Kathryn Oliver

This paper presents a recent review of the policy networks literature, both empirical and theoretical, and describes an ongoing project to map existing policy network data. Much of the literature on policy networks sees them variously as a mode of governance, and a metaphor for the reality of governance, or configurations of individuals/organisational engaged in a policy sector (Rhodes 1992b). Dowding asserted that the field of policy networks is divided into those who believe that the network gives rise to a policy through convergence (ties forming through mutual beliefs and values within an epistemic community – the advocacy coalition framework (Haas 1992, Sabatier- & Jenkins-Smith) or those who perceive policy networks as a way of linking state-level structures with interpersonal ‘micro’ interactions; i.e. a description of how entitites are linked through the enacting of power and bargaining (Harsanyi, Rhodes & Marsh). Therefore, to be analytically useful, the concept of a policy network must be able to explain in network terms (structure, position, characteristics) policy outcomes or processes. These explanations must work in a range of domains and contexts. Understanding policy network formation, change and process can inform us not only about how policy processes work, but also how ideas and evidence are found and passed between actors. The theory of policy networks should be able to explain the common features of policy networks (as opposed to networks of other kinds), which this project is aiming to identify. Using an interdisciplinary, multi-theoretical and methodological approach, our project will add to the conceptual and empirical literature on policy networks. We end with some proposals for the development of the field, and invitations to participate in the ongoing project.

Public health interventions may have a range of adverse effects. However, there is limited guidance as to how evaluations should address the possibility of adverse effects. This discussion paper briefly presents a framework for thinking about the potential harms of public health interventions, focusing on the following categories: direct harms; psychological harms; equity harms; group and social harms; and opportunity harms. We conclude that the possibility of adverse effects needs to be taken into account by those implementing and evaluating interventions, and requires a broad perspective on the potential impacts of public health strategies

Objectives: To examine evidence from studies exploring the relationship between childhood obesity and educational attainment.Design: A systematic review of secondary analyses and observational studies published in English after 1997 examining attainment as measured by grade point average or other validated measure, in children aged 6 to16 years, in high-income countries.Methods: Eleven databases from the fields of public health, education and social science were searched, along with 19 specialist registers and catalogues. Hand searching of relevant journals, contacting of experts and citation searching were undertaken. Two reviewers used standardized tools to independently carry out data extraction and assess the quality of included studies. Evidence was synthesized in a narrative summary.Results: Twenty-nine studies were identified for inclusion. Overall, the evidence suggested that higher weight is weakly associated with lower educational attainment among children and young people. Differences between average attainment of overweight and non-overweight children were marginal, with potentially negligible real-world implications for test scores. Limited evidence suggested that little variation in achievement was explained by weight status alone. Almost half the studies found that other factors, such as socioeconomic status, may better explain much of the negative association between obesity and attainment.Conclusion: Theoretical and methodological inconsistencies were evident both within and between many of the studies. As such, the results of the included studies must be interpreted with caution. If the negative association between obesity and attainment is accepted, it still remains doubtful whether obesity is exerting a socially important effect upon educational attainment.

"""Background: Persistent health inequalities encourage researchers to identify new ways of understanding the policy process. Informal relationships are implicated in finding evidence and making decisions for public health policy (PHP), but few studies use specialised methods to identify key actors in the policy process.

Methods: We combined network and qualitative data to identify the most influential individuals in PHP in a UK conurbation, and describe their strategies to influence policy. Network data were collected by asking for nominations of powerful and influential people in PHP (n= 152, response rate 80%), and 23 semi-structured interviews were analysed using a framework approach.

Results: The most influential PHP makers in this conurbation were mid-level managers in the NHS and local government, characterised by managerial skills: controlling policy processes through gate keeping key organisations, providing policy content, and managing selected experts and executives to lead on policies. Public health professionals and academics are indirectly connected to policy via managers.

Conclusions: The most powerful individuals in public health are managers, not usually considered targets for research. As we show, they are highly influential through all stages of the policy process. This study shows the importance of understanding the daily activities of influential policy individuals.
"""

AIMS:

A report of a systematic review of reviews which examines the impact of having midwives-led maternity care for low-risk women, rather than physicians.
BACKGROUND:

  A rising birth rate, increasing complexity of births, and economic constraints pose difficulties for maternity services in the UK. Evidence about the most effective, cost-effective, and efficient ways to give maternity services is needed.
DATA SOURCES:

  Searches were carried out in August-September 2009 of ten electronic databases, 16 key nursing and research websites, and reference lists of 56 relevant reviews. We also contacted 38 experts for information. No date restrictions were employed.
REVIEW METHODS:

  A narrative review of systematic reviews or 'meta review' was conducted using transparent and systematic procedures to limit bias at all stages. Systematic reviews that compared midwife-led care during pregnancy and birth with physician-led care were eligible for inclusion.
RESULTS:

  Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified.
CONCLUSIONS:

  For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care.

"Introduction
Public health policy-making activities are currently split between local authority and NHS organisations. Despite an increasing body of research on evidence-based policy (EBP), few studies explore the process of policy-making. Little is known about how policies are made in a local context, or how (scientific) evidence is used. Previous research has ignored the ‘human element’ in EBP. Social network analysis (SNA) techniques are becoming increasingly important in health policy. This paper describes an innovative study giving a fresh perspective on policy-making processes in public health.

Methods
A social network analysis of public health policy making networks in Greater Manchester based on publicly available data (documents, websites and meeting papers) and an electronic survey, asking actors to nominate those who influenced their own views, those who were powerful, and those who were a source of evidence or information.

Results and conclusions
Policy-making networks are described. Formal executive roles are loosely related to perceived influence and power. Evidence-seeking networks are less coherent, with key organisations not represented. These data indicate the importance of collaboration and good relationships between researchers and policy-makers, but few academic researchers with a direct impact on health policy were identified within the networks."

Background

There are high levels of concern about childhood obesity, with obese children being at higher risk of poorer health both in the short and longer terms. Children's attitudes to, and beliefs about, their bodies have also raised concern. Children themselves have a stake in this debate; their perspectives on this issue can inform the ways in which interventions aim to work.

This systematic review of qualitative and quantitative research aimed to explore the views of UK children about the meanings of obesity and body size, shape or weight and their own experiences of these issues.
Methods

We conducted sensitive searches of electronic databases and specialist websites, and contacted experts. We included studies published from the start of 1997 which reported the perspectives of UK children aged 4-11 about obesity or body size, shape or weight, and which described key aspects of their methods. Included studies were coded and quality-assessed by two reviewers independently.

Findings were synthesised in two analyses: i) an interpretive synthesis of findings from open-ended questions; and ii) an aggregative synthesis of findings from closed questions. We juxtaposed the findings from the two syntheses. The effect of excluding the lowest quality studies was explored. We also consulted young people to explore the credibility of a subset of findings.
Results

We included 28 studies. Instead of a focus on health, children emphasised the social impact of body size, describing experiences and awareness of abuse and isolation for children with a greater weight. Body size was seen as under the individual's control and children attributed negative characteristics to overweight people. Children actively assessed their own size; many wished their bodies were different and some were anxious about their shape.

Reviewers judged that children's engagement and participation in discussion had only rarely been supported in the included studies, and few study findings had depth or breadth.
Conclusions

Initiatives need to consider the social aspects of obesity, in particular unhelpful beliefs, attitudes and discriminatory behaviours around body size. Researchers and policy-makers should involve children actively and seek their views on appropriate forms of support around this issue.

Abstract
Background  If research addresses the questions of relevance to patients and clinicians, decision-makers will be better equipped to design and deliver health services which meet their needs. To this end, a number of initiatives have engaged patients and clinicians in setting research agendas. This paper aimed to scope the research literature addressing such efforts.

Methods  A systematic search strategy combined electronic searches of bibliographic databases with handsearching and contacting key authors. Two researchers, initially working independently, described the relevant reports.

Findings  Over 250 studies addressed patients’ or clinicians’ priorities for research and outcomes for assessment. This literature described different routes for patients and clinicians to contribute to research agendas. Two-thirds of the studies addressing patients’ or clinicians’ research questions were applicable across health care, with the remainder focussed on specific health conditions. The 27 formal studies of patient involvement revealed a literature that has grown in the last decade. Although only nine studies engaged patients and clinicians in identifying research questions together, they show that methods have advanced over time, with all of them engaging participants directly and repeatedly in facilitated debate and most employing formal decision-making procedures.

Conclusion  A sizeable literature is available to inform priorities for research and the methods for setting research agendas with patients and clinicians. We recommend that research funders and researchers draw on this literature to provide relevant research for health service decision-makers.

Introduction
Much attention has been paid to the role of individuals in evidence utilisation. Mainly this focuses on (a) how to increase uptake of research, (b) validating models of knowledge transfer (c) advocating for the use of knowledge brokers. Recently published research corroborates the importance of interpersonal relationships which these studies assert. The literature provides several frameworks to describe the activities associated with knowledge brokerage. However, little is known about the activities of actors who are influential in policy making. This study aims to describe the activities of powerful and influential actors and compare them with standard KB frameworks.
Methods

24 semi-structured interviews with national, regional and municipal policy makers were carried out. The data were transcribed and analysed using framework analysis to categorise and explain the strategies used by actors to influence policy.

Findings

Although influential actors did use knowledge brokerage as a strategy to influence policy, this was just one item in their toolkit of methods to influence policy.  A range of knowledge brokerage roles were described by actors, which overlap with knowledge brokerage frameworks presented in the literature. However, these activities were just a subset of a larger spectrum of activities which fell into four categories; controlling policy organisations, controlling policy content, controlling policy makers, and using network structures

Discussion

While it is important to help policy makers to find and use evidence, the literature largely ignores the fact that there are already individuals out there playing knowledge brokerage roles. SNA can identify these individuals. These actors use a range of activities to influence policy. By categorising these activities, a deeper understanding of the policy process can be developed, and practical targeted messages developed by academics.

Statements
1. Introducing  knowledge brokers from academia into the policy arena ignores the day-to-day activities of policy actors
2. To influence policy, researchers should consider adopting a more pro-active approach to make and exploit links with influential actors

Background: Involving consumers in research is becoming a recognised method of ensuring that researchers and policy makers meet people’s needs and priorities more effectively, appropriately and acceptably. The Cochrane Collaboration has been at the forefront of consulting health service users about effectiveness reviews. This paper presents an innovative consultation of healthy young people about reviews of qualitative and observational studies. These methods may be of future relevance for consumer work with effectiveness reviews. Objectives: To use a range of methods to involve children and young people at different stages in the systematic reviewing process, and to assess its effect on a review of qualitative studies, and a review of correlational studies. Methods: During two workshops with children and young people aged 12-17, undertaken in partnership with the National Children’s Bureau, participants were presented with two systematic reviews on childhood obesity. Children were presented with the thematic synthesis from a review of children’s views on obesity, and asked to comment on the findings and draw implications for future interventions from them. Next, children were shown a systematic map of correlational studies exploring the link between obesity and educational attainment. They prioritised certain topics, to narrow the focus for an in-depth review, and considered the plausibility of theoretical and statistical associations found in the literature. Results: Children highlighted gaps in the evidence base provided by views studies, indicating new areas for primary research. They drew a range of implications for service providers and carers from the findings of the views research synthesis. For the correlational studies, they selected associations deserving further investigation. Reflections on the process are also presented. Conclusions: While involving children and young people in research is challenging, the results demonstrate the benefits of doing so, particularly for policy-relevant research.

Caird, Jennifer and Rees, Rebecca and Kavanagh, Josephine and Sutcliffe, Katy and Oliver, Kathryn and Dickson, Kelly and Barnett-Page, Elaine and Thomas, James (2010) The socioeconomic value of nursing and midwifery: a rapid review of reviews. EPPI-Centre report, no. 18 . EPPI-Centre, Social Science Research Unit, Institute of Education, University of London. ... Full text not available from this repository. ... Official URL: http://eppi.ioe.ac.uk/cms/Default.aspx?tabid =2469&... ... IOE EPrints is powered by EPrints 3 and is hosted by ULCC.

Background: Knowledge brokerage (KB) is promoted as a way for researchers to influence policy and practice. KB can be approached analytically as a collection of activities or strategies used by individuals to influence policy, but little is known about how policy is influenced by individuals. We aimed to identify policy-influencing strategies described by individuals involved in the policy process and compare them with KB frameworks.
Methods: Semi-structured interviews (n = 23) were carried out with a purposive sample of individuals involved in public health policy (gathering or analysing information, developing or implementing policy) in a  large city in the UK. Individuals were recruited as part of a network study (Oliver 2013), and were approached to achieve representativeness in terms of professional group and centrality. Data were collected between January – September 2010, and were analysed using a framework approach.
Principle findings: KB activities were used by all professional groups, although most frequently by NHS managers and council officers. However, these formed a small part of a wide spectrum of activities which were used to influence policy, which ranged from design and management of key organisations, to influencing individuals directly. Examination of the discourse around these activities showed that influential individuals were able to exercise autonomy throughout the policy process, and used all strategies at appropriate times.
Conclusion: Policy is influenced by exceptional individuals who use a range of strategies to initiate, manage and control policy, including KB strategies. All professional groups were shown to use these strategies, with the most influential individuals being health and council managers. This paper presents a novel approach to understanding the relative importance of KB activities in influencing policy. Our analysis sheds new light on the policy process and suggests researchers are unlikely to influence policy using traditional KB approaches.

When a company develops a new product, they do so on the back of years of market research; understanding the needs of the target population, assessing the competitors, considering how to provide competitive edge, and predicting the likely market share of new product. Why does the same not apply to products developed by universities and other research organisations?
Although there are differences, research outputs can be seen as any other product entering a competitive market place. This means comparisons can be drawn between their producers (corporations and researchers respectively) and the techniques used to market or disseminate the product in question. Clearly, the motivations of corporate business and research groups are different. Corporations may be  driven by profit, innovation, sustainability, longevity, and workforce pressures. To many, this will sound wildly divorced from the reality of conducting research – and will question the apparent difference in motivation. Businesses are driven to maximise profit, and researchers (in applied health sciences) are motivated to produce high-quality research which can inform practice and policy. Few researchers – perhaps increasingly in the new impact-driven world – would disagree that they would like their research to have more effect on the real world. . Even though researchers are not financially motivated, however, most would be keen to  maximise the impact of our research; quite apart from the fact that we are often funded by public money, and are thus also motivated by public duty to increase our impact, are increasingly measured by our impact.
Businesses use a range of methods to increase their knowledge of the market place and help predict the likely reach of their product. For example, when Apple brings out a new iPhone model, they know they want to achieve a certain percentage market share, and so they develop a strategy to aggressively market the new product. Do researchers go through the same process of estimating the market share, developing a target percentage or a strategy to reach it?
In fact, many research outputs can be considered in the same way as any other product. For example, health services researchers may be interested in developing a needs assessment tool for a patient group. Potential and actual users of the tool could be identified (Clinical Commissioning groups, charities, community services), and contacted to assess usage, and thus calculate the market share. On the back of this information, decisions about targeted dissemination could be made, the development of new products could be informed, and so forth.
The concepts of ‘marketing’ and market share have been used in health services research before, although primarily to understand the population share of hospitals (Garnich 1987) or to market particular services (Banaszak-Holl 1996). This paper discusses some features of the business world which, if applied to production and dissemination of research outputs may enhance the ability of researchers to influence policy and practice.

Context: Despite 20 years of research into evidence-based policy (EBP), and continued drive from both policy makers and researchers to increase the amount of research evidence used by policy, persistent barriers to the use of evidence remain are found in the literature. However, it is not clear what explains this persistence.
Methods: This paper analyses this literature in detail to try and explain the persistence of barriers and facilitators. We critically describe the literature in terms of its theoretical underpinnings, definitions of ‘evidence’, methods, and underlying assumptions of the research. We aim to illuminate the EBP discourse by comparing the EBP literature with approaches from other fields.
Findings: Much of the research in this area is theoretically naive, focusing primarily on the uptake of research evidence and privileging academics’ research priorities over policy makers’ priorities. Little empirical data analysing the processes or impact of evidence use in policy is available to inform researchers or decision-makers. EBP research often assumes that policy makers do not use evidence; and that more evidence – meaning research evidence - use would benefit policy makers and populations.
Conclusions: We find that most EBP research is based on unsupported assumptions. The agenda of ‘getting evidence into policy’ has sidelined the empirical description and analysis of how research and policy actually interact in vivo. Rather than asking how research evidence can be made more influential, academics should aim to understand what influences and constitutes policy, and produce broader, more critically and theoretically informed studies of decision-making. We question the main assumptions made by EBP researchers, explore the implications, and propose new directions for EBP research.
Keywords: Evidence-based policy; critical analysis, knowledge utilization, science and technology studies

"Public health policy actors are encouraged to use evidence in the decision-making process. However, little is known about what types of evidence policy actors working in local settings prefer to use. This study evaluates policy actors’ needs and sources of information, at regional and local levels.
Methods
An electronic survey with telephone follow-up was carried out amongst public health policy actors and evidence producers working in a large UK city. Respondents were asked which types of evidence they used regularly, found most useful, and what were their main sources of information. Semi-structured interviews added qualitative depth to the categorical responses generated by the survey.
Results
Policy actors use a much greater range of evidence and information than is often indicated in the literature on evidence-based policy. Local data were by far the most used and most valued type of information, followed by practice guidelines. The main source of information were Government websites, followed by information obtained through personal contacts, including public health professionals, council officers and politicians. Academics were rarely consulted and research evidence was rarely seen as directly relevant.
Conclusions
Policy actors use a wider range of evidence types than previously discussed in the literature. Although local data were most valued by policy actors, results suggest that these were accessed through personal contacts, rather than specialised organisations. Systems to provide local high-quality evidence for public health policy should be supported.
"

The evidence-based policy movement claims that more research evidence should influence policymaking. It is not clear how evidence is found or whether it influences decision making in public health, although it is known that personal relationships between evidence users and producers facilitates use of evidence. Current perspectives in the literature fail to address relational aspects of finding evidence and influencing policy.

In this study, social network analysis is used to study the relationships between perceived power, influence, and sources of evidence. Network and qualitative data about were gathered from a policy community in a large urban area in the UK. Powerful and influential people were initially identified using centrality scores. Their characteristics were compared with themes from the qualitative interview, including a narrative about insiders and outsiders in the policy process. Hubs and Authorities analyses were used to test these idea in the network data. Authorities tended to correspond to formal hierarchy, but the Hubs were mainly mid-level managers in the NHS and local councils.

These findings were then compared with a evidence network to see (1) where powerful and influential people got their information and (2) whether there was a relationship between being a source of information and being influential. The results showed that evidence-producers are not influential or powerful in this policy network. Powerful and influential actors are in some cases also considered source of evidence; more frequently these individuals were described in terms of roles (e.g. gatekeeping, brokerage) or personal characteristics. An additional analysis of roles (Gould-Fernandez roles) was therefore carried out to explore what roles were played by different actors in the networks with respect to evidence-brokerage and the policy process.

The results show that occupying advantageous network positions is dependent on both structural circumstance and individual characteristics; in other words, having the right person in the right place. To be effective, these individuals are able to identify important relationships, create and maintain them. Their ability to influence depends on having personal skills explicitly manage network structure. Although not a new conclusion for the business or organisational theory fields, it is new in the field of evidence-based policy.

IntroductionPublic health policy-making activities are currently split between local authority and NHS organisations. Despite an increasing body of research on evidence-based policy (EBP), few studies explore the process of policy-making. Little is known about how policies are made in a local context, or how (scientific) evidence is used. Previous research has ignored the ‘human element’ in EBP. Social network analysis (SNA) techniques are becoming increasingly important in the health sector, and have been used in policy analysis elsewhere. This paper describes an innovative study giving a fresh perspective on policy-making processes in public health.Methods• A social network analysis of public health policy making networks in Greater Manchester based on publicly available data (documents, websites and meeting papers) and an electronic survey • Observation of local authority and NHS decision-makers at key policy meetings 2010-11 in the Greater Manchester areaResultsThese data indicate the importance of collaboration and good relationships between researchers and policy-makers, but few academic researchers with a direct impact on health policy were identified within the networks. Some overlap was found between NHS and local authority networks, with bridging organisations acting as sites of contact between the two. Additional assessment of the data the key meetings indicated differences in decision-making, evidence-seeking and evidence-using behaviour between NHS and local authority policy-makers. ConclusionsNHS and local authorities function as distinct cultures with separate decision-making and evidence-using behaviours. Network analyses indicate the existence of some links between the two, but these were largely centred on individuals instead of formal structures. The importance of individual effectiveness, authority and activity are discussed. Additional research will be conducted to assess changes due to future reorganisations

""Introduction: Persistent health inequalities are the focus for much public health policy activity. Understanding the policy response to public health problems, the role of evidence, and the roles and strategies of different actors may help explain this persistence. Research suggests that policy actors often access knowledge through interpersonal relations, but current perspectives in the literature do not analyse relational aspects of finding evidence and influencing policy. Identifying powerful and influential actors (in terms of personal characteristics, strategies, and network properties) offers a method of exploring the policy process and evidence use.

Methods: Network data were gathered from a public health policy community in a large urban area in the UK (n = 152, response rate 80%), collecting relational data on perceived power, influence, and sources of evidence about public health policy. Hubs and Authorities analyses were used to identify powerful and influential actors, to test whether powerful and influential actors were also sources of information; and betweenness and Gould-Fernandez brokerage were used to explore the importance of structural position in policy networks. These data were analysed in conjunction with qualitative data from semi-structured interviews (n = 24) carried out with a purposive subsample of network actors. Characteristics of powerful and influential actors, the use of evidence in the policy process, and roles and strategies used to influence policy were analysed using a framework approach, and combined with network data.

Results: The most influential actors were mid-level managers in the NHS and local authorities, and to a lesser extent, public health professionals. These actors occupied advantageous positions within the networks, and used strategies (ranging from providing policy content, to finding evidence, to presenting policy options to decision-makers) to influence the policy process. Powerful actors were also sources of information for one another, but providing information did not predict power. Experts, academics and professionals in public health were represented in the networks, but were usually more peripheral and played fewer roles in the policy process. This study presents empirical evidence to support the suggestion that recognition of network structure assists individuals to be influential, and proposes a framework to categorise their activities.

Conclusions: In order to influence policy, actors need good relationships with other influential actors, and the skills to exploit these relationships. The relational approach is useful for both identifying powerful and influential people (potential evidence-users) and for exploring how evidence and information reaches them. Identifying powerful and influential actors and describing their strategies for influencing policy provides a new focus for researchers in evidence-based policy, and for those wishing to influence policy. For academics and researchers, this study demonstrates the importance of directly creating ties with decision-makers.""

We welcome the glossary of theories presented last month by Smith & Katikireddi (2012) and applaud the intention to introduce wider thinking from the political sciences on these subjects to health researchers. Drawing on our practical experiences in the fields of healthcare management and health services research, we would like to identify three related areas which may also be useful for the public health audience. We suggest this commentary solely to help the glossary to be more widely used and increase its impact.