Six Public Policy Recommendations to Increase the Translation and Utilization of Research Evidence in Public Health Practice

Widespread adoption of evidence-informed public health is vital to improving population health.^1-3 However, the inconsistent use of research evidence in public health practice is a challenge.^3-5 Despite strong advocacy for evidence-informed public health, public health practice is often not based on the best available research evidence.^6,7 In this commentary, we focus on how public policy can support the translation and utilization of research evidence in public health practice.

Evidence-informed public health requires the effective translation and utilization of research evidence in practice. Several interrelated barriers hinder research evidence translation and utilization in practice, including insufficient capacity among public health practitioners, decision makers, and organizations to integrate research evidence into practice; research evidence that does not address the needs of practitioners and decision makers; and research findings that are not communicated or disseminated in ways that reach decision makers and practitioners.^8-14 While we acknowledge that each barrier needs to be addressed to improve research evidence translation and utilization in practice, in this commentary we focus on barriers in the production, communication, and dissemination of research. We highlight these barriers because we have experienced them as researchers who seek to translate our research into practice.

Public policy can help to address barriers by creating enabling environments for research evidence translation and utilization. Public policy influences research priority areas, the research produced, and the way it is communicated and disseminated.^15-18 Researchers respond to indicators from research funding bodies (who, in public health, are often governments) about what is (and what is not) expected to be funded.^17,18 Despite the influence of public policy on the translation of research evidence, few attempts have been made to propose public policy recommendations to support research evidence translation and utilization in practice. Rather, to date, the literature has mainly focused on what individual researchers and research institutions should be doing to increase the likelihood of research evidence influencing practice. Consequently, policy makers lack guidance about which public policy initiatives are likely to increase research evidence translation and utilization.

To assist public health policy makers, we present 6 actionable public policy recommendations that address 2 barriers to research evidence translation and utilization in practice: (1) research evidence that does not address the needs of practitioners and decision makers and (2) research findings that are not communicated and/or disseminated in ways that reach practitioners and decision makers. We contend that, if actioned, these public policy recommendations would support researchers to produce actionable evidence and communicate and widely disseminate their findings in accessible formats. These recommendations are based on our experience as researchers and supported by literature from knowledge translation and related areas.

• Recommendation 1: Public policy funding priority areas should promote collaborative research across disciplinary and organizational boundaries so that research addresses the needs of practitioners and decision makers.

Promoting collaborative research across disciplinary and organizational boundaries ⁶ has been proposed as one way to improve the relevance and applicability of research findings so that they address the needs of practitioners and decision makers.^3,19,20 Transdisciplinary research is one type of collaborative research that involves researchers from various disciplines working together to address complex problems, in partnership with those affected by the problem (people with lived experience) and those in a position to do something about the problem (ie, practitioners and decision makers). Community-based participatory research is another type of collaborative research that can help bridge the gap among research, practice, and policy through community engagement and attention to existing relationships, needs, and assets in a community. ²¹ Increasingly, academic institutions are exploring how to incentivize researchers’ engagement with practitioners and decision makers. ²²

Collaborative research is problem focused and shifts the paradigm from the researcher being considered the expert to researchers, practitioners, and decision makers as experts who all bring vital and complementary knowledge and skills to address complex problems. ²³ Along with the production of relevant and actionable research findings, the involvement of practitioners and decision makers in collaborative research can increase the capacity of public health practitioners and decision makers to use research evidence through, for example, changes in attitudes toward research. ²⁴ It can also encourage researchers to address problems that are of concern to practitioners and decision makers. Emerging literature supports the proposition that collaborative research may produce research that is useful to practitioners and decision makers, increase the adoption and application of research in practice and policy, and improve population health outcomes.^19,25,26 Although emerging, evidence for the effectiveness of collaborative research on the uptake of research evidence in practice and policy is in its infancy. ²⁷ Therefore, research is needed that focuses on both the influence of collaborative research on the uptake of research evidence and subsequent health outcomes and the pathways by which these outcomes are achieved, such as attitudes toward research.

• Recommendation 2: Public policy funding should recognize and support strategies that assist in successful collaborative research, such as funding system intermediary roles or supporting professional development for researchers to gain the necessary skills to engage in collaborative research.

Creating successful collaboration across disciplines and organizational boundaries is challenging. Expectations of researchers who engage in collaborative research are high and include producing rigorous, high-quality research that contributes to community change. ²⁸ Consequently, the researchers’ role is not only to generate new research evidence but also to act as “change agents” (ie, participate in processes that aim to address real-world issues). ²⁹ Furthermore, bringing together experts in various public health disciplines and working with diverse community partners (eg, community members, practitioners, industry partners, decision makers) requires a particular skill set to effectively engage community partners, appreciate diverse perspectives, integrate various forms of knowledge, and build trusting relationships.^30,31 Provision of funding for a “system intermediary” (also known as knowledge broker, boundary spanner partnership broker, knowledge integration specialist) ³⁰ as part of collaborative research teams is a potential strategy to facilitate successful collaboration. These professionals have expertise in the integration of disciplinary expertise, research translation, and implementation.^31,32 They help bring together researchers, practitioners, and decision makers to generate new research findings and translate those findings into practice and policy. ³³ Alternatively, public policy could support skill building/professional development of research students and researchers to engage in collaborative research, for example, in engaging diverse community partners, appreciating diverse perspectives, and building trusting relationships.

• Recommendation 3: Public policy funding schemes should support long-term collaborations among researchers, practitioners, and decision makers.

A long-term funding commitment beyond the life of a single research project is needed for meaningful collaborations among researchers, practitioners, and decision makers. ³⁴ However, the focus of most research funding is single research projects. Institutional support, especially from government, for ongoing collaboration is required, and incentives and financial support are needed for activities that connect researchers, practitioners, and decision makers and enable knowledge translation activities, even after projects formally end. ³⁴ Institutional and financial support may provide a foundation for follow-up research that is co-designed based on mutually identified needs and priorities, which in turn have the potential to further enhance research translation and utilization and population health outcomes. Examples include (1) after the formal end of a collaborative project, a memorandum of understanding could be encouraged between the institutions or other interinstitutional agreements could be established to support postproject research translation events and activities, which will keep researchers, practitioners, and decision makers connected, or (2) allowance of funding requests could be included in project applications to support ongoing engagement beyond project delivery and continue actions toward implementation success and other opportunities for embedding evidence in practice.

• Recommendation 4: Public policy funding guidelines should recognize and reward the application of research designs and methodologies that are conducive to the production of research evidence that is high quality, relevant, and actionable in practice.

Addressing the complex issues faced by practitioners and decision makers requires the application of research methodologies that can attend to complexity. Practitioners and decision makers require research evidence that is appropriate to their settings and populations and that helps in understanding complex causal pathways to population health outcomes. Although incentives within the academic research environment generally favor designs with strong internal validity, these designs sometimes do not address questions of transferability (how well the intervention works in different contexts) and generalizability (how well the intervention can be scaled up).^35,36 For research evidence to be used in practice and policy, researchers need to apply designs and methods that strengthen the internal and external validity of findings, including those that elicit understandings of the relationship between intervention and context.^37,38 A shift is needed from the current situation—in which funding schemes often reward researchers for interventions that have potential for large effect sizes in a highly controlled research setting, rather than their potential feasibility and scalability^35,37—to research designs that seek to balance internal and external validity.^37,39

To maximize research translation and utilization in practice, a need exists to recognize research designs and methodologies that are conducive to both the production of high-quality research evidence and its translation and utilization into policy and practice.^36,37 The value of research designs that consider effectiveness, the contexts of implementation, and the interrelated and nonlinear mechanisms that lead to outcomes has been recognized.^39-41 Examples of such approaches include the following:

• Case study research, which is increasingly recognized as a desirable approach to evaluating complex interventions.^39-41 A distinguishing feature of case study research is that it pays attention to the contextual factors that interact with interventions to produce outcomes. ⁴¹ Case studies consider context, complexity, and mechanisms for understanding how, where, and why interventions have their observed outcomes, ⁴¹ providing useful and actionable research to guide practice and policy.^35,42 However, in terms of hierarchy of evidence, grading instruments generally rely on traditional evidence hierarchies that place randomized controlled trials at the top of the hierarchy, regardless of the research problem being addressed, and place other types of research lower in the hierarchy. ⁴³

• Research designs that integrate a range of methods in an iterative way. For example, Green et al proposed an integration of quasi-experimental and inductive designs to evaluate complex public health interventions. ⁴⁴ These types of designs facilitate the production of evidence of interest to researchers, practitioners, and decision makers and avoid tradeoffs between external and internal validity.

• Hybrid effectiveness-implementation designs, which blend design components of effectiveness and implementation research. It has been suggested that blended designs can provide benefits such as rapid translational gains, effective implementation strategies, and useful information for decision makers. ⁴⁵

Public policy funding criteria for public health interventions should include, as a part of the assessment matrix, matters relating to implementation, such as feasibility and scalability along with the potential for efficacy. Funding criteria could include the development and application of quality indicators for research that seeks to have an impact on society and advance science. Furthermore, funding guidelines should ensure that expert reviewer panels include sufficient representation of specialists with expertise in various study designs and specify that study designs should fit the research problem being addressed, rather than favoring a particular study design. Training could also be provided to funding reviewers to enhance their competencies in assessing the knowledge translation component of funding applications. ⁴⁶

• Recommendation 5: Public policy should fund dissemination costs beyond peer-reviewed journals through full funding of knowledge translation activities so that research findings are communicated and disseminated to reach practitioners and decision makers.

One of the main barriers to the translation and utilization of research evidence in public health practice is a disconnection between how researchers communicate and disseminate their findings (ie, peer-reviewed publications/academic journals and conferences) ⁴⁷ and how practitioners and decision makers learn about the latest research evidence (eg, webinars and workshops, individual communication, social media).^47-50 Research findings are often not easily accessible, tailored, or effectively disseminated or readily shared with practitioners.^51-53 Often, research findings are (1) presented in a way that does little to demonstrate their relevance and applicability to local circumstances and (2) not easily accessible to nonacademic audiences because of language and communication style focused on discipline-based readership (eg, practitioners may have limited understanding of statistical terms and jargon used in research ⁵⁴ ). Research findings may not always be timely and actionable because of lengthy timelines for publication in academic journals and books, which makes it difficult for decision makers and practitioners to use them.^6,37 Furthermore, researchers are often not incentivized to engage in research evidence translation activities. ²²

For research evidence to be used in practice and policy, it needs to be relevant, accessible, and available in a form that practitioners and decision makers can use (eg, webinars, conferences, workshops, advocacy groups, social media, newsletters).^47-50 For example, research evidence dissemination needs to target practitioners and decision makers through tailored messaging and appropriate mediums, such as summary briefings with clear statements of implications for practice and policy, tools and guidance, interactive educational sessions, and media engagement. For effective dissemination to occur, researchers need to be trained and/or incentivized to make their research more accessible to nonacademic audiences, such as decision makers and practitioners, and to disseminate their research findings through a range of channels and to a range of audiences beyond academic journals and scientific conferences. ²² Synthesis and translation should be co-created with practitioners and decision makers to ensure that language and messaging is appropriate, reinforcing the importance of support for collaboration beyond the research project and for translation activities to be resourced. Funding schemes need to support dissemination through fully resourcing knowledge translation plans and recognize dissemination activities in funding timelines (eg, dissemination is likely to occur during and after the project’s conclusion). Furthermore, mechanisms for monitoring dissemination activity from funded projects should be examined to ensure researcher accountability for research translation activities.

• Recommendation 6: Countries should establish a “one-stop” centralized and interactive public health knowledge exchange portal to communicate and disseminate research evidence in a way that meets the needs of public health practitioners.

A potentially effective strategy for disseminating research evidence is the establishment of a centralized national public health knowledge exchange portal. Such a web platform would support access by practitioners, decision makers, researchers, and the public to evidence-informed literature and resources and serve as a forum for knowledge exchange across sectors and organizational boundaries. ⁸ Knowledge exchange portals usually allow user-friendly, integrated access to relevant content and resources in one place. ⁸ They bring together practitioners, decision makers, and researchers for knowledge exchange and encourage the sharing and dissemination of evidence-informed information. ⁸ Formative evaluation studies suggest that practitioners and decision makers require easily accessible, clear, and concise information and collaborative features to engage in knowledge exchange. ⁸ When combined with other translation strategies such as tailored and targeted messaging, knowledge exchange portals can influence the use of research evidence in public health practice.^8,55

Based on our knowledge, these types of portals are becoming more popular, especially in high-income countries, ⁸ but their establishment and maintenance seem to depend on institutions and project-by-project funding, which results in many smaller-scale portals that are not regularly updated and maintained. Thus, it may be difficult for researchers, practitioners, and decision makers to use them because of the fragmentation and lack of systemic effort to (1) integrate and/or connect similar portals, (2) continuously fund portal maintenance, and (3) promote the use of knowledge exchange portals. Therefore, a commitment to long-term funding of such portals is integral to their success as a mechanism for research evidence dissemination.

Conclusion

In this commentary, we have provided recommendations to policy makers who seek to support the translation and utilization of research evidence in public health practice. We included public policy recommendations important for the production of relevant and actionable research evidence, effective communication, and wide dissemination of research findings. The suggested policy recommendations are complementary and, as such, can work toward closing the research-to-practice-and-policy gap and improving population health outcomes. Although our evidence suggests that policy recommendations could be applicable across various contexts and settings, we acknowledge that applicability and relevance of these recommendations depends on country-specific political, legal, academic, economic, and overall public health contexts and that decisions related to public health policy development, policy implementation, and funding may be made at different levels and in different settings, which may limit the generalizability of the recommendations. Finally, given the importance of evaluation of public policies and policy initiatives, if these policy recommendations were to be implemented, we recommend rigorous evaluation of their effectiveness and impact.