This document summarizes a presentation about evidence-informed decision making and the role of intermediaries. It discusses how decisions are influenced by various factors and defines evidence-informed decision making. It also presents models depicting how research is translated into action. The presentation then focuses on a study conducted in Kenya on the role of academic knowledge brokers in linking research to policy. The study used social network analysis to map networks between universities and government. It identified common attributes of knowledge brokers, including experience and strong interactive skills. Finally, it discusses various strategies knowledge brokers use to engage with policymakers and provides recommendations to strengthen these relationships.

1. MOVERS, SHAKERS, AND
GATEKEEPERS:
THE ROLE OF INTERMEDIARIES IN
EVIDENCE-INFORMED DECISION MAKING
Nasreen Jessani, DrPH
Presentation for:
Johns Hopkins Centre for AIDS Research
Implementation Science Scientific working group
13 April 2016

2. OVERVIEW
• Evidence-informed decision making
• The focus on intermediaries/knowledge brokers
• Academic knowledge brokers in Kenya: A mixed methods
study of relationships, characteristics and strategies
• Adapting the study to USA (and JHSPH)
• Relevance to CFAR

3. HOW ARE DECISIONS MADE?

4. WHAT INFLUENCES DECISIONS?
Political
complexities
Party
preferences
Other evidence Social, religious and
cultural norms
(acceptablity)
Relative benefit/harms
of other options – cost,
impact, equity, speed
etc…
Ecological
impacts
Other actors – lobbyist,
activists, media,
epistemic communities,
stakeholders, funders
Operational
practicality

5. EVIDENCE INFORMED DECISION MAKING
• “purposeful and systematic use of the best available
evidence to inform the assessment of various options and
related decision making in practice, program development,
and policy making (OAPN Canadian Centre of Excellence,
2010)
• “a continuous interactive process involving the explicit,
conscientious and judicious consideration of the best
available evidence to provide care” (Canadian Nurses
Association, 2010).
• policy should be informed by a wide breadth of evidence,
not just hard research. Key issues include the quality,
credibility, relevance and the cost of the policy.

6. MODELS DEPICTING RESEARCH TO ACTION
Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for
a map?J Contin Educ Health Prof 2006;26:13–24.
Lavis, Lomas, Hamid, et al. “Assessing country-level efforts to link research to action.”
Bulletin of the WHO. August 2006. p. 622
BUT:
- transactional not relational
- Assumes homogeneity of actors

7. !
!
!
CONTEXT'
CONTEXT'
Other'influences'
PUSH'
FACTORS'!
PULL'
FACTORS!
"!!
!
LINKAGE'AND'
EXCHANGE'FACTORS!
!
Academic!Institutions!

8. Unidimensional Gatekeepers Unskilled Outsource to
specialists
ACADEMIC KNOWLEDGE BROKERS
Photo credit : http://bit.ly/1sHMceE Photo credit : http://bit.ly/1ruaULZ Photo credit : http://bit.ly/1rub5XB Photo credit : http://bit.ly/1plaeoN

9. Invisible Uniquely
positioned
Skilled Credible
ACADEMIC KNOWLEDGE BROKERS
Picture credit: www.zizaza.com

10. Academic
researchers
Policymakers
Academic Knowledge
Brokers: HYBRID/
BLENDED/
EMBEDDED
Connected to policymakers as conduit to policy influence
AND
Advisors to academic peers on evidence to policy

11. WHAT DID WE WANT TO LEARN?
Mapping the
networks
Do academic knowledge brokers exist?
An exploration of research-to-policy
networks of faculty from six Schools of
Public Health in Kenya
Understanding
the brokers
The human capital of knowledge
brokers: An analysis of attributes,
capacities and skills of academic faculty
at Kenyan schools of public health
Strategies for
engagement
Navigating the academic and political
environment: Strategies for engagement
between public health faculty and policy
makers in Kenya

12. HOW DID WE FIND OUT?

13. THE ACADEMIC CONTEXT IN KENYA
KEY FACTS
• 39 Universities
• 6 Schools of Public
Health
‒ 5 with presence in
Nairobi
• Revenues from non-
governmental
sources: 16.4% to
31.6% of total
income
• Research not
confined to
traditional academic
bodies

14. MAPPING THE NETWORKS
DO ACADEMIC KNOWLEDGE BROKERS
EXIST? AN EXPLORATION OF RESEARCH-TO-
POLICY NETWORKS OF FACULTY FROM SIX
SCHOOLS OF PUBLIC HEALTH IN KENYA

15. • 16 Ministries
• 6-10 Ministries per
SPH (range of
connections)
• Unique interplay
between each SPH and
government
• All SPHs connected to
MOPHS and MOMS
• Some “Monopoly”
relations
• Several overlapping or
shared connections
INSTITUTIONAL RELATIONS

16. Legend
Academic Faculty
Policymaker (various
ministries)
Academic Knowledge
Broker
Academic Faculty –
externally influential
Academic Faculty –
internally trusted
WHOLE NETWORK: KENYATTA UNIVERSITY SPH

17. IDENTIFICATION OF KNOWLEDGE BROKERS
2
2
2
1
x
• 124 Academic faculty
surveyed
• 5 Schools of Public
Health with presence in
the Capital
• 7 Knowledge Brokers
Identified
• 4 Schools of Public
Health with Knowledge
Brokers
• Potential KBs
across all 6 SPHs
Number of KBs in specific
SPH

18. INDIVIDUAL ACADEMIC-POLICYMAKER NETWORKS
RANGE IN SIZE, PREVALENCE, DEPTH AND BREADTH
Institution
No. of
respondents
No. of
Policymakers by
respondent
No. of unique
contacts No. % Max. Avg.
No,
Shared %.
PM relation
Prevalence1
PM relation
Depth3
PM relation
Breadth2
22 43 36 16 72% 7 1.95 5 14%
15 34 27 12 80% 4 2.27 4 15%
29 49 27 16 55% 7 1.69 9 33%
24 21 16 13 52% 3 0.88 4 25%
17 17 15 7 41% 6 1.00 2 13%
17 40 31 12 71% 7 2.35 5 16%.
124 204 109 (unique) 76 61% n.a. n.a n.a. n.a.
1 Prevalence of academic-policymaker relations: absolute no. of faculty connected to >=1 policymaker; Proportion of same (Col 4/Col 2)
2 Breadth of academic-policymaker relations: maximum no. of PM contacts mentioned by any one faculty at the SPH; Avg no. of relations (Col 2/Col 1)
3 Depth of academic-policymaker relations: total no. of shared PM contacts in network; Proportion of relations shared (Col 6/Col 3)

19. CONCLUSION
• SNA is a useful tool to:
Map location and distribution of
• academic expertise
• SPH connections to ministries (and others)
Enhance visibility of
• existing KBS
• “potential” KBs
Identify
• Unique connections
• Overlapping/ shared connections
• Gaps

20. UNDERSTANDING THE KBS
THE HUMAN CAPITAL OF KNOWLEDGE
BROKERS: AN ANALYSIS OF ATTRIBUTES,
CAPACITIES AND SKILLS OF ACADEMIC FACULTY
AT KENYAN SCHOOLS OF PUBLIC HEALTH

21. COMMON ATTRIBUTES AND CHARACTERISTICS OF KBS
FALL UNDER 5 MAJOR CATEGORIES
Socio-
demographics
Professional
competence
Experiential
knowledge
Interactive
skills
Personal
disposition

22. COMMON ATTRIBUTES AND CHARACTERISTICS OF KBS
FALL UNDER 5 MAJOR CATEGORIES
Key elements
• >45yrs, majority male
• PhD or equiv. degree
• >=1 foreign degree
• Academic position
varied, history of admin
responsibility
Socio-
demographics
• Practical experience
• Policy insights
Experiential
knowledge
• Technical expertise
• Relevant research focus
• Leadership experience
Professional
competence
“be focused in an area of expertise because
then you become visible.…and therefore to be
sought after when there're issues that require
policy engagement…regardless of who is in
[office], or what the political structure is like”
-Leadership, KB, GLUK
“…the more senior one is, the greater will
be the opportunity to engage in
policymaking”
-Leadership, KB, GLUK
“ [Academics] have theory [but] when we deal
with an outbreak, which requires more
practical input….We have other
organizations which are very good like the
WHO, UNICEF, CDC”
-Policymaker, MOPHS

23. COMMON ATTRIBUTES AND CHARACTERISTICS OF KBS
FALL UNDER 5 MAJOR CATEGORIES
Key elements
• Creation and
maintenance of
networks
• Communication skills,
Interpersonal skills
Interactive skills
Personal
disposition
• Social and moral
conscience
• Determined and
unrelenting
• Respectful, team player
“with presidents - both Moi and later Kibaki.…
gave me the platform and confidence when I
moved to the university that, I knew where to get
certain support or help.”
-Leadership, KB, MUSOPH
“We had to get somebody who can lead this
team, who is well known in the government
circles, who knows politicians quite well, that
is also quite conversant with the health
situation in the country”
-Policymaker, PresOffice
“…sometimes you have these pushy
characters who think they can push their
way into Government... Present the good
results and wait for change to happen in its
own good time…It is a process...”
-Policymaker, MoLD

24. CONCLUSION
Unique combinations of sociodemographic attributes, professional competencies,
experiential knowledge, interactive skills and personal disposition facilitate KB activities
Individual attributes, capacities and skills of KBs are not unique in and of themselves,
but are advantageous when employed strategically and collectively.
Direct experience with policymaking arena enhances appreciation and navigation
of political structures and processes. Leadership position facilitatory, not sufficient
Personal networks provide credibility, perceived power to influence, preferential
political access
While some characteristics may be innate, others can be learned.

25. STRATEGIES TO ENGAGE
NAVIGATING THE ACADEMIC AND POLITICAL
ENVIRONMENT: STRATEGIES FOR
ENGAGEMENT BETWEEN PUBLIC HEALTH
FACULTY AND POLICY MAKERS IN KENYA

26. CURRENT STRATEGIES FOR FACULTY-POLICYMAKER
ENGAGEMENT
Expert
invitations
Deliberative
dialogues
Initiated by National
Level Government
Initiated by Schools of Public
Health
Direct
dissemination
Leveraging
student
professionals
Honorary
appointments
Mediated
engagement

27. COMMON THREAD: RELATIONSHIPS
“the most important one is of course
one on one connection. If you know
somebody at a certain government
department or ministry and they know
me and they know my capabilities, they
would be able to quickly pick a phone
and say: ‘we are doing this. Can you
join us on this and this day? We are
starting to work on this”
-Leadership, KEMU

28. UNDERAPPRECIATED AND/OR UNDERUTILISED
STRATEGIES FOR ENGAGEMENT
Initiated by Government OR Schools of Public Health
Face to face
individual
interactions
Institutionalized
Collaborations
Mediated
engagement
Enhanced
visibility

29. PROACTIVE IN-PERSON INTERACTIONS
• “Face to face..is practical and feasible, because if it is
somebody outside of Nairobi, chances are that I may not do it.
When there is face to face interaction, chances are that that
network will stay for some time.”
Policymaker, MoLD
• “If they sit and say ‘Oh if the government wants our advice, let
them come!’ that is not going to work really…just visit me …”
Policymaker, MOPHS
• “You see, its just a matter of writing a letter…to the officer and
he responds and tells you ‘On this date we are ready for you.
Come!”
Policymaker, MoMS

30. INSTITUTIONALIZED COLLABORATION
• “the clever universities have always tried to consult with the
government, to find out about the relevancy of the programs
that they are initiating at the university.”
Policymaker, MoPHS
• “If dialogue had taken place between academicians, at the
curricular development (stage) with the policy makers…then
we would have produced medical officers who are …also
capable of taking care of these facilities.”
Leadership, KEMU
• “unless we collaborate…we’ll never make it, so that if a
university comes up with a major project, you can now bring
on board other experts from the sister universities”
Leadership, Knowledge Broker, KUSPH

31. MEDIATED ENGAGEMENT
• “When I do research, it doesn't mean I have to go to the
ministry... I can also [ask] a colleague who is better placed as a
communicator to go and present.”
Faculty member, Knowledge Broker, MUSOPH
• “When you don’t know [the policymaker], you create a
medium to that person, you create a third party who will know
them...”
Leadership, GLUK
• “if you have new research findings…put it in the newspapers.
[Policymakers] don't read the journals, they may not attend the
conferences…but they are going to read it in the papers”
Policymaker, MOPHS

32. ENHANCED VISIBILITY - ADVOCACY
• “Between 1990 to 1999 we [academics] kept on telling the
government that AIDS is going to kill. But the President had not
listened to us for a long time. Most of us had to go to the
activists, from academia to activism for anybody to hear us.”
Leadership, GLUK
• “You might see me in the corridors and then I happen to bump
into ‘so-and-so’ …someone might say, “You must be associated
with so-and-so’ And I don’t want to be associated with anyone. I
mean, you want to be as independent as you can be.”
Knowledge Broker, SPHUoN
• “don’t just stop at the PS…or your Minister, go out to other
ministers, members of parliament - Make sure that they are also
aware of this issue so that they can support you in it.”
Policymaker, MoLD

33. CONCLUSIONS
Academic faculty as well as policymakers utilize a variety of strategies for
engagement – some more effective and utilised than others
The perceived responsibility for engagement continues to lie with
academia. KBs appeared distinct amongst their peers
Delicate balance between leveraging personal individual relationships
and establishing more sustained institutional partnerships.
Combination of deliberate and opportunistic strategies required.
Increased chance of uptake when tailored to policymaker preferences,
responsive to current political requirements, and personalized.

34. RECOMMENDATION: INDIVIDUAL
• Existing KBs should
• nurture existing relations with policymakers as well as peers
• tailor strategies for policy engagement to the context and
audience
• Non-KB faculty should
• consult with existing KBs for support and advice
• increase capacity to understand and navigate the policy
environment
• enhance tangible skills
• SPH leadership should
• recognize the value of intangible KB characteristics
• create opportunities for networking and learning

35. RECOMMENDATION: INSTITUTIONAL
• SPHs should use SNA to understand competition, mobilise
collective action, enhance their visibility and relevance
• SPHs should not only passively support KB activities but also
actively invest in individual KB endeavors
• Recognize and leverage existing KBs, support emergence of
potential KBs, and systematically recruit faculty with KB-
specific characteristics
• Institutionalize processes for sustained engagement to accelerate
information flow
• Invest in technological solutions to overcome barriers to
communication and networking

36. RECOMMENDATION: NETWORK
• Collaborate with other SPHs and academics for a unified
voice
• Build institutional relations with policymakers
• Involve policymakers in SPH curricula design, research
formulation
• Leverage media as a key conduit for raising political
profile of public health issues, spotlighting key
researchers, gaining policymaker attention

37. ADAPTING THE
KENYAN STUDY TO USA
The influence of JHSPH faculty on public health
decision-making: A mixed methods study exploring
networks, relationships and engagement strategies

38. STUDY OBJECTIVES
• Understand the network
of relationships that
faculty at JHSPH foster
at the city, state, federal
and international levels in
order to contribute to
public health decision-
making.
Networks
• Explore how JHSPH
faculty play a role in
bringing evidence to
bear on city, state,
federal government
and/or global level
public health decision-
making.
Strategies for
evidence
informed
decision
making
• Uncover the
perceived attributes
and capacities of
SPH faculty (that
make them effective)
in bridging the
evidence-to-policy
divide.
Faculty
attributes and
capacities
• Identify the
organizational and
environmental factors
that facilitate or hinder
JHSPH faculty
engagement with
decision makers
Proximal &
distal
determinants of
engagement

39. RELEVANCE:

40. LINKS WITH
APPROACH:
• Implementation research that uses SNA as well as qualitative
approaches to map as well as interrogate HIV/AIDS networks
• Eg: Latkin, C et al (1995): Using social network analysis to study
patterns of drug use among urban drug users at high risk for HIV/AIDS
• SNA: Network density and size of drug subnetworks were positively associated
with frequency of drug injection
• USING SNA TO IDENTIFY INTERMEDIARIES: are these subnetworks
linked by key brokers? Is there a strength in weak ties? Are there key people
linking different networks – the movers and the shakers? Are there key people
who can help break these links – the gatekeepers? Who are the influencers?
• QUAL: Why is this case? How do these networks get built/maintained? What
factors facilitate or hinder these relations? What is the relative contribution of
the network structure to the patterns of drug use seen?
• SO WHAT?: What kind of interventions could therefore mitigate the impact of
this association? Who can be leveraged to assist with this?

41. LINKS WITH
IMPACT:
• Implementation research with results that have policy and/
or practice implications so as to contribute to evidence-
informed decision making
• Observational, experimental etc…
• Understanding the dynamics of disease transmission AND identifying
possible areas for intervention and control
• Mapping influential peer/social networks AND identifying ways of
affecting the structure of the network to mitigate (or enhance) such
influence
• Establishing key interventions amongst populations of interest and
mapping the change of network structure over time as a result.

42. “You build a staircase of convincing people to change a
policy…you don’t carry out the burden as if it’s yours of
changing the policy. The burden has to be shared and that’s
why networks and multiple approaches are so important to
change policy”
-Leadership, GLUK
THANK YOU!