9 23 15 38 Perceived value placed by funding bodies on research transfer activities (n = 40) 26 65 11283 8 Perceived value placed by universities on research transfer activities (n = 41) 31 76 6 15 4 10 Rated 1 or 2 on a 5-point scale Rated 3 on a 5-point scale Rated 4 or 5 on a 5-point scale policy options in the past two years. Although policy mak- seems likely that new approaches are required that more ers drew on research findings to contribute to the content closely target the specific needs of policy users [25]. There of policy, it was not often used to set agendas or to evalu- is evidence that decision makers appreciate very brief ate policy. summaries of research findings, preferably with a more detailed structured abstract and along with clear state- This paper identifies four potential strategies for increas- ments of implications for practice [27,28]. The Canadian ing the use of research in policy. Health Service Research Foundation's (CHRSF) 1:3:25 format (one page of main messages, a three-page execu- First, making research findings more accessible is likely to tive summary, and a 25-page report), for example, is be helpful. Policy makers reported that they often found widely recommended [29]. it difficult to access brief summaries and systematic reviews. Many respondents also indicated that research Second, increasing the opportunities for interaction and conducted in NSW was often not presented in a useful exchange between policy makers and researchers is key to way to inform policy and program issues. Similar results promoting the use of research evidence in policy. This was have been reported by others [19,25,26]. The difficulty in identified by both policy makers and researchers in our accessing reviews was reported despite the fact that NSW samples, consistent with the findings of two systematic Health employees have access to research reviews on the reviews [3,30]. Our respondents reported a moderate cur- web through the Clinical Information Access Project rent level of interaction, indicating that partnership and (CIAP), encompassing a wide range of research databases collaboration is feasible. For example, around half of the such as Medline and Cochrane. In contrast, participants researchers reported being involved in policy develop- reported that they could easily access local data and that ment committees, being used as a sounding board or these data were very useful. Decision makers at NSW being funded by government for policy-relevant research. Health have access to data resources including the Health Likewise, around half of the policy makers indicated that Outcomes Information Statistical Toolkit (HOIST) which they were involved in some research activities. This was in houses a wide range of relevant population-based data broad agreement with researchers' views about their collections (eg census data and morbidity and mortality involvement of policy makers. data). This system allows manipulation, analysis and reporting of data at the state and regional level. There Opportunities for researchers and policy makers to meet appears to be a high level of awareness and use of this sys- informally and mechanisms to help policy makers and tem and other sources of local health data within the Area researchers to identify individuals relevant to their work Health Services and Department of Health. are likely to be important in promoting exchange. Policy makers in our sample reported that they often wanted to Researchers reported a high level of effort in disseminat- seek advice from researchers, but sometimes could not ing their research to policy makers. Thirty nine percent of find the expertise that they needed, and that they tended respondents had regularly developed targeted strategies to use existing contacts. Researchers perceived that input for communicating their findings to non-academic audi- from policy makers into their research would be of value ences. While peer review papers and conference papers but were often not sure how best to identify appropriate remain the standard methods of dissemination, there is individuals. certainly evidence of a second tier dissemination strategy aimed at policy makers, primarily through research A greater intensity of interaction and exchange is achieved reports and presentations. by actively involving policy makers in conceptualising, designing, and implementing research [31]. Experiences However, despite these efforts by researchers, policy mak- with 'research partnership' models in the UK suggest that ers still found it difficult to access research findings. It the involvement of decision makers both focuses the Page 8 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 research on users' needs and encourages a better under- With regard to incentives for researchers to engage in standing on the part of researchers of the decision making research transfer activities, there is a need to develop a environment [32]. In Australia, funding schemes such as measure of the impact of research on policy. A reliable Australian Research Council linkage grants and the measurement tool would enable these activities to be National Health and Medical Research Council's new included in consideration of applications for promotion Partnership Awards require the formal involvement of an or in assessment of research track record for funding industry partner, and are important mechanisms for applications. For example, the Netherlands Council for encouraging collaboration between researchers and policy Medical Sciences has developed a methodology and indi- makers. Internationally, the CHRSF's Research, Exchange cators for evaluating the societal impact of applied health and Impact for System Support program [33] and United research [40]; this is considerably more sophisticated than Kingdom's National Institute for Health Research Service the generic measures for research impact proposed as part Delivery and Organisation Programme [34] might pro- of the (now abandoned) Australian Research Quality vide models for the future in Australia. Framework. Third, there are clearly some structural barriers to increas- Finally, there was a view among policy makers that there ing the use of research in policy that could be addressed. is a lack of relevant research that could inform policy. Both policy makers and researchers felt that enhancing Almost half the sample believed that the health research policy makers' understanding of research is important; being conducted in NSW was not relevant, or had variable likewise, the need to improve research infrastructure and relevance, to health policy. To increase the relevance of funding was regarded as important in generating relevant research, policy makers need be able to clearly identify evidence. Policy makers felt that organisational reinforce- and communicate gaps in knowledge and policy priorities ment for evidence-informed policy could be improved. for research to researchers. A greater understanding of the Although researchers agreed that there was a high need to policy context by researchers could increase relevance by increase the use of research by policy makers, more than focusing the research on more useful questions, collecting one-third of the respondents in the current sample did not information critical for policy decisions (for example on regard these activities as being a high personal priority. costs) and improving the description of the research This is in part the result of a perception among researchers results and their implications. Research partnerships may that their efforts to impact on policy were not valued by improve the relevance of research and therefore its trans- Universities or by funding agencies. This view is probably lation to policy [41]. well founded; for example, in Canada, Phaneuf et al. [35] surveyed academic promotion committee members and The development of a national system for health data found that they regarded peer review publications as sub- linkage through the National Collaborative Research stantially more important in their decision making than Infrastructure Strategy (NCRIS) Population Health work with policy. Although it was not directly examined Research Network presents particular opportunities for in this study, it is evident that concerns about intellectual new policy-relevant health research in Australia. Linked property, independence and the right to publish are also person-based data for entire populations provides power- structural barriers to a greater engagement of researchers ful information about the outcomes of health systems, with policy agencies [36]. and how these are shaped both by environmental factors, patient factors and service configuration. However, to pro- There seems little doubt that it will be necessary to address vide the information health policy makers need, this these structural barriers to increase the use of evidence in enhanced capacity to describe and monitor system out- policy. In terms of increasing the receptivity of policy comes must be accompanied by new multidisciplinary makers to research, the two main approaches that have research to develop health service interventions and test been described are the use of tools to assess organisational these in real-life service settings. capacity to acquire and apply research evidence (for exam- ple a self-assessment tool developed by the CHRSF [37]) We intend to repeat our policy maker and researcher inter- and continuing education programs (for example the views in 2010. The 2010 sample of policy makers is likely CHSRF-sponsored Executive Training for Research Appli- to be almost entirely new, given the rapidity of change cation (EXTRA) program [38]). A relevant Australian within the policy environment. Nonetheless, we would example is the Australasian Cochrane Centre (ACC) Pol- hope to demonstrate increased use of research evidence in icy Liaison Initiative, through which the ACC provides health policy in NSW, as a result of the activities of the Sax support and training to an Evidence-Based Policy Net- Institute and initiatives such as the NHMRC Partnerships work within the Australian Government Department of Program and the NCRIS Population Health Research Net- Health and Ageing [39]. work, and reflecting a general, worldwide interest in pro- Page 9 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 15. Grol R, Grimshaw J: From best evidence to best practice: effec- moting the efficient transfer of research evidence into tive implementation of change in patients' care. Lancet 2003, policy. 362:1225-1230. 16. Lomas J: Research and evidence-based decision making. Aust N Z J Public Health 1997, 21:439-441. Competing interests 17. Rychetnik L, Wise M: Advocating evidence-based health pro- The authors declare that they have no competing interests. motion: reflections and a way forward. Health Promot Int 2004, 19:247-257. 18. Jacobson N, Butterill D, Goering P: Organizational factors that Authors' contributions influence university-based researchers' engagement in DC oversaw the design and conduct of the researcher knowledge transfer activities. Sci Commun 2004, 25:246-259. 19. Ross J: The use of economic evaluation in health care: Aus- interviews, undertook data analysis, and drafted the man- tralian decision makers' perceptions. Health Policy 1995, uscript. SR contributed to the conception and design of 31:103-110. the study, and to the development, drafting and editing of 20. Adily A, Ward J: Evidence based practice in population health: a regional survey to inform workforce development and the manuscript. LJ and AZB contributed to the conception organisational change. J Epidemiol Community Health 2004, and design of the study, and helped to draft the manu- 58:455-460. 21. Adily A, Westbrook J, Coiera E, Ward J: Use of on-line evidence script. MC oversaw the design and conduct of the policy databases by Australian public health practitioners. Med maker interviews, undertook data analysis, and helped to Inform Internet Med 2004, 29:127-136. draft the manuscript. LR contributed to the design of the 22. Kingwell BA, Anderson GP, Duckett SJ, Hoole EA, Jackson-Pulver LR, Khachigian LM, Morris ME, Roder DM, Rothwell-Short J, Wilson AJ: study and helped to draft the manuscript. All authors read Evaluation of NHMRC funded research completed in 1992, and approved the final manuscript. 1997 and 2003: gains in knowledge, health and wealth. Med J Aust 2006, 184:282-286. 23. Shah S, Ward JE: Outcomes from NHMRC public health Acknowledgements research project grants awarded in 1993. Aust N Z J Public The authors would like to thank the participants in the interviews and Health 2001, 25:556-560. acknowledge the advice of the Getting Research into Policy and Practice 24. National Health and Medical Research Council: When does quality assurance in health care require independent ethical review? Advice to Insti- (GRIPP) Committee. tutions, Human Research Ethics Committees and Health Care Professionals Canberra: Commonwealth of Australia; 2003. References 25. Crosswaite C, Curtice L: Disseminating research results the 1. Dobrow MJ, Goel V, Upshur REG: Evidence-based health policy: challenge of bridging the gap between health research and context and utilisation. Soc Sci Med 2004, 58:207-217. health action. Health Promot Int 1994, 9:289-296. 2. Hanney SR, Gonzalez-Block MA, Buxton MJ, Kogan M: The utilisa- 26. Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J: How tion of health research in policy-making: concepts, examples can research organizations more effectively transfer and methods of assessment. Health Res Policy Syst 2003, 1:2-29. research knowledge to decision makers? Milbank Q 2003, 3. Innvær S, Vist G, Trommald M, Oxman A: Health policy-makers' 81:221-248. perceptions of their use of evidence: a systematic review. J 27. Dobbins M, Jack S, Thomas H, Kothari A: Public health decision- Health Serv Res Policy 2002, 7:239-244. makers' informational needs and preferences for receiving 4. Lin V: Improving the research and policy partnership: An research evidence. Worldviews Evid Based Nurs 2007, 4:156-163. agenda for research transfer and governance. In Evidence- 28. Thurston SJ, Craig D, Wilson P, Drummond MF: Increasing deci- Based Health Policy: Problems and Possibilities Edited by: Lin V, Gibson B. sion-makers' access to economic evaluations: alternative Melbourne: Oxford University Press; 2003:285-297. methods of communicating the information. Int J Technol 5. Weiss CH: The many meanings of research utilization. Public Assess Health Care 2008, 24:151-157. Adm Rev 1979, 39:426-431. 29. Canadian Health Services Research Foundation: Reader-Friendly Writ- 6. Rudd K: Address to Heads of Agencies and members of Sen- ing 1:3:25 Ottawa: Canadian Health Services Research Foundation; ior Executive Service. Canberra: Australian Public Service Com- 2001. mission; 2008. 30. Lavis J, Davies H, Oxman A, Denis JL, Golden-Biddle K, Ferlie E: 7. Davis DA, Taylor-Vaisey A: Translating guidelines into practice. Towards systematic reviews that inform health care man- A systematic review of theoretic concepts, practical experi- agement and policy-making. J Health Serv Res Policy 2005, ence and research evidence in the adoption of clinical prac- 10(Suppl 1):35-48. tice guidelines. CMAJ 1997, 157:408-416. 31. Walter I, Davies H, Nutley S: Increasing research impact 8. Davis P, Howden-Chapman P: Translating research findings into through partnerships: evidence from outside health care. J health policy. Soc Sci Med 1996, 43:865-872. Health Serv Res Policy 2003, 8(Suppl 2):58-61. 9. McWilliam CL, Stewart M, Brown JB, Feightner J, Rosenberg M, Gut- 32. Ross S, Lavis J, Rodriguez C, Woodside J, Denis JL: Partnership man G, Penning M, Stewart M, Tamblyn R, Morfitt G: Promoting experiences: involving decision-makers in the research proc- evidence-based health policy, programming, and practice for ess. J Health Serv Res Policy 2003, 8(Suppl 2):26-34. seniors: Lessons from a national knowledge transfer project. 33. Research, Exchange and Impact for System Support (REISS) Can J Aging 2003, 22:415-425. Competition [http://www.chsrf.ca/funding_opportunities/reiss/ 10. Pope C: Resisting evidence: The study of evidence-based index_e.php] medicine as a contemporary social movement. Health 2003, 34. NHS Service Delivery and Organisation Research and Development 7:267-282. Programme: Building Evidence for Improvement: A Plan for Developing the 11. Canadian Health Services Research Foundation: Issues in Linkage and NHS Service Delivery and Organisation Research and Development Pro- Exchange between Researchers and Decision Makers Ottawa: Canadian gramme Within the National Strategy for Health Research in England Lon- Health Services Research Foundation; 1999. don: NHS Service Delivery and Organisation Research and 12. Crewe E, Young J: Bridging Research and Policy: Context, Evidence and Development Programme; 2006. Links London: Overseas Development Institute; 2002. 35. Phaneuf M-R, Lomas J, McCutcheon C, Church J, Wilson D: Square 13. Kavanagh A, Daly J, Melder A, Jolley D: Assessing the quality of pegs in round holes: The relative importance of traditional evidence for public health problems. In Evidence-Based Health and nontraditional scholarship in Canadian universities. Sci Policy: Problems and Possibilities Edited by: Lin V, Gibson B. Melbourne: Commun 2007, 28:501-518. Oxford University Press; 2003:70-79. 36. Holman CD: An end to suppressing public health information. 14. Lomas J: Improving Research Dissemination and Uptake in the Health Sec- Med J Aust 2008, 188:435-436. tor: Beyond the Sound of One Hand Clapping Hamilton, Ontario: McMas- ter University Centre for Health Economics and Policy Analysis; 1997. Page 10 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 37. Canadian Health Services Research Foundation: Is Research Working for You? Ottawa: Canadian Health Services Research Foundation; 38. Denis JL, Lomas J, Stipich N: Creating receptor capacity for research in the health system: the Executive Training for Research Application (EXTRA) program in Canada. J Health Serv Res Policy 2008, 13(Suppl 1):1-7. 39. Misso M, Brennan S, Green S: [O47] Encouraging and support- ing Australian policy makers to use Cochrane reviews: what have we learnt so far? In 13th Cochrane Colloquium; Melbourne; 2226 October 2005 Melbourne; 2005. 40. Council for Medical Sciences: The Societal Impact of Applied Health Research: Towards a Quality Assessment System Amsterdam: Royal Netherlands Academy of Arts and Sciences; 2002. 41. Lomas J: Using 'linkage and exchange' to move research into policy at a Canadian foundation. Health Aff 2000, 19:236-240. Publish with Bio Med Central and every scientist can read your work free of charge "BioMed Central will be the most significant development for disseminating the results of biomedical researc h in our lifetime." Sir Paul Nurse, Cancer Research UK Your research papers will be: available free of charge to the entire biomedical community peer reviewed and published immediately upon acceptance cited in PubMed and archived on PubMed Central yours — you keep the copyright BioMedcentral Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp Page 11 of 11 (page number not for citation purposes) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australia and New Zealand Health Policy Springer Journals

Increasing the use of evidence in health policy: practice and views of policy makers and researchers

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Springer Journals
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Copyright © 2009 by Campbell et al; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; Public Health; Social Policy
ISSN
1743-8462
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1743-8462
DOI
10.1186/1743-8462-6-21
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19698186
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Abstract

Background: Better communication is often suggested as fundamental to increasing the use of research evidence in policy, but little is known about how researchers and policy makers work together or about barriers to exchange. This study explored the views and practice of policy makers and researchers regarding the use of evidence in policy, including: (i) current use of research to inform policy; (ii) dissemination of and access to research findings for policy; (iii) communication and exchange between researchers and policy makers; and (iv) incentives for increasing the use of research in policy. Methods: Separate but similar interview schedules were developed for policy makers and researchers. Senior policy makers from NSW Health and senior researchers from public health and health service research groups in NSW were invited to participate. Consenting participants were interviewed by an independent research company. Results: Thirty eight policy makers (79% response rate) and 41 researchers (82% response rate) completed interviews. Policy makers reported rarely using research to inform policy agendas or to evaluate the impact of policy; research was used more commonly to inform policy content. Most researchers reported that their research had informed local policy, mainly by increasing awareness of an issue. Policy makers reported difficulty in accessing useful research syntheses, and only a third of researchers reported developing targeted strategies to inform policy makers of their findings. Both policy makers and researchers wanted more exchange and saw this as important for increasing the use of research evidence in policy; however, both groups reported a high level of involvement by policy makers in research. Conclusion: Policy makers and researchers recognise the potential of research to contribute to policy and are making significant attempts to integrate research into the policy process. These findings suggest four strategies to assist in increasing the use of research in policy: making research findings more accessible to policy makers; increasing opportunities for interaction between policy makers and researchers; addressing structural barriers such as research receptivity in policy agencies and a lack of incentives for academics to link with policy; and increasing the relevance of research to policy. Page 1 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 and promotion within the higher education system Background Evidence from research can enhance policy development depends on publication in peer-reviewed journals as by identifying new issues for the policy agenda, informing opposed to broader knowledge transfer activities, and decisions about policy content and direction, or by evalu- there is a general lack of administrative and monetary sup- ating the impact of policy [1-5]. Although evidence from port for translation-oriented work. research is only one of the many factors considered in pol- icy development, there is an increasing recognition of its There are very few studies of engagement between potential value. In a recent speech to senior public serv- researchers and policy makers in Australia. In 1995, Ross ants, the Australian Prime Minister identified seven key examined the use of economic evaluations by senior pol- aspects of policy making, one of which was the use of evi- icy makers (n = 34) from the New South Wales (NSW) dence; he went on to emphasise the importance of evi- Health Department and the Commonwealth Health dence-based policy making as part of a robust culture of Department and found that only 38% of the policy mak- policy contestability [6]. ers had ever used economic evaluations to inform policy development [19]. A survey of population health staff in However, it is evident that many opportunities to use evi- an Area Health Service in NSW found that most felt that dence from research in policy are currently missed [7-10], there was a lack of evidence on which to base policy and with some authors suggesting that the consideration of that an evidence based approach would improve practice evidence by policy makers is 'haphazard' at best [3,11-14]. [20]; relatively few reported using a web-based portal, the Grol and Grimshaw conclude, for example, that "one of the Clinical Information Access Program, to access evidence most consistent findings in research of health services is the gap about population health interventions [21]. between evidence and practice" (p. 1225) [15]. A recent study of reports from completed projects funded A lack of communication, exchange and understanding through National Health and Medical Research Council between researchers and policy makers is often regarded (NHMRC) grants found that only 14% of principal inves- as a major contributor to the failure to consider the rele- tigators felt their research had influenced public health vant evidence. This has been well described by Lomas who practice, and only nine percent believed their work had noted that "efforts by researchers and by decision makers seem made any impact on health policy [22]. An earlier survey to proceed largely independently. Both have their own (often of NHMRC grant recipients asked about the potential misplaced) ideas about the other's environment. Opportunities value of different approaches to enhancing research dis- for ongoing exchange and communication are few. ...It is like semination [23]. The most highly rated suggestions two people trying to assemble a jigsaw puzzle, each with half the included encouraging greater demand for research find- pieces but each working in a separate room" (p. 439) [16]. ings and better skills at judging 'good' research among policy makers, encouraging policy makers to become Relatively little is known about the ways in which involved in research, better infrastructure support for pub- researchers and policy makers work together or about bar- lic health research, and more research funded by health riers to increasing exchange. A systematic review of 24 organisations. studies of health policy makers' perceptions indicated that the most important facilitator of research use was per- This study aimed to explore the views and current practice sonal two-way communication between researchers and of both policy makers and researchers about the use of policy makers [3]. Research suggests that evidence is more evidence in policy. Specifically, the study aimed to: likely to be used to inform policy if it is relevant and acces- sible [14,17] and there are incentives supporting its con- i. Describe the extent to which policy makers and sideration [3,14]. However, past studies in this field are researchers believed that research is currently used to mostly surveys of opinions rather than accounts of current inform policy use, communication or exchange. ii. Investigate current practice in relation to the dissemina- Even less is known about the views of researchers about tion of and access to research findings for policy factors that might increase their participation in policy rel- evant research and engagement with policy makers. Only iii. Explore the extent of communication and exchange one study exploring the views of health researchers was between researchers and policy makers and located; it reported that researchers were concerned about the risks posed to an academic career by spending time on iv. Examine incentives for increasing the use of research in engagement with policy agencies [18]. In Australia, tenure policy Page 2 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 ice Development and of Population Health from each of Methods Setting the Area Health Services were sent a letter of invitation The Sax Institute was established in 2002 with core fund- from the NSW Chief Health Officer (n = 54). ing from the NSW Department of Health. The Institute is a unique organisation in Australia that aims to build Interview schedule excellent policy- and practice-focused health research and The interview schedule included both closed and open- increase the impact of this research on health policy, pro- ended questions and asked about respondents' involve- grams and services. The Institute is an independent, not- ment in policy development, access to and use of research for-profit organisation structured as a coalition of mem- findings, and involvement in research activities and net- ber organisations. Membership is open to Universities, works. Participants were asked to think broadly about pol- Schools and research groups with programs in public icy and to include in their answers policy in the form of health and health services research. At the time of the small-scale local plans or operational issues through to study the Institute's members included 34 research groups large-scale programs or system-wide directions, and relat- (six Universities and 28 Schools/research centres) of ing to a variety of issues including resource allocation, national and international standing, representing most of service patterns, or the delivery of health care or public the Universities and research groups that undertake public health programs. In responding to questions about health and health services research in NSW. A full list of research, participants were asked to include any kind of members and details about membership are available on formal or systematic process of collecting and analysing the Sax Institute's website http://www.saxinstitute.org.au. data, including stand-alone studies, studies that form part of a broad thematic program of research, and research Procedure reviews. The study was designed as a quality assurance exercise to Interviews with researchers assess, and inform the further development of, the Sax Institute's programs for improving links between research Participants and policy. The study complied with the definition of a Sixty senior population health and health services quality assurance activity as set out in the relevant researchers were invited to participate through a letter sent National Health and Medical Research Council guidelines from the Chief Executive Officer of the Sax Institute. [24]. Specifically, participants were being interviewed in Invitees included nominated representatives from the their professional capacity to describe their current prac- Institute's member Universities (n = 6), nominated mem- tice; the interviews were undertaken with the informed bers from the Institute's member Schools and research consent of participants; participants were unlikely to suf- centres (n = 28), and one additional nominee from each fer burden or harm; and no personal details or identifying member School and research centre currently employing information were collected. Accordingly, the approval of two or more senior researchers (n = 26). a human research ethics committee was not sought. Interview schedules Separate interview schedules were prepared for research- The structured interview schedule included both closed ers and policy makers and samples identified as described and open-ended questions and asked about respondents' below. The procedure for administering both sets of inter- involvement in policy development, dissemination of views was the same. Structured telephone interviews were their research and its impact on policy, and degree of conducted by trained interviewers from an independent involvement of policy makers in their research. The research company. Potential participants were initially descriptions of the terms 'policy' and 'research' were the contacted by telephone and asked to identify a suitable same as those provided in the interviews with policy mak- interview time; a minimum of six follow-up call attempts ers. were made to establish contact. Participants were informed that their responses would be fully de-identi- Results fied. Interviews took an average of 30 minutes to com- Sample Policy makers plete. The interviews were not recorded, but responses to open-ended questions were handwritten verbatim and Of the 54 people approached, six people were on subsequently coded using thematic analysis to identify extended leave or had transferred from their area. Of the common categories. remaining 48 potential participants, 10 did not respond to the letter of invitation. The final sample consisted of 38 Interviews with policy makers interviewees (79% response rate). Participants All members of the NSW Department of Health Policy The 38 policy makers interviewed were employed at sen- Development Committee and all directors of Health Serv- ior levels of the NSW Department of Health (n = 14) and Page 3 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 the Area Health Services (n = 24). Over half (58%) had ting issues onto the policy agenda, informing policy con- worked in their current position for more than two years. tent and direction, and evaluating the implementation or All participants had been involved in policy development the impact of a policy. in the last 12 months, with 71% having developed more than five policies and 84% having approved policies Respondents were asked to estimate, for those policies developed by other staff. Respondents were involved in that they had developed or approved, whether research developing a range of policies relating to population was used to inform: (a) none of these policies; (b) less health (eg state wide immunisation strategy, Area-level than a quarter; (c) between a quarter and a half; (d) public health plan), health service provision (eg cancer between half and three quarters; or (e) more than three services plan), governance and administration (eg patient quarters. The majority of respondents used research only information privacy), and clinical care (eg collection of infrequently to inform policy agendas. Sixty six percent of urine samples for testing). respondents used research in agenda setting on less than a quarter of occasions in the previous year; this included Researchers two participants who had never used research to inform Of the 60 researchers approached, six were unavailable policy agendas. Most participants also used research infre- during the study period and four no longer held a sub- quently to evaluate the implementation or impact of pol- stantive research position. Of the remaining 50 potential icies: 60% had used research to evaluate policies on less participants, five opted out of the study and four could than a quarter of occasions in the previous year. This not be contacted. Forty-one researchers completed an included three participants who had never used research interview (82% response rate). The 41 researchers inter- to evaluate policies. viewed were drawn from 29 of the Sax Institute's member organisations across NSW. All but one respondent (98%) Use of research to inform policy content or direction was had worked in an academic research environment for more common. All respondents had used research to eight or more years (range 3 to 40 years, mean 19 years). inform policy content at some time in the previous year, Interviewees identified their primary research areas as and only 11% reported using research on less than a quar- public health (56%), health services (51%), clinical and ter of policies. Nevertheless, only a minority of partici- medical sciences (27%), and equity (12%). pants (29%) used research to inform content on more than three-quarters of policies. Is research currently used to inform policy? Policy makers Researchers Respondents were asked to indicate how much of a need Eighty five percent of respondents perceived a high need there is to increase the use of research in policy making to increase research use by policy makers (rated 4 or 5) using a five point scale. Sixty three percent of respondents and the remainder believed that there was a moderate felt that there was a high need to increase the use of need (rated 3). research (rated 4 or 5) and a further 24% believed that there was a medium need (rated 3). Table 1 shows researchers' reports of the impact of their research on policy. Two thirds of the respondents reported Figure 1 shows respondents' reports of their use of that findings from their research had been used to inform research in policy in the past 12 months in terms of get- health policy or practice within NSW, and 69% agreed that a research review they had undertaken in the previous two years had impacted on policy in some way. Thirty nine percent could identify findings from their research that they believed should have been used to inform local policy or practice, but which had not been used. When asked to describe how their research had influenced health policy or practice, respondents most often felt that their research or reviews had increased policy makers' aware- ness of an issue. Are research findings accessible and useful? Policy makers Policy makers' views about the p evaluation Figure 1 olicy agenda setting; (b) policy conten impact of research on: t/direction; and (c) (a) Respondents were asked whether the health research Policy makers' views about the impact of research undertaken by researchers in NSW was relevant to policy on: (a) policy agenda setting; (b) policy content/direc- and program development. Over one third of respondents tion; and (c) evaluation. (39%) felt that local research was relevant, but most of Page 4 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 Table 1: Researchers' views about the impact of research on policy or practice and reported dissemination Research findings Research review (n = 41) (n = 29) IMPACT OF RESEARCH ON POLICY n % n % Own research or reviews have been used to inform policy or practice 27 66 20 69 Had findings that were not used by policy but were potentially important 16 39 NA NA Own research increased policy makers' awareness of the issue 24 59 19 66 Own research helped to get the issue on the policy agenda 20 49 13 45 Own research assisted policy makers in formulating the policy issue 19 46 14 48 Own research helped policy makers to identify policy alternatives 17 41 11 38 Own research helped policy makers to choose the preferred policy option 20 49 9 31 Own research used to justify the final policy 20 49 12 41 DISSEMINATION Published in peer review journal 36 88 9 31 Published in report for funding agency 27 66 16 55 Published in report for stakeholders 22 54 10 34 Presented at conference 37 90 10 34 Presented to policy makers 21 51 13 45 Presented to practitioners 26 63 8 28 Researchers who had contributed to a review in the previous two years Most recent research paper or review these (87%) believed that the research was not presented terms of decision making. Summaries of local data were in a useful way. In total, only 5% of the interviewees felt rated as highly useful by 78% of these respondents, with that local research was both relevant and presented in a 72% rating brief research summaries and 64% rating sys- useful way. tematic reviews as highly useful respectively. Researchers Figure 2 shows participants' reports about their use of three different types of research syntheses over the past 12 Respondents were asked how often they had used various months. It is evident that policy makers needed all three strategies to communicate their research findings in the types of synthesis, but had difficulty finding brief research previous two years. Twenty three (56%) reported that they summaries and systematic reviews when they were often identified the policy or practice implications of their needed. Policy makers who accessed research syntheses research findings, but only 14 (34%) regularly developed reported that these were almost always of some use in explicit policy recommendations or summaries from their research for policy makers. Sixteen (39%) respondents had frequently developed targeted strategies for commu- nicating their research to non-academic audiences, and 18 (44%) often wrote reports or papers about their research for non-academics. Table 1 shows respondents' reports of dissemination in relation to the most recent research study or review in which they had been involved. Although the most com- mon dissemination strategies were conference papers and peer review papers, half reported a presentation of find- ings to policy makers. How much communication and exchange is there between researchers and policy makers? Pol pr Figure 2 ev icy makers' ious 12 m need f onths or and use of research syntheses in the Policy makers Policy makers' need for and use of research synthe- Most policy makers (n = 28, 74%) had wanted to contact ses in the previous 12 months. a researcher during the past 12 months to sound out an Page 5 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 issue. Of those who had wanted to discuss ideas with a of research questions, or assisted with the dissemination researcher in the previous year, 57% (42% of the total of research results. Half of the interviewees reported active sample) were easily able to contact a relevant researcher participation in a research team. However, fewer had been when needed. involved in the sorts of activities that are likely to facilitate communication and application of research, such as par- Table 2 shows policy makers' communication and ticipating in the analysis, writing up and publication of exchange with researchers in the past 12 months. Most the research results. Eighteen percent of the sample had respondents had attended forums to hear research find- collaborated on a successful competitive research grant. ings and about half of the respondents had actively invited researchers to participate in the policy process by Researchers providing a research perspective or joining a policy devel- Table 2 also shows researchers' reports about communica- opment committee. tion with policy makers in the last two years. Almost all had presented their research findings at a conference or More than two-thirds of the policy makers had acted in an forum where state- or Area-level policy makers were likely advisory role in research, participated in the development to have been present, but only half had presented their Table 2: Exchange between researchers and policy makers POLICY MAKERS' REPORTED EXCHANGE WITH RESEARCHERS Links with researchers in the previous 12 months (and reports that these links were useful ) (n = 38) n% Attended forums with researchers and policy makers to hear about research findings 33 (12) 87 (32) Invited researchers to give a research perspective in an area of policy development 22 (15) 58 (39) Invited researchers to be an active member of a policy development committee 18 (14) 47 (37) Regularly used research contacts as a sounding board for policy work 28 (20) 74 (53) Contracted a research group or individual to conduct a research review or study 20 (15) 53 (39) Involvement in research in the previous 12 months (n = 38) n% Acted in an advisory capacity to a research team 26 68 Contributed to the development of research questions 28 74 Collaborated on a successful competitive research grant 7 18 Active member of a research team 18 47 Collaborated in analysis and writing up of findings 16 42 Authored or co-authored a research publication 12 32 Assisted in dissemination 25 66 RESEARCHERS' REPORTED EXCHANGE WITH POLICY MAKERS Involvement in policy activities in the previous two years (n = 41) n% Presented research findings at a forum where NSW policy makers likely to have been present 32 78 Presented research findings at a forum organised specifically for NSW policy makers 21 51 Actively participated on a health policy development committee 23 56 Used as a 'sounding board' by a policy maker to provide a research perspective 27 66 Funded by NSW policy agency to conduct a review of research 12 29 Funded by NSW policy agency to conduct a research project 21 51 Involvement of policy makers in research in the previous two years (and reports that this involvement was n% useful ) (n = 41) Acted in an advisory capacity to a research team 28 (16) 68 (39) Discussed ideas for research questions 29 (16) 71 (39) Collaborated on a competitive research grant 25 (13) 61 (32) Active member of a research team 20 (8) 49 (20) Collaborated on analysis or writing up of results 18 (5) 44 (12) Co-authored research publication 17 (7) 41 (17) Assisted in disseminating results 18 (15) 44 (37) Rated 4 or 5 on a 5-point scale Page 6 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 research findings to a forum specifically for policy makers. quality and credibility of the research (33%); a receptive Two thirds had been approached informally to provide a policy environment the 'right research at the right time' research perspective on a policy issue, half had been (33%); and research that was designed specifically to funded by a local policy agency to conduct research, and address policy priorities (19%). The 16 researchers who a third had been funded to undertake a research review. felt that their research should have been but was not used to inform policy reported that the use of their research was Eighty percent of interviewees had wanted to involve a impeded by: research findings that were politically sensi- policy maker in their research at some time in the previ- tive or inconsistent with policy directions (38%); the ous two years. Of these, 58% (46% of the total) were eas- importance of other policy drivers, such as politics or ily able to find a policy maker to contribute when needed, media (31%); and practical constraints to the implemen- but 27% found it difficult to contact a policy maker and tation of findings, such as financial implications (25%). 15% could not find an appropriate person. For those Respondents' suggestions for improving the impact of interviewees who did find a policy maker to contribute to their research on policy and practice included: encourag- their research, this was almost always (79%) based on an ing a better understanding of the importance of research existing relationship. among policy makers and politicians (31%); more oppor- tunities for dialogue and interaction with policy makers Table 2 summarises the ways in which respondents had (25%); and more research and funding (19%). involved policy makers in their research in the previous two years. Policy makers were most often approached by Respondents indicated that none of the policy making, researchers to sound out ideas for research questions or research funding or academic sectors provided significant act in an advisory capacity to a research team, such as incentives to increase research uptake (Table 3). Thirty through a steering committee. Respondents felt that these eight percent of respondents felt that the NSW Depart- were the most useful roles for policy makers in terms of ment of Health placed a high value (rated 4 or 5 on a five influencing the direction, implementation, interpretation point scale) on policy being supported by research. Most or dissemination of their research. respondents believed that funding bodies did not value academics' achievements in research transfer when evalu- What could be done to increase the use of research in ating their track record, and that Universities did not value policy? these achievements when considering promotion. Policy makers In response to an open question, the most common rea- Discussion sons for not using research in policy were: the absence of This paper reports findings from interviews with both sen- appropriate and/or relevant research (29%); a lack of ior policy makers and researchers in NSW. While the sam- skills or capacity to access or acquire relevant research ples were small, this reflects the size of the relevant (24%); the need to consider local agendas and other pol- research and policy communities in NSW, and the icy drivers (24%); and time pressures (21%). The most response rates were good. frequently nominated strategy for improving the use of research in respondents' organisations was improved Policy makers and researchers recognise the potential of access to research and researchers (32%). Participants' research to contribute to policy and are making significant suggestions included: "building bridging systems between attempts to integrate research into the policy process. researchers and policy makers" and "standing arrangement Most policy makers reported having needed data and with key research groups and key research people who can read- reviews in the past 12 months, having commissioned ily assist in policy making". research or reviews during this period, and having used evidence to contribute to the content of policy. The rates Fifty five percent of the respondents were not aware of a of use of evidence by policy makers appear to be some- NSW Health guideline that required evidence to be what higher than those reported in previous Australian checked during policy development. Forty two percent of surveys (eg [19]). Similarly, over the past 12 months, most the sample perceived that NSW Health placed a high value researchers felt that their work had had a policy impact; in (rated 4 or 5 on a five point scale) on policy being sup- particular, they felt that their research had contributed to ported by research. raising awareness of issues and to setting policy agendas. Researchers However, policy makers and researchers agreed that much Of the 27 researchers who reported that their research had more could be done to increase the use of research in pol- been used in policy, the most commonly cited facilitators icy. Reports of current practice indicated that only around identified in response to an open question were: existing half of the researchers thought their research had been relationships and networks with policy makers (33%); the used to get issues on the policy agenda or select preferred Page 7 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 Table 3: Researchers' views about incentives and motivation to improve research uptake 1 2 3 None/little Medium High n% n % n % Perceived value placed by NSW Health on policy being supported by research (n = 39) 15 38 9 23 15 38 Perceived value placed by funding bodies on research transfer activities (n = 40) 26 65 11283 8 Perceived value placed by universities on research transfer activities (n = 41) 31 76 6 15 4 10 Rated 1 or 2 on a 5-point scale Rated 3 on a 5-point scale Rated 4 or 5 on a 5-point scale policy options in the past two years. Although policy mak- seems likely that new approaches are required that more ers drew on research findings to contribute to the content closely target the specific needs of policy users [25]. There of policy, it was not often used to set agendas or to evalu- is evidence that decision makers appreciate very brief ate policy. summaries of research findings, preferably with a more detailed structured abstract and along with clear state- This paper identifies four potential strategies for increas- ments of implications for practice [27,28]. The Canadian ing the use of research in policy. Health Service Research Foundation's (CHRSF) 1:3:25 format (one page of main messages, a three-page execu- First, making research findings more accessible is likely to tive summary, and a 25-page report), for example, is be helpful. Policy makers reported that they often found widely recommended [29]. it difficult to access brief summaries and systematic reviews. Many respondents also indicated that research Second, increasing the opportunities for interaction and conducted in NSW was often not presented in a useful exchange between policy makers and researchers is key to way to inform policy and program issues. Similar results promoting the use of research evidence in policy. This was have been reported by others [19,25,26]. The difficulty in identified by both policy makers and researchers in our accessing reviews was reported despite the fact that NSW samples, consistent with the findings of two systematic Health employees have access to research reviews on the reviews [3,30]. Our respondents reported a moderate cur- web through the Clinical Information Access Project rent level of interaction, indicating that partnership and (CIAP), encompassing a wide range of research databases collaboration is feasible. For example, around half of the such as Medline and Cochrane. In contrast, participants researchers reported being involved in policy develop- reported that they could easily access local data and that ment committees, being used as a sounding board or these data were very useful. Decision makers at NSW being funded by government for policy-relevant research. Health have access to data resources including the Health Likewise, around half of the policy makers indicated that Outcomes Information Statistical Toolkit (HOIST) which they were involved in some research activities. This was in houses a wide range of relevant population-based data broad agreement with researchers' views about their collections (eg census data and morbidity and mortality involvement of policy makers. data). This system allows manipulation, analysis and reporting of data at the state and regional level. There Opportunities for researchers and policy makers to meet appears to be a high level of awareness and use of this sys- informally and mechanisms to help policy makers and tem and other sources of local health data within the Area researchers to identify individuals relevant to their work Health Services and Department of Health. are likely to be important in promoting exchange. Policy makers in our sample reported that they often wanted to Researchers reported a high level of effort in disseminat- seek advice from researchers, but sometimes could not ing their research to policy makers. Thirty nine percent of find the expertise that they needed, and that they tended respondents had regularly developed targeted strategies to use existing contacts. Researchers perceived that input for communicating their findings to non-academic audi- from policy makers into their research would be of value ences. While peer review papers and conference papers but were often not sure how best to identify appropriate remain the standard methods of dissemination, there is individuals. certainly evidence of a second tier dissemination strategy aimed at policy makers, primarily through research A greater intensity of interaction and exchange is achieved reports and presentations. by actively involving policy makers in conceptualising, designing, and implementing research [31]. Experiences However, despite these efforts by researchers, policy mak- with 'research partnership' models in the UK suggest that ers still found it difficult to access research findings. It the involvement of decision makers both focuses the Page 8 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 research on users' needs and encourages a better under- With regard to incentives for researchers to engage in standing on the part of researchers of the decision making research transfer activities, there is a need to develop a environment [32]. In Australia, funding schemes such as measure of the impact of research on policy. A reliable Australian Research Council linkage grants and the measurement tool would enable these activities to be National Health and Medical Research Council's new included in consideration of applications for promotion Partnership Awards require the formal involvement of an or in assessment of research track record for funding industry partner, and are important mechanisms for applications. For example, the Netherlands Council for encouraging collaboration between researchers and policy Medical Sciences has developed a methodology and indi- makers. Internationally, the CHRSF's Research, Exchange cators for evaluating the societal impact of applied health and Impact for System Support program [33] and United research [40]; this is considerably more sophisticated than Kingdom's National Institute for Health Research Service the generic measures for research impact proposed as part Delivery and Organisation Programme [34] might pro- of the (now abandoned) Australian Research Quality vide models for the future in Australia. Framework. Third, there are clearly some structural barriers to increas- Finally, there was a view among policy makers that there ing the use of research in policy that could be addressed. is a lack of relevant research that could inform policy. Both policy makers and researchers felt that enhancing Almost half the sample believed that the health research policy makers' understanding of research is important; being conducted in NSW was not relevant, or had variable likewise, the need to improve research infrastructure and relevance, to health policy. To increase the relevance of funding was regarded as important in generating relevant research, policy makers need be able to clearly identify evidence. Policy makers felt that organisational reinforce- and communicate gaps in knowledge and policy priorities ment for evidence-informed policy could be improved. for research to researchers. A greater understanding of the Although researchers agreed that there was a high need to policy context by researchers could increase relevance by increase the use of research by policy makers, more than focusing the research on more useful questions, collecting one-third of the respondents in the current sample did not information critical for policy decisions (for example on regard these activities as being a high personal priority. costs) and improving the description of the research This is in part the result of a perception among researchers results and their implications. Research partnerships may that their efforts to impact on policy were not valued by improve the relevance of research and therefore its trans- Universities or by funding agencies. This view is probably lation to policy [41]. well founded; for example, in Canada, Phaneuf et al. [35] surveyed academic promotion committee members and The development of a national system for health data found that they regarded peer review publications as sub- linkage through the National Collaborative Research stantially more important in their decision making than Infrastructure Strategy (NCRIS) Population Health work with policy. Although it was not directly examined Research Network presents particular opportunities for in this study, it is evident that concerns about intellectual new policy-relevant health research in Australia. Linked property, independence and the right to publish are also person-based data for entire populations provides power- structural barriers to a greater engagement of researchers ful information about the outcomes of health systems, with policy agencies [36]. and how these are shaped both by environmental factors, patient factors and service configuration. However, to pro- There seems little doubt that it will be necessary to address vide the information health policy makers need, this these structural barriers to increase the use of evidence in enhanced capacity to describe and monitor system out- policy. In terms of increasing the receptivity of policy comes must be accompanied by new multidisciplinary makers to research, the two main approaches that have research to develop health service interventions and test been described are the use of tools to assess organisational these in real-life service settings. capacity to acquire and apply research evidence (for exam- ple a self-assessment tool developed by the CHRSF [37]) We intend to repeat our policy maker and researcher inter- and continuing education programs (for example the views in 2010. The 2010 sample of policy makers is likely CHSRF-sponsored Executive Training for Research Appli- to be almost entirely new, given the rapidity of change cation (EXTRA) program [38]). A relevant Australian within the policy environment. Nonetheless, we would example is the Australasian Cochrane Centre (ACC) Pol- hope to demonstrate increased use of research evidence in icy Liaison Initiative, through which the ACC provides health policy in NSW, as a result of the activities of the Sax support and training to an Evidence-Based Policy Net- Institute and initiatives such as the NHMRC Partnerships work within the Australian Government Department of Program and the NCRIS Population Health Research Net- Health and Ageing [39]. work, and reflecting a general, worldwide interest in pro- Page 9 of 11 (page number not for citation purposes) Australia and New Zealand Health Policy 2009, 6:21 http://www.anzhealthpolicy.com/content/6/1/21 15. Grol R, Grimshaw J: From best evidence to best practice: effec- moting the efficient transfer of research evidence into tive implementation of change in patients' care. Lancet 2003, policy. 362:1225-1230. 16. 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Adily A, Ward J: Evidence based practice in population health: a regional survey to inform workforce development and the manuscript. LJ and AZB contributed to the conception organisational change. J Epidemiol Community Health 2004, and design of the study, and helped to draft the manu- 58:455-460. 21. Adily A, Westbrook J, Coiera E, Ward J: Use of on-line evidence script. MC oversaw the design and conduct of the policy databases by Australian public health practitioners. Med maker interviews, undertook data analysis, and helped to Inform Internet Med 2004, 29:127-136. draft the manuscript. LR contributed to the design of the 22. Kingwell BA, Anderson GP, Duckett SJ, Hoole EA, Jackson-Pulver LR, Khachigian LM, Morris ME, Roder DM, Rothwell-Short J, Wilson AJ: study and helped to draft the manuscript. All authors read Evaluation of NHMRC funded research completed in 1992, and approved the final manuscript. 1997 and 2003: gains in knowledge, health and wealth. 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Denis JL, Lomas J, Stipich N: Creating receptor capacity for research in the health system: the Executive Training for Research Application (EXTRA) program in Canada. J Health Serv Res Policy 2008, 13(Suppl 1):1-7. 39. Misso M, Brennan S, Green S: [O47] Encouraging and support- ing Australian policy makers to use Cochrane reviews: what have we learnt so far? In 13th Cochrane Colloquium; Melbourne; 2226 October 2005 Melbourne; 2005. 40. Council for Medical Sciences: The Societal Impact of Applied Health Research: Towards a Quality Assessment System Amsterdam: Royal Netherlands Academy of Arts and Sciences; 2002. 41. Lomas J: Using 'linkage and exchange' to move research into policy at a Canadian foundation. Health Aff 2000, 19:236-240. Publish with Bio Med Central and every scientist can read your work free of charge "BioMed Central will be the most significant development for disseminating the results of biomedical researc h in our lifetime." Sir Paul Nurse, Cancer Research UK Your research papers will be: available free of charge to the entire biomedical community peer reviewed and published immediately upon acceptance cited in PubMed and archived on PubMed Central yours — you keep the copyright BioMedcentral Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp Page 11 of 11 (page number not for citation purposes)

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Australia and New Zealand Health PolicySpringer Journals

Published: Aug 24, 2009

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