Transla'ng public health research for policymakers and advocates

Transcription

1 Transla'ng public health research for policymakers and advocates Alexandra B. Morshed, MS, and Rachel G. Tabak, PhD, RD Preven;on Research Center in St. Louis, Brown School, Washington University in St. Louis September 28, 2017 Physical Ac;vity Policy Research Network Mee;ng

2 Funding Our research was funded in part by: Na;onal Cancer Ins;tute at the Na;onal Ins;tutes of Health (grant numbers 1R01CA , R25CA , and P30 CA09184) Na;onal Ins;tute of Diabetes and Diges;ve and Kidney Diseases (grant number 1P30DK092950) Washington University Ins;tute of Clinical and Transla;onal Sciences (grant numbers UL1 TR and KL2 TR000450) from the Na;onal Center for Advancing Transla;onal Sciences

3 Overview: Policy dissemina'on research Policy dissemina;on research the study of the targeted distribu0on of scien0fic evidence to policymakers to understand how to promote the adop0on and sustainment of evidence-based policies (Purtle et al. 2018) some;mes referred to as knowledge transfer and knowledge exchange (esp. Canada, U.K., Australia) Focused on big P policies, e.g., laws, regula;ons Types of policy dissemina;on research: Exis;ng body of research consists of two categories: audience and interven;on studies Study design and methods: Does not lend itself well to RCTs (inverse evidence law) Dependent on opportunis;c, natural experiments Challenges and opportuni;es: Redefining evidence Response rates with policymakers Publicly-available data Sampling

4 Importance of policy dissemina'on research Policy important for chronic disease preven;on and control Policy transla;on gap exists Diverse needs among policy actors for research framing (Kingdon s framework, policy stream) Advocacy organiza;ons play a key role in policymaking Lible research exists on knowledge transla;on in this group

5 Examples of policy dissemina'on research carried out at StL-PRC Differences between research framing preferences, informa;on use, and perceived reliability of sources between legislators and advocates What is useful to advocates as they work with policymakers? Differences in legislator preferences by policy subject area Dissemina;ng research through legisla;ve tes;monies

6 Cross-sec'onal study state legislators (elected to state houses or senates): Randomly sampled from popula;on of 7,525 state legislators from all 50 states and Puerto Rico, Guam, and US Virgin Islands. 265 who priori;ze work around issues related to cancer, obesity, diet/ nutri;on, physical ac;vity, or tobacco-use. 125 who priori;ze work around behavioral health issues.

7 Cross-sec'onal study 2 77 state-level advocates: Advocacy agencies iden;fied using state-specific Google searches. All working on issues related to cancer, obesity, nutri;on, physical ac;vity.

8 Data Collec'on Phone surveys: Informa;on seeking and u;liza;on (1-5 frequency ra;ng). Preference for research framing (1-5 importance ra;ng). Reliability of informa;on by source (1-5 reliability ra;ng). Ques;ons adapted from a previously developed measure (Bogenschnieder et al. 2010), and validated with state legislators and cogni;vely tested with representa;ves of the advocate sample. Among advocates, open-ended ques;ons to capture aspects of research and evidence use in advocacy. Among legislators, open-ended ques;on about the influence of legisla;ve tes;mony on decisions about policy.

9 Differences between legislators and advocates working on cancer, risk factors Gender (%) Age (%) Educa'on (%) Stance on social issues (%) Stance on fiscal issues (%) Tenure (mean) Female < Some college College deg. Postgraduate Liberal Moderate Conserva;ve Liberal Moderate Conserva;ve Years in legislature or advocacy Legislators (n=265) Advocates (n=77) All differences are significant at p <.05

10 Legislators vs. advocates preferences Advocates overall use and seek informa;on more oqen than legislators (except informa;on from legisla;ve research bureaus) For research framing, themes common to both groups: Value and use research evidence, but do not contact researchers Prefer understandable, concise, relevant, ac;onable, ;mely informa;on, that includes cost-effec;veness data (Morshed et al., 2017)

11 Legislators vs. advocates preferences (cont.) Research framing, differences: Legislators: rela;onships of trust, internal legisla;ve research bureaus Advocates: Rigorous, generalizable research, including local data Reliable sources of informa;on: Both groups: rank universi;es as highly reliable sources Advocates rely on government sources, legislators on cons;tuents Important for developing and tailoring dissemina'on strategies

12 Qualita've data from advocates (Eyler et al. 2014) Analyses of open-ended ques;ons about use of research and what makes it useful when working with policymakers, inc. barriers, successes, and recommenda;ons. Most advocates do not have formal policy training and they learn on the job. Success depends on developing and maintaining a professional rela;onship with policymakers to facilitate flow of informa;on. Using research that is understandable, concise, uses stories, relevant to local actors, credible, and ;mely.

13 Tailoring by personal characteris'cs - Age With regard to frequency of using sources of evidence, compared to those 50+ years of age, advocates <50 were significantly less likely to: Abend seminars or presenta;ons where research is discussed (ra;ng 3.0 vs. 3.8) Take the results of a relevant scien;fic study into account (ra;ng 4.0 vs. 4.5) Talk with colleagues about research on issues (ra;ng 4.2 vs. 4.6) (Tabak et al. 2015)

14 Tailoring by personal characteris'cs Posi'on on social/fiscal issues Differences in reliability and believability of research informa;on from a government source: Moderate on social issues rated most highly, followed by liberals, independent/others, and conserva;ves (4.6 vs. 4.1 vs 3.6) Liberal on fiscal issues rated higher than conserva;ves (ra;ng 4.2 vs. 3.5) Differences in reliability and believability of research informa;on from a university source Fiscally independent/other higher than fiscally conserva;ve (ra;ng 5 vs. 3.8) Socially conserva;ve lower than moderates (3.7 vs. 4.7) (Tabak et al. 2015)

15 Tailoring by subject area Legislators who priori;ze behavioral health issues differ from those who do not: (Purtle et al. 2016) More likely to use research evidence to determine their health policy priori;es More oqen abend research seminars or presenta;ons (but both groups use research frequently, both less frequently read scien;fic ar;cles and reports, and neither contacts researchers oqen) Place a higher premium on research that is unbiased, concise, and tells a story State legislators working on cancer control value scien;fic evidence more highly than those working on other issues (Brownson et al. 2016)

16 Usefulness of legisla've tes'mony Examined how hearing tes;mony influences legislators decisions about policy, and what characteris;cs of the tes;mony are important using qualita;ve data. (Moreland-Russell et al. 2015) Legisla;ve tes;mony at least par;ally influences policy decisions. Most common reported result from tes;mony was increased awareness, and to a lesser extent policy decision-making. Characteris;cs of the presenter (such as credibility, exper;se) were most influen;al characteris;cs of the tes;mony.

17 Model for dissemina'on of research e.g., incen;ves for academics for engagement with policymakers Source Delivered by someone trusted Unbiased Relevant to cons;tuent Concise inc. cost data Message Channel (Brownson et al. 2017) Audience (receiver) e.g., for elected officials Short ;me frames Short aben;on spans Decisions by consensus Reac;onary

18 Connect with your audience Understand your audience/ their current posi;on What do they care about? What are their informa;on needs? Where, when and how do they seek informa;on?

19 Future research direc'ons 1. Research assessing effec;veness of dissemina;on strategies. 2. Lible research exists among advocates, despite important role: Advocates percep;on of what works in communica;ng research matches legislators preferences observed in this study. Advocates place emphasis on developing and maintaining rela;onships with policymakers, act as informa;on channels to policymakers. They rou;nely build coali;ons around common policy issues and coordinate messaging. Partnerships with advocates may address barriers researchers face. Ø Research tes;ng the effect of dissemina;on strategies that target advocates can help understand how these partnerships can enhance policy research transla;on.

20 Acknowledgements We thank Dr. Ross Brownson for contribu;ng slides and other inputs into this presenta;on. We would also like to acknowledge the members of the team that produced our research studies: Beth Dodson, Amy Eyler, Ross Brownson. The following slide includes the full cita;ons for the papers discussed today and other cited literature.

21 References Bogenschneider K, et al. Policymakers' Use of Social Science Research: Looking Within and Across Policy Actors. J Marriage Fam Apr;75(2):263. Brownson RC, et al. Framing research for state policymakers who place a priority on cancer. Cancer Causes Control Aug 1;27(8): Brownson RC, et al. Gewng the word out: new approaches for dissemina;ng public health science. JPHMP doi: /PHH Eyler AA, et al. The connec;on between research and policy advocacy in the United States: a qualita;ve study. Health Behavior & Policy Review. 2014;1(1):50-7. Field P, et al. Evidence-informed health policy - the crucial role of advocacy. Interna;onal journal of clinical prac;ce Apr;66(4): Gen S, Wright AC. Policy advocacy organiza;ons: A framework linking theory and prac;ce. Journal of Policy Prac;ce. 2013;12(3): Moreland-Russell S, et al. " Hearing from all sides" How legisla;ve tes;mony influences state level policy-makers in the United States. Int J Health Policy Manag Feb;4(2):91. Morshed AB, et al. Peer Reviewed: Comparison of Research Framing Preferences and Informa;on Use of State Legislators and Advocates Involved in Cancer Control, United States, Prev Chron Dis. 2017;14. Oliver K, et al. A systema;c review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res Jan 3;14. Purtle J, et al. Uses of research evidence by State legislators who priori;ze behavioral health issues. Psychiatric Services Jul 1;67(12): Tabak RG, et al. Accessing evidence to inform public health policy: a study to enhance advocacy. Public Health Jun 30;129(6): Zahariadis N. Ambiguity and Mul;ple Streams. In: Weible CM, Saba;er PA, eds. Theories of the Policy Process. Cambridge, MA: Westview Press; 2014.

22 Thank you! Ques'ons? Alexandra B. Morshed Rachel G. Tabak

23 Generalizability Limits to generalizability include: Different policy networks (e.g., paberns of interac;on between public and private actors in policymaking), which can influence coordina;on and access to new actors or ideas into decision-making sphere Different topic areas have varying acceptability and likelihood of policy enactment, and are associated with varia;on in research framing preferences Presence of exis;ng policies on a topic is associa;on with further policy enactment