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Decision-making of knowledge brokers in moving evidence to action along pathways in global health

Author:Theresa Canova Norton

This post was originally published by the Evidence & Policy blog on 31 March 2021.

We have re-issued the article that has already been published by the Evidence & Policy blog. We would like to express gratitude to the kind offer of the editorial board of the Evidence & Policy blog.

Theresa Canova Norton

‘An e-mail never made me change the way I do things’, a colleague once said. Implicit in this statement is the idea that passively receiving information alone is unlikely to motivate change. How might this observation inform the way we approach disseminating the best available evidence? This is what we explore in our Evidence & Policy article, ‘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’.

Knowledge brokers are intermediaries who provide a potentially vital role galvanising change. Studies of knowledge brokers have mostly taken place in high-income countries, so we know much less about knowledge brokers in LMICs. To help address this gap, a global health focused research team conducted three studies following up with knowledge broker participants of international conferences in 2012, 2013 and 2015. The aim was to identify whether evidence from the conferences was shared with others and led to actions such as changes in health policy and practice, and what factors influenced decisions to share and act on evidence.

Over three years, the team surveyed a total of 600 health professionals in more than 65 countries and interviewed a subset of participants based in Africa, Asia, Europe and the Americas. Our findings suggest many knowledge brokers have hybrid professional roles (e.g. faculty member and healthcare provider), providing pathways for moving evidence from one setting to another. Knowledge brokers were characterised by a ‘can do’ spirit and a vision of how evidence might be actioned.

In selecting evidence for action, knowledge brokers described undergoing a reflective decision-making process in which they weighed internal and external factors that may act as barriers or facilitators to change, summarised in in Figure 1. The fit between evidence and the broker’s professional role, their capabilities and world-view were internal facilitators for action. External facilitators included information suggesting that evidence had been successfully implemented in a comparable setting, and alignment with local contexts and international best practices. Health programmes engaged in activities to advance uptake of evidence might develop profiles of health system actors using the figure to assess fit of the evidence to intended audiences.

Figure 1: Internal and external factors influence knowledge brokers in their decisions to select evidence for action.

Opportunities exist to conduct further research about, and better support, knowledge brokers in LMICs via organisational efforts to build practice- or policy-oriented knowledge brokering capacity (e.g. links with academic research institutions or ministries of health). These approaches could include development competency checklists for hiring individuals and teams for knowledge brokering, strategic identification and engagement of mobiliser knowledge brokers in hybrid professional roles, and incentivising knowledge brokering as part of professional reward systems. Global dissemination of evidence could be strengthened through increased linkages between regional evidence networks to build global coverage of dissemination and knowledge brokering. Finally, future research could investigate the factors influencing sustained increases in evidence-informed decision-making following knowledge brokering interventions.

The role of knowledge brokers in health systems will likely evolve to keep pace with changing evidence and emerging public health crises, such as the COVID-19 pandemic. While, as humans, we often yearn for interaction with one another as a means of connecting to new knowledge, greater use of technological platforms for virtual meetings and webinars, such as Zoom, offer the potential for knowledge brokers to expand their reach to stakeholders and span boundaries between settings.


You can read the original research in Evidence & Policy:


Theresa Canova Norton is a research fellow supporting the Army Public Health Center in the United States. She previously worked for more than 20 years in global health implementation programmes focused on evidence-based health policy and practice.


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