A bridge from the “ivory tower”: involving communities in research

The Hawksmoor Towers – an imposing pair of white stone buildings at All Souls College, Oxford – are the very picture of academia’s ivory tower. Noble and enduring, the Towers evoke an idealistic view of the university as sacred ground for the free exchange of ideas, a place where the commercial interests of the “real” world never disrupt the simple goals of teaching and learning. The flipside of this protected terrain – and the paradox of the ivory tower – is the problem of accessibility.

The argument for accessible scientific research moves from two principles: first, that scientists should care whether or not their research is usable; and second, that relevant audiences should be aware of new information that may help them to do their jobs. Many of today’s researchers are doing what they can to involve specific, key members of their communities in shaping their work.

At the Institute for Work & Health, which specializes in applied research, scientists know that the value of their work depends on its relevance to a broader community of occupational health and safety professionals and policy-makers. This can mean anything from providing clinicians with new information about the proper treatment of back pain to discovering the best way for employers to interact with injured workers.

Institute scientists devote a considerable proportion of their time to ensuring their research is clear and meaningful for non-academic audiences. Guiding this process is the department of Knowledge Transfer and Exchange (KTE).

KTE bridges gap between research and practice

At the Institute, KTE refers to the practice of communicating and interacting with external partners and translating research findings into action. These external partners or “stakeholders” are audiences with a vested interest in the topics under investigation, and can be different from project to project. In general, though, Institute scientists can expect to work with policy-makers and practitioners from workers’ compensation boards, government, clinicians, organized labour, and employer and injured worker groups.

The job of tapping into this group of stakeholders falls to KTE Associates such as Kiera Keown. Her role is to help scientists identify and respond to the questions and needs of their non-research partners. Since every research project is different, the KTE component is always custom-made.

On any given day, Keown can switch gears from writing lay summaries of research projects to asking scientists tough questions about the usability of their work. Hers is not a job that can be easily described. I try to work as a bridge between the worlds of research and practice, she says.

Though Keown prefers a flexible approach to knowledge transfer, she says there are standard points at which stakeholders may be invited to participate in a research project. In some cases, the Institute will call on external partners at the outset of a project to help with topic selection and the setting of appropriate goals. In others, stakeholders will participate periodically as a project develops, offering feedback and keeping the interests of external partners in view. Once a project is complete, stakeholders may comment on the results or help with the development or distribution of research tools.

Over the years we’ve seen greater interest from stakeholders in how the research process works, says Keown. Likewise, researchers are becoming more involved in knowledge transfer. Many will approach KTE staff at the start of their research for input on how best to involve stakeholders.

Stakeholders involved in review of participatory ergonomic interventions

Last winter Keown led the knowledge transfer component on a systematic review of participatory ergonomic (PE) interventions. A PE program is one that invites workers to help improve work situations and processes to promote better safety, comfort and productivity. The PE review, led by Institute Associate Scientist Dwayne Van Eerd, considers the best ways to implement PE programs in workplaces. Van Eerd and his team assessed the quality of many studies on the same topic before assembling the results.

As one KTE project to cross Keown’s desk, the PE review illustrates some of the ways that stakeholders can participate in the Institute’s research. Stakeholders who want to keep up with the latest research in their areas of expertise tend to be interested in the snapshots of the body of research that systematic reviews provide.

The PE review is no exception. The topic was selected by stakeholders who had become interested in an earlier study by Institute Senior Scientist Dr. Donald Cole, which found PE programs to be effective at reducing workplace injuries. These stakeholders wanted to know how to implement PE programs to achieve similar benefits.

We feel it’s important to include stakeholders in all of our reviews, says Van Eerd. In this case especially so, since our stakeholders were important in identifying the need for a review on PE process and implementation.

With the help of Keown, Van Eerd assembled a network of external partners with expertise in ergonomics and musculoskeletal disorders to participate in a preliminary input meeting. Here, stakeholders gave feedback to the review team regarding topic selection and project planning

Policy-maker, ergonomist take part in review

Among those present was John VanderDoelen, who is the Director, Workplace Insurance, Health and Safety Policy Branch at the Ontario Ministry of Labour. I worked in the area of ergonomics early in my career, says VanderDoelen, explaining his motive for participating. More recently, I’ve had cause to look at regulatory policy issues related to ergonomics. I felt that a comprehensive review of the literature would assist workplace parties in implementing effective PE programs.

Also involved in this project was Judy Village, an ergonomist and private consultant. Her role differed from VanderDoelen’s insofar as she was a member of the review team, working alongside researchers at every stage in the review process, from developing appropriate search terms to appraising scientific studies, and assembling the results.

I operated as a full member of the review team as opposed to serving in the advisory capacity of a typical stakeholder, she says. I brought a practical perspective to the review: that of a working ergonomist. In the end, Village and other stakeholders influenced the research process in ways neither they nor the researchers could have anticipated.

Van Eerd expanded the review to include the grey literature, which is content that has not been reviewed by other independent scientists before publication, such as trade magazines, conference proceedings or association newsletters. Village knew from practical experience that health and safety professionals often refer to the grey literature for information and guidance. She, along with the other stakeholders felt strongly enough about expanding the literature search that she helped to secure additional funding to do so from WorkSafeBC, the workers’ compensation agency in British Columbia.

I joined the project out of personal interest, but I couldn’t have taken the time away from my consulting work if I hadn’t received the funding, she says. The final review looked at 33 peer-reviewed and 19 grey literature documents, and benefited from the input of more than 70 occupational health and safety experts in Ontario, Manitoba and British Columbia.

Feedback leads to practical outcomes

As the review came to an end, reaction meetings were held in B.C. and Ontario to give stakeholders a say in how the results would be shared. Keown is now working with Van Eerd to incorporate the feedback from these meetings into a research tool for use in the community.

In this case, we’re designing a tool to help ergonomists and other health and safety professionals to implement PE programs in ways that our review found to be effective. Since we now know that workplace support is important for a successful PE program, for example, we can add this item to a checklist of other essential steps.

Keown and Van Eerd plan to solicit further input from stakeholders before releasing the finished tool. The purpose, said Van Eerd, is to ensure the research will be relevant outside academic circles.

We feel that the potential recommendations that arise from the prevention reviews should be useful to our prevention partners. Stakeholder input can ensure that we are targeting the recommendations for practical outcomes.

By all accounts, the process of including stakeholders in the PE review was a rewarding one. Attendance at the various meetings was high, and follow-up surveys showed that stakeholders held a high opinion of the researchers and the review itself. VanderDoelen is no exception. I felt that the researchers considered and incorporated my ideas and suggestions, he says. Our relationship was collaborative, with all of us working to determine the best way forward.

Review results will be used

VanderDoelen is equally optimistic about how the research results will be used. He says, The review will be of assistance to the Ministry of Labour in providing advice directly to workplace parties, as well as in supporting policy approaches in the future.

Village anticipates the results will benefit other ergonomists. The review really clarified the content of the current literature and allowed us to discuss important barriers and facilitators surrounding PE programs, she says. I’m already sharing the results when I teach or consult with organizations.

Village’s final point confirms a fundamental theory of knowledge transfer and exchange: those who participate in the research process are more likely to use and to share the results. This is partly because participation gives stakeholders a sense of ownership over the study.

Stakeholder involvement is crucial in order for the end product to be relevant to external audiences, says VanderDoelen. Early stage participation helps to define the research question and to incorporate external information needs. It also helps to generate buy-in for the findings.

The PE review was certainly comprehensive. The researchers benefited from the input of external partners and built the foundation for further collaborations down the road. If the follow-up surveys are anything to go by, the stakeholders were satisfied too.

But is it accurate to say that the KTE component was successful? Does improved awareness of the research mark the success of a KTE initiative? Or, does a change in clinical practice have to happen as a result of something that has been learned?

Keown admits that KTE professionals don’t yet have a clear answer to the question of success. Formal evaluations of KTE are something we’re starting to get involved with. But right now our strategy is to focus on a simple but important goal: providing our stakeholders with new research in formats that are relevant, understandable and usable.

Source: At Work, Issue 54, Fall 2008: Institute for Work & Health, Toronto