Four practical steps to increase knowledge exchange between researchers and policymakers

Posted by Peter van der Graaf, NIHR Knowledge Mobilisation Research Fellow, Teesside University

Are you keen to have impact with your research but get lost in all the knowledge exchange frameworks and models that are out there? In this blog, Peter calls upon 10 years’ experience working in translational public health for Fuse to identify four practical steps to develop collaborative research and achieve meaningful change in policy and practice.

We know all about the challenges of using research to inform policy and practice, especially in public health where the evidence base for interventions or programmes is patchy or contested. In response to these challenges, countless models and frameworks have been developed that try to define the knowledge exchange process (how research evidence can be used, in combination with other types of knowledge, to change policy and practice). Practitioners and researchers venturing into the field of knowledge exchange can be bewildered by the options available which don’t go beyond concepts and fail to describe in practical terms what research translation looks like in reality.

Here I want to share practical guidance from our research on ‘how to do’ knowledge exchange by reflecting on a model that has been developed in Fuse over the last ten years. Our approach to achieving practice and policy change has been to engage with practitioners, policymakers and the public through communications and knowledge brokerage, to co-create relevant research, influence policy and practice debates and promote evidence uptake. Below I have broken this down into four practical steps:

• Step 1. Awareness raising: Making evidence users, funders and support organisations aware of our existence, our research and engagement opportunities, including engaging our partners early in setting the agenda for future research.
• Step 2. Sharing knowledge: Creating opportunities for research users and producers to come together to explore opportunities for mutual learning and knowledge exchange through collaborative events, our responsive research service (AskFuse), and patient and public involvement.
• Step 3. Making evidence fit for purpose: Localising and tailoring evidence to context by offering a knowledge brokering service, embedded research, and increasing awareness of the different pressures faced by people in health policy, practice and academia.
• Step 4. Supporting uptake and implementation of evidence: Developing long-term relationships with policy and practice partners to co-create evidence, build capacity for practice change, and change practice and policy.

It is important to link a range of knowledge exchange activities that engage policymakers and practitioners at different levels, intensities and points in their decision-making and development processes.

For example, before meeting with policy and practice partners, we develop tailored research briefs that summarise study findings in an accessible and visual way, and that emphasise recommendations and implications for policy and practice. Involving Fuse researchers in developing these briefs improves their knowledge exchange skills, while providing them with ‘calling cards’ to initiate relationships with policymakers for further collaborative work. These conversations are often followed by requests to AskFuse on how knowledge users can apply the research evidence in a specific context, invitations to engage in collaborative research, or to support capacity building and implementation.

Knowledge exchange between academia and public health practitioners and policymakers can be complicated and at times bewildering. Breaking the process down into practical steps illustrates that knowledge exchange is empirical and relational.

"Whatever their answer, double it and you should be close..."

Posted by Hannah Mehmood, Medical Student, Newcastle University

Hannah undertook a 6-week NIHR School for Public Health Research (SPHR) internship with Fuse based at Newcastle University in summer 2020. She was supervised by Fuse / NIHR SPHR Doctoral Student, Cassey Muir.

A question asked in every GP consultation is how much alcohol a patient drinks. It provides a useful insight into a person’s physical, social, and psychological health. According to my GP tutor, most people underestimate the amount they drink, as well as the impact this has on them.

Substance misuse is a complex issue, and as a medical student I have learned to focus on the impact of problematic drug and alcohol use on individual patient wellbeing. Last summer, as an NIHR SPHR intern, I studied substance misuse from a different perspective. The basis of my internship was a research project focusing on young people whose parents misuse drugs and alcohol. I aimed to explore how young people viewed school and education to understand if this environment could be used to deliver supportive interventions.

I analysed ten UK based qualitative studies which examined the experiences of young people affected by parental substance misuse. Qualitative studies examine non-statistical data to develop themes and deep understanding of the research question. The young people from the studies I explored were under the age of 25 and from various social, economic and demographic groups.

Young people viewed school as a space away
 from issues they may face at home

I was particularly interested in the ways in which young people viewed school as a separate space away from issues they may face at home, to the extent that many young people did not even discuss their home life with close friends. But despite the mental separation of home and school, the reality of their home life often prevented a complete detachment of the two. One young person described how caring for her parent resulted in frequently missing school, while another recognised that his aggressive behaviour in school was a way to offload stress at home.

Many young people also expressed a lack of trust towards their place of education, as well as a desire to blend-in with their peers. This contributes to barriers in identifying young people who may benefit from intervention, as many are fearful of being singled out while in the detached school environment.

In conducting my research, I came to appreciate the difficulty in generating themes from such varied experiences. I often felt that my insights did not do justice to the nuances of each individual story. I discussed this in a virtual meeting with a programme coordinator at ADFAM, a national charity that works with families affected by drugs and alcohol. Her experience, delivering interventions at an operational level, allowed me to see how my research fit into the real world. I came to understand that while research is conducted with the aim of applying findings to whole populations, these findings are only actionable when combined with existing knowledge and expertise. This discussion was a lesson in the value of cross-collaboration, an important tool in bridging the gap between research and intervention.

Over six weeks I have broadened my understanding of public health, conducted my own research project, developed my professional skills, and furthered my personal career goals. Although this internship took place remotely, my mentors enabled me to virtually meet various public health professionals. Hearing about their research roles, motivation and future plans has shown me the variety of career paths available within public health and helped to develop my own ambitions. The NIHR SPHR internship with Fuse has been a valuable personal and professional experience and I would recommend it to other students interested in pursuing a career in public health.

Part of our Fuse blog Student Series

The Fuse blog Student Series showcases posts by students who have been challenged to write a blog as part of their studies at one of the universities in the Fuse collaboration, the NIHR School for Public Health Research, or perhaps further afield. The authors may be new to blogging and we hope to provide a 'safe space' for the students to explore their subject and find their voice in the world of public health research.

Images:

1. 'Doctor with prescription stop drinking alcohol' by Marco Verch Professional Photographer via Flickr.com, copyright © 2019 (Attribution 2.0 Generic (CC BY 2.0)): https://m.flickr.com/photos/30478819@N08/48719845996

3. Logo courtesy of ADFAM https://twitter.com/AdfamUK/photo

Placement, parcels and a pandemic: five weeks embedded in a public health team

Posted by Maisie Rowland, Research Assistant and Registered Nutritionist, Human Nutrition Research Centre (HNRC), Newcastle University

Newcastle Civic Centre

My research has taken me from primary schools in the West End of Newcastle to rural schools in the mountains of Moshi, Tanzania but I have always been curious about other job roles and what they involve. I have also been interested in how, as researchers, we can collaborate with those outside of academia to ensure that the research we do has the desired impact. So on seeing an advertisement for an embedded researcher placement in Newcastle City Council with the Public Health team, I put in an application. This felt like a great opportunity to expand my knowledge of other job sectors, while creating links outside the university and maintaining my work in the HNRC (working there one day a week). Before I knew it, I was walking to the city’s Civic Centre for the first day of my five-week placement.

I spent my first week learning about the wide variety of projects and roles the team were involved in, such as the redevelopment of Fenham library to include a drugs and alcohol recovery hub and the health education with schools and young people. I was able to sit-in on a number of interesting meetings and was able to contribute to the Wider Determinants of Health team meetings. I learned about how projects happen and was surprised at how much it differed from a university research setting, such as the different resources used for background research for projects and the differences in terms of ethical approvals. I was also given the opportunity to put forward my ideas and interests and, working alongside my colleagues Dr Annette Payne (Health Improvement Practitioner) and Lorna Smith (Speciality Registrar in Public Health), we developed an idea for a project working with food banks. As a nutritionist, I have a strong interest in this area. Through conducting online research, and visiting food banks and ‘pay as your feel’ supermarkets, we gained an insight into how these organisations and similar providers work. We also learned about the nutritional content of ‘standard’ emergency food parcels, the demographics of those who find themselves needing to use food banks, the situations these people might be in, and finally the shocking numbers of people finding themselves in need of using them. From this research, we developed a report which was presented at the Public Health Senior Management Team meeting for approval and feedback from other team members. Our project was well received, which was encouraging, and we were given the go-ahead to continue with our work.

Life Foodbank in Newcastle upon Tyne

From this background research, I learned that those who use food banks have usually been referred through care providers (such as through school or through social workers), and there is a limit on the number of times they are able to use the food bank. Help is given in the form of an emergency food parcel containing at least three days’ worth of food, and users are often offered help and advice which aims to resolve the issues that have led them there. Although there has been nutritional guidance on the food parcels, the reality is that a lot of the food comes from public donations. Therefore, as the donations vary, so will the food parcels. Within the team, we considered possible changes to the parcels that could be suggested, in order to benefit those who have to use food banks. It was quickly decided that any work we did would be with the food banks themselves, rather than those using the food bank. We devised a plan with three ‘phases’, including:

• 
  Phase one involved a consideration of how to suggest very small changes to the ‘food call outs’. For example, typical foods that are given in food parcels, and are regularly requested in the call outs, include breakfast cereals, soups, pasta and pasta sauces, rice, tins (beans, meat, vegetables, and fruit), tea or coffee, sugar, biscuits, snacks, jams, and fruit juice. Due to the variation in these particular food groups, and the variation in the foods that are donated to the banks, the nutrient content of the packages will also vary widely. Our suggested changes to the call outs will include requesting tinned fruit in juice rather than syrup, reduced sugar/salt baked beans and tinned pasta in sauce, tinned vegetables without added salt or sugar, and higher fibre/lower sugar breakfast cereals.
  

• Phases two and three will involve creating some user-led resources for the food banks such as recipe cards, which will provide inspiration for different meals that could be made from the foods in the parcels. We also hope to include a ‘community access card’, which will provide information on nutrition, healthy weight ranges and local support available. The local support would involve signposting to free cooking classes, food banks and ‘pay as you feel’ supermarkets, community groups, and computer facilities at libraries.

Food parcel single person packing list from the Trussel Trust

As I approached the end of my placement (which felt like it was ending just as quickly as it started!), we made plans to keep in contact about the ongoing development of the resources. We planned meetings with a food poverty group and with those running the food banks, and felt that good progress was being made. However, during the last week of my placement Covid-19 put a halt to our work. The last meeting that I attended in the council was geared towards how it could help to mitigate the impacts of the inevitable poverty that the virus would induce, as schools and food banks began to close, and many people expected to lose their jobs. Current projects at the council are now on ‘pause’ and those working in Public Health are tasked with devising solutions to the increasing number of problems that are arising from the pandemic.

At a time in which increasing numbers of people may need to access food banks and services, projects in Public Health and nutrition seem particularly relevant. I hope to be able to continue the project that we started during my placement in the future, taking into account new factors that may develop through this pandemic.

Maisie has worked at Newcastle University for over five years, collaborating with colleagues and researchers in Public Health England, charities such as Coeliac UK, international nutrition research centres, and the media.

Images:

1. Bob Castle, CC BY-SA 3.0, via Wikimedia Common

4. Courtesy of the Trussel Trust: https://www.trusselltrust.org/wp-content/uploads/sites/2/2018/06/singlepersonpackinglist.png