Too many maps and not enough driving?
In reading Estabrooks et al. (2006) for last week’s class, I was intrigued by their reference to Oxman et al.’s paper (2005) titled “The OFF theory of research utilization,” which they cited as one of the rare appeals for less rather than more theory in research implementation. I often find myself struggling with theories and frameworks; I chose to do an MPH degree because the idea of doing something more “practical” appealed to me. I have never really felt drawn to the world of academia and the stereotype that being an academic involves “know[ing] more and more about less and less” (Choi et al., 2005, p. 632). This thinking in large part motivated my interest in learning about KT. Finally a place where all this research being done would be put into action – only to come to find out that there was a whole world of research and theories on KT itself!
Oxman et al. argue that there is too much theory and jargon being used in quality improvement and continuing education and that we should instead be relying on logic, common sense, and empirical evidence. They also argue that high-level theories use jargon that alienates anyone who is not already working closely with theory.
Based on my experience as a student, I agree with most of what Oxman et al. have to say. In reading through the KT literature, I get bogged down in the terminology. Moreover, the work of going through all of the theories to find which ones best fit a given KT scenario seems very laborious. After reading Michie et al’s (2008) paper on developing a list of behavioural change techniques, I could not help but think about all the time they must have invested just to identify techniques and conclude, inevitably, that more research is needed!
Similar frustrations were raised in Maryam’s blog the other week on behaviour change. In trying to figure out what works, it seems we just dig ourselves deeper into the research hole. Oxman et al. summarize this dilemma well in their criticism of Eccles et al.’s “need to immerse ourselves in the sacred writings of high level theories before we get our hands dirty” (p. 114). Many of us are drawn to public health because of this desire to be “doers” or “change-agents” (I realize I am just adding more jargon to the mix).
Nevertheless when I actually try to “do”, I find I struggle with Oxman et al.’s suggestions of using common sense and logic. Theories are often referred to in the KT literature as maps and I have to admit as a newcomer to the field of public health, I appreciate having a map that can orient me in my work. It might be that after just over a year in a university, I have been trained to not just rely on logic or common sense, but rather be ready to back up everything I say by citing my source. Nevertheless, when you are the one implementing a program or a research project, you want to trust that what you are doing works or can be useful, and that it’s not just based on what seemed like a good idea at the time.
I can appreciate that Oxman et al. do think that interventions should be evidence-based and are making the point that evidence does not necessarily have to come from theory. In large part, their argument is not against theory, but rather against an over-emphasis on theory. Instead they advocate for the need to consider other types of evidence including evaluating outcomes of interventions. Maybe the lesson is that we need to remember to occasionally just pick a map and go for a drive before we go back to our desks to “do” more research.
Choi, B. et al. (2005). Can scientists & policymakers work together? J. Epidemiology & Community Health, 59:632‐637.
Eccles, M., Grimshaw, J., Walker, A., Johnston, M. and Pitts, N. (2005). Response to ‘The OFF theory of research utilization’. J. Clin. Epidemiol., 58:117–118. http://dx.doi.org/10.1016/j.jclinepi.2004.09.003
Estabrooks, C.A., Thompson, D.S., Lovely, J.E. and Hofmeyer, A. (2006). A Guide to Knowledge Translation Theory. The Journal of Continuing Education in the Health Professions, 26: 25–36.
Fretheim, A., Flottorp, S. and Oxman, A. (2005). It is a capital mistake to theorize before one has data: a response to Eccles’ criticism of the OFF theory of research utilization. J. Clin. Epidemiol., 58:19–20. http://dx.doi.org/10.1016/j.jclinepi.2004.10.003
Michie, S., Johnston, M., Francis, J., Hardeman, W. and Eccles, M. (2008). From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology: An International Review, 57(4):660-680.
Oxman, A.D., Fretheim, A. and Flottorp, S. (2005). The OFF theory of research utilization. J. Clin. Epidemiol., 58:113. http://dx.doi.org/10.1016/j.jclinepi.2004.10.002