Greenhalgh Trisha, Fahy Nick
Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
BMC Med. 2015 Sep 21;13:232. doi: 10.1186/s12916-015-0467-4.
The 2014 UK Research Excellence Framework (REF2014) generated a unique database of impact case studies, each describing a body of research and impact beyond academia. We sought to explore the nature and mechanism of impact in a sample of these.
The study design was manual content analysis of a large sample of impact case studies (producing mainly quantitative data), plus in-depth interpretive analysis of a smaller sub-sample (for qualitative detail), thereby generating both breadth and depth. For all 162 impact case studies submitted to sub-panel A2 in REF2014, we extracted data on study design(s), stated impacts and audiences, mechanisms of impact, and efforts to achieve impact. We analysed four case studies (selected as exemplars of the range of approaches to impact) in depth, including contacting the authors for their narratives of impact efforts.
Most impact case studies described quantitative research (most commonly, trials) and depicted a direct, linear link between research and impact. Research was said to have influenced a guideline in 122 case studies, changed policy in 88, changed practice in 84, improved morbidity in 44 and reduced mortality in 25. Qualitative and participatory research designs were rare, and only one case study described a co-production model of impact. Eighty-two case studies described strong and ongoing linkages with policymakers, but only 38 described targeted knowledge translation activities. In 40 case studies, no active efforts to achieve impact were described. Models of good implementation practice were characterised by an ethical commitment by researchers, strong institutional support and a proactive, interdisciplinary approach to impact activities.
REF2014 both inspired and documented significant efforts by UK researchers to achieve impact. But in contrast with the published evidence on research impact (which depicts much as occurring indirectly through non-linear mechanisms), this sub-panel seems to have captured mainly direct and relatively short-term impacts one step removed from patient outcomes. Limited impacts on morbidity and mortality, and researchers' relatively low emphasis on the processes and interactions through which indirect impacts may occur, are concerns. These findings have implications for multi-stakeholder research collaborations such as UK National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care, which are built on non-linear models of impact.
2014年英国卓越研究框架（REF2014）生成了一个独特的影响案例研究数据库，每个案例都描述了一系列研究及其在学术界之外产生的影响。我们试图在其中的一个样本中探究影响的本质和机制。
研究设计包括对大量影响案例研究进行人工内容分析（主要产生定量数据），以及对较小子样本进行深入的解释性分析（获取定性细节），从而实现广度和深度兼具。对于提交给REF2014中A2小组的所有162个影响案例研究，我们提取了关于研究设计、所述影响和受众、影响机制以及实现影响所做努力的数据。我们深入分析了四个案例研究（选为影响途径范围的示例），包括联系作者获取他们关于影响努力的叙述。
大多数影响案例研究描述的是定量研究（最常见的是试验），并描绘了研究与影响之间直接、线性的联系。据说研究在122个案例研究中影响了一项指南，在88个案例中改变了政策，在84个案例中改变了实践，在44个案例中改善了发病率，在25个案例中降低了死亡率。定性和参与式研究设计很少见，只有一个案例研究描述了一种共同产生影响的模式。82个案例研究描述了与政策制定者的紧密且持续的联系，但只有第38个案例描述了有针对性的知识转化活动。在40个案例研究中，则没有描述为实现影响所做的积极努力。良好实施实践的模式特点是研究人员的道德承诺、强大的机构支持以及对影响活动采取积极主动的跨学科方法。
REF2014既激发了英国研究人员为实现影响所做的重大努力，也记录了这些努力。但与已发表的关于研究影响的证据（其描述大多是通过非线性机制间接发生）相比，这个小组似乎主要捕捉到了直接且相对短期的影响，与患者结果有一步之遥。对发病率和死亡率的影响有限，以及研究人员相对较少强调间接影响可能发生的过程和相互作用，令人担忧。这些发现对多利益相关者研究合作有影响，比如英国国家卫生研究院应用健康研究与护理领导力合作组织，其建立在非线性影响模型之上。
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