• Research translation: Journals are not sufficient

    Bill Gardner continues the conversation about translating health policy-relevant research for decision makers with a call for more journals dedicated to that mission.

    One thing would help is more journals that bridged the academy / policy gap. There are LOTS of journals. But there are few that edit for policy relevance and a broad audience while striving for a non-partisan, evidence-based approach. The paradigm cases are Foreign Affairs and Health Affairs, which may tell us that we need editors like Susan Dentzer or Fareed Zakaria with experience in journalism. I think these journals help in two ways. On the one hand, they give researchers a target journal to write for. They provide us with models of prose that has been cleaned of academic clutter. On the other hand, they provide journalists and policy makers with a filter, a table of contents and a twitter feed that is worth scanning.

    Journals such as Health Affairs and Foreign Affairs don’t just (potentially) serve the needs of journalists and policy makers. They also provide a medium by which researchers can simultaneously address those audiences and, crucially, get professional credit for doing so.

    However, as Bill acknowledges, there is a role for more personal communication media.

    Having said that, I am totally for “the more high-touch approaches of implementation science.” The revolution in social media is making it easier for a health quant on the Canadian coastline to converse with a journalist in Washington or a foundation president in Palo Alto.

    Kristin Rosengren also emphasized how personal connections facilitate translation. Journal articles often fail in this regard. They tend to be written in impersonal tones and are often cautious in drawing clear policy conclusions. Moreover, a specific journal is the voice of many authors. The brand is the journal not the researcher. That doesn’t help in fostering the personal connections that seem to be the conduits for most information flows. Finally, the timing of journal article publication is out of sync with the policy debate.

    The key step in successful translation is for researchers to reach those who can amplify their message and move it into the sphere occupied by policymakers. As Bill pointed out in an earlier post, the next rung above researchers in translation ladder is occupied by journalists and policy experts. To reach them, researchers need to repackage policy-relevant research findings in a way that is fast (rapidly responding to the debate), accessible, knowledgeable, relevant, credible, and personal (see chart below). What can fill this role?

    Blogs can. Journals, due reasons explained above, largely cannot. Yet, they are the raw material, so are important. They also provide more depth than blogs and, as of now, are the main dissemination route by researchers that confers professional credit.

    Journal articles often mistime the issues, though. That’s not their fault. It’s baked in the cake. It just takes too long to prepare manuscripts for publication. The policy debate changes at a pace on the order of hours or days. It takes weeks to months to put together a journal issue (years, in some cases, if you include the time to review and revise manuscripts). Blogs can help here, by resurrecting journal content just when it is needed. This is illustrated in the chart below. Time runs from left to right. The rainbow of colors at the top illustrate the different research products and publications pumped out by the academic sphere. Each color can be thought of as a different publication on a different issue.

    The differently ordered rainbow of colors at the bottom are the issues as they arise in the policy debate. Notice the timing mismatch between the policy debate and research products and publications (reflected by the fact that the colors are in a different order). It is due to this timing mismatch that press releases, which are issued at the time of publication, often miss the mark.

    However, a blog can bring to light prior journal publications just when they are relevant. (Twitter can do this too, but much more tersely, which is sometimes a strength, sometimes not.) That’s what the arrows in the chart above show, the repackaging and resurrecting by blogs of the content of prior publications for more immediate consumption.

    The research community has a vast store of published material relevant to policy issues. Only a minuscule fraction of it is noticed by the news media.  That material is in Health Affairs, but also Health Services Research, Health Economics, The New England Journal of Medicine, JAMA, and many other journals. What’s crucially needed is to make the content of those journals accessible and at the right time. Adding more journals to the mix is not likely to harm things, but it is woefully insufficient in helping bridge the divide.

    • Austin
      At first glance, to some, this might seem like a below the radar subject. Its vital however.

      You raise great points, yet, I must ask: what is the TIE brand?

      Look at your header. How does it communicate anything translationally related? Its pure wonk.

      Your sentence, “The brand is the journal not the researcher,” really popped. As a devoted reader, wishing I had your reach, I still am not sure of your mission.

      Who are you speaking to, and who is audience? You might say everyone, My take is other bloggers and those in the policy realm. If you want your reach and message to change, so must the strategy of the blog.

      Function follows form.

      I post this collegially and to engage. Please take in a wholehearted, cooperative spirit.


      • TIE’s mission is to communicate to journalists and policy experts the knowledge from health services research, health economics, and health law. Our principal source is the body of published material from those communities.

        Based on the feedback from those who we try to reach, as well as some metrics, we seem to be successful. That does not mean we can’t be better (though there are constraints). Feedback is always welcome.

      • Here’s one definition of the TIE brand: “Delivering the body of research to the arenas of health policy and policy reporting.” To fulfill this implies all the things in the post: fast, accessible, knowledgeable, relevant, credible, and personal. As bloggers, we strive to be these things, at least relative to journal articles. With how many journal article authors could you have this very exchange, in public, within hours of publication? Blogs are different and they are under-exploited for research dissemination.

    • No matter what communication strategy you use, you will be trying to influence people who are biased but, hopefully, not close-minded. Some will be biased in favor of what the research seems to recommend, some against but no matter which party is in power at the time, you will probably need to influence some of the against people.

      The question then becomes can the field produce evidence that is sufficiently clear and compelling to influence people whose natural biases push in the opposite direction? Here are some of the challenges.

      As you note, timing is important since it is hard to persuade people of to a question they’ve asked and answered or haven’t asked. It is not just the weeks to months it takes to get something published, but the much longer time it takes to do the research. The challenge is to anticipate a question that will be asked years from now. The time frame for Representative Ryan’s Medicare proposal may create that opportunity as long as the answers to the questions it raised aren’t locked in legislatively long before the research can be completed. As a researcher, how long would it take you, if you had the funds, to complete research that had the potential to provide compelling new evidence on some of the questions that proposal raises?

      Then there is the challenge of convincing people that research should be given more weight than anecdotal evidence that, on an emotional level, is vastly more compelling.. Consider the example someone gave me years ago of a person who looks at the evidence saying car A has is twice as likely to need major repairs within 3 years as car B but has a neighbor who is constantly cursing
      car B for breaking down. Look at the comments about having a panel decide which procedure to use versus leaving the decision to the individual doctor in the comments section of a blog about debt reduction.

      The media tends that use the phrase “experts say” without saying how many experts they’ve talked to or appearing to have a clue how many experts there might be in a particular field. When there really is a consensus, or near consensus, among experts, it would be nice to have evidence to show that. Evidence of consensus might not be compelling to researchers who focus on the actual evidence, but would be compelling to at least some policy makers.

    • I am always disappointed at how few people knowledgable about health care policy write about it in this accessible medium. Health care takes up 17% of our economy and is THE driver of future debt, yet few bother to read an write about it. Listen to the political debates and try to convince yourself that politicians have made a real effort to learn health care issues. Maybe if there were more reliable sources, it might get through to them.