Background
There has been growing emphasis on the importance of developing innovations that facilitate the transfer of research evidence into health policymaking [
1‐
3]. A number of innovations have been developed and tested to support policymakers’ capacity to engage with and use research in policy [
4,
5]. Some of these interventions utilise network- or web-based technologies due to the potential for such tools to reach a wide audience of decision-makers quickly and efficiently [
6,
7]. Knowledge platforms are one such web-based technology that has been increasingly used to improve how information is accessed, stored, shared, retrieved and distributed within organisations [
8,
9]. Evidence suggests that knowledge platforms could be used to overcome some of the barriers to Evidence Informed Health Policymaking such as difficulties in accessing, applying and disseminating up-to-date, credible and applicable research to policymakers. Furthermore, these platforms may be useful for organisations that lack tools and systems to support research access, generation and use in policy, as well as to establish and sustain policymakers’ partnerships with researchers [
10‐
16].
The Centre for Informing Policy in Health with Evidence from Research (CIPHER), is a centre for research excellence located in New South Wales, Australia, which was established to develop and test innovative ways to increase the use of research in health policymaking. One of the innovations developed by CIPHER was Web CIPHER (
http://cipher.org.au), an online web portal designed to help health decision-makers better utilise, access and engage with evidence from research, with the ultimate goal of increasing their use of research in their work. Upon its inception, Web CIPHER’s target audience was policymakers, practitioners and researchers from Australian agencies that routinely developed health policies, programs and practices, at either the state or federal level.
Web CIPHER utilises web and email technology to facilitate access to and delivery of relevant and up-to-date information about health research and policy. The website is password-protected and contains five key sections with regularly updated content: Hot Topics, Research Updates, Events, Multimedia and Blog. The site also includes static sections, such as the Research Portal and Research Tools, as well as an interactive Community Bulletin Board to facilitate communication between policymakers and researchers. These sections are described in Table
1.
Table 1
Details of the main features of each section of Web CIPHER
Hot Topics | Daily | Provides summaries and blurbs of news articles that are directly relevant to member agencies of Web CIPHER; direct links to these articles are provided | Media monitoring with keywords of interest set up via Google Alerts (e.g. “public health”, “research”, “evidence”, and “health policy”); articles are scanned daily and chosen for their relevance and interest to members of the Web CIPHER network; the emphasis is on intervention research, program reviews, locally-relevant news, or examples of evidence-based policy | Many of the selected articles promote the value and importance of evidence-informed decision making in health |
Research Updates | Fortnightly | Summaries of systematic reviews, research papers and reports, with links to full articles | Fortnightly scan of relevant journals and sources for systematic reviews, research articles and reports (e.g. Australian and New Zealand Journal of Public Health, Implementation Science); these sources are reviewed for research, reviews and reports of interest, with an emphasis on public health intervention research, program evaluation, locally-relevant research, and research translation | Articles are chosen specifically for their relevance to agencies within the Web CIPHER community; numerous articles focus on strategies to facilitate research use in policy; article summaries are written in an engaging, newspaper style to highlight the main findings, aid comprehension of full text articles, and highlight the policy relevance of findings |
Events | Monthly | Summaries of upcoming events of interest to health policymakers | Monthly scan of organisations of interest for relevant events (e.g. the Australian Commission on Safety and Quality in Health Care, the NSW Agency for Clinical Innovation, the National Health & Medical Research Council, the Australian Research Council, the Cochrane Collaboration) and organisations represented by Web CIPHER members | The section allows policymakers to learn about upcoming programs, seminars, and conferences to improve their research skills, expose them to the latest research findings, or provide opportunities to connect with researchers |
Multimedia | Monthly | Videos, audio recordings and presentations of interest to health policymakers | Monthly scan of email alerts from a range of organisations (e.g. the Australian Healthcare & Hospitals Association, the Australian Commission on Safety and Quality in Health Care) and organisations represented by Web CIPHER members | The media files posted in this section often discuss practical strategies and innovations to integrate research into policy, as well as the value of using research to inform policymaking |
Blogs | Monthly-quarterly | 500-word conversational-style articles written by health leaders, focusing on their area of expertise, with lessons for policymakers | Quarterly meetings with management team to agree on potential topics and contributors; pitch sent to contributor, and article written by contributor in consultation with senior staff member at the Sax Institute to ensure tone and style matches Web CIPHER requirements | Blogs are often geared towards improving policymakers’ perceptions of the value of evidence-informed decision-making, describing the latest research in bloggers’ area of expertise, and providing advice on strategies to improve the use of such research in decision-making; the blog style caters to the needs of policymakers by being engaging, current, relevant, practical and concise |
Community | As required | Bulletin board where users can post information for other community members, such as new research, jobs or opportunities | User-driven | Provides a forum where policymakers and researchers can communicate and connect, access research, disseminate relevant research studies to policymakers, and discuss its relevance to current policy decisions |
Research Tools | As required | Links to sources that provide high-level advice and methods on accessing research, appraising research and applying it to policy, and generating new research | Updated as required only; sources are those identified as high quality by CIPHER investigators and Web CIPHER users | Section provides links to key articles that provide methods on how to find research, and appraise the relevance and quality of research, as well as links to services offered by the Sax Institute for generating new research and reviews (when available evidence is lacking) |
Research Portal | As required | Links to sources of high quality research and data, such as the Cochrane Library, the Campbell Collaboration, health-evidence.ca, Eppi-CENTRE, NIHR Centre for Reviews and Dissemination, the Australian Institute of Health and Welfare and the Australian Bureau of Statistics | Updated as required only; sources are those identified as high quality by CIPHER investigators and Web CIPHER users | Section provides links to key websites that provide one-stop shopping for systematic reviews, evidence briefs, high quality research journals, databases, and reliable sources of data and statistics; the section can be particularly helpful to staff whose organisations do not provide tools and systems that assist them in searching for and accessing research |
Our preliminary research indicated that Web CIPHER showed great potential to improve how policymakers engaged with research [
17]. Data revealed that over a 16-month period, 223 users from policymaking organisations joined the website. Six organisations accounted for more than 60% of the total number of users that joined. Five of these organisations were state agencies, each based in New South Wales. The other was a federal agency (now defunct) based in the Australian Capital Territory. Three of the six agencies focused on specific fields in health (e.g. cancer, drug prescribing), whereas the other three worked more broadly across public health and health systems improvement.
Viewing time and bounce rates (i.e. the percentage of users leaving the website after viewing a single page) on Web CIPHER were well above average for most websites [
18]. The Blogs section was the most popular section on the site, followed by the Bulletin Board. Furthermore, a weekly email alerting members to newly posted Hot Topics, Research Updates and Blogs significantly increased the likelihood that users accessed Web CIPHER content, particularly those posts relating to new research.
We surmised that the Blogs were particularly popular for a number of key reasons. Firstly, they were written by trusted figures in health policy and research, which may have increased users’ perceived trust in the site, and their sense of community and social presence, all of which are predictive of website use [
19‐
23]. Research has shown that staff are more likely to use knowledge platforms if they are perceived as credible, and are championed by trusted, recognised and authoritative figures [
9,
24].
The blogs were also written in a clear and concise manner, with minimal jargon, and a conversational tone [
14,
25], akin to the style of newspaper reports [
26]. They were also delivered directly to users’ inbox via a weekly newsletter [
27], and presented in a format suitable for mobile phones, tablets or related devices [
26,
28]. The blogs often summarised relevant research findings [
25,
29] and provided clear and concrete recommendations [
14,
30]. Consequently, the blogs addressed some of the key barriers to research use such as limitations in policymakers’ research skills, complex presentation of research findings, excessive use of jargon and policy irrelevance [
13,
14,
31].
In light of these findings, we aimed to test a number of strategies to further increase policymakers’ Web CIPHER usage, and hence their engagement with research evidence. Firstly, we aimed to examine the effect on usage of increasing both (1) the number of blogs posted on the website, and (2) the relevance of blogs by focusing on topics relating to particular agencies’ goals and missions, and electing trusted figures within those agencies to author some of the blogs. Secondly, we aimed to examine the impact of increasing the number of articles (i.e. hot topics and research updates) relevant to particular agencies’ missions, goals and purpose. Testing the impact of these interventions would provide valuable evidence on possible strategies to enhance organisations’ usage of knowledge platforms and improve policymakers’ engagement with research in their work.
Based on the evidence and mechanisms described above regarding factors that promote both website and research use, the present study had a number of hypotheses:
1.
There will be a gradual increase in general Web CIPHER usage prior to and throughout the intervention period across all member organisations, as our previous research showed steady increases in the number of members throughout this period [
17].
2.
Increases in the number of blogs and tailored articles (i.e. hot topics and research updates) posted during the study period would each be associated with increases in general Web CIPHER usage across all policy agencies across the study period.
a.
This effect, however, would be greater for blogs compared to articles.
3.
Agencies will exhibit more sustained increases in general Web CIPHER usage following publication of blogs and articles targeted at their agency, relative to blogs and articles targeted at other agencies.
4.
Agencies will exhibit sustained increases in general Web CIPHER usage following publication of blogs written by someone internal to their agency, compared to someone external to it.
5.
In terms of usage for specific sections, the number of page views will be higher for blogs targeted at one’s agency, compared to blogs targeted at other agencies. This effect will be greater for blogs written by someone internal versus external to one’s agency.
6.
The number of page views will be higher for articles targeted at one’s agency compared to articles targeted at other agencies.
Discussion
The present paper documents the findings of an innovative study examining the impact of agency-tailored articles and blogs on policymakers’ usage of Web CIPHER, an online portal that aims to increase policymakers’ engagement and interest in research. The results provide us with insights into strategies to improve policymakers’ engagement with research using such online platforms but indicate that there is much still to be learnt.
We found mixed support for our hypotheses. In support of hypothesis 1, there was an increase in Web CIPHER usage across all member organisations prior to the intervention. Contrary to hypothesis 2, Web CIPHER usage among member organisations was significantly associated with the number of new articles posted but not the number of blogs posted across the intervention period. Articles on topics relevant to Agency 3 (relating to sexual and reproductive health) were the only articles to produce a sustained increase in usage across all agencies. There was slight support for hypothesis 3, as only Agency 3 showed sustained increases in usage following articles (and not blogs) specifically targeted at their own agency, and not following articles and blogs targeted at other agencies. There was no support for hypothesis 4, as neither the internally- nor externally-authored blogs led to sustained increases in usage for any agency. Three target agencies (2, 4 and 5) showed significant increases in usage following blogs and articles directed at other agencies although these increases were only temporary. In support of hypotheses 5 and 6, loglinear analyses revealed that, among the existing Web CIPHER users from the target agencies, page views for articles and blogs targeted at one’s agency were higher than those targeted at other agencies. This effect was stronger for internally- versus externally-authored blogs. This indicates that, although blogs did not increase Web CIPHER usage in general, users were more likely to view blogs targeted at their agency compared to other agencies, particularly when these were written by someone internal to their agency.
The first key finding was that usage among all member organisations increased as more articles (hot topics and research updates) were posted throughout the intervention period. It stands to reason that the more content that is posted the greater the likelihood of content being of interest to users, thereby prompting members to access the website. This suggests that usage may have been motivated by hedonic goals (i.e. a desire to experience fun, pleasure and enjoyment [
37]), which has been shown to be a significant driver of site usage. This is supported by the fact that the hot topics in particular were about new developments and initiatives that users likely did not know already, which would have contributed to their appeal. Because Web CIPHER is not set up to be a one-stop shop for research, it is unlikely that users were driven by utilitarian motivations such as the perceived usefulness of the information for achieving one’s work-related goals.
Further support for the hedonic explanation comes from the fact that there was a sustained increased in usage across all member organisations following articles posted about sexual and reproductive health (i.e. Agency 3’s topic). It is likely that users found these topics interesting to read about and personally relevant even though they were not necessarily relevant to most members’ work. It is well-documented that ‘sex sells’ [
38]; therefore, it is likely that Agency 3 articles were regarded as both appealing and personally relevant to users across all member organisations, which helped drive sustained increases in Web CIPHER usage.
Contrary to what was predicted, the number of blogs posted was not uniquely predictive of greater Web CIPHER usage. On the surface, these results are surprising in light of our previous study [
17], which found that blogs were the most popular section on the website. However, the blogs analysed in our original study were not specifically tailored to individual agencies. Rather, they were designed to be of general interest, focusing on broad topics such as the value of research in policy and skills to facilitate dissemination and translation [
17]. In contrast, in the present study, the blogs were tailored to specific agencies and fewer in number, and so were less likely to have broad appeal to users. Although the articles were also tailored to agencies, there was a large number posted throughout the intervention period (almost 100), meaning that there was likely to be something that sparked users’ interest and promoted greater usage. These findings lead us to infer that blogs in and of themselves might not necessarily be compelling enough to promote greater usage of such knowledge portals. Rather, for content to promote usage, it needs to be widely appealing, thought-provoking, interesting and, ideally, abundant and frequently updated. Further research is required to verify this conclusion.
Content relevance also influenced site usage to some degree. Firstly, the loglinear analyses showed that articles and blogs that were targeted to one’s agency had significantly greater page views than those targeted at other agencies. Secondly, Agency 3 exhibited a sustained increase in usage following the articles targeted to their agency. Such specific and sustained effects were not observed in other agencies, however. This indicates that agencies were more likely to read articles (and internal blogs) relevant to their agency, although these targeted articles only produced sustained increases in general Web CIPHER for Agency 3. It is possible that the articles posted in this period were directly relevant to the work and projects of Agency 3 staff at the time, thus encouraging them to continue visiting the site over the subsequent weeks. When articles on Agency 4 were posted, Agency 3’s usage significantly declined. These conclusions are tentative in light of the fact that similar effects did not emerge in any of the other agencies, demonstrating that further work is required to tease out the specific conditions under which relevance impacts upon usage of knowledge platforms.
Our results also provided some evidence for the impact of familiar authors on usage behaviour of agencies. Specifically, it was found that Agency 3 users showed a significant increase in usage following a blog written by an author internal but not external to the agency. This effect was temporary, however, and did not occur for the remaining target agencies. We predicted this effect would emerge across all agencies, because the internal authors would be more familiar, trusted and credible [
19,
21,
23], focus on agency-relevant topics, represent more obvious champions of research use for their agencies [
9], and trigger a greater sense of social presence and critical mass, relative to authors external to the agency. Something perceived as familiar might, on the other hand, be interpreted as mundane and repetitive. A familiar individual might also not necessarily be supported or positively regarded by users. Until further research is undertaken, firm conclusions regarding the impact of author familiarity on usage of such portals cannot be made.
Many organisations are now adopting the use of online knowledge platforms to help their staff better access, store, retrieve and exchange information across the organisation, and thereby improve organisational performance and adherence to best practices [
24,
39,
40]. Knowledge platforms could therefore be used to improve policymakers’ access, retrieval and exchange of research, thereby encouraging greater engagement with and use of research in their work [
17]. The present findings have implications for strategies to increase policymakers’ engagement with research through such knowledge platforms. Given that our study is the first of its kind, many of these findings are tentative, but nonetheless consistent with the extant research on factors that promote usage of websites and knowledge platforms [
8,
24,
39,
40]. Firstly, our findings suggest that there needs to be an abundance of widely relevant and regularly updated content on a website to provoke use. Our findings indicate that this content must be relevant (personally or professionally), but must also be interesting (i.e. novel, enjoyable, compelling, engaging, thought-provoking, appealing or stimulating) [
22,
23,
41‐
44]. Therefore, in order to attract policymakers and increase their engagement with health research, the content has to stimulate, entertain and engage akin to most forms of mass media, as well as be relevant. There should ideally be an abundance of content and it may also help if this content is written about or by experts in policy and health who are widely regarded and trusted.
Our findings further suggest that blogs in and of themselves are not uniquely predictive of greater use. We propose that, for blogs to promote usage, they must also be widely appealing, engaging and interesting (as suggested by our previous research [
17]), rather than being highly specific and targeted to a particular agencies’ program of work. Given that the number of articles uniquely predicted greater usage over time, and that frequent blogs (e.g. once a week) would require a great deal of work to coordinate and produce, it is possible that blogs might not be worth the investment as a strategy to enhance usage of similar knowledge platforms. Further research is needed to tease this relationship out.
Our study represents the first attempt to undertake an in-depth, longitudinal investigation of policymakers’ usage of an online portal directed at health policymakers using time series analysis and Google Analytics. Ours is also the first to test the impact of a range of strategies to increase policymakers’ usage of such portals over time. Previous studies on the use of knowledge platforms and websites have primarily been cross-sectional in design and present correlational findings. In these studies, it is difficult to make definitive conclusions as to what strategies have causal impacts on staff engagement with such platforms. Interrupted time series analysis, however, allows one to examine behaviour (i.e. Web CIPHER usage) before and after an identifiable event or intervention (i.e. the posting of agency-tailored blogs and articles), in order to evaluate the impact of this behaviour [
36,
45]. Although all threats to validity of causal inferences cannot be ruled out using such an analysis strategy [
33], our study goes some way towards providing stronger conclusions about what strategies can be used to improve policymakers’ engagement with and use of such platforms.
The present study also had some limitations. Firstly, although there were a relatively large number of policymakers from all member organisations collectively (n = 392), there was a small number of policymakers from the individual target agencies. Selection bias may also have been an issue in the present study given that all users voluntarily elected to login and use the website, and so may have had pre-existing interests in knowledge platforms. Our conclusions may therefore only apply to this self-selected sample. Furthermore, the use of sessions as the main indicator of usage has issues, because it does not take into account the number of users opening these sessions. Specifically, it is possible that a single user could have opened all the recorded sessions, making sessions a somewhat biased indicator of usage. Also we had no control over historical events that occurred throughout the intervention period that may have influenced usage, aside from the intervention itself. For example, the blogs targeting Agency 1 were posted towards the end of 2014, prior to the Christmas holiday break. Agency 1 showed significant decreases in usage following the onset of these blogs, but this was most likely the result of the subsequent holiday period than the blogs themselves. Blogs were posted outside of their scheduled date due to a number of logistical reasons which may have reduced their potential impact on Web CIPHER usage among the target agencies.
Conclusion
Knowledge platforms are a recent innovation that may potentially improve policymakers’ capacity to access and apply research to their work. It is important to mention, however, that knowledge platforms require agencies to have ready access to the appropriate technology such as computers, tablets, smartphones and high-speed internet access, which may not be the case for certain low- and middle-income countries [
46]. Therefore, the findings presented here may only apply to health policy agencies in some countries. Nonetheless, we provide an innovative and novel investigation of the impact of strategies to increase policymakers’ usage of one such knowledge platform, known as Web CIPHER. Specifically, we examined the effect of publishing hot topics, research updates and blogs on topics of direct relevance to some of Web CIPHER’s member agencies. The results were highly variable, although a number of interesting trends emerged. Firstly, general usage of Web CIPHER gradually increased over time, and this was significantly predicted by the number of tailored articles (i.e. hot topics and research) that were posted throughout the Study Period, but not the number of blogs. Articles focused on sexual and reproductive health (but not other topics) were followed by sustained increases in usage for users across all member organisations. Further, only one of the five target agencies exhibited sustained increases in usage when articles were published directly targeting that agency. Finally, page views were higher for articles targeted at one’s agency versus other agencies. For blogs, this effect was stronger when the author was internal versus external to one’s agency. The findings suggest that usage was more strongly driven by interest, enjoyment, appeal and personal relevance, as opposed to agency specificity and work relevance.
In light of these mixed results, a number of tentative implications emerged regarding strategies to improve policymakers’ use of knowledge platforms. First and foremost, the content needs to be personally relevant, widely interesting, engaging, appealing to users and frequently updated, regardless of whether this content consists of news articles, research updates or blogs. Recruiting familiar and trusted authors could possibly augment the effectiveness of these strategies. Although further research is required, the present study goes some way towards better understanding what strategies might be effective for increasing policymakers’ engagement with research through the use of online knowledge platforms.
Acknowledgments
We would like to thank Sian Rudge for corresponding with the target agency communications department to identify blog authors and assisting in the commissioning of blogs. We would like to thank Kellie Bisset for helping commission the blogs, and for maintaining and coordinating the overall direction of Web CIPHER. We wish to thank all the policymakers and researchers that directly contributed content on Web CIPHER, particularly those that provided blogs and multimedia. We would also like to acknowledge the chief investigators of the CIPHER Centre for Research Excellence, for conceptualising the development of Web CIPHER and other innovations designed to increase the use of research in policymaking. CIPHER is a joint project of the Sax Institute; Australasian Cochrane Centre, Monash University; the University of Newcastle; The University of New South Wales; The University of Technology, Sydney; the Research Unit for Research Utilisation, University of St Andrews and University of Edinburgh; and the University of Western Sydney.