Research, policy and funding - academic treadmills and the squeeze on intellectual spaces

The eye of the beholder: how do public health researchers interpret regression coefficients? A qualitative study

BACKGROUND

Calls for improved statistical literacy and transparency in population health research are widespread, but empirical accounts describing how researchers understand statistical methods are lacking. To address this gap, this study aimed to explore variation in researchers' interpretations and understanding of regression coefficients, and the extent to which these statistics are viewed as straightforward statements about health.

METHODS

Thematic analysis of qualitative data from 45 one-to-one interviews with academics from eight countries, representing 12 disciplines. Three concepts from the sociology of scientific knowledge and science studies aided analysis: Duhem's Paradox, the Agonistic Field, and Mechanical Objectivity.

RESULTS

Some interviewees viewed regression as a process of discovering 'real' relationships, while others indicated that regression models are not direct representations, and others blended these perspectives. Regression coefficients were generally not viewed as being mechanically objective, instead interpretation was described as iterative, nuanced, and sometimes depending on prior understandings. Researchers reported considering numerous factors when interpreting and evaluating regression results, including: knowledge from outside the model, whether results are expected or unexpected, 'common-sense', technical limitations, study design, the influence of the researcher, the research question, data quality and data availability. Interviewees repeatedly highlighted the role of the analyst, reinforcing that it is researchers who answer questions and assign meaning, not models.

CONCLUSIONS

Regression coefficients were generally not viewed as complete or authoritative statements about health. This contrasts with teaching materials wherein statistical results are presented as straightforward representations, subject to rule-based interpretations. In practice, it appears that regression coefficients are not understood as mechanically objective. Attempts to influence conduct and presentation of regression models in the population health sciences should be attuned to the myriad factors which inform their interpretation.

Policy Analysis for Prevention and Control of Influenza in Aged Care

OBJECTIVE

This study aimed to analyze national influenza infection control policy documents within aged care settings by identifying the consistencies, inconsistencies, and gaps with the current evidence and by evaluating methodological quality. Aged care providers can use these findings to identify their policy documents' strengths and weaknesses.

DESIGN

A quality and content analysis of national level policy documents.

SETTING AND PARTICIPANTS

Aged care settings rely on national agencies' policy recommendations to control and prevent outbreaks. There is limited research on the effectiveness of control measures to prevent and treat influenza within aged care settings. Because of the complexities around aged care governance, the primary responsibility in developing a comprehensive facility-level, infection-prevention policy, falls to the providers.

METHODS

The analysis was conducted using the (1) International Appraisal of Guidelines, Research and Evaluation assessment tool, containing 23 items across 6 domains; and the (2) Influenza Related Control Measures in Aged Care settings checklist, developed by the authors, with 82 recommendations covering: medical interventions, nonmedical interventions, and physical layout.

RESULTS

There were 19 documents from 9 different high-income countries, with a moderately high methodological quality in general. The quality assessment's average score was 40.2% (95% CI 31.9%-44.7%). "Stakeholder involvement" ranked third, and "Editorial independence" and "Rigor of development" had the lowest average scores across all domains. The content analysis' average score was 37.2% (95% CI 10.5%-21.5%). The highest scoring document (59.1%) included term definitions, cited evidence for recommendations, and clear measurable instructions. "Physical Layout" had the least coverage and averaged 21.9% (95% CI 4.2%-37.5%), which shows a substantial gap in built environment recommendations.

CONCLUSIONS AND IMPLICATIONS

Existing policy documents vary in their comprehensiveness. The higher scoring documents provide an ideal model for providers. The checklist tools can be used to assess and enhance documents. Further research on document end-user evaluation would be useful, as there is room for improvement in methodological quality and coverage of recommendation coverage, especially related to physical layout.

Rank Has Its Privileges: Explaining Why Laboratory Safety Is a Persistent Challenge

Environmental, health, and safety management systems have become common in research settings to improve laboratory safety through systematic observation and self-regulation. However, there is scant empirical evidence assessing whether these surveillance and inspection systems meet their intended objectives. Using data from safety inspections in research laboratories at a large university, we investigate whether conducting inspections, and recording and reporting findings back to the formally responsible actors (i.e., principal investigator scientists) lead to the improvement of regulatory compliance. Our analyses identify a population of well-funded, high-status, tenured researchers whose non-compliant practices persist. Our interviews with environmental, health, and safety personnel suggest that higher-status actors disengage from the regulatory system, the compliance officers, and the system's feedback process by their variable recognition and acknowledgment of relevant regulations, attention to the inspection reports, and responses to the feedback concerning repair of the unsafe situation. This study extends previous literature on regulatory compliance by providing evidence for the role of power and status in explaining actor-level non-compliant behavior.

Co-option, control and criticality: the politics of relevance regimes for the future of political science

Over the last 20 years, the notion of relevance vis-à-vis political science became not only a subject of academic debates but also a domain of practice, largely due to the developments in the research funding, increasingly referred to as the 'impact agenda'. In this article, we explore how the growing focus on socio-economic impact as the assessment criterion of research funding shapes the discipline of political science itself—its knowledge production, dissemination and the emergent forms of accountability of political scientists. The article presents the results of a major international study that has examined the emergence of ‘impact agendas’ across 33 countries. We report on the changing idea of relevance of political science through the lens of its strategic ambiguity and historical evolution. We then explore these broader trends through an in-depth analysis of the UK as an ‘extreme case’ and a blueprint for funding system reforms. These developments, we argue, are not a mere funding policy innovation but rather a paradigm-level change, reshaping the position of political science in society as well as the types of scholarship that are possible and incentivised.

An atlas of health inequalities and health disparities research: "How is this all getting done in silos, and why?"

Research on health inequalities and health disparities has grown exponentially since the 1960s, but this expansion has not been matched by an associated sense of progress. Criticisms include claims that too much research addresses well-trodden questions and that the field has failed to gain public and policy traction. Qualitative studies have found researchers partly attribute these challenges to fragmentation resulting from disciplinary and methodological differences. Yet, empirical investigation ('research on research') is limited. This study addresses this gap, employing mixed-methods to examine, at scale, how and why this field is defined by insular research clusters. First, bibliometric analysis identifies and visualizes the 250 most-connected authors. Next, an algorithm was used to identify clustering via citation links between authors. We used researcher profiling to ascertain authors' geographical and institutional locations and disciplinary training, examining how this mapped onto clusters. Finally, causes of siloing were investigated via semi-structured interviews with 45 researchers. The resulting 'atlas' of health inequalities and health disparities research identifies eight clusters of authors with varying degrees of connectedness. No single factor neatly describes observed fragmentation, health equity scholars exhibit a diverse disciplinary backgrounds, and geographical, institutional, and historical factors appear to intersect to explain siloed citation patterns. While the configuration of research activity within clusters potentially helps render questions scientifically manageable, it affirms perceptions of the field as fragmented. We draw on Thomas Kuhn and Sheila Jasanoff to position results within theoretical pictures of scientific progress. Newcomers to the field can use our findings to orient themselves within the many streams of health equity scholarship, and existing health equity scholars can use the atlas to move beyond existing geo-disciplinary networks. However, although stronger cross-cluster engagement would be likely to improve insights, the complex nexus of factors underlying the field's structure will likely make this challenging in practice.

Scaling up: The politics of health and place

Research into the role of place in shaping inequalities in health has focused largely on examining individual and/or localised drivers, often using a context-composition framing. Whilst this body of work has advanced considerably our understanding of the effects of local environments on health, and re-established an awareness of the importance of place for health, it has done so at the expense of marginalising and minimising the influences of macro political and economic structures on both place and health. In this paper, we argue that: (i) we need to scale up our analysis, moving beyond merely analysing local horizontal drivers to take wider, vertical structural factors into account; and (ii) if we are serious about reducing place-based health inequalities, such analysis needs be overtly linked to appropriate policy levers. Drawing on three case studies (the US mortality disadvantage, Scotland's excess mortality, and regional health divides in England and Germany) we outline the theoretical and empirical value of taking a more political economy approach to understanding geographical inequalities in health. We conclude by outlining the implications for future research and for efforts to influence policy from 'scaling up' geographical research into health inequalities.

Heteronomy in the arts field: state funding and British arts organizations

For Bourdieu, the field of cultural production is comprised of an autonomous and a heteronomous sector. A heteronomous sector is one that is interpenetrated by the commercial field. I discuss an arena that, until recently, was part of the relatively autonomous sector in the field of cultural production - the supported arts sector in the United Kingdom - and argue that it became more heteronomous, due to the penetration by the state. Heteronomy due to the commercial field is present but secondary to, and driven by, the actions of the state. Political parties' attempts to diffuse and legitimate a particular economic ideology have led to state demands that arts institutions adopt neoliberal business practices in exchange for funding. Government giving to the arts, previously at arm's length, proved to be a Faustian bargain that demanded significant repayment in the form of lost autonomy. Coercive pressures from the state, enacted over time, show how the domination of one field over another can occur, even when the domination is resisted.

Characteristics of good supervision: a multi-perspective qualitative exploration of the Masters in Public Health dissertation

Background

A dissertation is often a core component of the Masters in Public Health (MPH) qualification. This study aims to explore its purpose, from the perspective of both students and supervisors, and identify practices viewed as constituting good supervision.

Methods

A multi-perspective qualitative study drawing on in-depth one-to-one interviews with MPH supervisors (n = 8) and students (n = 10), with data thematically analysed.

Results

The MPH dissertation was viewed as providing generic as well as discipline-specific knowledge and skills. It provided an opportunity for in-depth study on a chosen topic but different perspectives were evident as to whether the project should be grounded in public health practice rather than academia. Good supervision practice was thought to require topic knowledge, generic supervision skills (including clear communication of expectations and timely feedback) and adaptation of supervision to meet student needs.

Conclusions

Two ideal types of the MPH dissertation process were identified. Supervisor-led projects focus on achieving a clearly defined output based on a supervisor-identified research question and aspire to harmonize research and teaching practice, but often have a narrower focus. Student-led projects may facilitate greater learning opportunities and better develop skills for public health practice but could be at greater risk of course failure.

Health and medical research funding agencies' promotion of public engagement within research: a qualitative interview study exploring the United Kingdom context

BACKGROUND

Public engagement (PE) has become a common feature of many liberal governmental agendas worldwide. Since the turn of this century there has been a succession of United Kingdom policy initiatives to encourage research funding agencies, universities and researchers to reconsider how they engage with citizens and communities. Although most funding agencies now explicitly promote PE within research, little empirical work has been carried out in this area. In this study, we explored why and how health and medical research funding agencies in the United Kingdom have interpreted and implemented their role to promote PE within research.

METHODS

Semi-structured interviews were carried out with 30 key informants from 10 agencies that fund health or medical research. Data were also gathered from agencies' websites and documentation. The analysis was based on the constant comparative method.

RESULTS

Across agencies, we found that PE was being interpreted and operationalised in various different ways. The terminology used within funding agencies to describe PE seems to be flexibly applied. Disciplinary differences were evident both in the terminology used to describe PE and the drivers for PE highlighted by participants - with applied health science funders more aligned with participatory models of PE. Within the grant funding process PE was rarely systematically treated as a key component of research. In particular, PE was not routinely incorporated into the planning of funding calls. PE was more likely to be considered in the application and assessment phases, where it was largely appraised as a tool for enhancing science. Concerns were expressed regarding how to monitor and evaluate PE within research.

CONCLUSIONS

This study suggests funding agencies working within specific areas of health and medicine can promote particular definitions of PE and aligned practices which determine the boundaries in which researchers working in these areas understand and practice PE. Our study also highlights how the research grant process works to privilege particular conceptions of PE and its purpose. Tensions are evident between some funders' core concepts of traditional science and PE, and they face challenges as they try to embed PE into long-standing systems that prioritise particular conceptions of 'scientific excellence' in research.

Beyond bridging the know-do gap: a qualitative study of systemic interaction to foster knowledge exchange in the public health sector in The Netherlands

Background

Despite considerable attention currently being given to facilitating the use of research results in public health practice, several concerns remain, resulting in the so-called know-do gap. This article aims to identify the key tensions causing the know-do gap from a broad perspective by using a systemic approach and considering the public health sector as an innovation system.

Methods

An exploratory qualitative design including in-depth semi-structured interviews was used, with 33 interviewees from different actor categories in the Dutch public health innovation system. The analyses employed an innovation system matrix to highlight the principal tensions causing the know-do gap.

Results

Seven key tensions were identified, including: research priorities determined by powerful players; no consensus about criteria for knowledge quality; different perceptions about the knowledge broker role; competition engendering fragmentation; thematic funding engendering fragmentation; predominance of passive knowledge sharing; and lack of capacity among users to use and influence research.

Conclusions

The identified tensions indicate that bridging the know-do gap requires much more than linking research to practice or translating knowledge. An innovation system perspective is crucial in providing information on the total picture of knowledge exchange within the Dutch public health sector. Such a system includes broader stakeholder involvement as well as the creation of social, economic, and contextual conditions (achieving shared visions, building networks, institutional change, removing financial and infrastructural barriers), as these create conducive factors at several system levels and induce knowledge co-creation and innovation.

Advocacy for health equity: a synthesis review

Context

Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to—and distributions of—the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts.

Methods

This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature.

Findings

The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with or experience of hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short-termism also act as barriers. These barriers could be tackled through long-term actions to raise public awareness and understanding of the SDH and through training of health professionals in advocacy. Advocates need to take advantage of “windows of opportunity,” which open and close quickly, and demonstrate expertise and credibility.

Conclusions

This article brings together for the first time evidence from the academic and the gray literature and provides a building block for efforts to advocate for health equity. Evidence regarding many of the dimensions is scant, and additional research is merited, particularly concerning the applicability of findings outside the English-speaking world. Advocacy organizations have a central role in advocating for health equity, given the challenges bridging the worlds of civil society, research, and policy.

What kinds of policies to reduce health inequalities in the UK do researchers support?

BACKGROUND

Despite a wealth of research and policy initiatives, progress in tackling the UK's health inequalities has been limited. This article explores whether there appears to be consensus among researchers about the kinds of policies likely to reduce health inequalities.

METHODS

Ninety-nine proposals for addressing health inequalities were identified from multiple sources. Forty-one researchers participated in a survey assessing the extent to which they believed each proposal would reduce health inequalities, based on three criteria. The 20 proposals generating most support were employed in a second stage, in which 92 researchers indicated which proposals they felt would have the greatest impact on reducing health inequalities.

RESULTS

Some consensus exists among researchers about the policy approaches likely to reduce UK health inequalities: a more progressive distribution of income/wealth, greater investment in services for deprived communities, plus regulatory policies to limit the impact of lifestyle-behavioural risks. However, researchers' support for proposals varies depending whether they are asked to express their expert opinion or to comment on the strength of the available evidence.

CONCLUSIONS

When consulting researchers about health inequalities, policymakers need to consider whether they are seeking research-informed expertise or assessments of the available evidence; these questions are likely to yield different responses.

UK research funding bodies' views towards public participation in health-related research decisions: an exploratory study

BACKGROUND

A challenge facing science is how to renew and improve its relationship with society. One potential solution is to ensure that the public are more involved in the scientific process from the inception of research plans to scientific dissemination strategies. However, to date, little is known about how research funding bodies view public participation in research funding decisions, and how they involve the public into their strategies and practices. This paper provides insights into how key representatives working in the UK non-commercial research funding sector perceive public participation in health-related research funding decisions and the possible implications of these.

METHODS

We conducted qualitative semi-structured interviews with 30 key stakeholders from 10 UK non-commercial research funding bodies that either partially or exclusively fund health-related research. The findings were written up in thematic narrative form.

RESULTS

The different disciplines that encompass health research, and their differing frames of 'science and society', were found to influence how research funding bodies viewed and implemented public participation in research funding decisions. Relevant subsets of the public were more likely to be involved in research funding decisions than lay public, which could be linked to underlying technocratic rationales. Concerns about public participation stemmed from the highly professionalised scientific environment that the public were exposed to. Additionally, from a more positivist frame, concerns arose regarding subjective views and values held by the public that may damage the integrity of science.

CONCLUSION

Underlying assumptions of technocracy largely appear to be driving PP/PE within the research grant review process, even in funding bodies that have overtly democratic ideals. Some conceptions of technocracy were more inclusive than others, welcoming different types of expertise such as patient or research-user experiences and knowledge, while others suggested taking a narrower and more positivist view of expertise as techno-scientific expertise. For research to have its maximum impact when translated into healthcare, health policies and health technologies, there needs to be sensitivity towards multiple frames of knowledge, expertise and underlying values that exist across science and society.

The Possible Experts: How Epistemic Communities Negotiate Barriers to Knowledge Use in Ecosystems Services Policy

The increased salience of how to value ecosystems services has driven up the demand for policy-relevant knowledge. It is clear that advice by epistemic communities can show up in policy outcomes, yet little systematic analysis exists prescribing how this can actually be achieved. This paper draws on four decades of knowledge utilisation research to propose four types of ‘possible expert’ who might be influential on ecosystems services. Broad findings of a literature review on knowledge use in public policy are reported, and the four-fold conceptualisation pioneered by Carol Weiss that defines the literature is outlined. The field is then systematised by placing these four modes of knowledge use within an explanatory typology of policy learning. With how, when, and why experts and their knowledge are likely to show up in policy outcomes established, the paper then proposes the boundaries of the possible in how the ecosystems services epistemic community might navigate the challenges associated with each learning mode. Four possible experts emerge: with political antenna and epistemic humility; with the ability to speak locally and early to the hearts and minds of citizens; with a willingness to advocate policy; and, finally, with an enhanced institutional awareness and peripheral policy vision. The paper concludes with a brief discussion of the utility of the analysis.