The current paper outlines the knowledge translation activities of the Access 3 project, which were specifically designed to inform NSW youth health policy. We believe the design of this translation activity represents a step forward in Australian youth health policy making as it brought together a range of different perspectives including those of young people, academics, health workers and policymakers to co-create policy recommendations using a strong evidence base on youth health issues and a theoretically derived knowledge translation framework. Specifically, the knowledge translation forum led to the co-creation of 6 policy themes of areas for policy action with 25 specific policy recommendations proffered. Participant satisfaction with the knowledge translation forum was high and, importantly, the policy recommendations from the workshops can be evidenced within the subsequent NSW Youth Health Framework . These results speak strongly to the success of building considered approaches to policy development and knowledge translation.
There are several aspects of the knowledge translation forum that likely contributed to this success. Central to these is the utilisation of the knowledge translation frameworks of Lavis et al and Grimshaw et al [1, 2]. These frameworks provided structure to the planning, execution and evaluation of the knowledge translation forum including the specific workshop activities and the knowledge dissemination strategies utilised. We therefore focus subsequent discussion around the key questions posed within these frameworks.
What should be transferred?
Effective knowledge translation requires quality evidence [1, 2]. Whilst researchers and research organisations, field experts, clinicians, consumers, peak bodies, and government bodies are often good sources of information, the evidence they provide is not always fit for direct policy translation [1, 9, 28]. The best evidence to support policy changes comes from pooled research knowledge in the form of systematic reviews or from research studies that are sufficiently large and targeted at specific policy questions [1, 2, 9, 10]. The quality, relevance and timeliness of evidence are particularly important influences on knowledge uptake [10, 29]. Presenting evidence in the form of ‘ideas’ rather than research data also improves the likelihood of translation, particularly when working with diverse groups and non-academic audiences .
In relation to the Access 3 project, the knowledge created through studies 1 to 3 are of high quality and relevance in that they were designed specifically for answering policy questions relevant to youth health [23, 24]. The demand-driven nature of the tendering process for the Access 3 work meant that this knowledge was sought after by the policymakers and developed in a timely manner with policymakers involved in the planning, execution and translation aspects of the project. Also, the translation forum allowed the research team to present the findings from studies 1 to 3 in the form of ‘research themes’ or ‘ideas’ and to transform these into actionable policy recommendations that were broadly aligned with the remit of NSW Health. Together, these approaches appear to have provided valuable information to policymakers that were subsequently transferred into specific policy goals.
To whom should research knowledge be transferred?
The target audience for knowledge translation activities must be clearly identified to ensure success [1, 2]. Having a well-defined target group allows knowledge translators to better understand the types of decisions and decision-making environments that exist for the particular target, which in turn, allows for the tailoring of knowledge translation strategies . For the current study, the target audience was defined as policymakers from the NSW Ministry of Health. The goal of the knowledge translation workshop was for these policymakers to be aware of and utilise the findings and policy recommendations from the Access 3 knowledge translation forum to inform policy development for the NSW Youth Health Framework . Consideration of the political and organisational constraints that face NSW Health policymakers was built into the planning, execution, and evaluation of the knowledge translation activities.
A key aspect of this approach was gaining an understanding of the NSW policymaking environment and the factors that influenced decision-making processes within it. Working with policymakers throughout the research and knowledge translation process helped build this collaborative partnership. Importantly, the Access 3 research and knowledge translation forum sat in the context of the broader relationship with the policymakers where researchers sat on a policy development reference group and gave comments on the policy and separately presented the research findings to policy committees.
By whom should research knowledge be transferred?
Effective knowledge-translation requires a credible messenger to deliver evidence to target audiences [1, 2, 10]. Individuals (e.g., health professionals, researchers, or consumers), groups, organisations, and the healthcare system can all act as messengers for knowledge translation activities focused at policymakers . Whilst building credibility with this target audience may be difficult and/or time-consuming, it is an important aspect of effective knowledge translation [1, 2]. The current study utilised a broad stakeholder collaborative to deliver our message to the NSW Ministry of Health. We utilised the voices of expert clinicians and impartial researchers as they are shown to be authoritative messengers for the development of evidence-informed health policy [1, 10]. We also included policymakers in the knowledge translation forum and research processes to ensure that the collaborative had a sound understanding of the policy process and the context surrounding NSW Health policy agendas.
We also made sure to actively include young people in the policy development process (as well as throughout the entire Access 3 project). To date, efforts to include young people in the development of policy remains variable across settings and portfolios with inclusion influenced by a range of political and ideological factors . Furthermore, when young people have been involved in the development of policy, this has often been limited to participating in rigidly structured consultations that have featured top-down approaches to policy development [30, 31]. Such efforts have even been labelled ‘tokenistic’ in their approach . To counter this, we prioritised the active inclusion of young people in the formulation of specific policy recommendations for the youth health policy. Throughout the knowledge translation process, the members of the core research team took on the role of knowledge brokers [2, 10, 28, 32, 33] working as intermediaries to build important connections between knowledge suppliers (i.e. researchers, clinicians and young people) and knowledge users (i.e. policymakers). This process featured bi-directional communication between stakeholders and policymakers to promote trust and greater understanding .
How should research knowledge be transferred?
A key explanation for the research-policy gap is the disparate and asynchronous responsibilities, priorities, and processes that exist within the domains of research and public policy [1, 2, 10, 12, 16, 33]. Research is typically investigator driven and usually proceeds in a steady, methodical, and linear fashion with publication of research findings often prioritised over translation efforts . In contrast, policy is often developed in a fast-paced, unpredictable environment that involves a raft of competing demands, priorities, and stakeholders [1, 2, 10, 16]. Whilst public policy is applied by nature, policy decisions may be influenced more by opinion and political ideals rather than unbiased empirical evidence. Developing evidence informed public policy thus requires strong and deep collaborations between researchers and policymakers [2, 16, 33]. Researchers are required to develop relevant, timely and helpful evidence that can be effectively translated into policy. Policymakers must appraise available evidence, navigate entrenched political and economic interests, and balance these alongside the social acceptability of the policy they are tasked to deliver .
There is a growing evidence base to guide choice of knowledge translation strategies aimed at policymakers . Specific factors that facilitate research uptake include interactive engagement between researchers and policymakers, and improved relationships and skills [10, 28]. Knowledge translation is thus most effective when it starts early, builds support through champions and brokers, understands contextual factors, and is timely, relevant, and accessible . For the current study, we utilised workshops involving variety of stakeholders and built deep relationships over a period of time to provide formulated recommendations to government through an established pathway. The partnerships built between investigators, forum participants and NSW Health underpinned the strength of this translation approach.
With what effect should knowledge be transferred?
When considering knowledge translation, it is important to determine how it is hoped that research knowledge will be used . In a health setting, this may be getting a clinician to change their behaviour in the face of research evidence whereas, in a public policy setting, the goal may be less concrete and may simply be to inform debate, especially given competing organisational and political factors [1, 2]. For the current study, the overarching goal was to develop implementable policy recommendations that could be provided to the NSW Ministry of Health for consideration for inclusion in the youth health framework . The fact that the research themes and recommendations provided to Ministry can be mapped onto policy items within the framework suggests that this approach was effective.
It is important to note the limitations of our research and knowledge translation approach. First, it is difficult to get an objective metric of knowledge translation success. Whilst document analysis allowed the authors to map policy recommendations onto the NSW Youth Health Framework  this approach may be considered subjective and hence may over or underestimate the impact of knowledge translation efforts. Whilst we acknowledge this limitation, the positive evaluation we received from policymakers engaged in the workshop suggests that our approaches were indeed impactful.
Second, whilst the forum led to a number of implementable policy recommendations, there were some recommendations that fell outside of the scope of NSW health policy. Specifically, these recommendations were related to federally administered Medicare structures that can shape the role and function of general practitioners. Importantly, this issue was highlighted and discussed at the knowledge translation forum. It was underlined that there was an audience for these kinds of recommendations beyond the NSW youth health framework. We believe that knowledge translation never ends in a closed system and that changes in one part of the overall health system will inevitably have flow on effects throughout the health system. Future work could look at how the development of the NSW youth health framework influenced and impacted the later development of policies across Australia at both a state and federal level.
Third, the required set up and timing of the forum meant some concessions had to be made. For example, the timing of the forum was due to policymakers needs and not the researchers and thus required the presentation of preliminary rather than final research results. Furthermore, as a face-to-face forum, there was limited in-person participation from rural areas. Nevertheless, the final findings of the research matched the themes presented at the knowledge translation forum and a rural reference group meeting was also held to supplement the forum findings. Overall, we believe that the approaches used were appropriate and led to strong levels of engagement from stakeholders and robust recommendations for policy.
Fourth, it is important to note that NSW health commissioned the Access 3 research and knowledge translation forum which likely had an impact on policymaker buy-in. It is probable that engaging policymakers would be more difficult when this is not the case. Regardless, we believe that the knowledge translation frameworks and approaches outlined in this paper provide a strong model for collaboration between researchers and government. These ways of working can likely assist the development of strong relationships like those developed for the Access 3 studies.
Finally, the current study stopped short of examining the actual implementation of policy recommendations that made their way into the NSW health framework. This was considered beyond the scope of our study and knowledge translation process. Measuring the success of knowledge transfer beyond decision making in the public policy realm is difficult as the routes from which research informed decisions translate into actual social, economic or health outcomes are complex .
In summary, we believe that the utilisation of knowledge translation theories and youth inclusion led to the successful transfer of evidence-based knowledge from the Access 3 studies into NSW health policy. We would therefore encourage researchers from abroad to consider such approaches for the development of youth health policy within their respective states and countries. By actively engaging young people and utilising theoretically supported knowledge translation frameworks, we can build more inclusive and appropriate health policies that promote the health of our younger generations. Within New South Wales, there is now a clear opportunity to examine the implementation of policy recommendations . By conducting this research, we may better understand the contexts, mechanisms, and outcomes surrounding policy implementation in the youth health space which will provide a clearer picture of how evidence is translated into subsequent action.