Perspectives of California Legislators on Institutional Barriers and Facilitators to Non-Partisan Research Evidence Use in State Health Policymaking.

BACKGROUND: Bridging the translational gap between research evidence and health policy in state legislatures requires understanding the institutional barriers and facilitators to non-partisan research evidence use. Previous studies have identified individual-level barriers and facilitators to research evidence use, but limited perspectives exist on institutional factors within legislatures that influence non-partisan research evidence use in health policymaking. OBJECTIVE: We describe the perspectives of California state legislators and legislative staff on institutional barriers and facilitators of non-partisan research evidence use in health policymaking and explore potential solutions for enhancing use. DESIGN: Case study design involving qualitative interviews. PARTICIPANTS: We interviewed 24 California state legislators, legislative office staff, and legislative research staff. APPROACH: Semi-structured recorded interviews were conducted in person or by phone to identify opportunities for enhancing non-partisan research evidence use within state legislatures. We conducted thematic analyses of interview transcripts to identify (1) when research evidence is used during the policymaking process, (2) barriers and facilitators operating at the institutional level, and (3) potential solutions for enhancing evidence use. RESULTS: Institutional barriers to non-partisan research evidence use in health policymaking were grouped into three themes: institutional policies, practices, and priorities. Interviews also revealed institutional-level facilitators of research evidence use, including (1) access and capacity to engage with research evidence, and (2) perceived credibility of research evidence. The most widely supported institutional-level solution for enhancing evidence-based health policymaking in state legislatures involved establishing independent, impartial research entities to provide legislators with trusted evidence to inform decision-making. CONCLUSIONS: Potential institutional-level changes within state legislatures may enhance evidence use in health policymaking, leading to improved health outcomes and lower healthcare costs for states.

Testing Multiple Methods to Effectively Promote Use of a Knowledge Portal to Health Policy Makers: Quasi-Experimental Evaluation.

BACKGROUND: Health policy makers and advocates increasingly utilize online resources for policy-relevant knowledge. Knowledge brokering is one potential mechanism to encourage the use of research evidence in policy making, but the mechanisms of knowledge brokerage in online spaces are understudied. This work looks at knowledge brokerage through the launch of Project ASPEN, an online knowledge portal developed in response to a New Jersey legislative act that established a pilot program for adolescent depression screening for young adults in grades 7-12. OBJECTIVE: This study compares the ability to drive policy brief downloads by policy makers and advocates from the Project ASPEN knowledge portal using a variety of online methods to promote the knowledge portal. METHODS: The knowledge portal was launched on February 1, 2022, and a Google Ad campaign was run between February 27, 2022, and March 26, 2022. Subsequently, a targeted social media campaign, an email campaign, and tailored research presentations were used to promote the website. Promotional activities ended on May 31, 2022. Website analytics were used to track a variety of actions including new users coming to the website, page views, and policy brief downloads. Statistical analysis was used to assess the efficacy of different approaches. RESULTS: The campaign generated 2837 unique user visits to the knowledge portal and 4713 page views. In addition, the campaign generated 6.5 policy web page views/day and 0.7 policy brief downloads/day compared with 1.8 views/day and 0.5 downloads/day in the month following the campaign. The rate of policy brief page view conversions was significantly higher for Google Ads compared with other channels such as email (16.0 vs 5.4; P<.001) and tailored research presentations (16.0 vs 0.8; P<.001). The download conversion rate for Google Ads was significantly higher compared with social media (1.2 vs 0.1; P<.001) and knowledge brokering activities (1.2 vs 0.2; P<.001). By contrast, the download conversion rate for the email campaign was significantly higher than that for social media (1.0 vs 0.1; P<.001) and tailored research presentations (1.0 vs 0.2; P<.001). While Google Ads for this campaign cost an average of US $2.09 per click, the cost per conversion was US $11 per conversion to drive targeted policy web page views and US $147 per conversion to drive policy brief downloads. While other approaches drove less traffic, those approaches were more targeted and cost-effective. CONCLUSIONS: Four tactics were tested to drive user engagement with policy briefs on the Project ASPEN knowledge portal. Google Ads was shown to be effective in driving a high volume of policy web page views but was ineffective in terms of relative costs. More targeted approaches such as email campaigns and tailored research presentations given to policy makers and advocates to promote the use of research evidence on the knowledge portal website are likely to be more effective when balancing goals and cost-effectiveness.

The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis.

BACKGROUND: Middle Managers (MMs) are thought to play a pivotal role as knowledge brokers (KBs) in healthcare organizations. However, the role of MMs who function as KBs (MM KBs) in health care is under-studied. Research is needed that contributes to our understanding of how MMs broker knowledge in health care and what factors influence their KB efforts. METHODS: We used a critical interpretive synthesis (CIS) approach to review both qualitative and quantitative studies to develop an organizing framework of how MMs enact the KB role in health care. We used compass questions to create a search strategy and electronic searches were conducted in MEDLINE, CINAHL, Social Sciences Abstracts, ABI/INFORM, EMBASE, PubMed, PsycINFO, ERIC and the Cochrane Library. Searching, sampling, and data analysis was an iterative process, using constant comparison, to synthesize the results. RESULTS: We included 41 articles (38 empirical studies and 3 conceptual papers) that met the eligibility criteria. No existing review was found on this topic. A synthesis of the studies revealed 12 MM KB roles and 63 associated activities beyond existing roles hypothesized by extant theory, and we elaborate on two MM KB roles: 1) convincing others of the need for, and benefit of an innovation or evidence-based practice; and 2) functioning as a strategic influencer. We identified organizational and individual factors that may influence the efforts of MM KBs in healthcare organizations. Additionally, we found that the MM KB role was associated with enhanced provider knowledge, and skills, as well as improved organizational outcomes. CONCLUSION: Our findings suggest that MMs do enact KB roles in healthcare settings to implement innovations and practice change. Our organizing framework offers a novel conceptualization of MM KBs that advances understanding of the emerging KB role that MMs play in healthcare organizations. In addition to roles, this study contributes to the extant literature by revealing factors that may influence the efforts and impacts of MM KBs in healthcare organizations. Future studies are required to refine and strengthen this framework. TRIAL REGISTRATION: A protocol for this review was not registered.

A qualitative descriptive study of the role of nurse, allied health and physician middle managers who function as knowledge brokers in hospitals.

BACKGROUND: Knowledge brokers (KB) are increasingly being employed in health care to implement evidence-based practice and improve quality of care. Middle managers (MMs) may play a KB role in the implementation of an innovative or evidence-based practice in hospitals. However, how MMs' broker knowledge in hospitals and their impact on practice has not been adequately studied. AIM: To describe the role that MMs play in brokering knowledge in hospitals and their impact. METHOD: A qualitative descriptive study was conducted to generate a detailed description of MM experiences as KBs in hospitals. Data were collected using semi-structured telephone interviews with MMs in Ontario, Canada. Participants were purposively sampled to ensure variation in MM characteristics and a diverse representation of perspectives. Data were collected and analyzed concurrently using an inductive constant comparative approach. RESULTS: Twenty-one MMs from teaching and non-teaching hospitals participated. MMs described 10 roles and activities they enacted in hospitals that aligned with published KB roles. We found differences across professional groups and hospital type. Teaching status emerged as a potential factor relating to how MM KBs were able to function within hospitals. MMs reported enhanced patient, provider, and organizational outcomes. LINKING EVIDENCE TO ACTION: Middle managers may play an important KB role in the implementation of evidence-based practice in hospitals. An improved understanding of the KB roles that MMs play may be important in boosting evidence base practice in health care to ultimately improve quality of care. Administrators need a better understanding of the current KB roles and activities MMs enact as this may lead to more organizational structures to support MM KBs in health care.

Applying the Theoretical Domains Framework to understand knowledge broker decisions in selecting evidence for knowledge translation in low- and middle-income countries.

BACKGROUND: Health-related organisations disseminate an abundance of clinical and implementation evidence that has potential to improve health outcomes in low- and middle-income countries (LMICs), but little is known about what influences a user decision to select particular evidence for action. Knowledge brokers (KBs) play a part as intermediaries supporting evidence-informed health policy and practice by selecting and synthesising evidence for research users, and therefore understanding the basis for KB decisions, can help inform knowledge translation strategies. The Theoretical Domains Framework (TDF), a synthesis of psychological theories, was selected as a promising analysis approach because of its widespread use in identifying influences on decisions to act on evidence-based healthcare guidelines. This study explored its application in the context of KB decisions regarding evidence for use in LMICs. METHODS: The study analysed data collected from participants of a 2015 global maternal and newborn health conference in Mexico. A total of 324 conference participants from 56 countries completed an online survey and 20 from 15 countries were interviewed about evidence use and sharing after the conference. TDF domains and constructs were retrospectively applied and adapted during coding of qualitative data to enhance understanding of the KB decision process in selecting evidence for action. RESULTS: Application of the TDF involved challenges related to overlapping constructs, retrospective use, and complexities of global health settings and relevant knowledge. Codes needed to be added or adapted to account for how KBs' internal reflections on external factors influenced their actions in selecting evidence to share and use, and the decisions they made during the process. Four themes of the rationale for changing the TDF were identified during analysis, namely Influences from Beyond the Organisation, Knowledge Selection as a Process, Access and Packaging of Knowledge, and Fit for Use. CONCLUSIONS: Theories of individual behaviour, such as those in the TDF, can enhance understanding of the decisions made by actors such as KBs along dissemination and knowledge translation pathways. Understanding how KBs reflect on evidence and interact with their environment has the potential for improving global dissemination efforts and LMIC-to-LMIC exchange of implementation evidence.

From Kisiizi to Baltimore: cultivating knowledge brokers to support global innovation for community engagement in healthcare.

BACKGROUND: Reverse Innovation has been endorsed as a vehicle for promoting bidirectional learning and information flow between low- and middle-income countries and high-income countries, with the aim of tackling common unmet needs. One such need, which traverses international boundaries, is the development of strategies to initiate and sustain community engagement in health care delivery systems. OBJECTIVE: In this commentary, we discuss the Baltimore "Community-based Organizations Neighborhood Network: Enhancing Capacity Together" Study. This randomized controlled trial evaluated whether or not a community engagement strategy, developed to address patient safety in low- and middle-income countries throughout sub-Saharan Africa, could be successfully applied to create and implement strategies that would link community-based organizations to a local health care system in Baltimore, a city in the United States. Specifically, we explore the trial's activation of community knowledge brokers as the conduit through which community engagement, and innovation production, was achieved. Cultivating community knowledge brokers holds promise as a vehicle for advancing global innovation in the context of health care delivery systems. As such, further efforts to discern the ways in which they may promote the development and dissemination of innovations in health care systems is warranted. TRIAL REGISTRATION: Trial Registration Number: NCT02222909 . Trial Register Name: Reverse Innovation and Patient Engagement to Improve Quality of Care and Patient Outcomes (CONNECT). Date of Trial's Registration: August 22, 2014.

A research utilisation framework for informing global health and development policies and programmes.

A shift in the culture and practice of health and development research is required to maximise the real-world use of evidence by non-academic or non-research-oriented audiences. Many frameworks have been developed to guide and measure the research utilisation process, yet none have been widely applied. Some frameworks are simplified to an unrealistic linear representation while others are rendered overly complex and unusable in an attempt to capture all aspects of the research utilisation process. Additionally, many research utilisation frameworks have focused on the policy development process or within a clinical setting, with less application of the translation process at the programme level. In response to this gap - and drawing from over a decade of experience implementing research utilisation strategies - we developed a simple, four-phase framework to guide global health and development efforts that seek to apply evidence to policies and programmes. We present a detailed description of each phase in our framework, with examples of its relevance and application illustrated through our own case study experiences in global health. We believe the utility of this framework extends beyond the health sector and is relevant for maximising use of evidence to achieve the Sustainable Development Goals.

Academic knowledge brokers in Iran's health sector: Characteristics, skills, and qualifications.

BACKGROUND: Knowledge brokers, as a bridge between producers and users of knowledge, need a set of skills and abilities to fulfill their role. The current study was carried out with the aim of identifying the characteristics, skills, and qualifications needed by knowledge brokers in Iran's health sector. MATERIALS AND METHODS: This qualitative study was conducted through semi-structured interviews with 18 participants selected using social network analysis and snowball method from June to December 2022. All interviews were analyzed through the conventional content analysis method using the MAXQDA, version 20. RESULTS: Two main categories (personality traits and professional competencies) and six subcategories (extroversion, acceptability, problem-solving skills, interactive skills, specialized skills, and specialized knowledge) were identified for knowledge brokers in Iran's health sector. Interpersonal communication skills, negotiation and persuasion skills, knowledge in both policymaking and research fields, and marketing and commercialization skills were defined as the most important factors in knowledge brokering. CONCLUSION: Identifying and training qualified and interested individuals to undertake the task of knowledge brokering, by taking into account the characteristics identified in this research and strengthening the required skills and qualifications, can increase the effectiveness of knowledge brokering and help to bridge the gap between research and policymaking.

University-Based Researchers as Knowledge Brokers for Climate Policies and Action.

Responding effectively to climate crisis requires strong science-policy links to be put in place. Past research on the research-policy interface indicates longstanding challenges that have become more acute in the case of climate science, since this requires multi-disciplinary approaches and faces distinctive political challenges in linking knowledge with policy. What can be learned from the experiences of university-based researchers seeking to influence policy as they try to operate in the brokering space? With this in mind, an empirical study was designed to capture the detailed views and experiences of forty researchers in four universities across four countries-Bangladesh, Germany, Uganda and UK. It found a wide range of different researcher attitudes to policy engagement, diverse methods of engaging, a preference for working with government and civil society over private sector policy actors, and a perceived need for more university support. The findings suggest a need to rethink conditions for engagement to create spaces for knowledge exchange and cooperation that can contribute to policies for societal transformation. More attention also needs to be paid to interdisciplinary research approaches, improving research connections with private sector actors, and strengthening university research links with local communities. Finally, the position of university based researchers in the Global South will require strengthening to improve North-South knowledge exchange, capacity development, and incentives for policy engagement.

Afin de répondre efficacement à la crise climatique, il est nécessaire de mettre en place des liens solides entre la science et la politique. Les recherches antérieures sur l'interface recherche-politique indiquent des défis de longue date qui sont devenus plus aigus en ce qui concerne la science du climat, car cela nécessite d'adopter des approches pluridisciplinaires et de faire face à des défis politiques bien distincts pour faire le lien entre les connaissances et les politiques. Que peut-on apprendre des expériences des chercheurs et chercheuses universitaires qui cherchent à influencer les politiques tout en essayant d'entrer en négociation ? Dans cette optique, une étude empirique a été conçue pour recueillir les points de vue et les expériences détaillés de quarante chercheur·euse·s de quatre universités réparties dans quatre pays - le Bangladesh, l'Allemagne, l'Ouganda et le Royaume-Uni. L'étude a détecté un large éventail d'attitudes différentes des chercheur·euse·s à l'égard de l'engagement politique, diverses méthodes d'engagement, une préférence pour le travail avec le gouvernement et la société civile par rapport aux acteurs politiques du secteur privé, et un besoin perçu de plus de soutien universitaire. Les résultats suggèrent la nécessité de repenser les conditions d'engagement afin de créer des espaces d'échange de connaissances et de coopération qui peuvent contribuer aux politiques de transformation sociétale. Il faut également accorder une plus grande attention aux approches de recherche interdisciplinaires, à l'amélioration des liens entre la recherche et les acteurs du secteur privé et au renforcement des liens entre la recherche universitaire et les communautés locales. Enfin, la position des chercheur·euse·s universitaires dans les pays du Sud devra être renforcée pour améliorer l'échange de connaissances Nord-Sud, le développement des capacités et la motivation à l'engagement politique.

Profiling knowledge brokers in the rehabilitation sector across Canada: A descriptive study.

RATIONALE: Knowledge brokers (KBs) can help promote the uptake of the latest research evidence into clinical practice. Little is known about who they are, the types of roles they perform, and the training they receive. Establishing a portrait of Canadian KBs working in the rehabilitation sector may inform health care organizations and knowledge translation specialists on how best to advance KBs practices. The overall goal was to describe the profile of KBs working to promote the uptake of evidence within rehabilitation settings in Canada. Specifically, this study aimed to describe the sociodemographic and professional characteristics, work activities, and training of KBs. METHODS: A cross-sectional online survey was administered to KBs working in rehabilitation settings across Canada. The survey included 20 questions covering sociodemographic and professional characteristics, work activities, and training opportunities. Response frequency and percentage were calculated for all categorical variables, and the weighted average (WA) for each role was calculated across participants. Descriptive analysis was conducted for all open-ended questions. RESULTS: Of 475 participants accessing the website, 198 completed the survey questionnaire, including 99 clinicians, 35 researchers, and 26 managers. While over two-thirds of respondents had completed a graduate degree, only 38% reported receiving KBs-related training. The respondents' primary roles corresponded to a linking agent (WA = 1.84), followed by capacity builder (WA = 1.76), information manager (WA = 1.71), facilitator (WA = 1.41), and evaluator (WA = 1.32). CONCLUSIONS: KBs are mostly expert clinicians who tend to perform brokering activities part-time targeting their peers. Participants mostly perform the linking agent, capacity builder, and information roles. Moreover, only a few participants received formal training to perform brokering activities.

Determinants that influence knowledge brokers' and opinion leaders' role to close knowledge practice gaps in rehabilitation: A realist review.

RATIONALE: Despite the available evidence to support optimal practices in rehabilitation, significant knowledge practice gaps persist. Opinion leaders (OLs) and knowledge brokers (KBs) can enhance the success of knowledge translation (KT) interventions and improve uptake of best practices among clinicians. However, the literature on the mechanisms underpinning OLs'/KBs' activities, and guidance on the type of support needed for successful implementation of these roles in rehabilitation contexts is scarce. This research aimed to highlight the differences and similarities between OLs and KBs with respect to context, mechanism, and outcomes as well as describe the common patterns of OLs and KBs by creating a context-mechanism-outcomes configuration. METHODS: We conducted a realist review to synthesize the available evidence on OLs/KBs as active KT strategies. A search was conducted across five databases up to November 2019. Two independent reviewers extracted the data using a structured form. A context-mechanism-outcome configuration was used to conceptualize a cumulative portrait of the features of OLs/KBs roles. RESULTS: The search identified 3282 titles after removing duplicates. Seventeen studies (reported in 20 articles) were included in the review. Findings suggest a number of desirable features of OLs/KBs roles that may maximize the achievement of targeted outcomes namely being (a) embedded within their organization as "insiders"; (b) adequately skilled to perform their role; (c) identified as able to fulfil the role; (d) appropriately trained; and (e) able to use different KT interventions. CONCLUSION: Findings of this realist review converge to create a context-mechanism-outcomes configuration with suggestions to optimally utilize OLs/KBs in rehabilitation. The configurations suggest desirable features that can lead to a greater potential to achieve targeted goals. It is preferable that OLs/KBs be embedded in the organization and that they are adequately skilful and well-trained. Also, OLs/KBs should perform the required roles using KT interventions adapted to the local context.

Brokering science, blaming culture: The US-South Korea ecological survey in the Demilitarized Zone, 1963-8.

This paper examines the planning, execution, and closure of the US-Korea Cooperative Ecological Survey project in the Korean Demilitarized Zone (DMZ) in the 1960s. In this period, the U.S. National Academy of Sciences (NAS) initiated bilateral scientific cooperation between the NAS and similar organizations in developing countries along the line of the developmental turn of U.S. foreign assistance. Working closely with the NAS, U.S. conservationists used this scheme to introduce nature conservation practices and the discipline of ecosystem ecology to developing countries. In this context, by way of the NAS's Pacific Science Board, two countries' biologists initiated the preliminary cooperative project in the DMZ in 1966. Korean and U.S. scientists soon began to realize that their collaboration was marked by dissonance. The U.S. side attributed the cooperation failure to Korean culture while the Korean side criticized the unequal structure of their cooperation. Joining the global historiography of Cold War scientific collaboration, this paper pays particular attention to the intermediaries of the collaborative project and their rivalry. It argues that political struggles revolving around the position of go-betweens - as what I call knowledge brokers - on the recipient side provoked contestation between American and Korean scientists. The contention between the two sides played out in the collaboration coming to an end, albeit partially. Throughout this analysis, this study suggests paying more serious attention to the politics of scientific exchange among actors on the recipient side as an outset from which to analyze the heterogeneity of the Korean side without losing sight of their active role in the building process of American hegemony.

The 'dark side' of knowledge brokering.

Deploying knowledge brokers to bridge the 'gap' between researchers and practitioners continues to be seen as an unquestionable enabler of evidence-based practice and is often endorsed uncritically. We explore the 'dark side' of knowledge brokering, reflecting on its inherent challenges which we categorize as: (1) tensions between different aspects of brokering; (2) tensions between different types and sources of knowledge; and (3) tensions resulting from the 'in-between' position of brokers. As a result of these tensions, individual brokers may struggle to maintain their fragile and ambiguous intermediary position, and some of the knowledge may be lost in the 'in-between world', whereby research evidence is transferred to research users without being mobilized in their day-to-day practice. To be effective, brokering requires an amalgamation of several types of knowledge and a multidimensional skill set that needs to be sustained over time. If we want to maximize the impact of research on policy and practice, we should move from deploying individual 'brokers' to embracing the collective process of 'brokering' supported at the organizational and policy levels.