A report of research carried out by Frontier Economics Ltd on behalf of the. Department for Work and .. Research definition. .. At the level of process and organisation, relationships between policy makers and researchers seem. Political scientists are increasingly exhorted to ensure their research has of the policy process, according to which policy-makers are keen to. Read chapter 9 The Relationship Between Research and Policy Development: Today, the nation faces an array of housing and urban policy challenges.
Each HUD administration is able to draw on that body of research, each is able to add to it during its term, and each leaves behind it a body of completed studies and studies in process that are intended to be of use to its successor.
The research is ongoing because HUD has had the same basic missions for many years, as well as many of the same programs. Yet although the missions have seldom changed and the major programs have long histories, some programs have been terminated, and there have been modifications in all of them. Some of the modifications have occurred in response to changes in policy priorities and some to address program management or other problems identified in the course of program operations.
Research contributes to the decision to undertake new programs and the design of the programs. Experience with the programs, once they have begun operations, often raises issues of program effectiveness or cost, and identifies problems that need attention. Research is often undertaken to address these issues, to evaluate the effectiveness of the programs, answer specific questions about them, and suggest modifications. It is an iterative process. This is particularly true of the research program, and most particularly true in recent years as the size of the research budget has been constant or shrinking.
Research is undertaken to answer questions or resolve problems; when the budget is limited, fewer questions or problems can be addressed. This reduction in research can have negative consequences for HUD policy makers and the public; use- ful information is not available when it is relevant.
The cost is real, albeit indirect and easily overlooked. The research activities in any given year will not cover all of the major program areas of HUD.
But over time research has covered nearly all of them. Policy development in any given year draws on the research activities of the last several years, and even longer. Section 8 new construction; tenant-based assistance, with a focus on cost; housing vouchers, with a focus on program outcomes; the Community Development Block Grant CDBG formula; housing mar- ket discrimination; and regulation of the government sponsored enterprises, Fannie Mae and Freddie Mac.
There is some overlap between the first two examples, since both programs were authorized under Section 8 inand some of the major research projects over the next several years covered both. Also, the second and third both concern the programs that provide assistance to households, tracing the development of policy along different dimensions and over somewhat different periods of time.
Housing assistance has routinely constituted well over one-half of the HUD budget. It differed from previous project-based subsidy programs in that the subsidy was explicitly based on the income of the assisted household. The commitment to an income-conditioned subsidy was derived in part from Housing in the Seventies U. Department of Housing and Urban Development,the major study of previous subsidy programs. The study did not recommend enacting a program like Section 8 new construction, but its recommendation for income-conditioned subsidies became part of the program.
By the late s it was becoming clear to policy makers that the Section 8 New Construction Program was exceptionally expensive. The evaluation by Abt Associates Wallace et al.
With respect to outcomes, the evaluation found that the new construction program primarily served white elderly households and that few minority households participated; in contrast the certificate program was generally representative of the eligible population. The recommendations of the commission report were adopted by the administration, and inCongress repealed the Section 8 New Construction Program.
The repeal applied to further projects. The inventory of Section 8 projects remained as assisted housing. By the early s, the question of whether and how to preserve these projects for their low-income residents became an important public policy concern. Like its predecessor program under Sectionthe subsidy contracts for Section 8 new construction had a year term, after which the owners could opt out of the program. This study, with results published in andprovided the most extensive data yet available on the Section 8 inventory.
In Congress enacted the Mark to Market Program to preserve as much of Section 8 inventory as financially reasonable and provide housing assistance for the residents of those projects whose owners chose to convert them to market-rent housing. The s witnessed a shift in the policy consensus away from access to health care and expansion of coverage and toward cost containment and "shrinking the system" 3,5,7,8,9, The issue of health sector reform has been on the agenda of almost all countries ever since, and new models of health systems and services organization have come into play.
New policy instruments have become necessary, and these have generated great demand for new knowledge about how to control health systems more effectively. As a result, there is no general agreement on how to distinguish between applied social science research in health delivery systems, health services research, and health policy analysis.
Such criticism also raises the issue of emphasis: The issue of the diffusion of service innovations gained prominence, as did the search for evidence for public health and health policy.
Thus, the problems posed by the difficulty in transferring scientific information or research results to decision-making have become a subject for academic thinking. As many authors point out, whether research results or scientific evidence have contributed significantly to public policy depends largely on how one defines public policy and the policy development process.
Opposing approaches can be identified in the recent past. One view of the policy-making and policy-formation processes sees them as sets of explicit, authoritative decisions by sets of identifiable public officials. The other view argues that a more complex, general political process is involved, strongly influenced by values, opinions, and actions which move decisions in certain directions in the political, social, and economic systems.
In the first approach, the impact of research results tends to be evaluated in terms of the direct effects on such decisions; in the second, "research performance" should be evaluated in terms of its overall ability to shape debate and action. Accordingly, one should not expect any specific result of any specific study to play a central role in any specific decision, but should look toward the nature of the issues being raised and the debate surrounding theses issues.
In the wake of these discussions and changes in direction, analysis of the health policy process has gained prominence, and efforts are under way to equip and formalize the health sector decision-making process by developing "facilitator" tools.
Generally speaking, the literature warns that the fields of knowledge production and policy formulation and implementation are very different: Meanwhile, this lack of clarity makes it difficult to establish strategies to effectively draw these two activities closer together on the basis of greater cooperation and visible, concrete results. In addition, much of the frustration surrounding attempts to apply research results to policy stems from mistaken expectations as to what such application means 12, as well as to a lack of any clear perception of what the decision-making process is really like There is also no single way of viewing that process, and depending on which analytical perspective is used, the "entry points" for research in the policy process also shift, as do the variables that interact in it Terms such as "informed choice", "considered decision", "rational policy", "evidence-based policy", "strategic research", and "essential national research" have been used to express the belief in the need to build a "bridge" between research and policy.
National and international seminars, congresses, and scientific meetings have focused on the "research-to-policy" issue. A number of moves have attempted to facilitate the use of research results in policies, including the preparation of tool kits for defining research priorities, demand for and utilization of health policy and systems research, and capacity-building Training Materials and Tools, Alliance for Health Policy and System Research, http: Increasingly, such agencies are requiring that research protocols state this link explicitly and discuss specific strategies for this purpose.
Still, little is known about where, how, and by whom such a bridge is to be built The health field provides abundant examples of the complex relationship between research results and policy formulation and of the ways by which scientific evidence influences specific causes of disease or individual behavior changes.
Taking prevention as an example e. The interests involved in these issues are far more varied and extend far beyond the health sector 3, The purpose of this article is to offer a literature review on this subject, based on selected authors, and to discuss their arguments and some of the main theoretical approaches to explain or back the relationship between the production of scientific knowledge and its use in policy formulation and implementation.
The first section presents several analytical models designed to explain these relationships. The second reviews the issue of the use of research results and policy-making. The third analyzes the literature on the interaction between researchers and policymakers.
The fourth reviews issues related to the spread of knowledge, knowledge transfer, and evidence base in health policy and practice. The initial hypothesis is that there is an excessive formalization of instruments and pragmatic simplification in the proposals designed to draw the two fields research and policy closer, while the importance of formulating and developing analytical and explanatory frameworks that perhaps offer more promise in this process is underestimated.
Some explanatory models for use of research in policy The term "knowledge transfer" is increasingly used to describe a series of activities contained in the process of generating knowledge based on user needs, disseminating it, building capacity for its uptake by decision-makers, and finally tracking its application in specific contexts. While there is increasing interest in knowledge transfer for health policy and practice, there is still no dominant explanatory model to guide efforts in this area, and there is little empirical research on what has worked in specific contexts.
Weiss 17 is cited in the literature as having pioneered the identification and description of seven models to illustrate how research is used in policy formulation or how it functions as a guide for the decision-making process. From those models, authors are defining analytical categories that enable this knowledge to be extended. The knowledge-driven model assumes that basic research leads to applied research, to development, and finally to application of the results, and the problem-solving model starts with a problem that needs solving, in turn requiring research, the results of which lead to action being taken.
In the late s, the concept of use expanded to encompass at least three different types of meaning: With regard to evaluation of study results, Kirkhart 19 criticized the traditional concept of use as being unidirectional, episodic, intended, and instrumental. It failed to adequately describe types of impact deriving from sources other than the results of evaluation, or unintended results or gradual, incremental impact over time.
Kirkhart addressed issues such as the ways by which the results of an evaluation study are used, including an examination of the ways how and to what extent the evaluator participates, affects, supports, and proposes mechanisms that foster behavior changes in people and systems. This places new importance on the impact of evaluation itself, rather than on any immediate use of its output From this perspective, it is supposed to be easier to measure the extent of changes in a program or the views of strategic actors than in the use of study results.
In a similar approach, Rich 21 characterizes the use of research results in the following stages, viewed from a process perspective: Kirkhart thus proposes the development of an integrated theory of influence, enabling the impact of research or evaluation to be assessed, by replacing the category "use" with its more restricted meaning with "influence", defined as the "capacity or power of persons or things to produce effects on others by intangible or indirect means" 19 p. The integrated theory of influence rests on three dimensions: Source relates to the initial cause of a process of change.
Sources can arise either in the evaluation process process-based or the results results-based. The former are oriented towards increasing understanding among the actors, changing their sense of the values and developing new relationships, dialogues, and networks.
The categories used are: Evaluation of results is seen in terms of the more conventional categories of instrumental, conceptual, symbolic, and strategic influence. A second dimension of influence identified by Kirkhart 19 p. Lastly, influence is seen in terms of three categories of temporal dimension: Patton 22 identifies a typology of use that stresses processes rather than products: Meanwhile, Forss et al. Despite the extensive literature the majority of the studies have not been cited herethe state-of-the-art on the most effective and efficient knowledge transfer strategies is still in its infancy.
Use of research results and policy-making in health The authors' thinking and models are useful for understanding the various ways by which research results are used in policy-making. Even admitting to a specific rationality in each of these processes, the real world is not so linear: The search to find and accumulate evidence thus becomes the other important part of this equation.
These are basic political science categories. The formulation, implementation, and evaluation of social policies are heavily guided by the values and concepts of social realities shared by the leading actors in the various process levels, or by bureaucratic elites.
These values and concepts provide the "terms of the debate" on policies, delimiting and circumscribing the policy agenda at any given moment Meanwhile, the political, economic, and institutional context of the decision-making process shapes the range of available options and affects decision-makers' choices 25, i. Besides, the policy formulation process is completely different from the implementation process, so that a proposal for change rarely retains its original characteristics when implemented, because it alters the status quo and mobilizes actors to defend their interests.
Overall, the central category that emerges from such discussions is power, with its innumerable facets and dimensions. Each concrete case also involves different explanatory variables for policy change, and each variable implies that the research has played a specific role. Some variables are particularly important, as Brown points out on the basis of case studies in the United States. There is a certain consensus among authors concerning various barriers that hinder or prevent research from being used in the decision-making process.
However, little headway has been made on proposals to surmount these barriers; the question is whether simply surmounting them will solve the impasses or whether this approach although necessary is really sufficient to promote greater use of research in policy formulation and implementation.
Brown 14 argues that some variables are fundamental, although they should not be considered absolute. In addition, the degree to which research actually influences policy varies inversely with the complexity of the issue under study. The first health services research activity that he identifies with an important influence on policy formulation and implementation and which is not exactly research, but relates to it is documentation: In addition, compiling statistical data allows establishing temporal and spatial correlations.
However, Brown cautions that quantitative and qualitative databases and statistical indicators cannot be considered research results per se, but are the raw material on which research is shaped and without which it cannot be conducted.
He also emphasizes that "documentation is not always a step toward action; sometimes it stultifies it" 14 p. When the right predisposition or political and material conditions exist, information can become a powerful weapon to spur the shift from political rhetoric to concrete action.
However, information alone cannot create such a predisposition. Likewise, Bardach 27 states that policy analysis theory proposes that evidence is information that affects existing beliefs by important persons about significant features of the problem under study and how it might be solved or mitigated. A second role of health service research in policy design, according to Brown 14, is analytical, i.
In a conflictive reform context, research that raises doubts about the omnipresent list of alternatives for government intervention can prompt policy-makers to take action. Yet it also is a two-edged sword, since it can call attention to aspects unforeseen by policymakers and thus discredit both the policy as formulated and the proposed alternatives. A major challenge to contextualizing evidence for policymaking is recognition that a broad information base is required [and] considering the evidence within the context in which it will be used is critical for effective policymaking and practice".
A final role that Brown highlights for health systems and services research is prescription. The political force of empirical evaluation and analytical constructs resides in the "scientific" character they lend to reform proposals, reinforcing decision-makers' prior positions.
Research can thus play a variety of roles in policy. The task of prescription differs greatly from those of documentation and analysis: On the other hand, more narrowly focused studies, directed exclusively to problem-solving, have no broader implications and do not contribute to the build-up of knowledge achieved by pursuing a line of research that lasts over time.
Prescription requires understanding not just how and why actors and institutions behave as they do under given conditions, but also and more importantly how such behavior can be altered under new conditions; and here not even the most complete documentation or analysis is enough to ensure any result. In addition, in order to "prescribe" solutions, researchers would have to shed their academic guise and explore avenues not entirely authorized by their theoretical and methodological frameworks, thus running the risk of being discredited by actual developments.
Seen thus, health systems and services research has been very erratic as a prescriptive guide and, in the endeavor, has tended to deviate from the field of research and to confuse it with others, such as technocratic and planning activities. In practice, however, these fields are very different and operate with distinct conceptual universes. In summary, Brown 14 regards research as most valuable to policy in supporting the documentation that describes the system; most erratic in analyzing how policy functions and explaining what works, and how and why; and considerably limited in its prescriptive capacity.
Thus, the potential contribution of research to the decision-making process has less to do with offering definitive solutions to the problematic issues in debate and more with improving the quality of the terms of the debate.
Thus, the ability to change the nature of public debate on a given issue is an important form of power, because bringing ideas, proposals, and interests into confrontation is an important force in changing the balance of power among the various contesting groups. Other authors, like Weiss 17 and Majone 28, reinforce this argument.
The contradiction here is that as the research field becomes more developed and promising, the range of results, explanations, arguments, and recommendations tends to expand, and the field may thus appear more "chaotic" to decision-makers. In other words, an active, highly-skilled scientific community in the health systems and services research field, closely attuned to institutional niches in the state apparatus and civil society and with a secure place in the decision-making arena such as the "policy networks" 29,30 or the "epistemic communities" 31,32 is certain to foster better debate, but not necessarily better policy results.
Also distant from the "rational" approach and closer to Brown and Walt, some authors recognize an "incremental" dimension to the use of knowledge 26,33,34, placing new importance on the complexity of the decision-making process; this dimension identifies conditioning factors complementary to scientific knowledge, such as interests, values, established institutional positions, and personal ambitions.
This view includes a political and institutional approach to the decision-making process, where identifying and characterizing the actors and interrelations is a key dimension to understanding the process and the use of research results in a framework of political negotiation, rather than restricted to criteria sustained by scientific evidence.
Interaction between researchers and decision-makers as an explanatory dimension conditioning the use of research results Interrelations between researchers and decision-makers have been considered a prime factor in analyzing knowledge transfer processes. Analysis of the weaves or models of interrelations between researchers and decision-makers is relevant when one realizes that the use of scientific knowledge depends largely on certain characteristics of the actors researchers' behavior and de-cision-makers' receptiveness.
Various authors ha- ve examined and promoted different ways of improving interrelations between researchers and decision-makers, such as collaborative or "allied research" 35, or constructivist approaches to evaluative research 36, including strategies to improve the knowledge output for decision-making. This approach fosters a political and institutional analysis of relations between actors and organizations in the interconnections between research and policy formulation and implementation processes as a conditioning or independent variable in the use of knowledge or its impact on decision-making processes dependent variable.
Their conceptual framework for such interactions is based on Rich 21, viewing possible opportunities for contact at the following research stages: As already mentioned, use is characterized by dimensions in which several stages play out from a process perspective, summarized as receiving and reading; information processing; and application. Viewed in a less linear light, interaction could be defined as a number of "disordered interactions" that take place between researchers and users, more than a sequence starting with the needs of researchers or decision-makers.
Lomas 38 has built on this literature and used the term "push and pull" to describe specific potential actions to promote knowledge transfer. Push strategies involve transforming the message according to the needs of specific audiences. This represents a departure from "one-size-fits-all" dissemination strategies. Pull strategies include efforts to build capacity at the user end, such as workshops to explain how to access information and evaluate its scientific rigor.
Meanwhile, Lomas 39, Lavis et al. Such activities include providing opportunities for researchers and users to jointly define the research question, maintain contact during the research process, and following completion discuss findings and the potential implications for policy and practice. In their study of Canadian policy-makers, Landry et al.
They found that scholarly research was as likely to be used as applied research, and that highly theoretical qualitative research was slightly less likely to be used than quantitative studies. Their conclusions can be summarized as follows: Looking at the knowledge production and decision-making processes suggests several points where contact between these two dimensions and logics could be useful.
The identification and analysis of these points of contact or interfaces charts another process: They call these contacts "moments of opportunity", since the actors in one process learn from or contribute to those in the other.
They also emphasize that the main challenge for applying research results to policy is to learn to create or recognize such moments of opportunity, and then to act effectively to take advantage of them. Starting with the left side of a conceptual figure and moving counter-clockwise, the research process includes the stages of idea generation, design, data gathering, analysis, and application an interrelationship represented by arrows.
Following the arrows, the research results can lead to new ideas and research projects, or may also be applied.
The policy process is similarly represented, starting on the left side of the conceptual figure and moving clockwise. When the needs or problems that arise can be addressed on the basis of specific policies, there is an endeavor to gather information on them from a variety of sources.
Interest groups may lobby at various moments and thereby influence definition of priorities among the needs, decisions, or policies. As in the previous process, some arrows return to the information-gathering stage, before policy is designed. Some decisions generate a search for additional information and further negotiations, while others produce policies. New policies can also lead to new interest groups and new political challenges.
Other authors 44 formulate concepts similar to the "moments of opportunity", containing the idea that knowledge can be useful in generating chan-ge only when a "window of opportunity" appears. It is important that analysis examines the actors in the process and evaluates the sources of information they trust, the type of information that interests them, how they evaluate information, what motivates them to make decisions, and the actors with whom they interact, compete, and form alliances.
In their figure, two larger intersecting circles represent civil society and the state.
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Other smaller circles represent the interest groups' real or potential impact on policies. Researchers are one such group. Also shown graphically are the mutual influences between interest groups and decision-makers. Public policies the focus of their study are formulated by public decision-makers and thus stand at the intersection between state and civil society.
Actors are located in one sphere or another, or at their intersections. Other studies propose a variant on stakeholder analysis, featuring researchers as a group with the ability to intervene in the decision-making process 46 and in the policy formulation process directly or through other key stakeholders over whom they have influence. This interpretation sees the decision-making process as susceptible to influence not only from the knowledge generated by research, but also from the research process itself.
This notion allows analyzing the influence of the knowledge produced separately from the influence of the process by which such knowledge is produced. Similarly, the position to be taken towards the problem at hand cannot be interpreted separately from the context and stakeholder analysis.