Research-active behaviours among public health decision-makers

PHLARPs identified a wide range of behaviours that they perceived as dimensions of research activity within LAs. We grouped these behaviours into five broad themes: (i) types of research undertaken in LAs, (ii) research governance, (iii) accessing research, (iv) research partnerships, and (v) applying research. Across PHLARP responses, greater emphasis was placed on behaviours related to research production than to accessing or applying research evidence.

Types of research undertaken in public health practice

Service evaluation was identified as a dominant type of research production within LAs. For example, a PHLARP discussed how “most of the research that you could possibly do in the local authority, at least from what I’ve observed, has to do with evaluation of existing interventions”. LAs want to understand the health impacts of their services, how they can be improved, if they are cost-effective, and whether they should be recommissioned. For example, when reflecting on the change in research activity they had observed, a PHLARP noted that “people are now starting to want to evaluate work that’s being done and finding out if it’s going to be cost-effective, or if it’s going to be worth ruling out”.

LAs also regularly undertake public consultations (e.g., through surveys and focus groups), eliciting the views and priorities of residents to inform strategy development such as through Joint Strategic Needs Assessments. In the case of both public consultation and evaluation, PHLARPs often aided their LA in improving the rigour of this evidence production through, for example, advising on data collection methods. A PHLARP described such a process: “They run surveys across their service users regularly. What’s happening differently now is they’re coming to me before they send the surveys out. And they say, ‘Can you tell me if this looks okay?’”

Research governance

PHLARPs contrasted LA-based research to that led by research institutions, with the latter often referred to as “academic”, “formal”, or “proper” research. A PHLARP described this variation: “Although people in local authorities do research, they don’t do similar research to what universities do, and there’s a whole different system, approaches, divisions, services.” This distinction was predominantly based on universities having ethics and peer review publication processes that were often lacking within LAs.

PHLARPs described the added time needed for LAs to link into a universities’ ethics system should they wish to seek ethical approval, a challenge considering existing capacity constraints and time-sensitive research needs. Furthermore, because research governance systems akin to academia were not in place, PHLARPs discussed how LA research did not tend to be published within peer-reviewed journals, but also that such publication was often not a priority for LAs: “As soon as it comes to, you need ethical permissions to make it an academic piece, that’s where it drops because for [the LA’s] work they don’t need it because they are not sharing that data. […] Publications are a currency for me, but not for them.” In some cases, however, LAs possessed internal ethics processes which varied in scale and formality. For example, one of the PHLARPs established an internal research advisory group to review all incoming planned research.

Research partnership arrangements

Partnerships with research organisations were regularly discussed, reflecting another dimension of research activity. The extent to which LAs participate in research production as part of these collaborations varies substantially. In some cases, LAs commission research organisations to undertake a piece of work, with little ongoing involvement. For example, a PHLARP noted, “If [the LA] wanted a service to be evaluated, they would hire a private consultancy or something to do the work. They would outsource the actual work. So, they are not doing it, but they have thought about it.” PHLARPs also provided several examples in which their LA contributed to academic research through, for example, advising on research priorities, providing light-touch feedback on research projects, connecting academics into the community (e.g., to facilitate public involvement), and promoting research opportunities across the local area and within the LA.

Greater levels of collaboration also take place between LAs and research organisations, including co-design in which LAs provide insight and shape the project throughout its lifespan. For example, when speaking about a recent piece of research undertaken in partnership with a university, a PHLARP described how “we co-designed the whole intervention with them, so it was a collaborative effort”. A few of the PHLARPs discussed how such collaboration can improve the relevance of research to the LA and foster greater local support. For example, a PHLARP identified the benefits of public health co-design throughout the research process: “The passion is there right across the board, and you can just tell the difference when you’ve got people in a team working together for something rather than just providing support.”

Another type of partnership in which LAs are frequently involved is community engagement. This dimension of research activity was described as going beyond gathering local priorities to actively involving residents and community groups within research, as well as service and policy development. As one PHLARP described, “We also wanted to co-create the proposal with [local stakeholders]. We wanted to have patient and public involvement from the beginning. So, we created a community steering group.” Benefits that were identified in relation to community engagement included strengthening trust with the local community, enhancing the relevance of research, and accessing research that was already being conducted by local charities and community organisations.

Accessing research

Public health teams access existing evidence through a wide range of channels. The extent to which they consult peer-reviewed literature varies substantially across LAs. In some cases, established links with academic institutions and/or internal research support staff meant LA staff could access literature reviews and other research articles with relative ease and did so on a regular basis. For example, a PHLARP noted, “If [public health staff] are interested in a topic, they could just ask the librarian to do the search for them and come up with the brief. And we have a public health intelligence and analyst team, and if anyone has any question whatsoever about anything, [that team] could find you the data on it. And then give you a report as well.” However, not only was this support lacking in many LAs, but systems often did not even allow access to the literature. Several PHLARPs discussed the significant time and effort they had invested in establishing this access for colleagues.

Accessing existing evidence also regularly took place through a variety of alternative channels such as journal clubs and through more accessible research outputs (e.g., videos, blogs). PHLARPs also described how their public health colleagues engaged in cross-LA learning to, for example, consult about new interventions with which other LAs had experience. For example, a PHLARP indicated that in the context of addressing an emerging public health issue, “The first thing we do is not looking up literature, it’s to consult [a nearby] Council because they are bigger, and they probably do [similar] projects.” Although publishing in peer-reviewed journals is not often a priority for LAs, their internal evidence can still often be accessed through verbal consultation or, for example, within Joint Strategic Needs Assessment reports.

Evidence use

PHLARPs described several examples in which local evidence had been applied in the context of service delivery and policy development, primarily focused on evidence emerging from evaluations and public consultations. Little was said, however, on how existing academic research is used to shape public health decisions. One PHLARP emphasised the value of recognising the stages within policy cycles which present key opportunities for academics to influence LA decisions through their research: “There would be specific points in time where research and evidence can be plugged in in the most effective way to help shape and understand and inform what local authorities are trying to do.”

Motivation to engage in research activity

We identified six psychological dimensions feeding into LA staff’s motivation to engage with research: (i) perceived feasibility of undertaking research, (ii) perceived value of research, (iii) attitudes towards academia, (iv) interest in research, (v) conceptualisations of research, and (vi) confidence in research abilities. Many of these dimensions relate to institutional barriers constraining research activity such as budgetary constraints and a misalignment between LA and academic priorities.

Perceived feasibility

All PHLARPs emphasised the severe capacity constraints experienced by their LA colleagues and perceptions among colleagues that conducting research was unfeasible. Research does not tend to be incorporated within most LA public health practitioner job descriptions, and “I don’t have time” was identified as a common initial reaction to research opportunities, with other activities such as service delivery prioritised. For example, a PHLARP described how research is “almost seen as a thing that’s a bit of an annoyance, at the moment, because it interferes with the current work”. As such, PHLARPs discussed the need to make their colleagues aware of the resources that were available to support research activity (including themselves) as well as the diversity of ways in which colleagues could become involved in research, many of which were minimally resource-intensive. For example, a PHLARP described how “when we initially started [working on the funding application], the first thing was that people need to be convinced that this is something we could put in, that it’s feasible”.

Perceived value

Motivation to engage with research was also influenced by the perceived value of the research to residents. While most PHLARPs had observed their LA colleagues to recognise the value of evidence-informed decision-making, the immediate value of academic-led research to the community was not always apparent, limiting involvement. As such, PHLARPs emphasised the importance of clearly articulating this value and aligning research with the strategic priorities of the LA: “It’s not enough just to just to present things that are clearly fantastic […]. [Research] needs to be very much tailored to the local context. It needs to be informed by specific local needs that you’re then demonstrably meeting.” PHLARPs reflected on instances where co-design enhanced the immediate value of research and thus fostered local buy-in.

Attitudes towards academia

Attitudes towards academia within the LA are also likely to influence LA staff’s willingness to engage with research. Unfortunately, academics are often viewed with a certain degree of wariness due to, for example, negative prior experiences in which the LA received little benefit from academic research involvement. Many PHLARPs described being on the receiving end of such negativity themselves because of their association with a research organisation. Examples of initial reactions PHLARPs received from LA colleagues included “Why is someone from the university contacting me to try to pester me about research and stuff?”, “Who is the NIHR to tell us what to do and what not to do?”, and “Ahh, you’re one of them swotty types”. To overcome such perceptions, PHLARPs described the need to build trust with colleagues and distance themselves from academic institutions. For example, one PHLARP described how they would introduce themselves as being based in a local city rather than a university “because that almost sets the person off as ‘they’re an academic’. Even little, small things that could really help”. Similarly, another PHLARP described removing academic links within email signatures.

Interest in research

PHLARPs also discussed how colleagues possessed naturally varying levels of interest in research. Unsurprisingly, LA staff with a research background were more likely to proactively demonstrate enthusiasm for research involvement. For example, a PHLARP described how “there were people who were excited, and they got in touch with me immediately and said, ‘I want to do more research, how can I do it?’”. PHLARPs spoke about identifying those most interested in research who could become champions and promote research across their teams. These PHLARPs would tailor their communications about research opportunities, requesting different levels of involvement based on initial levels of interest.

Conceptualisations of research

PHLARPs also spoke about how fostering a shared understanding of the word “research” can be critical to encouraging local involvement. For example, LA staff often did not perceive local evaluation as research:

Initially [the LA staff] thought that whatever they were doing, “Oh, it’s not research, it’s just an evaluation […]”. I said, the only difference between what you are doing and research, whatever you think goes on in the university, is that there is no research ethics and governance. That’s all. Everything else, the processes you are following, are pretty much the same.

Similarly, PHLARPs described how such internally produced evidence was often not considered as research by academics: “Councils are doing research in terms of they are doing data collection, and they are interpreting the results, and those results are influencing policy decisions or practice decisions. But a university or any academic setting would not consider that as ‘research’ in quotes because it’s not peer-reviewed, maybe the robustness of the methodology would be questioned.” As such, PHLARPs sought to broaden and establish a shared understanding of “research” within LAs and across stakeholders.

Confidence in research abilities

Finally, a few PHLARPs spoke about apprehension to engage with research among colleagues due to a lack of confidence: “There’s almost that kind of uncertainty of taking that first step into research.” However, the presence and knowledge of the PHLARPs themselves was perceived as reassuring to staff, helping to ease these initial hesitancies. Research training organised by the PHLARPs further addressed such apprehension.