Guell Cornelia, Mackett Roger, Ogilvie David
MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
Department of Civil, Environmental and Geomatic Engineering, University College London, Chadwick Building, Gower Street, London, WC1E 6BT, UK.
BMC Public Health. 2017 Jan 5;17(1):17. doi: 10.1186/s12889-016-3940-x.
For the prevention and control of chronic diseases, two strategies are frequently highlighted: that public health should be evidence based, and that it should develop a multisectoral approach. At the end of a natural experimental study of the health impacts of new transport infrastructure, we took the opportunity of a knowledge exchange forum to explore how stakeholders assessed, negotiated and intended to apply multisectoral evidence in policy and practice at the intersection of transport and health. We aimed to better understand the challenges they faced in knowledge exchange, as well as their everyday experiences with working in multisectoral remits.
In 2015, we conducted participant observation during an interactive event with 41 stakeholders from national and local government, the third sector and academia in Cambridge, UK. Formal and informal interactions between stakeholders were recorded in observational field notes. We also conducted 18 semistructured interviews reflecting on the event and on knowledge exchange in general.
We found that stakeholders negotiated a variety of challenges. First, stakeholders had to negotiate relatively new formal and informal multisectoral remits; and how to reconcile the differing expectations of transport specialists, who tended to emphasise the importance of precedence in guiding action, and health specialists' concern for the rigour and synthesis of research evidence. Second, research in this field involved complex study designs, and often produced evidence with uncertain transferability to other settings. Third, health outcomes of transport schemes had political traction and were used strategically but not easily translated into cost-benefit ratios. Finally, knowledge exchange meant multiple directions of influence. Stakeholders were concerned that researchers did not always have skills to translate their findings into understandable evidence, and some stakeholders would welcome opportunities to influence research agendas.
This case study of stakeholders' experiences indicates that multisectoral research, practice and policymaking requires the ability and capacity to locate, understand and communicate complex evidence from a variety of disciplines, and integrate different types of evidence into clear business cases beyond sectoral boundaries.
为预防和控制慢性病，经常强调两种策略：公共卫生应以证据为基础，以及应采取多部门方法。在一项关于新交通基础设施对健康影响的自然实验研究结束时，我们利用知识交流论坛的机会，探讨利益相关者如何评估、协商并打算在交通与健康交叉领域的政策和实践中应用多部门证据。我们旨在更好地理解他们在知识交流中面临的挑战，以及他们在多部门工作中的日常经验。
2015年，我们在英国剑桥与来自国家和地方政府、第三部门及学术界的41名利益相关者举行的互动活动中进行了参与观察。利益相关者之间的正式和非正式互动记录在观察现场笔记中。我们还进行了18次半结构化访谈，以反思该活动及一般的知识交流情况。
我们发现利益相关者要应对各种挑战。首先，利益相关者必须协商相对较新的正式和非正式多部门职权范围；以及如何协调交通专家（他们倾向于强调先例在指导行动中的重要性）与健康专家（他们关注研究证据的严谨性和综合性）的不同期望。其次，该领域的研究涉及复杂的研究设计，且往往产生的证据难以确定能否转移到其他环境中。第三，交通计划的健康结果具有政治影响力，并被战略性地利用，但不易转化为成本效益比。最后，知识交流意味着多种影响方向。利益相关者担心研究人员并不总是具备将研究结果转化为易懂证据的技能，一些利益相关者希望有机会影响研究议程。
这项关于利益相关者经验的案例研究表明，多部门研究、实践和政策制定需要具备定位、理解和交流来自不同学科的复杂证据的能力，并将不同类型的证据整合到超越部门界限的清晰商业案例中。
