Background
The role that local government can play in improving population health is recognised Internationally. Yet, there are very limited research systems that exist within local government to support their ability to create and synthesis the evidence needed for preventative and public health interventions. Most research systems exist outside of the local authority and are based within health, community and academic partnerships [
1]. In England, local government has become a key constituent for addressing health inequalities and influencing the health of individuals and communities [
2]. While this has been lauded as an effective approach to tackle the multiple determinants of health, there are concerns that generating and utilising research evidence to inform decision-making and action is a challenge [
3,
4]. This situation is not isolated to England and international reviews have shown various ways in which local government access and acquire evidence for decision-making – one review suggesting six models and approaches between local government and research systems [
1]. Indeed, evidence-informed decision-making is complicated and involves integrating the best available research evidence with contextual factors including community preferences, local issues, political preferences and public health resources [
5]. With this backdrop, this paper reports research which sought to understand the capacity to collaborate, deliver and utilise research across one metropolitan district council. The research explored current assets within local government in relation to research development and evidence implementation and how these could be further harnessed. Moreover, the research identified limitations and shortcomings which prevented research use and activity from flourishing. The paper draws out implications more widely for local government and how to reconfigure the relationship between research, evidence and decision-making in public health.
The transfer of public health functions in England from the National Health Service (NHS) to local government in 2013 aimed to bring about improvements to population level health and to reduce health inequalities. While the delivery of public health can vary in local authorities [
6], this reorganisation saw a change in culture from a narrow focus on health care pathways to one of a politically led environment with opportunity to influence the wider determinants of health and wellbeing. As part of this, Health and Wellbeing strategies are a vehicle for local governments to act on the wider determinants of health and wellbeing and provide an opportunity to adopt an evidence-based approach to local decision making and prioritisation of limited resources across local government. Nonetheless, the use of evidence and published research within these strategies is not common practice. Analysis of Health and Wellbeing strategies by Beenstock et al. [
7] identified that only five out of 47 Health and Wellbeing strategies referred to published research evidence and only three cited National Institute for Clinical Excellence (NICE) guidance.
Barriers to the use of research and evidence to guide decision making include the questioning of the credibility of the evidence [
3,
4] and the transferability of evidence that is out of context and not generated in the local setting [
3]. Studies exploring how evidence in local authority public health practice is used have highlighted the disconnect in understanding between policy makers and academics, especially in regard to what constitutes robust and useful knowledge [
8]. Indeed, locally generated data are viewed by decision makers as fitting the political context, having more transferability, and thus having a bigger influence on their local decision making [
9]. In addition, a systematic scoping review exploring the use of evidence in local public health decision making concluded that researchers need to develop a deeper understanding of evidence requirements from the perspective of decision-makers [
10].
The Local Government Association (LGA) [
11] further reiterated the value of research in local government settings. The LGA recently highlighted that ‘local government needs practical research providing solutions that can be applied in real world situations. Councils can benefit from engaging in research partnerships’ (p.8). The report suggests the need for increased capacity and development of the local authority research system. Other reports have also signalled the importance of taking a population level, non-clinical and transdisciplinary approach to public health interventions and research [
12]. How that vision translates into practice and work ‘on the ground’ is relatively under-explored and understood. So, while the rhetoric is strong, it is clear that there are significant challenges based on the “daily rush to support frontline delivery of services with a lack of resources” (p.8) in local government. This means that time, expertise, and space to use or generate research is a struggle [
13].
In the UK the National Institute of Health Research (NIHR) funds health and social care research that aims to improve people’s health and wellbeing. The NIHR recognised the position that local government can have to improve population health and set out a funding call (in April 2020) to identify how local authorities could be developed into locally based research systems and to shape future investment. The research presented here was conducted following a successful application to the local authority research system funding call. The research was based in one local authority in the north of England where qualitative methodology was employed, operationalised through interviews, focus groups, meeting observations and documentary review. This paper focuses specifically on interviews and focus groups with a range of local authority personnel (described in more detail shortly) to enable greater understanding of the capacity of the local authority to collaborate and deliver research.
Methods
The research was undertaken between August–November 2020. The overarching aim was to explore the current research assets in the local authority and to determine how these could be nurtured and replicated within the organisation to foster a stronger research culture. In addition, the research sought to identify any perceived barriers that exist to the local authority working with academic partners. In particular, to establish research capacity and opportunities, and explore with key members of the organisation how a sustainable research system could be developed to impact on local resident’s health, reduce health inequalities and identify the most important research outcomes. The theoretical underpinning of the research was the Research Capacity Development Framework [
14].
The study adopted a collaborative approach throughout from the funding bid development to outputs and dissemination. A project steering group was established which included representation from: the local authority at strategic, operational and political levels, neighbouring local authorities who had also received NIHR funding, local academic intuitions, NHS research infrastructure support networks and the local NHS hospital trust. This steering group supported with the study design, recruitment and data analysis and, following the study, knowledge transfer and dissemination. The study was chaired by an elected member. In the UK an elected member is chosen to represent their local area and inform and influence the decisions and running of the local authority. Elected members may have key responsibility for different portfolios such as health, children’s services, planning and transport.
Data collection was undertaken by an Embedded Researcher (ER) who was based within the local authority for the study period. The ER model is becoming increasingly highlighted as allowing a joined-up approach to creating and using knowledge by placing a researcher in a non-academic organisation to better link research and practice [
15]. The decision to use an ER in this study was so that it could potentially provide greater depth and insight within an organisation through having a researcher integrated within the culture and environment. However, this was compromised during the Covid-19 pandemic and the ER became digitally, rather than physically, embedded in the local authority. As part of the ER process, a co-applicant of the study facilitated access for the ER to attend to attend online team meetings at the operational and strategic level with various departments across the local authority in order to meet employees, develop a rapport with teams and raise awareness of the study. This included attending team meetings and formal committees. The ER was introduced to strategic directors by another co-applicant of the study who was also a member of the Local Authority leadership team. Prior to the study starting the strategic leadership were informed and supportive of the study, this helped with rapport building in preparation of the interviews. While the research team conceded that the original intention was for the ER to be co-located in situ with staff in the local authority, there was still methodological learning and value from a digitally ER working within the organisation. This is reflected upon later.
Setting
The research focused on a single local authority in the north of England. The area is one of the largest Metropolitan Districts in the country and is one of the largest cities in the UK, without its own university, with levels of educational attainment below average. The area is in the top twenty-percent of the most deprived districts in England and on average, people die younger than in other parts of England. Cardiovascular, cancer and respiratory illnesses are in high levels in the district resulting in people becoming ill at a younger age, having to live with their illnesses longer compared to most of the rest of the country.
Sample
Purposive sampling was used for both identifying individuals for the interviews and focus groups. The sampling was conducted with support of the project steering group in which a discussion was had to identify the key strategic roles and groups from across the authority that would need to be included. The steering group also identified groups of people who were research active (involved in delivering or commissioning research or who held a research related qualification), roles within public health where research was considered to be used in practice on a regular basis, and elected members who had responsibilities for different portfolios across the local authority. Participants were recruited via email invitation. All participants were provided with a briefing paper, written by members of the project team and co-applicants employed by the local authority, and a participant information sheet, prior to data collection to ensure informed consent was gained. Consultation with the study steering group informed the sampling of three focus groups which were conducted with: Focus Group 1 - Elected Members (n = 3), Focus Group 2 - Public Health Officers (n = 6) and Focus Group 3 - Officers with research interests across the local authority (n = 4). Interviews (n = 7) were conducted by the ER with Corporate Directors and Service Managers purposively sampled to enable the research questions to be explored fully.
All data collection was undertaken online using Microsoft Teams due to social distancing restrictions of the Covid-19 pandemic. All aspects of the study received ethical approval from both Leeds Beckett University and Sheffield Hallam University and access permissions were gathered from the local authority via the strategic leadership team. Interviews and focus groups were conducted in parallel due to the short time frame in which to conduct the research and lasted between 30 and 60 minutes. Interviews and focus groups explored a range of issues which were informed through the Research Capacity Development (RCD) framework developed by Cooke [
14,
16]. The RCD works at individual, organisational and systems levels, with a purpose to develop research that is useful and impactful to society [
17,
18]. Assessing both the assets and potential for RCD of an organisation can help articulate what a partner may bring to a collaboration and can be considered an important aspect of win-win research partnerships. The RCD framework has been applied in a range of contexts and in developing of organisational research strategy [
16].
Using the principles of the RCD framework [
18] the interview schedules and focus group guides covered: linkages and partnership; skills and confidence in the workforce and wider community; infrastructure of the council and wider partnerships, research use and dissemination, experience and assets of coproduction in projects (including citizen and public engagement in projects); and ownership, leadership and sustainability of research activity (both by Officers and Elected Members).
Data analysis
Interview and focus group recordings were transcribed by an external transcription company, anonymised and shared as a secure online file which was accessible by three members of the research team. All transcripts were coded on NVivo 12 by the ER and two members of the research team cross checked a sample for coding accuracy. Data were analysed using framework analysis [
19]. Framework analysis was used as an expedite method given the short timescale for the project funding and was deductively informed following the RCD framework [
14]. Specific elements of the RCD framework were used in the development of the matrices – a core aspect of framework approach – this seemed pragmatic in deductively analysing the data set given the RCD framework was used to inform the data collection tools (as discussed earlier). Given the limited timeframe set by the funder for the research delivery, the data was analysed sequentially with interview analysis being completed first followed by focus groups. This was based on pragmatics, but also was beneficial in refining analytical categories and themes during the process and supported the triangulation of the two sets of data. Inductive coding and inductive thematic development was also part of the analytical process to enable specific ‘local’ issues within the local authority to be represented.
Discussion
This paper sought to understand how research evidence could be more effectively used to inform decision-making in a local authority, focusing particularly on what strengths and assets are currently embedded in the organisational make-up and to identify any potential areas for development. Uniquely, the research design was underpinned by an ER model which has high utility in gaining depth of information and recognising contextual and local factors – we argue that such an innovative methodological approach offers a new contribution to understanding the use of research and evidence in local government. While this ER was largely ‘digitally integrated’, there were particular benefits with adopting a model whereby rapport could be developed with individuals within the local authority to foster rich data gathering. This is discussed again later in this section.
Influenced heavily by evidence-based medicine, evidence-based public health is a long-standing principle of great importance in research and practice. This principle has been amplified by the movement of Public Health into local authorities, with the increasing emphasis on ‘economic rationalism’ and the need to justify expenditure, and ensure that funds are deployed to maximum returns [
20]. With the political dimension that local authorities hold, economic rationalism and evidence-based decision making is crucial to ensure democratic legitimacy but, to date, little research exploration has focused on this matter. If local authority personnel are to successfully implement change, then they must draw on the evidence base to aid and support decision-making [
21] by elected officials. Indeed, this rhetoric was well understood in this study, and the practical challenges were also recognised by participants.
This study showed the significant challenge for local authority practitioners and policy-makers using evidence to good effect. Some of these issues are unsurprising and have been noted elsewhere [
7], it is perhaps axiomatic that busy practitioners working in local authority do not have the space or time to engage in research, evidence generation or assessment and this study re-enforced that this situation has not necessarily changed over time. While this is understandable, it can be a fundamental shortcoming for effective evidence-based decision-making. There is also a strong ethical imperative to adopt the principles of evidence-based practice to ensure that health promotion and public health activity does no harm, either directly or indirectly, by wasting limited funds on ineffective or inappropriate interventions, or by raising unrealistic expectations about what might be achieved. Similar to the findings of the study reported in this paper, in a study by Li et al. [
20 , p.196], health promotion practitioners stressed the value of evidence for this reason. One participant in their study noted: ‘I do firmly believe that we need some evidence before we launch into things. I think the prospect of doing harm is too great to not have some inkling of where it is going to go’.
The context of public health within a local authority, a political domain, is also interesting for research and evidence utilisation. Lifestyle drift is the inclination for policy that recognises the need to act on upstream social determinants only to drift downstream to focus on individual lifestyle factors [
22]. In a culture where lifestyle interventions are significantly easier to evaluate, and are facilitative of political cycles, it is understandable why more entrenched determinants of health, which takes years to address (i.e. poverty), are often ignored [
23]. This strikes to the epicentre of the tension between academic rigour and expedient decision-making and was highlighted here as a common issue in local government. Public health is a very evidence-focused arena, and some have suggested that English local authorities are not a natural home for traditional evidence-based practice. Local government systems are political systems with key decisions needing locally elected officials’ approval [
6]. This has direct relevance to research leadership in local authority and having individuals who subscribe to research and evidence-based principles at the pinnacle of local authority structures. The research demonstrated that where this was in place, it fostered stronger commitments to research and evidence-based decision-making within teams and services.
It has been suggested that training for practitioners in interpreting research evidence is a necessary competency to aid professional judgements [
24]. Both Li et al. [
20] and Owusu-Addo et al. [
24] have demonstrated that practitioners in health promotion value evidence from researchers that is context-bound, and relates directly to their own practice, rather than evidence which is more abstract or out-of-context. This was shown in this study where decision-makers had a preference for context-specific evidence. Yet, in reality this can be difficult, and extracting useful evidence from various contexts is critical and does require advanced skills and understanding. The research showed a strong appetite for individuals and groups within the local authority to improve their research skills, and moreover suggested viable ways to do that through training and qualifications and strong connections with academic organisations and institutions. The need for research competency and capacity in local authority is something that is commonly known both nationally and also internationally [
25]. Owusu-Addo et al. [
24] highlighted that training programmes which build and maintain common skill sets and language among local public health practitioners in Ghana was necessary to accomplish evidence-based public health goals.
The literature highlights the benefits and challenges associated with utilising an ER approach to gather data [
15]. Our experience was overwhelmingly positive, in terms of accessing rich and detailed data for analysis and interpretation. The ER approach drew on ethnographic principles, including interviews and observations, but was fundamentally premised on being responsive and agile to opportunities that were presented within the local authority. While the ER was ‘digitally’ embedded and not ‘physically’ embedded as a result of the pandemic, this did not pose significant disadvantage. Indeed, as discussed earlier, in some cases it facilitated expedient access to key personnel who may have otherwise not have been made available. There were, however, some limitations with the study: access and rapport building with employees at the local authority was limited through attendance at pre-arranged meetings and the methods of data collection with limited opportunity for informal conversations, such as those that take place in an office environment; the short-time frame set by funders to set up, deliver and report on the research meant the study team and ER had to focus on ensuring that data collection was prioritised with less time to establish the ER into wider teams across the local authority.
The skill-set of the ER was crucial in being able to navigate both the local authority processes and also the academic collaborators making up the study team. Where challenges arose, they were mitigated by strong partnerships between the research team and the local authority staff (especially those acting as research collaborators) as well as the project steering group. This collective partnership between all constituents worked exceptionally well and enabled data gathering on barriers and facilitators to be conducted relatively smoothly. The ER approach offered the opportunity to gather insight from within the organisation that we are confident would not have been uncovered using other approaches to data gathering.
Conclusions
The study, utilising a unique ER approach, has explored and shed further insight into the decision-making processes and evidence-based decision-making in local government. Public health practice and practitioners are accustomed to the use of evidence-based decision making, yet this study showed how the democratic and organisational structure of local government challenges how effectively evidence is used in practice. Furthermore, increasing demands, limited capacity and resources impact on even the most research engaged practitioners’ ability to do research. The research highlighted the criticality of research leadership to challenge the status quo in the process of policy development and decision making in local government and move it to one that uses evidence-based principles and prioritises the use and development of research undertaken within local government organisations.
The ER model has high utility in gaining depth of information and recognising contextual and local factors which would support research capacity development in local government. Local government, place based collaborations, and academic institutions should explore and develop opportunities for ERs to bridge the organisational divides, in doing so developing trusted relationships, continued staff development and research capacity.
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