‘Maybe we can turn the tide’: an explanatory mixed-methods study to understand how knowledge brokers mobilise health evidence in low- and middle-income countries

Abstract

Background: Little is known about how knowledge brokers (KBs) operate in low- and middle-income countries (LMICs) to translate evidence for health policy and practice. These intermediaries facilitate relationships between evidence producers and users to address public health issues.<br />Aims and objectives: To increase understanding, a mixed-methods study collected data from KBs who had acted on evidence from the 2015 Global Maternal Newborn Health Conference in Mexico.<br />Methods: Of the 1000 in-person participants, 252 plus 72 online participants (n=324) from 56 countries completed an online survey, and 20 participants from 15 countries were interviewed. Thematic analysis and application of knowledge translation (KT) theory explored factors influencing KB actions leading to evidence uptake. Descriptive statistics of respondent characteristics were used for cross-case comparison.Findings: Results suggest factors supporting the KB role in evidence uptake, which include active relationships with evidence users through embedded KB roles, targeted and tailored evidence communication to fit the context, user receptiveness to evidence from a similar country setting, adaptability in the KB role, and action orientation of KBs.<br />Discussion and conclusions: Initiatives to increase evidence uptake in LMICs should work to establish supportive structures for embedded KT, identify processes for ongoing cross-country learning, and strengthen KBs already showing effectiveness in their roles.<br /><br />key messages<br /><br /><ol><li>Little is known about how knowledge brokers mobilise evidence in low- and middle-income countries.</li><br /><li>A multi-country study of knowledge brokers identified promising practices for evidence uptake.</li><br /><li>Embedded brokers who adapted messaging and evidence to context in active relationships worked well.</li><br /><li>Capacity building should use KB promising practices and facilitate multi-country evidence exchange.</li></ol>

Midwives’ integration of post abortion manual vacuum aspiration in the Democratic Republic of Congo: a mixed methods case study & positive deviance assessment

“…Figure 3 represents a proposed framework explaining how positive deviants challenged professional boundaries, integrated MVA and increased the trust of their medical peers. Knowledge brokers in similar contexts to the DRC have been shown to successfully disseminate information based on their ability to actively seek opportunities to demonstrate evidence-based practice, network and build relationships, and adapt to the immediate context [54]. Like knowledge brokers, positive deviants were driven by their internal motivation and beliefs of midwifery and sexual and reproductive rights.…”

Co-production and arts-informed inquiry as creative power for knowledge mobilisation

“…nature to 'what works, for whom, in what circumstances, and how?' Researchers and evaluators have increasingly adopted this perspective in analysing social systems (for example, Sherriff et al, 2019;Norton et al, 2021), with its influence surfacing, for instance, in debates about evidence-based versus evidence-informed policy and practice (Culyer and Lomas, 2006). Realism respects that knowledge is always partial and conditional, and emphasises the mechanics of explanation in developing sensible lessons about social systems that can travel between settings (Pawson and Tilley, 1997).…”

New evidence and policy research, well-established themes

“…• clarifying the role of key actors, such as by categorising different 'epistemic communities' and identifying the multiple types of required knowledge brokerage to help those communities interact (Waring et al, 2021); • making sure that knowledge brokers maintain close and frequent contact with research producers and users, such as by being 'embedded' in practice, which allows them to tailor evidence to context and influence practitioner receptiveness to research (Norton et al, 2021); • providing a realistic assessment of academic-practitioner partnerships, identifying not only their value but also the factors that cause their 'fragility' (Bacon et al, 2021); • using general insights from 'systems thinking' and specific models (such as 'collaborative conceptual modelling') to help 'translate' insights between participants (Neely et al, 2021).…”

“…Knowledge brokerage is difficult because it requires many strategies and skills that may not yet be possessed by single actors (Waring et al, 2021). Although we can identify some good practice and success, there is a major lack of a supportive structure for routine knowledge brokering (Norton et al, 2021). Partnerships between academics and practitioners are possible, but different cultures and uncertainty about funding always cause them to be fragile (Bacon et al, 2021).…”

“…• how knowledge brokers can help facilitate the use of knowledge in policy and practice (Waring et al, 2021); • how knowledge brokers operate in low-and middle-income countries (LMICs), in a context where global north countries tend to dominate evidence, theories and frameworks (Norton et al, 2021); • how academic-practitioner partnerships can be maintained and expanded (Bacon et al, 2021); • how to solve the 'transdisciplinary problems' that arise when researchers and practitioners collaborate to address 'wicked' policy problems (Neely et al, 2021).…”