Bridging Rural Health Research and Policy
In recent years, there has been considerable emphasize to try and strengthen the linkages between researchers and end users of healthcare, including health professionals, health decision makers and patients. According to the NIH Roadmap 1, some of these activities fall within the T2 category (translation to patients) although most would be included under T3 (translation to practice). Knowledge translation (KT) is another way to define these activities.2 KT has been defined as “…the exchange, synthesis and ethically-sound application of knowledge - within a complex system of interactions among researchers and users - to accelerate the capture of the benefits of research… through improved health, more effective services and products, and a strengthened health care system.” 3
Lavis and colleagues 4 propose that the KT process can best be captured in five questions: what is the message? who is the target audience? who is the appropriate messenger? by what processes or methods should the message be delivered? and how will we know if we have achieved the desired impact? According to Lavis, the four key audiences for KT are the general public, health care providers, decision-makers and policymakers.
A concept which is complementary to KT is knowledge brokering. A knowledge broker is any person or organization who synthesizes research evidence while adapting the findings to a given context. 4 Knowledge brokering links researchers and decision-makers, facilitating their so that they are able to better understand each other's goals and professional culture, influence each other's work, forge new partnerships, and use research-based evidence. Leaders in the field agree that knowledge brokering is the “human force behind knowledge transfer” and a dynamic activity that helps move information from a source to a recipient. 5 Knowledge brokering links health researchers to health policy makers to the health system itself.
One article 6 suggests five strategies for researchers and funders to follow to facilitate the update of research into rural health policy and practice:
- Engage end users when framing research,
- Tailor the design of products to meet the needs of the diversity of end users interested in health research,
- Make research products easily accessible to end users,
- Expand contact and working relationships with end users,
- Invest in developing greater capacity for effective dissemination.
Here at the Center for Rural Health, we try to take this advice to heart. Since our Center houses the State Office of Rural Health for Arizona, we take care to ensure that our research has applicability to the end users of healthcare across the state and, indeed, this is part of our mandate. Through events such as our annual Arizona Rural Health Policy Forum at the State Capitol Building, the release of reports for policy makers, and our programs such as the Arizona Rural Hospital Flexibility Program, we try to ensure that end users in our state are incorporating our research such that it might have maximum impact. Still, we would love to hear from you on how to improve our efforts in these areas.
- Westfall JM, Mold J, Fagnan L. Practice-based research – “blue highways” on the NIH roadmap. JAMA 2007; 297(4):403-6.
- Jacobson N, Butterill D, Goering P. Development of a framework for knowledge translation: understanding the user context. J Health Res Policy 2003;8(2):94–9.
- Knowledge translation strategy 2004-2009: innovation in action. Ottawa: Canadian Institutes of Health Research; 2005. Available: www.cihr-irsc.gc.ca/e/26574.html.
- Lavis JN, Robertson D, Woodside JM, et al. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Quarterly 2003;81(2):221–47.
- Lomas J. The in-between world of knowledge brokering. British Medical Journal 2007;334: 129–32.
- McBride T, Coburn A, MacKinney C, et al. Bridging Health Research and Policy: Effective Dissemination Strategies. J Public Health Management Practice 2008; 14(2): 150-4.