Date: 11 April 2017
I have been a researcher for over two decades. In that time, lamentations about the limited influence of research evidence have grown. But I think we researchers are largely to blame. We steadfastly insist on disseminating our knowledge in ways that we know don’t work.
Researchers usually write scientific papers, because publication is a key career performance metric. But scientific papers are read and digested by other scientists, not those who can act on our findings. Our ethnographic study showed how and why research doesn’t reach policymakers, like healthcare commissioners.
We found that local healthcare commissioners cannot retrieve papers from many scientific journals, as they often do not have passwords or subscriptions. Although open access publication helps, commissioners usually use Google, where scientific papers often do not appear - even if open access. If a commissioner can access a potentially relevant paper, the scientific jargon, ‘intro-methods-results’ structure and sheer length may be baffling, time-consuming and intimidating.
The next hurdle is in identifying and applying relevant findings. Often, there’s no clear, practical message so it’s discouraging to spend precious time wading through with a conclusion of ‘more research needed’. What’s more, successful interpretation requires someone who understands the research and can work with local commissioners to translate it into the local context. Research evidence published in scientific journals doesn’t get to commissioners because commissioners can’t access, understand, interpret or apply it.
Many researchers think that if their research informs guidelines, then job done. Commissioners often look at guidelines (especially from NICE), when revamping a service. But if the service is not under scrutiny, then the guidelines aren’t consulted. What’s more, few guidelines actually are acted on. Commissioners tend to implement the ‘doable’ ones, defined as those that align with current services that don’t cost any extra money. So as vehicles for transferring research evidence, guidelines have patchy success.
What about short, punchy summaries of research evidence? Again, access is a challenge. Commissioners’ trusted sources include the King’s Fund, Nuffield Trust and the Health Foundation. But these ‘think tanks’ tend to distribute their own reports, not summaries of research evidence. Other national organisations producing research summaries are not often on commissioners’ radar. And anyway, evidence briefs don’t mitigate the challenge of translating research findings to the local context, especially without a research-savvy interpreter. Sometimes, commissioners have access to a local evidence brief service. In observing meetings for our study, these were appreciated, as it meant that the research evidence had actually been consulted. But evidence briefs made little difference to decision-making, even with a tailor-made service. Commissioners tended to glance over the brief quickly, pick out the findings that concurred with their own views and then move on. Again, often no one was available to translate or lead a discussion on the implications.
So what does this mean for evidence-based decision-making? Well, researchers rely almost entirely on the written word to disseminate their findings, yet systematic reviews consistently find that personal contact between researchers and decision makers is crucial. Researchers like to write, but commissioners like to talk. Through conversations, discussions and stories, commissioners can get timely, relevant, adaptable, contextually-specific information quickly. This suits their information needs and working environment.
Commissioners also need ‘research translators’ to help interpret findings. But researchers stubbornly insist on pumping more written documentation into the system, thereby perpetuating the ‘research-practice gap’. We are our own worst enemies, driven to write mounting stacks of unread scientific papers to progress our academic careers.
So far researchers have had limited success in changing the behaviour of commissioners, because they are outside our scope of influence. As we can’t change them, we need to change ourselves. If research is to make a difference, then researchers have to start talking to commissioners.
A first step would be recognising that local ‘research translation’ is vital. In Bristol, we set up a team of embedded commissioners (into academia) and researchers (into commissioning) that, according to independent evaluators, had substantial success in stimulating conversations between researchers and commissioners. For more information see: www.bristol.ac.uk/primaryhealthcare/km.
Regardless of how those conversations are fostered, the wider research community needs to start making substantial cultural shifts. If we genuinely want our research to benefit society, then researchers need to write less and talk more. Now.
Lesley Wye shares insights from studying commissioners' use of research and explains how researchers can help bridge the gap between science and policy.
NIHR Knowledge Mobilisation Fellow & Senior Research Fellow, Centre for Academic Primary Care