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P93 Negotiating evidence in uncertain times: a qualitative study of knowledge exchange in transport and health
  1. C Guell1,
  2. R Mackett2,
  3. D Ogilvie1
  1. 1MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
  2. 2Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK

Abstract

Background Evidence-based public health requires research to support policy. Taking the opportunity of a knowledge exchange forum at the end of the Commuting and Health in Cambridge study, we investigated how stakeholders at the intersection of transport and health assessed and intended to apply evidence. Following the classic theoretical work on the “street level bureaucrat” who has to implement uncertain and often conflicting organisational directives and expectations, we particularly aimed to understand how stakeholders negotiated multisectoral evidence in local government against the backdrop of the integration of public health into local authorities and the dominant politics of austerity.

Methods We conducted participant observation during an interactive event with 41 stakeholders from national and local government, the third sector and academia, coupled with semistructured interviews with 17 of these participants. Formal and informal interactions between stakeholders were recorded in field notes. Interviews reflected on the event format and content as well as on knowledge exchange in general. Thematic content analysis of field notes and transcripts was undertaken.

Results Three pertinent themes were identified. First, stakeholders expressed uncertainties about finding a common language between research and practice and between sectors, and about who had the capacity to “translate” across these different boundaries. They also expressed differing expectations of evidence. While public health specialists tended to favour a hierarchical view of evidence that privileged trials, transport specialists tended to prefer case studies as precedents for workable solutions. Second, stakeholders encountered uncertainties about their preferred evidence. Population health studies often generated more complex results than those of apparently clear-cut randomised controlled trials; case studies highlighted the context-dependency of evidence and difficulties in transferring insights across settings. Third, stakeholders had to reconcile uncertainties around the idea of “health in all remits”. Despite its premise, public health was not always acknowledged to contribute to the goals of other policy sectors and stakeholders had to negotiate competing priorities, such as between health improvement and economic growth, or between integrated (multisectoral) and designated budgets.

Conclusion This comparatively small case study of stakeholders’ experiences indicates that multisectoral research translation requires people who can overcome silo-working, locate complex evidence from a variety of disciplines, and integrate different types of evidence into clear business cases. Practitioners in our study would welcome a clearer mandate that public health can contribute to achieving other policy objectives, as well as help from researchers to translate challenging evidence into practical recommendations.

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