Disseminating research findings
to impact policy
Jitendra Khanna
Technical Editor
The WHO Reproductive Health Library
"Ta mard sukhan na gufta baashed
Aib-o-hunarish na hufta baashed"
Sheikh Saadi
(Till a man says something, both his strong
and weak points remain hidden).
Objectives
Review some basic principles of communication
and information dissemination
Explore channels of dissemination for peers and
other stakeholders
Some exercises
_____________________________________
Based on
– HRP communication workshops
– Turning research into practice
– Institute of Health Economics report (2008)
Global publication of scientific research
From: New Scientist, 2008
Science in Iran
Iran increased its publication output nearly
tenfold from 1996 to 2004 (Institute for Scientific
Information)
Iran ranks 49th for citations, 42nd in paper
output, and 135th for citations per paper
According to a British government study (2002),
Iran ranked 30th in the world in terms of
scientific impact.
In 2008, Iran ranked 32, 46 and 56 in Chemistry,
Physics and Biology, respectively, in the world.
• from Wikipedia, 2009
Generally speaking….
Many problems – not as many sure solutions
May have solutions – but no direct power to
implement
Knowledge – this today that tomorrow
Knowledge is money (and power)
The big gap – researchers and public
The many brokers – noise or clarity?
Power of science – or weaknesses?
Interests – supportive and vested
Others
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Distribution of interventions in RHL
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Research to policy:
some basics questions
Whose idea was it anyway?
Was there interest in it before and during the
conduct of research?
Does the research group have credibility?
Where were the results published?
Who is opposed to the idea?
Is there capacity to implement the intervention?
What are the risks in implementing it?
Information dissemination
The circulation or wide dispersal of
information.
Medical.webends-com
What is communication?
"Any act by which one person gives to, or
receives from, another person information about
that person's needs, desires, perceptions,
knowledge, or affective states. Communication
may be intentional or unintentional, may involve
conventional or unconventional signals, may
take linguistic or nonlinguistic forms, and may
occur through spoken or other modes."
National Joint Committee for the Communicative Needs of Persons
with Severe Disabilities, 1992
Key points about communication
Exchange – two-way
Information (but reflects knowledge)
Intentional or unintentional
Linguistic or nonlinguistic
Needs, wants, perceptions, knowledge
Everybody (everything) says
something….
Shannon's model
Claude E. Shannon conceptualized the communication theory model in the late 1940s.
It remains central to communication study today.
Information
source
Message
Transmitter
Signal
Noise source
Receiver
Destination
Message
Adapted model of communication
Noise
Noise
Noise
Sender
Encoding
Signal
Decoding
Noise
Feedback
Noise
Noise
Receiver
Quality of communication
Varies, depending on
– Use of effective skills and strategies
– Understanding of audience(s)
– Use of correct channels
Skills can be learnt
Going from A to B… and back
Means of transport (information channel)
Timing (hook for the story)
Information about B (know the audience)
– Culture
– Likes / dislike
– History
Risks (What can go wrong)
Putting communication into
practice in research
Research
Research is part of a process
of knowledge production,
management and use.
A research institution is a
"knowledge" factory
Output:
Input:
information
information
Knowledge
Processing
The policy and execution
grinding mill
Information
Knowledge
Analyses of threats
and benefits Policy and
communication
Processing
Testing
Impact
Evaluation
Worlds apart
Since both research and policy-making are
complex activities and very different from
each other, mutual understanding requires
concisions effort.
– A generalization made based on research by
Fox and Oxman (2001)
Finding common ground
Dealing with people
Do we really make, and use reason in, all
our choices?
Philadelphia project
Cornell study (Schouffle 2004)
Video on choices
Funny, lucky, religious?
A
B
C
Exercise 1
Speaker
Interviewer
Observer
Interpersonal
communication
(person-to-person communication)
Five insights into
effective interpersonal
communication
Interpersonal communication
Conflict occurs
when communication fails
Insight No. 1
If people perceive an attack,
they will defend themselves.
Vicious circle of attack and defence
ATTACK
DEFEND
Conflict
Note:
Communication seeks to better understand
other viewpoints and
not necessarily
to agree with them.
Although, if you keep an
open mind, you may achieve
agreement as well.
Insight No. 2
Listening is more than just waiting
quietly for your turn to speak.
The "art" of listening
maintain an attitude of ‘inquiry’ and interest
gently probe to understand the other
draw out the other’s reasoning
ask for examples
check your understanding
listen with an open mind
refrain from preparing to destroy the other’s
argument or promote your own agenda
Insight No. 3
To really understand someone else's
viewpoint you have to be able to get
out of your own logic and into theirs.
???
Understanding other
people’s logic
Assume that people are rational
– People behave "rationally" based on their
internal logic:
• how they see things
• self-interest, which they are working to
maximize
• their important concerns
People
Other helpful assumptions
– Other people are going to see things
differently from you
– You can understand those differences and
their likely impact
The BLM syndrome
The anatomy of
action/communication
Logic of actions is based on
personal factors
Perception
of events
Personality
Mindset
Mind-set
Reasoning
Action
taken
Action and communication
Mindset:
the invisible side of communication
Inquiry
Open/closed questions
Open
– don’t influence the answer (transmit interest)
– seek information
Closed:
– seek agreement/disagreement
– don’t draw information
The ladder of inference
“Our ability to achieve the results we truly
desire is eroded by our thinking that:
our beliefs are the truth
the truth is obvious
our beliefs are based on real data
the data we select are the real data.”
Senge et al. The fifth discipline fieldbook.
Insight No. 4
To influence someone you have to be
able to speak their language.
Insight No. 5
Humility works!
In presenting your point of view:
state assumption
explain reasoning
explain context
give examples
invite testing of your assertions
reveal where you are least clear
avoid being defensive
(allow yourself to be vulnerable)
The nature of knowledge
and information…..
"REAL science depends on the
dispassionate search for truth."
– Robert K. Merton, Sociologist
"The wise see knowledge and action as
one."
-- the Bhagvad-Gita
Information vs knowledge
Words
Data
Non-personal
Relates to media
Computers/
technology
“Facts provided”
“What is conveyed…”
Internal process
Understanding
Personal
Longer-lasting
Shapes behaviours
“True, justified beliefs”
“Sum of what is
known”
Communication is to
information/knowledge as packaging and
transportation are to goods
Knowledge is a product that needs to be
managed
"Knowledge" management
“We have managed money and buildings
and people and energy. Now we need also
to manage the most precious commodity
of the 21st century knowledge and know
how.”
J A Muir Gray, Director, Research and Development.
NHS Executive Anglia and Oxford, Oxford.
BMJ, 26 September, 1998 (Volume 317)
Knowledge management is about using
people as a resource
Information management is about using
instruments, data, journals, media – what
is exchanged between people
Examples of underutilization of knowledge
In Mexico 14 out of 22 hospitals in Mexico City
were not using magnesium sulfate for the
management of eclampsia (A WHO study)
In the USA, patients received 55% of
recommended care and quality varied by
medical condition - 79% of recommended care
for senile cataract to 11% of recommended care
for alcohol dependence (McGlynn 2003)
20-30% of patients may get care that is not
needed or care that could be potentially harmful
(Schuster 2005)
Purpose of research
communication
Ensuring that all stakeholders are aware of
and use research evidence to inform their
health and health-care decision-making.
Some questions to ask
What should be transferred?
To whom should research knowledge be
transferred?
By whom should research knowledge be
transferred?
How should research knowledge be
transferred?
With what effect should research
knowledge be transferred?
What?
Knowledge ripe (synthesized) for transmission/
implementation? –
Proteus phenomenon – diminishing effect size
– Why systematic reviews are important
Type and quality of evidence
– Single study (observational – RCT)
– Systematic review
Urgency of situation/opportunity cost
Relevance to local setting
– In time
– Context
– Setting in which evidence was generated
To whom  1
Peers (for researchers)
–
–
–
–
Co-workers
Colleagues in the organization/university
Researchers in your field
Researchers in other fields
Issues
– Which journal
• International, regional, local
• Reputation, prestige, impact factor
– International meetings?
To whom?  2
Policy-makers
– Government leaders/officials
– Decision-makers
– Regulators
– Industry
Programme managers
Patients/public
Donors
By whom?
Whose responsibility is it anyway?
Researchers and brokers
"Dr Fox Effect"
THE DOCTOR FOX LECTURE: A PARADIGM OF EDUCATIONAL
SEDUCTION
Donald H. Naftulin, M.D., John E. Ware, Jr., and Frank A. Donnelly
Journal of Medical Education, vol. 48, July 1973, p. 630-635
The channels -1
For peers (information)
–
–
–
–
–
Journals
Meetings
Newsletters
Listservs
Etc.
For peers (behaviour change beyond policy)
–
–
–
–
Educational outreach (vs self-learning)
Opinion leaders
Audit and feed-back
Etc.
The channels -2
Policy- and decision-makers
– Policy briefs
– Press releases
• Radio/TV
• Print media (newspapers, magazines)
– Dissemination workshops and meetings
– Personal contact
Publics
– Internet
• Listservs
• Facebook?
–
–
–
–
Docudramas
Infotainment
Telephone
Celebrity ambassadors
How?
Planned dissemination efforts works better
– Time it well
Know your hurdles
– (Evidence for interviews and focus groups)
Know your supporters
______________________________________
Select media/interventions
– (Evidence for effectiveness generally weak)
Follow the plan
Evaluate
Reaching out to masses
Publics are often ignored as a stakeholder
Video
What effect?
Proactively listen to what comes back
Measure your success
– Success may be slow
– "Reason" may be less common than assumed
Evidence is often lacking
Evaluate
Keep at it
KT: What works… what doesn't…(from James Trostle)
Category
Influence
Content
Promote
Target-specific issues, concrete results, low-cost recommendations
High-quality research (not measured through publication)
Biomedical and quantitative research favoured
Impede
Mutual intellectual disdain
Differences in technical language
Promote
Groups have identified priority problems
Official research organizations in the health sector
International support for research
Impede
Differences in agendas, times, styles
Lack of technical background for policy-makers
Political culture values experience over information
Actions of interest groups, especially financial interest
Promote
Opportunities for informal communication
Formal communication channels (e.g. monthly bulletins)
Interest group equilibrium, or solutions consonant with interests
Impede
Difficulty communicating research questions or results
Vertical management of information
Promote
Researcher/decision-maker rotation
When research is urgent and relevant
Administrative change can promote policy change (new audiences)
Impede
Centralization: power and information
Vertical organization
Hierarchical power (middle more resistant)
Administrative change can impede policy change (discontinuity in priorities)
Restricted economic resources
Actors
Process
Context
Factor
Summary
Plan for use of knowledge before staring
research
Involve as many potential stakeholders as
possible (including end-users)
Plan for effective communication
strategies (including training of
researchers in communication skills)
Evaluate impact
Exercise
Group 1 - Researchers
– Key messages
– Stakeholders
– Strategy (elaborate)
Group 2 – Policy-makers
– Process for implementation
– SWOT analysis
– Strategy (elaborate)
SWOT
Strengths: Plus points of the findings.
Weaknesses: Potentially harmful
attributes of the findings.
Opportunities: External conditions
that are helpful to achieving impact.
Threats: External conditions that
could do damage.
Remarks
Adult learning: Adults don’t like being
told…prefer to be part of decision-making
“Change is difficult” – why?
Low-cost interventions preferred – but what
about opportunity cost?
Want best for less --- realistic?
Science being sidelined? Us health insurance
company policies
Why harsh approaches to BC are a no no?
RCTs best for intervention studies?
“Everyone has been made for some
particular work, and the desire for that
work has been put in every heart.”
– Jalal ad-Din Rumi
Thank you
From: New Scientist
People see things differently
We experience life differently
Information overload!
There is always more coming!
“Out beyond ideas of wrongdoing and
rightdoing, there is a field. I will meet
you there.”
"Knowledge resides in the user and not in
the collection [of information]. It is how the
user reacts to a collection of information
that matters."
-- Churchman, C.W. (1971). The Design of INQUIRING SYSTEMS: Basic Concepts
of Systems and Organization, Basic Books, New York, NY, p. 10.
Objectives
To understand key insights that affect the
quality of IPC.
To identify skills and attitudes associated
with those insights.
To increase awareness of one’s own
effectiveness in IPC through practice,
observation and feedback.
Communication-related terms used in
research dissemination
Communication
Information dissemination
Knowledge transfer
Knowledge transfer and exchange
Knowledge translation
HRP philosophy
For a research institution, the job is not
over until research findings:
– have been peer-reviewed and published
– have been disseminated to all
audiences (including lay)
– (where applicable) have led to policy
impact.
The view from the other side
Quality (credibility) of evidence
Extent of benefit
Costs and opportunity cost