Professor David Wright is based at the University of Leicester as Professor of Health Services Research. He is an experienced researcher and was the Professor of Pharmacy Practice at the University of East Anglia. Professor Wright provides his thoughts on how applicants need to re-think their approach to dissemination and consider the wider impact of the research proposed.
One of the last sections in most grant applications is ‘Dissemination strategy’ where you have traditionally been expected to outline your plans for external transference of the anticipated knowledge you intend to gain. It is one of those annoying boxes which you need to complete to ensure that the funder is reassured that you have at least thought about sharing your knowledge and promise to do so. It is often ‘annoying’ because by the time you have got to it, you have completed your background and research plan, with little energy remaining for this and the other boxes which require completion at this stage.
My traditional approach to completing the ‘Dissemination strategy’ box was to state the journals and conferences I planned to submit to and a promise to deliver a local dissemination event. For many years this strategy worked perfectly well, until I noticed that was starting to get criticised by reviewers with questions regarding how I plan to effectively transfer this new knowledge into practice. My response to state that I would ‘create a toolkit at the end of the project’ was also apparently wrong if provided as an afterthought at the end.
On reflection however, I now realise that my dissemination strategy is apparently no more effective than sending a ‘message in a bottle’ and that this is because the title for the section is misleading and its location at the end of the application is sending out the wrong message.
Responding to stage one feedback from an NIHR application resulted in me being forced to read Trisha Greenhalgh’s excellent book on ‘How to implement evidence based healthcare’. This was my first epiphany moment. Telling people what you have learned and how they should therefore now do it themselves is apparently completely ineffectual. No one likes having to accept someone else’s idea, as we always believe we can do it better and want to be able to create our own solutions. Sending the ‘new knowledge’ which I have created to third parties and expecting them to just to integrate it into their practice was incredibly naïve and completely non-understanding of human nature.
Consequently, if I wanted my new knowledge to be implemented, then I needed to create a strategy, preferentially underpinned by theory. The ‘Knowledge to Action framework’ is the implementation framework most commonly cited and similar to others that are available make it clear that along with your new knowledge you need to separate the central elements which can’t be altered from those which can be adapted locally for the recipient. A strategy to implement including recommendations for small scale initial implementation and testing and guidance on how to monitor, evaluate and revise accordingly are required to enable the recipient to modify and enhance the solution for local use.
When collating your new knowledge within the planned research process it is therefore necessary to identify those elements which have to remain, those which can be adapted and how implementation can be monitored locally in an efficient manner. The elements of the final toolkit are then created in a planned manner throughout the research process and are not just left to the end (as I had tried to get away with in one application).
A second project, where I developed an implementation toolkit, providing a variety of options to recipients, subsequently failed to be implemented and made me realise that unless the idea was firstly ‘adopted’ at all levels it was unlikely to be implemented. It was clear that if senior managers and owners did not buy into or ‘adopt’ the concept, then those on the ground ‘the implementers’ would find many other activities to undertake rather than working with my toolkit. Consequently, any dissemination strategy also needs to consider the process of ‘adoption’. Whilst there are theories to underpin the process of adoption, to date I have taken a pragmatic approach to this element. It is firstly about identifying the eventual target audiences and then integrating them into the research process either as part of a research advisory panel or steering committee. This is to ensure that the research and eventual messages associated with the findings are appropriately tailored. Having commissioners and patients on the inside from the outset should, in addition to enhancing the research process, enable you to develop an effective adoption strategy i.e. process for optimising their buy in to the final message.
Having then considered that I need plans for adoption and implementation, I realised that this is not about dissemination anymore (which suggests a one-way transfer of knowledge) but ‘impact’. Funders and employers have become increasingly focussed on ‘impact’ as this provides better value for money and in the case of HEIs is now has large carrots associated with it. It is no longer sufficient to demonstrate that you can create new knowledge and publish great papers but that this knowledge is going to be put to good use, and sooner rather than later.
Publishing in research journals means that the knowledge is never seen or found unless someone is looking for it. Presenting at conferences provides a target audience of other academics or practitioners, very few of whom will want to adopt and implement your new knowledge themselves. Furthermore, if the knowledge is not tailored for the anticipated audience, it will have no effect. Presenting results at local dissemination events will mean that your idea is unlikely to travel outside of your local geography.
So, if funders are interested in ‘Impact’ and not just ‘Dissemination’ then this must be clearly signposted as the actual assessment criteria. Furthermore, if they want researchers to create impact, then it should be central to the research plan where target audiences are identified and integrated into the team at the outset, plans for tailoring messages made clear throughout along with the development of any toolkit or documents to support implementation. The impact strategy should not be a separate box for completion at the end, in the same way that funders are moving to expect plans for patient and public involvement to be integrated into research plans.
Never again will applicants like myself then be planning to send their ‘messages in a bottle’ with limited control over when and where they land and whether the recipient will actually be interested in or able to read the contents of the bottle when they open it.