Moving Evidence Forward…to What End?

The translation of high quality scientific evidence for policy audiences is a complex challenge. Whether or not you can distinguish the differences between knowledge transfer, implementation science, dissemination, and translation, the fact of the matter is that getting evidence into the hands of people who need it, when they need it, to inform better policy and practice decisions is hard work. Very hard work.

And yet the movement of knowledge to action is the express vision of AcademyHealth and the goal of many who work in the applied, multi-disciplinary science of health services research. Recent posts by Bill Gardner, Ph.D. on his blog, Something Not Unlike Research, and Austin Frakt, Ph.D., at The Incidental Economist, lay out some of the challenges of this process.

Gardner lays out a schematic from academic study to decision maker that looks at the flow of information through trusted intermediaries. These intervening actors, whom Marsha Gold calls "policy intermediaries" in her 2009 Health Services Research article, "Pathway to the Use of Health Services Research in Policy," are the ones who usually digest new results and put them into a framework, format, and language that policymakers can use in making decisions. Gardner’s diagram also identifies how translation occurs through multiple media, depending on the presenter and the intended audience, and recognizes that communications are often bi-directional from researcher to intermediary and back again. He laments:

 "For better or worse, health researchers' careers are driven by journals with 5% acceptance rates and NIH institutes with 5% funding rates. These facts concentrate your mind on the value of your time."

Yet his intial proposal*—essentially a call for more publication outlets—fails to address how other types of translation ( i.e., the more high-touch approaches of implementation science and knowledge transfer) affect policymaker understanding and application of evidence.  And, perhaps more importantly, how little value is placed on investing the researcher’s time in these types of translation activities. Then again, what if it doesn’t even matter?

Frakt’s piece yesterday looks at the impact of information on policy through another lens. Specifically, recent research on how policy information influences partisan thinking compared to cues from political party leaders. So if we look back to Gardner’s framework of moving information through intermediaries to policy decision makers, how does exposure to information/evidence influence the thinking of these intermediaries?

There are highs and lows in Frakt’s summary of the research. The high: there is evidence that significant exposure to policy information can have more effect on thinking than party cues. The low: data (from a different study) pointing to the possibility that information can have a more, rather than less, polarizing affect. Says Frakt:

"All of this suggests that information is useful to people, not for building consensus, but as a cudgel and as a way to signal ideological affinity and affiliation. We may not be seeking information to arrive at truth or goodness, but to score debating points."

A cudgel...what a depressing thought for those of us passionate about evidence-based policymaking.

Feeding from the buffet line of these excellent posts, and admitting our own "ideological affinity" for evidence, here are few of the messages we take away:

• The success of any knowledge transfer and dissemination strategy is affected by the personal relationships and ideologies of the people you’re trying to reach.
• The research community is well served to seek out and respond not only to policymakers’ needs, but also to the needs of their intermediaries.
• Publication and dissemination are part of a complex process that requires significant effort from the research community – time and effort that isn’t widely rewarded.

Frakt ends with a question: should we just give up? Absolutely not.

Evidence matters, although not always in the way we think or hope. We must seek truth in the science, support and reward translation of knowledge into action, and develop relationships and understanding with policymakers and their intermediaries.

Says Frakt:

Expecting truth to be valued by all and evidence to always convince are high bars, too high. Yet evidence can still influence policy and, depending on your perspective, improve it.  (Emphasis added)

*Gardner expands on his thoughts here , including links to more commentary on TIE.

This post was written by Kristin Rosengren, AcademyHealth's director of communications