This Briefing Note was completed by the Research, Analysis, and Evaluation Branch (Ministry of Health) in collaboration with a member of the COVID-19 Evidence Synthesis Network. Please refer to the Methods section for further information.
This note provides a summary of best practices on how to package public health/epidemiological
information in such a way that it will be useful for decision-makers and will impact their decision-making.
*The full version of the Briefing Note including the Appendix can be accessed in the PDF file at the top of the page*
- Challenges to working with decision-makers include: logistics and coordination (e.g., urgency of requests, time, information sharing, duplication of work), negotiating tensions and building shared understanding (e.g., aligning research and policy considerations, extrapolation of results from indirect evidence), and external constraints (e.g., changes in personnel, political priorities). Moreover, barriers to the uptake of evidence syntheses by decision-makers include lack of user-friendliness, inaccessible language, dense layouts, and lack of policy-relevant syntheses (e.g., contextualization).
- Enablers that advance evidence use by decision-makers include: organizational factors (e.g., leadership, dedicated funding, training, champions), personality traits of knowledge synthesizers (e.g., pragmatic, political acuity, credible, persuasive), and stakeholder relationship building among knowledge synthesizers and users (e.g., goals-setting, establishing virtual/physical communication spaces, using knowledge brokers).
- Some health care organizations have formal knowledge translation plans designed to share evidence with end-users, which may include decision-makers in health care and government, while others offer advice on communicating with non-researchers or advocating for health issues that can be applied to these audiences.
- The research evidence and health care organizations across jurisdictions suggest a wide range of formats for presenting health and research data to decision-makers, for example: decision-support tools (e.g., evidence or policy briefs), systematic reviews, rapid reviews, guidances, presentations, teleconferences, face-to-face
meetings, consultations, conferences, workshops, executive or advisory committees, networking events, endorsements, newsletters, digital resource materials, social media, and media press releases.
- Key principles to consider in evidence synthesis outputs include: rigour, relevance, contextualization,
readability (e.g., plain language, brief bulleted summaries, visuals), and resources (e.g., time, funding, staff).
Analysis for Ontario
- Public Health Ontario provides scientific support to the government and the health sector through a variety of methods (e.g., written products, stakeholder engagement). The Registered Nurses Association of Ontario recommends starting with low-profile advocacy approaches (e.g., letter writing campaigns) and then gradually increasing to medium- and high-profile strategies (e.g., policy briefs, alliance-building).
- The end user needs to be considered and involved in knowledge translation strategies, including determining how much detail is preferred and how much knowledge can be feasibly comprehended from the evidence source. Multifaceted strategies are likely to be more effective in fostering evidence-informed policy-making.
According to Health Canada, knowledge translation is an active process that includes the synthesis, dissemination, exchange, and implementation (application) of knowledge to improve the health of people. Effective knowledge translation can accelerate the use of knowledge by:
- Focusing attention and resources on high priority research questions;
- Ensuring that the knowledge being used is based on the best available evidence;
- Ensuring that the knowledge is being implemented as intended;
- Ensuring important outcomes are being evaluated so that scarce resources are not wasted; and
- Supporting spread and scale-up of evidence-based practices, programs, and policies
This section summarizes best practices for knowledge translation of public health/epidemiological information to health sector leaders and decision-makers from scientific evidence and Canadian/international organizations
- Challenges of Working with Decision-Makers: These include: logistics and coordination (e.g., resource use, urgency of requests, time, information sharing, duplication of work by other knowledge synthesizers), negotiating tensions and building shared understanding (e.g., aligning research and policy considerations, extrapolation of results from indirect evidence, knowledge dissemination), and external constraints (e.g., changes in personnel, political priorities).
- Barriers to Uptake of Evidence Syntheses by Decision-Makers: These include lack of user-friendliness, inaccessible language, dense layouts, and lack of policy-relevant syntheses (e.g., contextualization, equity sensitive findings).
- Organizational Factors that Advance Research Use in Policy Organizations: These include: knowledge translation strategic plans, aligned visions, clear expectations/responsibilities, high-level of recognition/commitment, phased approaches and incremental changes, dedicated funding, management of research integration, systems and infrastructures of research use, institutional structures and rules for policymaking, training/mentoring, culture, leadership, staff engagement, networks and communication, capacity building, champions, resources, evaluation, and monitoring and feedback.
- Personality Traits of Knowledge Synthesizers: These include being: pragmatic, flexible, positive, persuasive, politically savvy, entrepreneurial, proactive, enthusiastic, comfortable working in a dynamic environment, credible, open-minded, autonomous, independent, self-sufficient, self-motivated, creative, and committed to principles of equity, inclusivity, respect, and cultural competence.
- Building and Maintaining Stakeholder Relationships among Knowledge Synthesizers and Users: Much of the identified literature focused on this topic, with strategies including: setting goals and priorities, governance, determining the level of engagement needed for each phase of knowledge development and translation processes, establishing virtual and physical communication spaces, project management documents, working groups, flexibility, education and training, and monitoring and feedback
- One particular strategy highlighted in the literature includes the use of knowledge brokers who work collaboratively with key stakeholders to facilitate the transfer and exchange of information in a given context. While they have operated in the private sector for years, their adoption by the health sector has been rather limited until recently. Their main activities include: identify, engage, and connect stakeholders; identify and obtain relevant information; facilitate development of analytic and interpretative skills; create tailored knowledge products (e.g., resource binders, policy briefs, logic models, journal article summaries, presentations, websites) and translate relevant findings to the local context; project coordination; and support communication and information sharing
- Knowledge Translation Strategies:
- Communication Formats: A wide range of approaches to increase the uptake and use of evidence in practice were highlighted in the research literature, including: decision-support tools (e.g., evidence or policy briefs), systematic reviews, rapid reviews, web portals and access to digital resource materials, teleconferences, face-to-face meetings, consultations, conferences, exchange forums, workshops, executive or advisory committees, networking events, presentations, newsletters, and media press releases.
- Principles: Characteristics to consider when matching users’ knowledge needs with an appropriate evidence synthesis output includes: rigour, relevance (e.g., local context), readability (e.g., plain, non-technical language, brief bulleted summaries, visuals), and resources (e.g., time, funding, personnel).
- Examples highlighted in the research literature include:
- Systematic Reviews: Two reviews (2016 and 2018) summarized the key features of a systematic review title framed as a question; one-page summary including clear take-home messages written in plain language; sections on relevance, impact, and applicability for decision-makers; methods section focusing only on the critical elements; bulk of the report focusing on results and interpretation; a liberal amount of white space with bullet points to avoid dense text; and simple tables. Researchers should consider tailoring different versions of reviews with key messages for relevant audiences
- Rapid Reviews: A review (2016) noted there is no agreed definition or methodology for rapid reviews, and there are a wide range of ‘shortcuts’ used to make rapid reviews faster than a full systematic review (e.g., limiting the scope, limiting data extraction to key characteristics and results, restricting the study types included). Consideration should be given to being transparent about the review methods, enabling a fair quality assessment (e.g., AMSTAR ratings), and maintaining a larger highly skilled and experienced staff who can be mobilized quickly and understand the type of products that might meet the needs of the decision-maker.
- Similarly, a recent commentary (2020) on how rapid review methods are more challenging during COVID-19 recommended the following knowledge translation strategies: use collaborative tools (e.g., online meeting platforms, email) for stakeholder involvement; use COVID-19 repositories and research/resource guides with lists of traditional and grey literature sources (e.g., LitCovid, COVIDEND); limit methodological assessments to only studies that are included in the analysis; use summary of findings tables without a descriptive writeup of results; consult experts to provide evidence contextualization at the review completion; disseminate above and beyond publishing in peer-reviewed journals (e.g., one-page evidence summaries with key messages highlighted upfront, infograms, podcasts, YouTube, LinkedIn, Twitter, media releases); and work with decision-makers to reconsider funding structures to allow living rapid reviews to be conducted on an ongoing basis during COVID-19.
- Limitations: Some literature suggests there are limited studies on non-clinical decision-makers and diverse knowledge translation strategies employed that make it difficult to identify which interventions are effective in fostering an organizational culture supportive of evidence-informed policymaking.
Knowledge translation resources were identified from the World Health Organization (WHO), American Public Health Association (APHA), United States’ Centers for Disease Control and Prevention (CDC), Australian Healthcare and Hospitals Association (AHHA), Joanna Briggs Institute (JBI), Centre for Reviews and Dissemination(CRD), Cochrane Collaboration, and National Institute for Health and Care Excellence (NICE).
- Principles: The WHO lists six principles for effective communications: actionable, accessible, relevant, timely, understandable, and credible. It is important to engage decision-makers during all phases of the evidence synthesis process (i.e., conception and design of research, search and data collection, data synthesis and interpretation, and knowledge dissemination and application), for example through advisors/members of expert panels or steering groups. It is also important to enhance the policy relevance of evidence syntheses (e.g., integration of qualitative and quantitative findings, contextualization).
- Communication Formats: The recommended types of knowledge translation strategies vary across organizations, and may include: written reports (e.g., policy briefs or statements, white papers, guidances), public meetings, radio interviews, podcasts, and videos. For example:
- Health Impact Assessments: These allow for the strategic evaluation of the potential effects of a policy, program, or project on a population, particularly vulnerable groups, based on democracy, equity, sustainable development, and ethical use of evidence. This provides decision makers with data and information that is typically hard to obtain – the realities of the local environment
- Policy Statements: The APHA suggests that policy statements represent substantially new content with externally directed action steps, or a major modification (revision or extension) of an existing policy statement. They should describe and endorse a defined course of action (e.g., legislation and regulations desired, new policies required for non-governmental organizations or private enterprises). Proposed policy statements should: present an objective summary of the problem; be concise; be written in plain language; accurately use 50 or fewer references to justify the call for defined action; and not exceed 10 pages.
- Guidances: NICE produces guidance and standards that are fit for an audience’s needs. They ensure that relevant audiences know about the guidance recommendations (e.g., ongoing access to all standards and recommendations through a website, digital sources, and journals), and encourage improvement through tailored local engagement (e.g., educational training, financial rewards, regulation and inspection requirements, data collection and monitoring systems, patient and third-sector organizations, share local examples of successful initiatives).
- Reviews: Cochrane produces systematic reviews of primary research in human health care and policy. Each review addresses a clearly formulated question and includes Plain Language Summaries (PLSs) to help people understand research findings. Averaging 400-700 words, PLSs are created using standard content, structure, and language to ease understanding and translation. Sections include: “What is the aim of this review?”, “Key Messages”, “What was studied in the review?”, and “What are the main results of the review?”.
- Evidence Syntheses: Many organizations (e.g., WHO, JBI, CRD) suggest including: one-page summaries with key messages tailored to the relevant audience; information on background, interventions, harms/risks, costs, and implications; summary tables; references; and plain language. Evidence synthesis products should be embedded in databases targeted to decision-makers and policy networks or other collaborative structures.
- Face-to-Face Meetings: To help communicate health care issues with elected officials and decision makers, the AHHA recommends that communications be planned (e.g., one-page agenda with bullet points), focused (e.g., up to three key messages or actions), relevant, and purposeful (e.g., clear call-to-action).
Knowledge translation resources were identified from the Canadian Agency for Drugs and Technologies in Health (CADTH), Canadian Institutes of Health Research (CIHR), Canadian Public Health Association (CPHA), College of Family Physicians of Canada (CFPC), Health Canada, and the International Development Research Centre (IDRC) Global Health Policy.
- Principles: Some organizations suggest engaging potential knowledge users throughout the research process. This includes identifying the need, adapting knowledge to the local context, identifying barriers and facilitators to knowledge use, tailoring and implementing knowledge translation strategies, monitoring knowledge use, evaluating outcomes, and sustaining knowledge use.
- Communication Formats: The types of knowledge translation strategies vary according to the knowledge user, but examples include: research questions, reports, guidelines, position statements, advisories, endorsements via letters of support, letters to political parties and members of the public service, in-person meetings, and media releases. For example:
- Policy Briefs: IDRC recommends including the following sections: one-page of take-home messages, three page executive summary, statement of the problem, background and/or context to the problem and its importance, pre-existing policies, policy options, critique of policy options, policy recommendation, and sources consulted or recommended. Pro-tips include, for example: using a professional tone as opposed to an academic one; limiting the focus to a particular problem or issue; being succinct, using short sentences/paragraphs, subsections, and plain language; using visuals (e.g., colours, images, quotes); ensuring recommendations are practical and feasible; including cost implications.
- Economic Evaluation Reports: CADTH reports generally include a preface, executive summary, abbreviations, glossary, objectives, background, review of economic evidence, methods, results, discussion, conclusions, references, and appendices. Wherever possible, plain language and visual graphics should be used and technical terms defined so that information can be easily understood by a reader without a technical background.
- Conferences: CIHR’s Best Brains Exchanges are one-day in-person meetings with senior policy makers, researchers, and implementation experts to discuss high priority health topics. The meetings consist of short, high-level presentations by researchers, followed by question-and-answer periods and facilitated discussions. The focus is on informal dialogue and contextualization of the evidence to the policy context.
- Public Health Ontario provides expert scientific and technical support to government, local public health units, and health care providers through a variety of methods (e.g., written products, videos, stakeholder engagement). This involves: 1) understanding the specific steps in the adoption process for policy implementation in the targeted organizations; 2) writing the policy; and 3) communicating the policy by emphasizing relationship building with key stakeholders and decision-makers. Specific recommendations include:
- Identifying which decision-makers will be the focus of support‐building efforts since choosing people at the wrong level or time can waste resources and may even jeopardize future strategies. Consider whether these decision-makers are most driven by: media coverage; their own beliefs and values; the needs of their clients or constituency; and other influential people or groups.
- Identifying the human and financial resources needed for implementation and development of a realistic and logically sequenced timeline.
- Encouraging decision-makers to prepare for organizations and/or people who are not supportive. Consider working with them to brainstorm who may oppose the policy.
- Determining if a shift from a supportive role to an advocacy one is needed if decision-makers resist or defer policy adoption.
- The Registered Nurses Association of Ontario recommends a range of advocacy approaches, starting with low profile strategies (e.g., letter writing campaigns to elected representatives) first, then gradually increasing to medium (e.g., meetings with government officials, policy briefs) and high (e.g., posters, media releases, alliance building) profile strategies if necessary. Important steps for approaching decision-makers include: framing the issue for the meeting to help prioritize their attention and resources; being clear and succinct; suggesting solutions; and assessing and re-evaluating outcomes of the meeting.
The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision-makers as the pandemic
continues. The following member of the Network provided an evidence synthesis product that was used to develop this Evidence Synthesis Briefing Note:
- Centre for Effective Practice. October 8, 2020. COVID-19 Evidence Synthesis Network: Evidence Support for Request #16: What are the best practices for knowledge translation of public health/epidemiological information to health sector leaders?