Feature: Research into policy and practice
21 September 2007. By David Carr.
If the outcomes of research are to create tangible health benefits, they typically need to be taken up in policy development and healthcare practice. But such uptake is influenced by many different factors, such as timing and the current priorities of policy makers, which are usually outside the control of researchers and funding agencies.
To get a better understanding of the factors at work, the Wellcome Trust examined a series of case studies in which its funded researchers have engaged with policy makers and practitioners. These case studies came from biomedical science in the UK and overseas, medical humanities, technology transfer and public engagement with science, and included some with significant achievements (see boxes). For example, scientists at the Trust's Major Overseas Programmes in South-east Asia and Kenya have had considerable success in getting the results of their research on malaria control into policy and practice at regional, national and global levels. And in the UK, several approaches have been used to influence policy and practice in science education, aiming to increase young people's interest in science and support science teachers' professional development.
Biomedical science in the UK
The Trust has supported the development of new cognitive behavioural therapies for a spectrum of psychological disorders - including bulimia, suicidal behaviour, post-traumatic stress disorders and social phobias - and their uptake into clinical practice. Therapies developed by researchers such as Professors Chris Fairburn and Mark Williams at the University of Oxford, and Professors Anke Ehlers and David Clark at the Institute of Psychiatry, have been recognised by the National Institute for Health and Clinical Excellence. In practice, however, there is still a considerable need to train clinicians in the use of these therapies.
Meanwhile, Dr Colin Kennedy at the University of Southampton has shown that universal newborn screening is an effective and sensitive way of finding permanent hearing impairment in babies in a population - and that early intervention improves language ability later on. Significantly, Dr Kennedy supported his population study with a health-economic analysis, highlighting that there would be no additional costs to using universal newborn screening. As of April 2006, every district in the UK is now providing universal newborn screening by the two-stage screening technique used in Dr Kennedy's studies.
Key lessons
For each case study, the researchers were asked for their perspectives on the challenges they had faced and the lessons they had taken from their experiences. Although the uptake of research into policy and practice is clearly a complex process, there are some factors that increase the likelihood of success.
As one might expect, it is essential that researchers are seen as independent, and that they have academic credibility. In developing countries, it is particularly important that they are recognised and build contacts locally (although it is sometimes only possible to change national policy by influencing the policy of key international organisations such as the World Health Organization).
An understanding of the political environment - knowing what topics are of concern to policy makers, and who influences the policy-making process - can be crucial. Discussions with policy makers and key users, ideally when the research is being planned, can help scientists to ensure that their work is targeted to policy needs, that their research application indicates how much time and how many resources they will need for dissemination, and that their research results are presented in a way that is attuned to policy makers' needs.
Another key factor - which is sometimes no more than a matter of luck - is the 'timeliness' of the research. If policy makers are actively concerned with or reviewing a topic, they are more likely to take account of the work; but if the same research is produced a year earlier, or a year later, it may not attract the same level of interest.
Finally, strategic relationships with 'intermediaries' can help researchers to promote the uptake of their research. These can include networks, specialist research communicators, non-governmental organisations, commercial sector public affairs groups and sometimes the media.
Conversely, there are a number of barriers that researchers face in getting their research into policy and practice. Foremost are communication difficulties, which can arise because researchers and policy makers do not understand one another's 'worlds'. But there are also issues with the time and financial costs required by dissemination work, which may fall outside the timeframe of normal grant funding, and with a perceived lack of recognition for such work by funders or academic institutions - who tend to value high-impact publications over work to engage policy makers. There is also a lack of support for and capacity in the evaluation of policy change, for example through health-economic and social science studies, particularly in developing countries.
International impact: Malaria
The Wellcome Trust South-east Asia Programme, led by Professor Nick White, has had a dramatic influence on the development of global malarial drug strategies.
Its most important contribution has been a series of studies showing that drugs derived from artermisinin, although more expensive, are more effective in the treatment of malaria than standard antimalarials such as quinine.
As a result, World Health Organization now promotes artemisinin-based combination drugs for the treatment of uncomplicated and multidrug-resistant malaria, and intravenous artesunate for treatment of severe malaria.
In Kenya, Professor Bob Snow of the Kenya Medical Research Institute-Wellcome Trust Research Programme was appointed Senior Malaria Adviser to the Ministry of Health in 1999. In this capacity, he led the team that developed the National Malaria Strategy, which forms the basis for malaria control in Kenya through to 2010.
Shaping UK science education
To influence UK education policy, the Trust's Public Engagement Development Group developed a programme of activities that encompassed grant funding, commissioned research, in-house policy work and strategic partnership funding,
In partnership with the Nuffield Foundation and the Salters' Institute, the Trust part-funded the successful pilot of Twenty First Century Science, a set of three new GCSE science courses that were made available to all schools in September 2006.
The Trust also entered into partnership with the Department for Education and Skills (DfES) in 2002 to establish a network of Science Learning Centres for continuing professional development of science teachers. The Trust committed £25 million to establish a flagship National Science Learning Centre, which became fully operational in November 2005, and the DfES provided £26m to support nine regional centres.
In tandem, the Trust funded the development of high-quality courses to run at these centres, and develops other teaching resources, such as the 'Big Picture' series, in-house. The Trust has also commissioned a series of influential reports on issues related to Science Education, such as Valuable Lessons (2001), which examined the teaching of social and ethical issues arising from biomedical science.
In many of the cases where Trust-funded research has been taken up into policy and practice, it has been thanks to the drive and commitment of the researchers involved. Where the research can have a useful impact, the Trust will encourage and support researchers in taking forward dissemination activities of this type. In particular, it is keen for grant applicants to build strategies for engaging users into their research proposals where this is appropriate.
The Trust is always keen to engage with grantholders in this area, and would welcome any feedback or questions related to this article. If you wish to discuss any issues raised here, please contact David Carr at d.carr@wellcome.ac.uk.