The current paper outlines the KT activities of the Access 3 project, which were specifically designed to inform NSW youth health policy. We believe the design of this translation activity represents a step forward in Australian youth health policy-making, as it brought together a range of different perspectives including those of young people, academics, health workers and policy-makers to develop policy recommendations using a strong evidence base on youth health issues and a theoretically derived KT framework. Formal KT processes have not been “built into” the development of prior youth health policies in NSW, and we feel the methods described here provide a strong platform for future efforts to support evidence-informed policy-making in this arena.
Specifically, the KT forum led to the development of six policy themes of areas for policy action with 25 specific policy recommendations proffered. Participant satisfaction with the KT forum was high and, importantly, the policy recommendations from the workshops can be evidenced within the subsequent NSW Youth Health Framework . These results speak strongly to the success of building considered approaches to policy development and KT.
There are several aspects of the KT forum that likely contributed to this success. Central to these is the utilization of the KT frameworks of Lavis et al. and Grimshaw et al. [6, 7]. These frameworks provided structure to the planning, execution and evaluation of the KT forum including the specific workshop activities and the knowledge dissemination strategies utilized. We therefore focus subsequent discussion around the key questions posed within these frameworks.
What should be transferred?
Effective KT requires quality evidence [6, 7]. Whilst researchers and research organizations, field experts, clinicians, consumers, peak bodies and government bodies are often good sources of information, the evidence they provide is not always fit for direct policy translation [5, 6, 32]. The best evidence to support policy changes comes from pooled research knowledge in the form of systematic reviews or from research studies that are sufficiently large and targeted at specific policy questions [5,6,7,8]. The relevance and timeliness of evidence are particularly important influences on knowledge uptake [8, 33]. Presenting evidence in the form of “ideas” rather than research data also improves the likelihood of translation, particularly when working with diverse groups and nonacademic audiences .
In relation to the Access 3 project, the evidence established through activities 1 to 3 is of high quality and relevance, as the activities were designed specifically for answering policy questions relevant to youth health [24, 25]. The demand-driven nature of the tendering process for the Access 3 work meant that this knowledge was sought after by the policy-makers and developed in a timely manner with policy-makers involved in the planning, execution and translation aspects of the project. Also, the translation forum allowed the research team to present the findings from activities 1 to 3 in the form of “research themes” or “ideas” and to transform these into actionable policy recommendations that were broadly aligned with the remit of NSW Health.
To whom should research knowledge be transferred?
The target audience for KT activities must be clearly identified to ensure success [6, 7]. Having a well-defined target group allows knowledge translators to better understand the types of decisions and decision-making environments that exist for the particular target, which in turn allows for the tailoring of KT strategies . For the current activity, the target audience was defined as policy-makers from the NSW Ministry of Health. The goal of the KT workshop was for these policy-makers to be aware of and utilize the findings and policy recommendations from the Access 3 KT forum to inform policy development for the NSW Youth Health Framework . Consideration of the political and organizational constraints that face NSW Health policy-makers was built into the planning, execution and evaluation of the KT activities.
A key aspect of this approach was gaining an understanding of the NSW policy-making environment and the factors that influenced decision-making processes within it. Working with policy-makers throughout the research and KT process helped build this collaborative partnership. Importantly, the Access 3 research and KT forum sat in the context of the broader relationship with the policy-makers, where researchers sat on a policy development reference group and gave comments on the policy and separately presented the research findings to policy committees.
By whom should research knowledge be transferred?
Effective KT requires a credible messenger to deliver evidence to target audiences [6,7,8]. Individuals (e.g. health professionals, researchers or consumers), groups, organizations and the healthcare system can all act as messengers for KT activities focused at policy-makers . Whilst building credibility with this target audience may be difficult and/or time-consuming, it is an important aspect for effective KT [6, 7].
Throughout the KT process, the members of the Access 3 team took on the role of knowledge brokers [7, 8, 32, 34, 35] working as intermediaries to build important connections between evidence suppliers (i.e. researchers, clinicians and young people) and evidence users (i.e. policy-makers). This process featured iterative and bidirectional communication between stakeholders and policy-makers to promote trust and greater understanding .
The KT activity utilized a broad stakeholder collaborative to deliver our message to the NSW Ministry of Health. We utilized the voices of expert clinicians and impartial researchers, as they are shown to be authoritative messengers for the development of evidence-informed health policy [6, 8]. We also included policy-makers in the KT forum and research processes to ensure that the collaborative had a sound understanding of the policy process and the context surrounding NSW Health policy agendas. We also made sure to actively include young people in the policy development process (as well as throughout the entire Access 3 project).
To date, efforts to include young people in the development of policy remains variable across settings and portfolios, with inclusion influenced by a range of political and ideological factors . Furthermore, when young people have been involved in the development of policy, this has often been limited to participating in rigidly structured consultations that have featured top-down approaches to policy development [36, 37]. Such efforts have been labelled “tokenistic” in their approach .
To counter this, we prioritized the active inclusion of young people in the formulation of specific policy recommendations for the youth health policy. The Access 3 project team shared a commitment to sustained and continuous youth engagement and encouraged KT stakeholders and their organizations (including the NSW Ministry of Health) to also value this engagement. Embedding such values throughout the KT process was considered an important design principle for building effective stakeholder engagement .
How should research knowledge be transferred?
A key explanation for the research–policy gap is the disparate and asynchronous responsibilities, priorities and processes that exist within the domains of research and policy [6,7,8, 10, 15, 35]. Research is typically investigator-driven and usually proceeds in a steady, methodical and linear fashion, with publication of research findings often prioritized over translation efforts . In contrast, policy is often developed in a fast-paced, unpredictable environment that involves a raft of competing demands, priorities and stakeholders [6,7,8, 15]. Whilst policy is applied by nature, policy decisions may be influenced more by opinion and political ideals rather than unbiased empirical evidence. Developing evidence-informed health policy thus requires strong and deep collaborations between researchers and policy-makers [7, 15, 35]. Researchers are required to develop relevant, timely and helpful evidence that can be effectively translated into policy. Policy-makers must appraise available evidence, navigate entrenched political and economic interests, and balance these alongside the social acceptability of the policy they are tasked to deliver .
There is a growing evidence base to guide choice of KT strategies aimed at policy-makers . Specific factors that facilitate research uptake include interactive engagement between researchers and policy-makers, and improved relationships and skills [8, 32]. KT is thus most effective when it starts early, builds support through champions and brokers, understands contextual factors, and is timely, relevant and accessible . For the current activity, we utilized workshops involving a variety of stakeholders and built deep relationships over a period of time to provide formulated recommendations to government through an established pathway. The partnerships built between investigators, forum participants and NSW Health underpinned the strength of this translation approach.
With what effect should knowledge be transferred?
When considering KT, it is important to determine how it is hoped that research knowledge will be used . In a health setting, this may be getting a clinician to change their behaviour in the face of research evidence whereas, in a policy setting, the goal may be less concrete and may simply be to inform debate, especially given competing organizational and political factors [6, 7]. For the current activity, the overarching goal was to develop implementable policy recommendations that could be provided to the NSW Ministry of Health for consideration for inclusion in the youth health framework . The fact that the research themes and recommendations provided to the ministry could be mapped onto policy items within the framework suggests that this approach was effective.
Strengths and limitations
The KT activity presented here featured both strengths and limitations. A key strength is that NSW Health commissioned the Access 3 project and KT forum, which likely had an impact on policy-maker buy-in. Demand-driven research is known to be more effectively translated [6, 7, 15, 35], and it is probable that engaging policy-makers would be more difficult when this is not the case. We believe that the KT frameworks and approaches outlined in this paper assisted the development of strong relationships and provide a strong model for collaboration between researchers and government that aligns with the WHO strategy on health policy and systems research .
A limitation of our approach is that it is difficult to obtain an objective metric of KT success. Whilst document analysis allowed the authors to map policy recommendations onto the NSW Youth Health Framework , this approach may be considered subjective and hence may over- or underestimate the impact of KT efforts. Whilst we acknowledge this limitation, the positive evaluation we received from policy-makers engaged in the workshop suggests that our approaches were indeed impactful.
Second, whilst the forum led to implementable policy recommendations, there were some recommendations that fell outside of the scope of NSW Health policy. Specifically, these recommendations were related to federally administered Medicare structures that can shape the role and function of general practitioners. Importantly, this issue was highlighted and discussed at the KT forum. It was underlined that there was an audience for these kinds of recommendations beyond the NSW Youth Health Framework. We believe that KT never ends in a closed system and that changes in one part of the overall health system will inevitably have flow-on effects throughout the health system. Future work could look at how the development of the NSW Youth Health Framework influenced and impacted the later development of policies across Australia at both a state and federal level.
Third, the required setup and timing of the forum meant some concessions had to be made. For example, the timing of the forum was due to policy-makers’ needs and not the researchers, and thus required the presentation of preliminary rather than final research results. Nevertheless, the final findings of the research matched the themes presented at the KT forum, which suggests that the impacts of timing were minimal in this case. Overall, we believe that the approaches used were appropriate and led to strong levels of engagement from stakeholders and robust recommendations for policy.
Finally, the current activity stopped short of analysing the underlying contexts, mechanisms or practices that led to policy translation or examining the actual implementation of policy recommendations that made their way into the NSW Health framework. This was considered beyond the scope of the Access 3 project and KT process. Measuring the pathways and success of knowledge transfer beyond decision-making in the health policy realm is difficult, as the routes from which research-informed decisions translate into actual social, economic or health outcomes are complex . Nevertheless, we recommend and would welcome future investigation focused on the implementation of youth health policies.
In summary, we believe that the utilization of KT theories and youth inclusion led to the successful transfer of evidence-based knowledge from the Access 3 project into NSW Health policy. We would therefore encourage researchers from abroad to consider such approaches for the development of youth health policy within their respective states and countries. By actively engaging young people and utilizing theoretically supported KT frameworks, we can build more inclusive and appropriate health policies that promote the health of our younger generations. Within NSW, there is now a clear opportunity to examine the implementation of policy recommendations . By conducting this research, we may better understand the contexts, mechanisms and outcomes surrounding policy implementation in the youth health space, which will provide a clearer picture of how evidence is translated into subsequent action.