4: WHO you want to reach – practitioners

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This chapter looks at ways that research is used by practitioners and how this could be improved. Using the five steps of good engagement, it starts with examples of research which matter to frontline staff and considers how these might reach individuals beyond academic journals. This includes an account of shifts in scholarly debate and understanding, from linear models in which research is packaged and distributed in the form of guidelines and toolkits, to more relational ways in which practitioners might engage with research through communities and professional activities. It is not just about how practitioners use research findings but what that knowledge is, using practice wisdom to interpret research in the context of daily work. Rich insights are given from interviews with practice-facing journalists, social media influencers and those spanning the worlds of practice and research in nursing, physiotherapy and social work. The chapter ends with practical pointers for enhancing the relevance and use of your research for practitioners.

I once interviewed some health leaders and asked them which research, if any, had changed their practice or made them think twice. One example given by a senior nurse was research by Jill Maben showing that at the level of wards or clinical teams, high rates of staff engagement were associated with positive patient outcomes (Maben et al 2012). Put simply, happy staff equals happy patients. It helped this chief nurse to make the case for various initiatives to enhance staff wellbeing and team cohesion – from protecting space and time for ward meetings and debriefs to team social outings.

Summary

This chapter looks at ways that research is used by practitioners and how this could be improved. Using the five steps of good engagement, it starts with examples of research which matter to frontline staff and considers how these might reach individuals beyond academic journals. This includes an account of shifts in scholarly debate and understanding, from linear models in which research is packaged and distributed in the form of guidelines and toolkits, to more relational ways in which practitioners might engage with research through communities and professional activities. It is not just about how practitioners use research findings but what that knowledge is, using practice wisdom to interpret research in the context of daily work. Rich insights are given from interviews with practice-facing journalists, social media influencers and those spanning the worlds of practice and research in nursing, physiotherapy and social work. The chapter ends with practical pointers for enhancing the relevance and use of your research for practitioners.

Step one: ask the right research questions

I once interviewed some health leaders and asked them which research, if any, had changed their practice or made them think twice. One example given by a senior nurse was research by Jill Maben showing that at the level of wards or clinical teams, high rates of staff engagement were associated with positive patient outcomes (Maben et al 2012). Put simply, happy staff equals happy patients. It helped this chief nurse to make the case for various initiatives to enhance staff wellbeing and team cohesion – from protecting space and time for ward meetings and debriefs to team social outings.

For evidence to be useful to practice and frontline staff, it needs to be the right kind of research which addresses real questions of importance. As Lawrence Green said some time ago: ‘if we want more evidence-based practice, we need more practice-based evidence’ (Green 2008). There are now mechanisms to set priorities which reflect practitioner and service user needs (see an account of the James Lind Alliance or JLA in the next chapter). The JLA exercise to identify priorities for social work research,1 for instance, includes topics on eligibility criteria and thresholds, self-neglect and models of supervision. These reflect practitioner concerns and needs and should optimise the chance of research being read and used.

Research examples – research which changes practice

In the past ten years, research has transformed practice in countless ways, from showing benefits of centralising services for patients with stroke (Fulop et al 2019) to the case for early intervention teams for people with psychosis (Correll et al 2018). Implementing evidence on infection control bundles, from changing catheters to identifying sepsis, has saved lives (Holmes et al 2015). More recently, the large-scale pragmatic UK RECOVERY trial involving several thousand COVID-19 hospital patients in the UK quickly identified a low-cost steroid as an effective form of treatment for those needing intensive care (RECOVERY collaborative group 2021). Research has the power not just to identify effective treatments but to save money – such as cheaper alternatives that work in treating wet macular degeneration (Chakravarthy et al 2013) to avoiding invasive shoulder surgery (Rangan et al 2015). There is growing evidence on effective interventions around families, from targeted home visits to new mothers to prevent child neglect to family drug and alcohol courts (www.whatworks-csc.org.uk). Research also shines a light on daily work practice, from intentional rounding in hospital wards (Harris et al 2019) to the emotional labour of healthcare assistants caring for older people with dementia (Scales et al 2017). And we understand more about the experience of people receiving services, from the work involved for people managing a long-term illness (May et al 2014) to the ways in which self-funders navigate the social care system (Baxter et al 2020).

Note that practice and practitioner here are a shorthand for the many and varied staff working in health and care, usually in service-facing roles. To name just a few in social care, this could include adult social care teams, family support workers, youth and youth justice workers, homecare service providers, voluntary sector staff as well as care home managers and staff.

Finding research which matters to staff (Box 4.1) is the first step to effective engagement. For instance, at our evidence centre we developed a review2 of pre-hospital emergency care research, selected and interpreted with ambulance organisations and staff. This included research on clinical aspects of managing patients, such as use of adrenaline in out-of-hospital cardiac arrests, but also qualitative research on how paramedics make decisions on whether or not to convey patients to hospital. Identifying and prioritising research which had resonance for practising staff was an important principle of our thematic reviews. As mentioned in the previous chapter (Box 3.4), we also recruited a pool of over 1,400 raters, the majority of whom were health and care professionals, to assess recent research papers for importance and relevance. These helped us to prioritise research of practice value to work up as critical summaries which would be shared more widely.

Research which addresses critical uncertainties is necessary but not sufficient to change practice. There also has to be effective mechanisms to reach practitioners. In Chapter 2, we saw how Best and Holmes (2010) usefully conceptualised the three stages of knowledge translation. In this chapter, we look in more detail at some of these features in relation to practitioners. This includes linear models such as the use of evidence in guidelines to relational modes where trusted individuals or organisations reach out to practitioners, recognising a more reciprocal, two-way exchange between research and practice. Examples in this chapter which use more relational approaches range from knowledge brokers to online communities of practitioners or Tweetchats. The final systems model recognises the complexity of the world in which staff work. Embedding evidence into professional development activities is an example of one kind of system-level effort to encourage practitioners to engage with research outputs.

Box 4.1 gives just some examples of research studies which have changed practice and have resonance for staff, from senior practitioners in family safeguarding to community matrons to clinical lead radiographers. But busy frontline staff are unlikely to come across this research through papers in academic journals (Squires et al 2011; Renolen et al 2018).3 They are more likely to see versions of the findings in news reports, practice journals, newsletters or online discussions as well as resources from intermediary bodies, from thinktanks to professional associations. This is partly about access but also about trust – emails or newsletter bulletins from a professional body are more likely to be read by practitioners than university press releases. Presenting the right information in the right way for practitioners is a skill. Eileen Shepherd, clinical editor for the Nursing Times has some good insights in how researchers can work with practice-facing journals (Box 4.2).

Interview – Eileen Shepherd

Reaching frontline nurses

For over 15 years, Eileen Shepherd has been clinical editor for the Nursing Times. This is a practice-facing journal, with the most-visited website in Europe. Eileen shared with me many insights for researchers on what makes for a good article. She often works with individual academics to shape their work to fit with reader interest. Indeed, her top tip is for researchers to approach editorial staff at practice-focused journals like hers at an early stage. They want to receive good content, including stories or news coverage of findings which may have been published elsewhere. The editorial team is happy to discuss if this is the right journal for the research and how they can support dissemination.

Eileen’s first principle is to start with a pen portrait of the reader you want to reach – whether it is an experienced cardiology nurse, first-year student or nurse manager. The pitch will be different, but it is a good exercise to imagine speaking to your target audience about what is interesting about your work. This might take the form of a summary of your research or a news story, blog or opinion piece. If you are considering a blog, choose one critical finding or aspect of your study and expand in a conversational way. Social media is also a good way to promote interest and have a conversation with your audience about what your research means and how it could change practice. It is important to look at the social media reach of journals and how they could support dissemination.

The other way that readers come to research through journals is for learning opportunities, reflection and preparation for revalidation. Eileen points to the value of linking articles to online journal clubs and reflective exercises which all provide a great opportunity for researchers to engage with new audiences.

In terms of the kind of research which are of interest to frontline staff, Eileen notes the importance of evidence in areas of everyday practice which cause anxiety with potential for error. This might be around diabetes management or respiratory rate monitoring; a series of articles on respiratory monitoring saw a peak of 20,000 downloads during the COVID-19 pandemic. There is always appetite for new evidence in areas like workforce, patient safety and wellbeing, as well as content on essential nursing skills. Eileen points to good collaboration between researchers and journal staff in the shared interest of getting high-quality information to staff delivering direct patient care.

Step two: understanding context

Involving practitioners at all stages of the study helps to ground the research in the realities of everyday working lives. It might be important to place a piece of research in relation to existing service pathways or the ways in which care is normally delivered. Practice knowledge also helps to align findings to relevant policy incentives and drivers. This might include professional or quality standards, guidelines or organisational and financial constraints. In the critical summaries of recent research which we produced, we identified leading individuals to reflect on the implications of the findings for their practice. Contextualising the research against normal caseloads or clinics was useful in guiding the reader on what the findings might mean for them.

Understanding the context and ways in which research may reach practitioners is important. Three particular mechanisms and aspects are highlighted here. They feature the embedding of research in guidelines; use of research in continuing professional development activities; and wider debates on practice wisdom and how this experience is used to interpret and contextualise research findings.

Embedding research in guidelines

The last 20 years has seen increasing use of formal products and mechanisms like clinical guidelines as a way to get research findings into practice. The setting up of the National Institute for Health and Care Excellence (NICE) in 1999 was an example of a wider trend of new public management (Pollitt and Bouckaert 2011), in which rational decision-making and systematic use of evidence featured prominently. In the 1990s, politicians were under fire for ‘postcode lottery’ or inconsistent decisions by local commissioners on new and costly treatment, such as variable access to beta interferon for people with multiple sclerosis (Timmins et al 2017). The pioneer evidence body in health, NICE, spawned a set of What Works centres espousing similar principles and generating evidence toolkits and guidelines for decision-makers in fields from criminal justice to education to economic growth (Gough et al 2018).

The scope of NICE’s guideline activity has expanded in recent years, from clinical treatment decisions in areas like managing chronic heart failure to broader work in public health and social care, such as multi-agency working in domestic abuse. The process of developing guidelines, with deliberative methods to assess evidence and use consensus methods to identify best practice with input from practitioners and service users, has itself become the subject of scholarly attention (for instance, Atkins et al 2013). It is recognised as part of a movement to codify knowledge into products and activities for organisations and individuals which can be tracked and monitored to ensure compliance with best practice and drive improvements, with guideline recommendations given statutory status in the UK since 2012 (see Wilson and Sheldon 2019: 78).

But there is growing recognition that guidelines are imperfectly implemented – Greenhalgh (2018) provides an overview of the theories and evidence to explain some of this variation in adherence (or indeed how it is framed as a problem of adherence in the first place). In Chapter 3, we saw how the ‘mindlines’ study (Gabbay and le May 2011) provided new insights on how practitioners use evidence. They described the social processes for practitioners in making sense of complex clinical issues, using coffee-room chat to check in, correct and adjust reasoning as part of a community in practice.

It is not helpful to think of the journey of evidence into practice as a rational, linear cycle or set of processes where nurses, therapists or managers articulate a problem, access formal guidelines or published evidence, appraise them and make an informed decision. The real world is not like that. This does not mean that research cannot influence policy and practice, but it does mean that researchers (working with others) need to make more active efforts to present, package and introduce their research into existing conversations and communities in the right way.

Interview – Elaine Maxwell

Speaking the language of practice

Elaine Maxwell, former chief nurse of two hospitals and non-executive director of an NHS trust with experience in research and evidence use, talks about what is important. This includes framing research in the right way for your audience, including the terms people use and their real concerns. In many ways, researchers need to become bi-lingual – or at least work with translators – explaining research findings in terms that mean something to frontline staff or managers.

What do frontline staff need? Elaine returned to nursing on ITU wards at the start of the COVID-19 pandemic and noted the shift in what information she wanted and needed. ‘My cognitive bandwidth narrowed and I could only take in so much information. I needed to get quickly to the findings and concentrate on the research which really mattered to me. I found the information and evidence around personal protective equipment (PPE) confused and confusing. There seemed to be little research in areas that were important to me, from the long-term effects of being on ventilators to the emerging pattern of “Long-COVID” condition.’

Researchers need to prepare their audience for their research and understand what the trade-offs and implications of results really mean. For instance, Elaine noted that a recent trial comparing standard mattresses with more expensive alternating pressure mattresses found no real difference. This was particularly important to nurses, who knew that patients often found the alternating pressure mattresses uncomfortable. This aspect was underplayed in discussion of findings (Nixon et al 2019), which focused on cost savings. She believed that stories of patients who couldn’t sleep for several nights during their hospital stay because of the noise and discomfort of alternating pressure mattresses would have added impact to the (already persuasive) economic argument. You need stories as well as statistics, to engage hearts as well as minds.

Elaine urges early career researchers to get your name known – join in conversations online or in person. Ask to write a blog for the professional organisation you’re pitching your research to, speak at their events or tweet about their conferences. Elaine knows of student nurses who have something to say who have gained profile and traction on social media and may be known to the chief nurse or nursing press. Social media is democratic, with little attention paid to formal roles and hierarchies.

Research as part of continuing professional development

A good way of making research useful is to embed it in activities like continuous professional development. Eileen Shepherd (Box 4.2) talks about online journal clubs and reflective learning resources on platforms like the Nursing Times. At our evidence centre, we identified learning and reflection points from particular pieces of research for practice sections of nursing and medical journals. These were questions which asked individuals to relate research-based innovations to their own practice and also review the strength and quality of evidence to develop research literacy skills.

In terms of continuing learning, Teresa Chinn (Box 4.7) developed an effective social online platform for nurses called WeLearning #AllOurHealth. This was a four-year social learning initiative with Public Health England to engage nurses in health promotion through topics like air pollution, cardiovascular disease prevention and mental wellbeing. The learning platform connected to Twitter-enabled discussion of latest evidence on a topic like tobacco control. There was a facility to record reflective practice on how individual staff used this evidence in their everyday work. This helped individual nurses chart their progress but also provided a powerful tool for researchers to demonstrate impact through the evidence journey and very small changes in practice. In Best and Holmes’ third generation of evidence use, a systems model recognises the complex and dynamic structures and contexts which affect individual practitioners. (Best and Holmes 2010) Appraisal, revalidation and continuing professional development are important mainstream incentives and activities for most professionals. Placing research at the heart of these learning and improvement activities moves it from the margins to a more central place in practice.

Embracing the wisdom of practice

Our thinking about how practitioners use research is also informed by greater understanding of how knowledge is transformed in the act of being used. This contrasts with traditional notions of pathways of evidence into practice. As Green notes, too often there is an assumption of the practitioner as an ‘empty vessel’ waiting to receive passively the completed artefact of the research study (Green 2008). There is now greater recognition of the way in which the experienced practitioner selects and interprets research in an active process of sense-making.

This emphasis on the tacit or practical knowledge of the practitioner, which is seen as equally important as formal research or knowledge, is an important development in thinking about how evidence is used. It emphasises praxis or professional wisdom, acquired from years of experience and knowledge through doing. The principal social worker reading a paper on self-neglect or the consultant midwife hearing a researcher talk about risk factors in post-partum haemorrhage bring to bear their own experience when they process this information. Over 25 years ago, Hutchinson and Huberman (1994) used constructivist learning theory to challenge passive models of adoption of research in schools. They saw research use as an active learning process where teachers ‘impose meaning and organisation on the disseminated information’ they encounter. In this sense, practitioners could be said to generate new knowledge in an act of co-creation (Freeman 2007).

This is true for individuals and groups of practitioners. Indeed, there is an interesting scholarly thread on how learning is situated in practice and the social identity and culture of particular professional groups. In this way, knowledge does not sit outside these self-forming groups or communities of practice (Lave and Wenger 1991). In fact, communities of practice may be formed by the very act of ‘thinking together’ and making sense of evidence in relation to the work they do. This is shown in one piece of research looking at two communities of practice, one based on knowledge about dementia for occupational therapists and the second on sepsis-based practice for critical care nurses. This research explores how the self-governing groups came together and succeeded (or not) in providing a rich, informal forum for exchanging knowledge (Pyrko et al 2017). The idea of community being a crucial part of learning and knowledge-sharing is expanded further in the book, The Social Life of Information. This was written originally 20 years ago by John Seely Brown (then chief scientist at Xerox) but still prescient, wanting to return the focus to people and the relationships they form, rather than technology, in understanding how information travels (Brown and Duguid 2017).

Mary Dixon-Woods in an essay on context explains the importance of leveraging practical wisdom to successfully deliver and implement quality improvement programmes. She uses her experience evaluating the programme which saw a dramatic reduction in central line infections in over a hundred intensive care units in Michigan. This success was attributed to an evidence-based checklist with a bundle of care processes shown to reduce infections. But the evidence itself was not enough to achieve such results. She notes from her careful observational study of the improvement programme up close that many of the benefits came from ‘creating a networked community structure that promoted social norms and shared learning’ (Dixon-Woods 2014: 92). This included allowing flexibility for local units and practitioners to use their ‘practical wisdom’ to adapt the checklist – retaining core principles and standards – to align with the best of local custom and practice. An approach which exalted the checklist as an artefact, to be lifted and shifted to any environment, would have limited success.

In recognising the mutual and creative process of interpreting research for use, and the active part played by practitioners in filtering, applying and contextualising findings to their everyday work, the debate has moved forward from the idea of top-down transfer of knowledge to evidence which is ‘collectively negotiated’ (Greenhalgh and Wieringa 2011).

Step three: involve practitioners in your research and outputs

At our evidence centre, having selected studies which resonated with staff, we then worked with the people we wanted to reach to interpret and make sense of the research. We used the collective wisdom – and sometimes competing perspectives – of experts of different kinds to extract implications for practice. This might mean contextualising research for different contexts, for instance, considering what the effects might be in wards which were staffed differently from research conditions. Having multiple professional perspectives – as well as those with lived experience as service users – enhanced our work. For instance, a project on frailty involved nurses, physiotherapists, occupational therapists, geriatricians and others. When presenting findings, practice-facing outputs might have a particular focus. Staff often wanted details of particular interventions which were evaluated – how many staff at what grade and skill mix made up a virtual ward team? Was there a ward clerk? How many sessions at what cost?

Using practitioner quotes and insights

‘It can be very stressful for our crews to bypass a local hospital to take a critically injured or unwell patient directly to a specialist centre. However, ambulance staff are now better equipped with medicines, equipment and knowledge – and the outcome data shows that we are doing the right thing for our patients.’

Mark Ainsworth-Smith, Consultant Pre-Hospital Care Practitioner, South Central Ambulance Trust

Source: NIHR (2016) Care at the Scene: Research for Ambulance Services. doi: 10.3310/themedreview-000827

In our evidence reviews, we illustrated the report with quotes from practitioners involved in the project. They reflected on the impact of the research on their everyday lives – for instance (Box 4.4) a senior paramedic considers the impact of research and audit which has informed centralisation of stroke and trauma services in recent years, improving patient outcomes but considering how this feels for ambulance staff. We also worked with practitioners to ask reflective questions for targeted groups of readers arising from the research. For instance, a review of evidence on serious mental illness showed the benefits of starting treatment without delay for people with first episodes of psychosis. We asked readers, ‘Do we know how many people with early signs of psychosis are waiting more than six months for treatment in our community?’ The aim was to translate research findings into actions that could be taken locally.

Practitioners as researchers

In recent years, we have realised the importance of engaging practitioners – if they are a target audience for the work – in the research itself. The model of the practitioner-researcher is now well-established, with clinical researcher roles drawing on medical models now increasingly common in nursing and allied health professionals and social work (Shaw and Lunt 2018). These hybrid roles are useful in bridging the divide between research and practice. Linking to ideas about the wisdom of practice and tacit knowledge, practitioners as researchers drive activity which is centred on problems arising in practice. The processes of doing research and using the results are closely aligned. In some disciplines and professions, the strengths of practitioner-led research draw on approaches such as constructivist theories, where learners construct their own knowledge from interpreting their experiences.

I talked to Sui Ting Kong, a social work researcher who helped to set up a practitioner research network (Box 4.5). There is a spectrum of research engagement, from full participation as main investigators or co-researchers to advising on study steering groups. Models of participatory research enable building of relationships throughout the study which will help in sharing findings at later points.

Interview – Sui Ting Kong

Involving social workers in doing and using research

Sui Ting Kong is an assistant professor of social work at the University of Durham, working in areas such as family violence. She talked to me about the interface between social work practice and research.

Her first message was not to privilege academic knowledge over practice knowledge – both should inform each other. That’s why she helped to set up a network of practitioner researchers in social work (through the professional body, British Association of Social Workers or BASW).

‘We struggled with our professional identity as a scientific discipline, because social work is a practising profession with a distinct knowledge base but not always fused with classic research traditions. But a turn in the last 30 years towards a stronger research culture in social work and social care has seen us realising we need to make research more practice-informed just as much as getting social work more evidence-informed. It has to be a two-way road. We have to force academics to forge knowledge with practice wisdom.

If we want to achieve impact, we need to involve practitioners in the production of research itself. We wanted to bring in likeminded research practitioners, set up a network, to think about new culture and new models of collaboration between research and practice. This helps us to build capacity for the profession to use and appraise research as well as take part in studies. At the same time ultimately what we want is to generate a new model of collaboration, providing a pool of practice knowledge collectively to inform research questions and practice-facing research. A very practical example recently was the way practitioners and researchers influenced a survey by BASW of practitioner experience of COVID-19, changing not just the way questions were asked but also thinking ahead on how findings can be accessed and analysed and interpreted. I have seen some exciting examples of participatory research hubs pairing academics with community partners, practitioners and families for instance projects on debt and poverty in Durham (Banks et al 2017).

We also want practitioners to engage creatively to develop or adapt scientific methods – innovation is important if we really want to democratise the process of knowledge production (and use) and make it more collaborative. Democratising is not giving up rigour, but challenging received methods, for instance looking at pragmatic trials in social work and issues like using wait lists as controls, we need the practitioner perspective to think about timing, the ethics and equities of this.’

Step four: partner with professional organisations and identify champions

In order to gain traction with particular staff groups, it is essential to work with formal and informal networks and professional bodies and communities. This is where practitioners meet, discuss new ways of working and receive information which is trusted. We engaged the Chartered Society of Physiotherapy early on in our review of evidence on musculoskeletal services in 2018. They hosted our first steering group, provided contacts (such as commissioners and specialist practitioners) and promoted and presented our review findings to their members, making up 95 per cent of the total profession. They also organised regional workshops to debate review findings for managers and practitioners developing musculoskeletal programmes and pathways and set up an implementation taskforce to support and monitor acceleration of evidence to practice. This included funding videos and patient-facing summaries of the review. They also provided a platform for promoting the findings through a popular physiotherapist podcast, with a reach of over 80,000 practitioners. Through their membership journal, the Society documented examples of evidence-led innovation such as physiotherapy-first clinics and new triage approaches in different parts of the country as part of the impact story.

Membership organisations and networks are powerful ways of engaging and promoting evidence (Figure 4.1).4 But engaging with these networks and partner organisations early on is important to give you leverage and credibility with practitioners. You want to create the ‘pull’ for your research, rather than just broadcast findings at the end of a project.

Figure 4.1:
Figure 4.1:

Working with partner organisations

Interview – Godfred Boahen

Finding trusted intermediaries

Godfred Boahen, who worked as a research lead for the BASW, spans the divide of social work practice and research. Godfred talked to me about the separate tribes of practice and academia with their own language and culture. ‘Academics need to understand the complexities of practice and the particular steps in the practice pathway where their findings might be useful. The more the researcher can do to tag their work in relation to particular work needs and practice pinch points, from safeguarding conversations to adoption assessments, the more likely it is to be used. It also helps if academics can specify who their findings are most likely to be relevant to, from teams working with people with severe autism to elected members with an interest in looked-after children.’

There is also an art in framing research in a way that will get the right attention – and may even change the conversation. An example given by Godfred is the acceptance of poverty as a core business of social work, a debate which was re-framed by research.

Most practitioners do not have access to academic journals. Researchers need to make use of trusted intermediaries, from bodies like SCIE in social work to thinktanks and professional bodies. And they may want to communicate directly via social media, although Godfred cautioned about particular ethical issues for social workers and others in using channels like Twitter when working in sensitive areas from adoption to safeguarding.

Knowledge brokers – practitioners as research champions

There are different kinds of influence and influencers. In work at our evidence centre, we tried to engage those with formal authority and profile, such as national clinical directors. But there were also individuals who were listened to and had sizeable numbers of followers on social media, although they may have been ‘ordinary’ practitioners. There is a science now of measuring influence, through social network analysis. This has been greatly used in marketing and other fields, but the basic premise is that you can chart relationships in a given community and identify those who are most connected and likely to influence others. Trish Greenhalgh, who has led work on how innovations spread, distinguishes between four types of influencer. These include peer opinion leaders – ‘people like us and who we like’ (my paraphrasing); expert opinion leaders – ‘people we look up to in our world’; champions – ‘people we trust who support an idea or cause’; and knowledge brokers – ‘people who understand us and them’ (Greenhalgh 2018: 187).

Knowledge brokers are typically employed to span the worlds of research and practice (Thompson et al 2006; Ward et al 2009; Bornbaum et al 2015). This includes the use of knowledge brokers in England’s regional collaborations between universities and health organisations (Evans and Scarborough 2014). Given the different cultures and languages of research and clinical practice, these ‘linking and bridging agents’ need special skills ‘to manage activity, enable interactions, develop shared spaces and negotiate tensions and conflict’ (Rycroft-Malone et al 2015: 111). Over and above those with formal roles who are employed as knowledge brokers, every field has people with personal authority and influence who have service or clinical experience and understand research. Such people are critical in ensuring that professional and public debate is informed by research and in sparking interest and ‘pull’ for new findings.

At our evidence centre, we employed a number of clinical advisors, who combined knowledge of evidence with experience in clinical and service settings. This included a senior nurse with research background who was able to develop service-facing products with input from frontline staff on topics from frailty to ward staffing and host fringe events at UK national nursing conferences. She was also able to identify individuals with ‘voice’ and reach to champion our work, as well as engaging herself in social media debates and conversations. This included Tweetchats with nurses around evidence on ward staffing and care homes research.

As a researcher, it is important to identify the service opinion leaders and influencers in your field with an interest in research who can amplify and extend the reach of your work in relevant communities.

Step five: present content which is engaging and accessible

Using social media to reach practitioners

Just as hybrid practitioner researchers or knowledge brokers can span two worlds, there are also people with backgrounds in clinical or practice work who work as journalists or communicators. Newer social media channels provide powerful platforms to reach a greater number of frontline staff. I spoke to two leading influencers, Teresa Chinn (Box 4.7) and Jack Chew (Box 4.8), who have built up successful platforms for practitioners and are skilled in embedding research in everyday exchanges on social media.

Interview – Teresa Chinn

Sparking connections between research and practice

Teresa Chinn set up the platform @WeNurses eight years ago – it now attracts just under 100,000 followers on Twitter and is a vibrant online community for nurses. Having not been particularly technology-minded, she joined Twitter to connect to people, feeling out of touch with practice news and developments as an agency nurse. This led her to set up an online network and forum to learn, share ideas, exchange evidence and practice tips. It is now a powerful platform for Tweetchats and active campaigns in areas from keeping staff active to raising money for nurses in crisis.

‘I set up @WeNurses to fill a personal need to mix with other nurses, because I was working as an agency nurse, going from place to place. At the time, an agency idea of continuing professional development was to stick you in front of a video that was three years old, and I didn’t feel I was learning or growing or staying up to date. Journals didn’t really help, partly as I have dyslexia – for me, the experience of reading a journal is flat, I always learn best by talking to people. What I wanted to do was to connect with other nurses, discuss things that interest us, keep up to date and see what is new that we ought to know.’

Teresa Chinn, as a successful social media leader, has a number of tips. ‘There’s no point in crafting a perfect study, beautifully prepared with infographics and only sharing once. Be quite persistent in messaging, repeat throughout the day, perhaps with slightly tweaked or tailored tweets.’ Like others, she points to the need for ‘colourful content’ – but, above all, to ensure that the headline message is clear. Also to frame research around the interests of the practitioner, keeping in mind what the audience needs.

Above all, Teresa reminds me that to be successful on Twitter you need to nurture and engage with your followers in a two-way process. ‘It is all about reciprocity’, not just broadcasting a message but responding to queries, enjoying the feedback and engaging in dialogue. And she urges researchers to ‘get out there and share your findings’ – although it may seem self-promoting, frontline staff want to know what researchers have discovered and there are people and facilities like @WeCommunities to help you get to the people who matter.

Interview – Jack Chew

Physiotherapists in conversation with research and researchers

Jack Chew is a physiotherapist who set up his own podcast, Physio Matters, which now has an average monthly audience of 25,000. He was inspired to set this up seven years ago. In his own words, ‘I was driving to work in Newcastle from Sheffield, a fairly long commute, and heard an Australian physiotherapy podcast, an interview with a great researcher on lateral hip pain, summarising her research and what it meant for practice. And I was a better clinician when I got to work because of this. Amazing. But later that evening, I clicked on to the next episode and I was furious, the guest speaker was a bit of a cowboy, saying things I knew to be demonstrable nonsense which were not challenged by the interviewer. In the space of the day, I realised the force of good and ill with this new medium. I was raging to my wife and she just said, why not do it yourself. So I did – I pick great guests, but give them a proper critical grilling – asking the questions you would ask as a physiotherapist, I am part of the audience.’

Like Teresa, he emphasises the two-way nature of a podcast, acting as a dialogue and exchange of knowledge and comment. The researcher can be in conversation with the practitioner (or proxy practitioner, as interviewer) and not just broadcast their findings.

His advice to researchers is to bear in mind the need to do more than inform. ‘When running events, shows or podcasts, you’ve got to find a way of being entertaining these days – people are accessing this material, including scientific papers, in their own time. Don’t spin or over-egg your findings, but make it interesting. Commuting, exercising, nightfeeds – that is when a lot of our audience are listening. So your work is competing with Netflix, Disney+, going for a walk with the family at weekends – not the Annals of Internal Medicine.’ In the present age, an important rule is to entertain before you inform.

At our evidence centre, we spent time producing attractive, practice-facing reports with many case studies and stories to bring the research to life. This included for instance illustration of how bathrooms and kitchens had been adapted for older people with disability in a review on assistive technology. We consider in later chapters how design can play an important part in making research accessible. Our reviews also included quotes from frontline staff identifying aspects of research which resonated with them and how it had affected their practice. Feature articles, with case studies used in the research or vignettes of patient and staff experience, can bring findings to life. Using journalistic principles helps to make material readable and interesting, as many of the experts I talked to confirm. It is what Teresa Chinn (Box 4.7) refers to as ‘colourful content’. But it is not just about the production values and adding a few stories. The key aspect underlined by many is the need to clarify the topline message and have a compelling line of argument. The more clarity you can get on your main messages, the better.

Practical pointers on reaching practitioners

Know who you are speaking to

Draw a pen portrait of your target audience – it may be a district nurse in her late 50s or a community development worker in his 20s. Give them names, family backgrounds and interests. What aspects of your research would be most relevant to them? What recent service or policy changes might affect them and how can you add this context to your findings? What language would you use to appeal to them and what channels and sources of information do they use in their work and non-work lives? To get a sense of what drives and interests them, read practice-facing journals and newsletters. Go to a virtual conference or seminar, browse the abstracts and speaker backgrounds and visit discussion threads and forums online.

Map your stakeholders

Work out who are the important professional organisations and networks in your field of study. Identify individuals with influence in your world – these may be different for social media and other contexts. Who are the peer influencers, expert influencers, champions and knowledge brokers? Who are the gatekeepers to important networks and communities? What are the connections between these individuals and organisations? Understanding the chains of influence for staff in question can help you target your findings and strengthen your engagement.

Write a feature article

Plan a feature article in a practice-facing journal, drawing out the main findings of your work with a practice readership in mind. Use hooks of recent policy or practice initiatives which are relevant. Start with an arresting example from your research or a first-hand testimony of the problem encountered on the ward round or home visit. Use case studies of real localities where the approaches you are evaluating are being used and interviews with named staff, if you can. Test out your draft article with people who reflect the target audience, whether speech and language therapists or substance misuse nurses.

Footnotes

Source: NIHR (2017) Better beginnings: improving health for pregnancy.

doi: 10.3310/themedreview-001598

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