A systematic review of barriers to and facilitators of the use of evidence by policymakers

Kathryn Oliver 0 Simon Innvar Theo Lorenc Jenny Woodman James Thomas 0 School of Social Sciences, University of Manchester , Bridgeford Street, M13 9PL Manchester , UK Background: The gap between research and practice or policy is often described as a problem. To identify new barriers of and facilitators to the use of evidence by policymakers, and assess the state of research in this area, we updated a systematic review. Methods: Systematic review. We searched online databases including Medline, Embase, SocSci Abstracts, CDS, DARE, Psychlit, Cochrane Library, NHSEED, HTA, PAIS, IBSS (Search dates: July 2000 - September 2012). Studies were included if they were primary research or systematic reviews about factors affecting the use of evidence in policy. Studies were coded to extract data on methods, topic, focus, results and population. Results: 145 new studies were identified, of which over half were published after 2010. Thirteen systematic reviews were included. Compared with the original review, a much wider range of policy topics was found. Although still primarily in the health field, studies were also drawn from criminal justice, traffic policy, drug policy, and partnership working. The most frequently reported barriers to evidence uptake were poor access to good quality relevant research, and lack of timely research output. The most frequently reported facilitators were collaboration between researchers and policymakers, and improved relationships and skills. There is an increasing amount of research into new models of knowledge transfer, and evaluations of interventions such as knowledge brokerage. Conclusions: Timely access to good quality and relevant research evidence, collaborations with policymakers and relationship- and skills-building with policymakers are reported to be the most important factors in influencing the use of evidence. Although investigations into the use of evidence have spread beyond the health field and into more countries, the main barriers and facilitators remained the same as in the earlier review. Few studies provide clear definitions of policy, evidence or policymaker. Nor are empirical data about policy processes or implementation of policy widely available. It is therefore difficult to describe the role of evidence and other factors influencing policy. Future research and policy priorities should aim to illuminate these concepts and processes, target the factors identified in this review, and consider new methods of overcoming the barriers described. - Background Despite an increasing body of research on the uptake and impact of research on policy, and encouragement for policymaking to be evidence-informed [1], research often struggles to identify a policy audience. The research-policy gap is the subject of much commentary and research activity [2-4]. Interventions to bridge this gap are the focus of recent systematic reviews [5-7]. To ensure these interventions are appropriately designed and effective, it is important that they address genuine barriers to research uptake, and utilise facilitators which are likely to affect research uptake. It is now well recognized that policy is determined as much by the decision-making context (and other influences) as by research evidence [8,9]. Policymakers perceptions form an important part of this story, but not the whole. Innvaer [10] aimed to review studies about the health sector, but the influence of the evidence-based policy movement is now recognized to be important across many policy areas. In the UK, with the creation of Clinical Commissioning Groups, Health and Well-Being Boards, and private providers moving into areas traditionally occupied by the NHS, a broader range of policymakers are becoming potential evidence-users than ever. Researchers need to take stock of what we know about evidence-based policy, what we dont know, and what can be done to assist these users. The last systematic review looking at policymakers perceptions about the barriers to, and facilitators of research use was Innvaer [10]. The findings from this review were corroborated by later research [11,12], but no systematic update has yet been undertaken. In addition to updating this review in the area of policymakers perceptions of barriers and facilitators to use of evidence in policy, we also wished to include perceptions from other stakeholder groups than policymakers, such as researchers, managers, and other research users. Furthermore, it may be possible to identify factors affecting research use without relying on the perceptions of research participants for example, ethnographic studies may produce observational data about knowledge exchange. In addition, we acknowledge that interest in using evidence to inform policy has spread beyond the health sector. Therefore, we aimed to update Innvaer [10] to include studies identifying all barriers and facilitators of the use of evidence in all policy fields. This review aimed to update and expand Innvaer [10], and broaden the scope of the review to: Identify factors which act as barriers to and facilitators of the use of evidence in public policy, including factors perceived by different stakeholder groups. Describe the focus, methods, populations, and findings of the new evidence in this area. Because this review has a larger scope that Innvaer [10], caution must be used in drawing direct comparisons; discussed further in the results. Methods A protocol for the review was developed and sent to an advisory group of senior academics (available from KO) in order to ensure that the methods and search strategies were exhaustive. To be included, studies had to be: Primary research (any study design) or systematic reviews categorising, describing or explaining how evidence is used in policymaking. Intervention studies were included. About policy (defined as decisions made by a state organisation, or a group of state organisations, at a national, regional or conurbation level). Studies of clinical decision-making for individual patients, or protocols for single clinical sites were excluded. About barriers or facilitators to the use of evidence (relational, organisational, factors related to researchers, policymakers, policy or research directly, or others). We did not exclude any studies on the basis of population. These criteria are therefore broader than those for Innvaer [10] by including all study designs, all populations and all policy areas. The following electronic databases were searched using adapted search strings from Innvaer [10] from July 2000 (the cut-off point for the earlier review) - September 2012: Medline, Embase, SocSci Abstracts, CDS, DARE, Psychlit, Cochrane Library, NHSEED, HTA, PAIS, IBSS. Searches combined policy terms with utilisation/use terms in the first instance. The full search strategy is available from the corresponding author on request; sample search available here (Additional file 1). Authors in the field were con (...truncated)