The use of research evidence in blood collection policy and practice: a qualitative study with front- line staff, middle managers, and senior managers

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Davison, Abigail R-A. Edwards, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6979390/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Dec, 2025 Read the published version in Health Research Policy and Systems → Version 1 posted 7 You are reading this latest preprint version Abstract Background There is a known disconnect between scientific knowledge and its application in routine practice, known as the research-practice gap. A potential strategy to encourage research engagement among end-users is embedding researchers within an organisation. This study set out to understand the views and experiences of senior managers, middle managers, and front-line staff in one department accessing and using research in a large organisation with embedded researchers. We also investigated staff capacity to engage with research to identify opportunities to strengthen the use of research-based evidence in practice. Methods We conducted 14 semi-structured in-depth interviews between November 2022 and April 2023 with senior managers, middle managers, and front-line staff working in the blood collection department at Australian Red Cross Lifeblood. Directed qualitative content analysis and the SPIRIT Action Framework were used to interpret the data. Results Capacity to engage with and use research varied greatly between participants and appeared to be affected by their role, training, and prior work experience. Participants valued research highly. However, only a few felt confident in their knowledge and skills to engage with research. Participants described a lack of visibility of research within the organisation as well as systems and structures to access research. Experiences with accessing research, generating research, and interacting with researchers were mostly limited to senior managers. Research was chiefly used by senior managers to support changes, followed by understanding blood collection issues, and informing policy development. Although present, research use was often not visible to front-line staff. Conclusions To increase research engagement and use, organisations should invest in strengthening their tools and systems, providing opportunities to increase individual knowledge and skills to engage with research, and increase the visibility of research and how it has been used. research use research engagement SPIRIT Action Framework blood evidence-informed policy making front-line staff middle managers senior managers policy makers Figures Figure 1 BACKGROUND Research is a source of knowledge that can help organisations improve their policies and procedures as well as overcome potential challenges. However, there is a known disconnect between scientific knowledge and its application in routine practice, known as the research-practice gap [ 1 , 2 ]. Consequently, policies and procedures may not be aligned with current evidence, leading to high costs, inappropriate practices, and waste of resources [ 3 ]. To facilitate knowledge translation (KT), it is essential for end-users to be able to access, understand and apply research evidence, but also to be motivated to embed research into practice [ 4 ]. However, end-users at various levels within an organisation may experience barriers to engaging with research. Frontline staff often have insufficient time to engage with research due to heavy workloads, lack of relevant skills, negative views on benefits of research to practice, and their roles often being task-oriented without authority to change practice [ 5 , 6 ]. Middle managers have been identified as instrumental in summarising research and disseminating this knowledge with their frontline teams [ 7 ]. However, they may also have limited knowledge of how to access, interpret, and appraise research. Further, research engagement of frontline staff and middle managers is affected by how it is supported and valued within the organisation (i.e. the implementation climate) [ 4 , 7 ]. A potential strategy to overcome the research-practice gap and encourage research engagement is to embed researchers within non-academic organisations. This strategy can increase the likelihood that research activities and the knowledge needs of policy-makers and practitioners (i.e., end-users) are aligned [ 2 , 8 , 9 ]. Further, it can build the capacity of end-users through exposure to research activities and provide opportunities to collaborate on finding solutions to organisational issues [ 2 , 8 ]. Embedding researchers in organisations has been shown to increase end-users’ access to research-based evidence, which can be used to address organisational challenges and create positive change [ 10 ]. Using the SPIRIT Action Framework, we conducted a qualitative study to explore research engagement amongst staff at an organisation with embedded researchers. The SPIRIT Action framework [ 11 ] has three domains (see Fig. 1 ). The first, individual and organisational capacity , focuses on potential determinants of research use including a) the value the individual places on using research, b) the confidence the individual has in their knowledge and skills for engaging with research, c) the perceived value their organisation places on using research, and d) the tools and systems their organisation has to support research use. The second, research engagement actions , focuses on potential actions that can be taken to engage with research and researchers. These include a) accessing research, b) appraising research for relevance and quality, c) generating or commissioning research and analyses, and d) interacting with researchers. The last domain, research use , captures the way in which research informs policy or practice. This domain captures a) conceptual use – where research is used to clarify understanding about a policy or practice issue, b) instrumental use – where research evidence directly informs policy or practice, c) tactical use – where research evidence is used to help justify or persuade others to support a predetermined decision, and d) imposed use – where research evidence is used due to organisational requirements.[ 11 , 12 ] The aims of the current study are to: 1) provide insight into how research is engaged with and used at an organisation with embedded researchers from the perspectives of people working at various levels; and 2) identify opportunities to strengthen KT. METHODS The study was conducted at Australian Red Cross Lifeblood (Lifeblood), which is the sole collector and provider of blood and blood components in Australia, collecting blood from voluntary and nonremunerated donors. Lifeblood is unique through its hybrid focus on manufacturing and supply of blood and blood-related products to the health sector, ensuring appropriate care and health of blood donors, and encouraging continued volunteerism of donors. It has an internal Research and Development (R&D) department which conducts basic and applied research to address problems faced by Lifeblood as well as gaps in knowledge in broader transfusion medicine. Our study population included members of the department focusing on blood collection which has a great potential for research engagement due to the applied nature of the research engaged in and R&D’s strong focus on solving blood collection problems [ 13 ]. We interviewed three groups of participants: 1) senior managers – responsible for policy development, 2) middle managers – donor centre managers and area managers who manage blood collection centres, and 3) front-line staff - registered nurses and non-medically trained nursing assistants who collect blood. Data collection The study was approved by the University of Sydney Human Research Ethics Committee (reference number 2020/254) and the Australian Red Cross Lifeblood Ethics Committee (2020#14). Semi-structured interviews were conducted by the first author from November 2022 to April 2023. A purposive sampling strategy [ 14 ] was adopted to ensure participants were diverse in their professional roles and locations. We invited five senior managers and five area managers (i.e. middle managers) to participate in the study via email. One of the senior managers, responsible for overseeing research activities in blood collection centres, then identified centres available to be contacted for our study. We first invited the centre manager (i.e., middle manager) to participate in an interview and they assisted in selecting front-line staff to participate in the study based on their workload and availability. In total, fourteen staff members participated in this study: five senior managers, six middle managers, and three front-line staff members from different centres. This sample size was deemed adequate to answer our research question while working within our constraints of available research participants and time [ 15 ]. Data collection occurred at a time when there were front-line staff shortages making it difficult for staff to leave their daily tasks such as collecting blood to participate in interviews. Participants had worked at the organisation between 3 and 31 years. Topic guides were tailored specifically for each participant group (see Supplementary Materials). With written consent, interviews were conducted via MS Teams, and each lasted 26–57 minutes. All interviews were recorded, and transcribed verbatim. The researchers The first author has worked as a researcher in the R&D department for eleven years. The second author holds a joint research position with the University of Queensland and R&D at Lifeblood and has worked in blood donation research for 23 years. The third author has previously worked as an internal researcher within R&D at Lifeblood for five years. These experiences and knowledge of the area informed the study approach, including study design, participant recruitment, data collection, analysis of data, and interpretation of the findings. Further, the researchers’ insider perspective may have resulted in more appropriate interpretation of the data due to a better understanding of the organisational context. The use of a coding framework as well as adherence to ethical and professional standards minimised the risk of potential bias. Data analysis Directed qualitative content analysis [ 16 ] was used to analyse the data. Guided by the SPIRIT Action Framework [ 11 ], a predetermined coding framework was developed including the following domains: capacity, research engagement actions, type of research use, and purpose of research use. First, transcripts were checked against the audio files which simultaneously allowed for familiarisation with the data. Second, the predetermined codes were pilot tested by two authors (AT, AE) independently applying them to two transcripts in MS Word with model fit subsequently discussed. Third, all transcripts were uploaded to NVivo (QSR International) for coding and analysis. The first author then applied the coding framework to all transcripts. Relevant data that did not fit into the predetermined coding framework were inductively coded. Finally, descriptions were written for each SPIRIT domain by examining the categories, codes, and coded data. RESULTS 1. Capacity for research use 1.1 Research is valued. All participants felt that research was “important” and of “interest” to their work facilitating blood collection. In particular, health-related research was valued highly by participants because they perceive that they work in health and often had a background in nursing. “Data and research I think are fundamentals for anyone who's playing in the healthcare space.” (Senior manager) However, some participants, in particular front-line staff, felt that it was unclear how research was used to inform blood collection policies and practices. “ For there to be an understanding that the changes we make and the things that we do are driven by research …we would have a lot of people that would not even know that. What is research? We would have a lot of people that don't understand where that sits with us in an organisation. ” (Middle manager) 1.2 Knowledge and skills. Participants reported a mixed level of knowledge and skills to engage with research, influenced by their educational background and prior work environments as opposed to their current position. For example, one senior manager felt confident engaging with research evidence through their previous work experience. When asked if they found it easy to apply research evidence, their response was: “Personally, I think it is, because I've been in roles in the past in healthcare, or in government, or in the universities. I don't know if everyone at Lifeblood, who I work with has that know-how though… But that's because I've been trained in that, and I've done it before.” (Senior manager) Other participants expressed less confidence in appraising, interpreting, and applying research due to a lack of education and/or training. “I see a lot of research papers come through and it's just way over my head, because I don't come from that… The research papers that I like to see are the ones that are a bit more basic for want of a better word, in terms of you don't need that clinical expertise or scientific expertise.” (Senior manager) 1.3 Tools and systems. The most frequently reported mechanism for accessing research was the inclusion of a plain language summary in a department newsletter. In particular, this was viewed as the only method for front-line staff to learn about research. “ I think that would probably be the only thing that I can think of that I would know about there being research being conducted and what the outcome was. ” (Front-line staff) Another reported mechanism for sharing research evidence was the internal library service. However, only two participants – from the same team – mentioned using the internal library service to access research. Many other participants did not know about it or believed it no longer existed. “ We've had a really good library, and you used to get an email out to say, "Oh, there's an article on whatever it was." And you could often request the article. But we obviously don't have a library anymore, or we do, but no one sends anything out. ” (Middle manager) Being a member of a committee was another mechanism for senior managers to learn about research and interact with researchers: “ We've got the committee, so we can hear what's coming up and papers and things we can see in that committee. ” (Senior manager). However, this was limited to senior managers; front-line staff and middle managers reported an absence of formal structures where they could hear about or interact with research: “ I don't think there's any set way that we share the information. ” (Middle manager). Other avenues mentioned by senior managers included webinars hosted by researchers, ad hoc meetings with researchers, and receiving a copy of the R&D annual report. In general, many participants felt there was a lack of a formal organisational structures or systems in place for them to access research. A few middle-managers and front-line staff could not recall receiving any information about research. As one participant explained: “ It isn't something that is easily accessed. If I currently was like, I'm really interested in X, I wouldn't know where to go… you'd have to go through people and hope that they know where to look. There's no ease of access. I would say that is a problem. ” (Middle manager). A few participants who were relatively new to the organisation also highlighted that accessing and learning about research is not included in training for new staff. “ I don't believe it sits alongside our training program at all …We do a lot of virtual learning and training now, and most of it's about compliance and stuff. But there isn't really a lot of research in any of that. ” (Middle manager). 2. Research engagement actions 2.1 Accessing research Some senior managers had actively searched for research to support their work, in particular those with a clinical background. However, they mentioned preferring to receive information rather than searching for it due to time constraints. “I love being pushed for information, I'm not great at trying to find it myself. That's probably more reflective of my workload and time.” (Senior manager). This experience was shared among middle managers and front-line staff. Most had not actively searched for research because of time constraints or not knowing where to look. As one participant explained: “ You just don't know where to look. Like, you don't have time to learn where all that stuff is. It's hard enough just learning where the [blood collection] resources are, let alone anything else to be honest. ” (Front-line staff). 2.2 Appraising research Of those who had accessed research, most did not indicate appraising its relevance and quality. This may be attributed to a lack of understanding of the content and methods of the research: “ I would read, but a lot of the data goes over my head unless it's in a graph form that I can easily understand or a pie chart or something. But a lot of it's interesting, really interesting. ” (Front-line staff) 2.3 Generating research or analysis Some senior managers indicated that they had partnered with researchers to conduct research. Two participants in particular highlighted collaborating with researchers to develop questionnaires and perform statistical analysis to evaluate an initiative. “I do work with researchers, and including researchers' help really and even statistical help and understanding the analysis and the reports. We've worked with researchers to set up survey questions and to get it done correctly.” (Senior manager) The other senior managers rarely commissioned research activities and were often informed of research evidence without playing an active role in generating it. When asked about any barriers to generating research, one participant mentioned a lack of motivation in the department: “I don't think there's a barrier. I think there needs to be more of an appetite for it.” (Senior manager). However, a potential method to overcome this barrier is to have someone actively championing the research: “ If you put it on Connect [internal website], you put it on the R&D page or whatever, no one’s gonna see it, no one's gonna talk about it. The only time that you'll get investment from probably most of the businesses is if someone was leading and driving and communicating it. ” (Senior manager) 2.4 Interacting with researchers Experiences of interacting with researchers was limited to senior managers and a few middle managers. All of the senior managers had regular interactions with researchers via meetings which would inform them about current research activities and findings. This exposure was seen as beneficial to be able to identify sources of information at a later date: “ …we can see what people are doing the research into, we can see the papers. And I think we know who to go to if we need more information. ” (Senior manager) However, one of the participants also highlighted that the timing of when the research is shared by the researcher and when it is needed by the end-user do not always align, demonstrating the need for other engagement strategies. “ We will go looking for it, maybe not when you want to tell us but there'll be a time where we'll think, "Oh, yeah. We heard about that. Let's go back and see what happened and what information we can find." ” (Senior manager). One middle manager mentioned being part of a steering committee of a research project because she was interested in the topic and reached out to the research team to be involved. Other middle managers talked about facilitating research activities in their centres such as collecting extra blood samples. “We were taking extra blood sample tubes for someone to collect. I was across that. But if it wasn't my centre, I may not necessarily know that research is happening in the background.” (Middle manager) 3. Research use 3.1 Tactical The most frequently reported use of research among senior managers was to support changes being made to policies and procedures. Senior managers reported they used research evidence to prepare papers for internal meetings to support a decision they would like to be made. They also indicated sharing this evidence in their communications to blood collection teams to encourage uptake of the change. “For me, in my teams and our delivery of change or delivery of any program is there is science behind it, and you have to tell the people that. That's how you get their buy in.” (Senior manager) However, the use of research in policy decisions was not always visible to middle managers and front-line staff. They expressed the desire to learn more about the research evidence that either informed or supported proposed changes. For example, when asked how important it was that changes were supported by research evidence, one participant responded: “To me it's very important, because that's how I function, evidence-based practice. I want to know all that to make sure that I’m operating with integrity.” But when asked if the evidence behind a change is often shared, she responded: “ No, not as much. If a change is implemented, it's just like, “heads up, this change is happening.” Often there's no why. So, people just go, "Oh, another change. What’s happening?" Whereas maybe if you had a why...” (Front-line staff). 3.3 Conceptual Senior managers recalled having used research conceptually to provide insights into issues the organisation was facing and using that research to inform policy changes. For example, one participant explained his view on the role of research: “Research is like the engine at the forefront of, like finding out why and then bring it to us and go well, this is what donors are saying or non-donors or lapsed donors are saying... Then we need to change it into ways our team can understand that research, turn into an operational BAU, and ensure that we communicate it to the team.” (Senior manager) Similarly, interventional research that was seen as too complicated and not fit for purpose had been used as inspiration for new procedures. For example, one senior manager described using a research study as inspiration to develop a new tool to improve collection success: “[The research] was a little bit complicated and it didn’t work. But that was a springboard for me.” (Senior manager) 3.2 Instrumental To a lesser extent, research was also reported to directly inform policy or practice changes. Participants mentioned using research evidence to inform changes to clinical practice such as donor selection criteria. As one participant explained: “ The research that's happening and what we're seeing out there does cascade through into changes to [standard operating procedures] or instructions or how we go about doing our work. ” (Senior manager) 3.4 Imposed None of the participants indicated that the organisation required them to use research. DISCUSSION This study examined the capacity and extent of research engagement of frontline staff, middle managers, and senior managers in one department within a blood collection agency with an embedded research team. Capacity to engage with research varied between senior managers and the other levels. Whilst research evidence was highly valued by all participants, middle managers and frontline staff described a lack of visibility of research within the organisation. Further, participants reported mixed knowledge and skills around engaging with research, influenced by their educational background and prior work settings. Senior managers most often reported more awareness of organisational tools and systems. They also reported more experiences engaging with research, such as accessing research evidence and interacting with researchers. However, almost all participants engaged with research evidence passively due to time and workload constraints. Research was mostly used by senior managers as evidence to support a predetermined decision, provide insights or generate ideas to manage blood collection issues, or to inform changes to blood collection policies. However, this use was often not visible to middle managers and frontline staff who expressed a desire to see more research evidence in communications about changes made to policies, procedures, and guidelines to increase their understanding of the change and motivate uptake. To our knowledge, this was the first study to examine research engagement among end-users in a blood donation setting. The experiences reported here, however, are similar to those noted in other health-related fields [ 17 – 19 ]. Barriers to research engagement, such as lack of time, poor access to research evidence and perceived lack of relevant research evidence, were also found in our study. Our recent review of the literature indicated that blood donor research literature is in the early stages of KT [ 20 ], which may affect the availability of relevant research evidence to end-users. Further, research has shown that transfusion medicine researchers typically engage in traditional diffusion strategies and consult with end-users but to a lesser extent use tailored dissemination strategies and actively engage end-users in their research [ 21 , 22 ]. These actions by researchers may have affected the engagement actions and research use observed in our study. A closer examination of determinants in the Capacity domain shows opportunities to strengthen research engagement as these determinants are potentially modifiable [ 12 ]. At an individual level, research was valued. However, the confidence of participants to engage with research appeared to be dependent on their education and prior work experience regardless of their managerial level. Individual capacity can be built through training, or individual or team-based mentoring with a KT specialist or researcher, both of which have been shown to increase research engagement [ 23 – 25 ]. At the organisational level, how research was used lacked visibility and gaps were identified around tools and systems to support research engagement. Research infrastructure might be improved through increasing awareness of and access to the internal library, an accessible research evidence database, and/or regular meetings highlighting relevant research accessible to all staff [ 25 – 27 ]. Further, how research has informed new or changes to existing policies or practices should be highlighted to increase visibility of research and encourage uptake among middle-managers and front-line staff [28]. Finally, dedicated KT positions, such as a senior leadership position for KT, could be introduced to champion research engagement and use through facilitating relationships between researchers and end-users, summarising relevant research, and providing research expertise to business priorities [ 24 , 26 ]. Limitations It is important to note the limitations of this study when considering the findings. First, our sample size was limited to fourteen participants. We achieved good representation of senior and middle managers within the single department targeted. However, we were only able to recruit three frontline staff from different centres due to recruitment occurring during frontline staff shortages. Further, we were limited in our recruitment to select blood collection centres due to organisational procedures. Whilst our participants provided great insights, a future survey study with a shorter time commitment could further explore some of these experiences among frontline staff. Second, due to the qualitative nature of this study, the information provided was subjective. The organisation could have more tools and systems in place to support research engagement than reported. Finally, the study was conducted within a single department of an organisation and additional work is needed to understand research engagement in other areas of the organisation and other blood collection agencies. Despite these limitations, this study provides insights into research engagement capacity, actions, and use of research of end-users working in a department within an organisation with embedded researchers and identified opportunities to further strengthen the visibility and use of research evidence in practice. Abbreviations KT Knowledge Translation R&D Research & Development Declarations Ethics approval and consent to participate This project has been approved by the University of Sydney Human Research Committee (2020/254) and the Australian Red Cross Lifeblood Ethics Committee (2020#14). Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding Australian governments fund the Australian Red Cross Lifeblood for the provision of blood, blood products and services to the Australian community. Author Contribution AT, BM, TD, and AW designed and planned the study. AT was responsible for the study conduct including data collection. AT and AE analysed the data under guidance of AW. AT wrote the first draft of the manuscript. All authors have been involved in drafting the manuscript and approved the final manuscript. Acknowledgement The authors would like to thank all the participants for participating in this study. Data Availability The data generated and/or analysed during the current study are not publicly available due privacy restrictions, but anonymised copies of original transcripts may are available from the corresponding author on reasonable request, subject to ethics and institutional approval. References Westerlund A, Nilsen P, Sundberg L. Implementation of Implementation Science Knowledge: The Research-Practice Gap Paradox. Worldviews Evid Based Nurs. 2019;16: 332-4. doi:0.1111/wvn.12403 Ward V, Tooman T, Reid B, et al. Embedding researchers into organisations: a study of the features of embedded research initiatives. 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Supplementary Files ThijsenetalSupplementaryMaterialsMAR2025.docx Cite Share Download PDF Status: Published Journal Publication published 29 Dec, 2025 Read the published version in Health Research Policy and Systems → Version 1 posted Editorial decision: Revision requested 12 Oct, 2025 Reviews received at journal 04 Oct, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviewers invited by journal 21 Sep, 2025 Editor assigned by journal 27 Jun, 2025 Submission checks completed at journal 27 Jun, 2025 First submitted to journal 26 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6979390","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522060658,"identity":"3e230993-0440-4019-8406-1a890769f916","order_by":0,"name":"Amanda Thijsen","email":"data:image/png;base64,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","orcid":"","institution":"The University of Sydney","correspondingAuthor":true,"prefix":"","firstName":"Amanda","middleName":"","lastName":"Thijsen","suffix":""},{"id":522060659,"identity":"533361dd-6a62-48af-904f-7115bda70363","order_by":1,"name":"Barbara Masser","email":"","orcid":"","institution":"The University of Queensland","correspondingAuthor":false,"prefix":"","firstName":"Barbara","middleName":"","lastName":"Masser","suffix":""},{"id":522060660,"identity":"e36c2a4a-3de9-466e-a099-f6de3258e92e","order_by":2,"name":"Tanya E. Davison","email":"","orcid":"","institution":"Research \u0026 Innovation","correspondingAuthor":false,"prefix":"","firstName":"Tanya","middleName":"E.","lastName":"Davison","suffix":""},{"id":522060661,"identity":"8a8f166f-9eed-4468-8f58-57263c553556","order_by":3,"name":"Abigail R-A. Edwards","email":"","orcid":"","institution":"The University of Queensland","correspondingAuthor":false,"prefix":"","firstName":"Abigail","middleName":"R-A.","lastName":"Edwards","suffix":""},{"id":522060662,"identity":"edefb02c-2f17-49f7-9988-4165d5436d90","order_by":4,"name":"Gabriel Moore","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Gabriel","middleName":"","lastName":"Moore","suffix":""},{"id":522060663,"identity":"81db0d9e-7d54-4deb-abdb-09024728f0cd","order_by":5,"name":"Anna Williamson","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Williamson","suffix":""}],"badges":[],"createdAt":"2025-06-26 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08:11:00","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80197,"visible":true,"origin":"","legend":"","description":"","filename":"4cc442892a234c9d93fc673068eaf25f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-6979390/v1/09ecdf48b1b46c3a3d6a7d46.xml"},{"id":92574229,"identity":"389e2e1a-6a11-445c-8ad4-319781727779","added_by":"auto","created_at":"2025-10-01 08:11:00","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90931,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6979390/v1/b88d16ad53b25fbae3cbefd9.html"},{"id":92574221,"identity":"48ecc8d5-2ac7-4dca-a584-62ebd0432911","added_by":"auto","created_at":"2025-10-01 08:11:00","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49766,"visible":true,"origin":"","legend":"\u003cp\u003eThe SPIRIT Action Framework\u003c/p\u003e\n\u003cp\u003eSource: Redman et al.[11]\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6979390/v1/4309e6050f186a6abec82e9a.jpeg"},{"id":99545654,"identity":"0bde72d5-6651-4d03-8e9a-80e5dbf4500a","added_by":"auto","created_at":"2026-01-05 16:09:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":706556,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6979390/v1/2b11a9d9-4fbc-48e6-a801-58dd033274da.pdf"},{"id":92574213,"identity":"89cd4546-ff24-4c54-a0b8-13e1ac8c6f9d","added_by":"auto","created_at":"2025-10-01 08:11:00","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":31497,"visible":true,"origin":"","legend":"","description":"","filename":"ThijsenetalSupplementaryMaterialsMAR2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-6979390/v1/0514c12d87e679c29f029df9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The use of research evidence in blood collection policy and practice: a qualitative study with front- line staff, middle managers, and senior managers","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eResearch is a source of knowledge that can help organisations improve their policies and procedures as well as overcome potential challenges. However, there is a known disconnect between scientific knowledge and its application in routine practice, known as the research-practice gap [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Consequently, policies and procedures may not be aligned with current evidence, leading to high costs, inappropriate practices, and waste of resources [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo facilitate knowledge translation (KT), it is essential for end-users to be able to access, understand and apply research evidence, but also to be motivated to embed research into practice [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, end-users at various levels within an organisation may experience barriers to engaging with research. Frontline staff often have insufficient time to engage with research due to heavy workloads, lack of relevant skills, negative views on benefits of research to practice, and their roles often being task-oriented without authority to change practice [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Middle managers have been identified as instrumental in summarising research and disseminating this knowledge with their frontline teams [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, they may also have limited knowledge of how to access, interpret, and appraise research. Further, research engagement of frontline staff and middle managers is affected by how it is supported and valued within the organisation (i.e. the implementation climate) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA potential strategy to overcome the research-practice gap and encourage research engagement is to embed researchers within non-academic organisations. This strategy can increase the likelihood that research activities and the knowledge needs of policy-makers and practitioners (i.e., end-users) are aligned [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Further, it can build the capacity of end-users through exposure to research activities and provide opportunities to collaborate on finding solutions to organisational issues [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Embedding researchers in organisations has been shown to increase end-users\u0026rsquo; access to research-based evidence, which can be used to address organisational challenges and create positive change [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUsing the SPIRIT Action Framework, we conducted a qualitative study to explore research engagement amongst staff at an organisation with embedded researchers. The SPIRIT Action framework [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] has three domains (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The first, \u003cem\u003eindividual and organisational capacity\u003c/em\u003e, focuses on potential determinants of research use including a) the value the individual places on using research, b) the confidence the individual has in their knowledge and skills for engaging with research, c) the perceived value their organisation places on using research, and d) the tools and systems their organisation has to support research use. The second, \u003cem\u003eresearch engagement actions\u003c/em\u003e, focuses on potential actions that can be taken to engage with research and researchers. These include a) accessing research, b) appraising research for relevance and quality, c) generating or commissioning research and analyses, and d) interacting with researchers. The last domain, \u003cem\u003eresearch use\u003c/em\u003e, captures the way in which research informs policy or practice. This domain captures a) conceptual use \u0026ndash; where research is used to clarify understanding about a policy or practice issue, b) instrumental use \u0026ndash; where research evidence directly informs policy or practice, c) tactical use \u0026ndash; where research evidence is used to help justify or persuade others to support a predetermined decision, and d) imposed use \u0026ndash; where research evidence is used due to organisational requirements.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] The aims of the current study are to: 1) provide insight into how research is engaged with and used at an organisation with embedded researchers from the perspectives of people working at various levels; and 2) identify opportunities to strengthen KT.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe study was conducted at Australian Red Cross Lifeblood (Lifeblood), which is the sole collector and provider of blood and blood components in Australia, collecting blood from voluntary and nonremunerated donors. Lifeblood is unique through its hybrid focus on manufacturing and supply of blood and blood-related products to the health sector, ensuring appropriate care and health of blood donors, and encouraging continued volunteerism of donors. It has an internal Research and Development (R\u0026amp;D) department which conducts basic and applied research to address problems faced by Lifeblood as well as gaps in knowledge in broader transfusion medicine. Our study population included members of the department focusing on blood collection which has a great potential for research engagement due to the applied nature of the research engaged in and R\u0026amp;D\u0026rsquo;s strong focus on solving blood collection problems [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. We interviewed three groups of participants: 1) senior managers \u0026ndash; responsible for policy development, 2) middle managers \u0026ndash; donor centre managers and area managers who manage blood collection centres, and 3) front-line staff - registered nurses and non-medically trained nursing assistants who collect blood.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003e The study was approved by the University of Sydney Human Research Ethics Committee (reference number 2020/254) and the Australian Red Cross Lifeblood Ethics Committee (2020#14). Semi-structured interviews were conducted by the first author from November 2022 to April 2023. A purposive sampling strategy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] was adopted to ensure participants were diverse in their professional roles and locations. We invited five senior managers and five area managers (i.e. middle managers) to participate in the study via email. One of the senior managers, responsible for overseeing research activities in blood collection centres, then identified centres available to be contacted for our study. We first invited the centre manager (i.e., middle manager) to participate in an interview and they assisted in selecting front-line staff to participate in the study based on their workload and availability.\u003c/p\u003e\u003cp\u003eIn total, fourteen staff members participated in this study: five senior managers, six middle managers, and three front-line staff members from different centres. This sample size was deemed adequate to answer our research question while working within our constraints of available research participants and time [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Data collection occurred at a time when there were front-line staff shortages making it difficult for staff to leave their daily tasks such as collecting blood to participate in interviews. Participants had worked at the organisation between 3 and 31 years.\u003c/p\u003e\u003cp\u003eTopic guides were tailored specifically for each participant group (see Supplementary Materials). With written consent, interviews were conducted via MS Teams, and each lasted 26\u0026ndash;57 minutes. All interviews were recorded, and transcribed verbatim.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eThe researchers\u003c/h3\u003e\n\u003cp\u003eThe first author has worked as a researcher in the R\u0026amp;D department for eleven years. The second author holds a joint research position with the University of Queensland and R\u0026amp;D at Lifeblood and has worked in blood donation research for 23 years. The third author has previously worked as an internal researcher within R\u0026amp;D at Lifeblood for five years. These experiences and knowledge of the area informed the study approach, including study design, participant recruitment, data collection, analysis of data, and interpretation of the findings. Further, the researchers\u0026rsquo; insider perspective may have resulted in more appropriate interpretation of the data due to a better understanding of the organisational context. The use of a coding framework as well as adherence to ethical and professional standards minimised the risk of potential bias.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eDirected qualitative content analysis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] was used to analyse the data. Guided by the SPIRIT Action Framework [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], a predetermined coding framework was developed including the following domains: capacity, research engagement actions, type of research use, and purpose of research use. First, transcripts were checked against the audio files which simultaneously allowed for familiarisation with the data. Second, the predetermined codes were pilot tested by two authors (AT, AE) independently applying them to two transcripts in MS Word with model fit subsequently discussed. Third, all transcripts were uploaded to NVivo (QSR International) for coding and analysis. The first author then applied the coding framework to all transcripts. Relevant data that did not fit into the predetermined coding framework were inductively coded. Finally, descriptions were written for each SPIRIT domain by examining the categories, codes, and coded data.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e1. Capacity for research use\u003c/h2\u003e\u003cp\u003e\u003cb\u003e1.1 Research is valued.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll participants felt that research was \u0026ldquo;important\u0026rdquo; and of \u0026ldquo;interest\u0026rdquo; to their work facilitating blood collection. In particular, health-related research was valued highly by participants because they perceive that they work in health and often had a background in nursing.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Data and research I think are fundamentals for anyone who's playing in the healthcare space.\u0026rdquo;\u003c/em\u003e (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHowever, some participants, in particular front-line staff, felt that it was unclear how research was used to inform blood collection policies and practices.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eFor there to be an understanding that the changes we make and the things that we do are driven by research \u0026hellip;we would have a lot of people that would not even know that. What is research? We would have a lot of people that don't understand where that sits with us in an organisation.\u003c/em\u003e\u0026rdquo; (Middle manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e1.2 Knowledge and skills.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants reported a mixed level of knowledge and skills to engage with research, influenced by their educational background and prior work environments as opposed to their current position. For example, one senior manager felt confident engaging with research evidence through their previous work experience. When asked if they found it easy to apply research evidence, their response was:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Personally, I think it is, because I've been in roles in the past in healthcare, or in government, or in the universities. I don't know if everyone at Lifeblood, who I work with has that know-how though\u0026hellip; But that's because I've been trained in that, and I've done it before.\u0026rdquo;\u003c/em\u003e (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOther participants expressed less confidence in appraising, interpreting, and applying research due to a lack of education and/or training.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I see a lot of research papers come through and it's just way over my head, because I don't come from that\u0026hellip; The research papers that I like to see are the ones that are a bit more basic for want of a better word, in terms of you don't need that clinical expertise or scientific expertise.\u0026rdquo;\u003c/em\u003e (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e1.3 Tools and systems.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe most frequently reported mechanism for accessing research was the inclusion of a plain language summary in a department newsletter. In particular, this was viewed as the only method for front-line staff to learn about research.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI think that would probably be the only thing that I can think of that I would know about there being research being conducted and what the outcome was.\u003c/em\u003e\u0026rdquo; (Front-line staff)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnother reported mechanism for sharing research evidence was the internal library service. However, only two participants \u0026ndash; from the same team \u0026ndash; mentioned using the internal library service to access research. Many other participants did not know about it or believed it no longer existed.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eWe've had a really good library, and you used to get an email out to say, \"Oh, there's an article on whatever it was.\" And you could often request the article. But we obviously don't have a library anymore, or we do, but no one sends anything out.\u003c/em\u003e\u0026rdquo; (Middle manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBeing a member of a committee was another mechanism for senior managers to learn about research and interact with researchers: \u0026ldquo;\u003cem\u003eWe've got the committee, so we can hear what's coming up and papers and things we can see in that committee.\u003c/em\u003e\u0026rdquo; (Senior manager). However, this was limited to senior managers; front-line staff and middle managers reported an absence of formal structures where they could hear about or interact with research: \u0026ldquo;\u003cem\u003eI don't think there's any set way that we share the information.\u003c/em\u003e\u0026rdquo; (Middle manager). Other avenues mentioned by senior managers included webinars hosted by researchers, ad hoc meetings with researchers, and receiving a copy of the R\u0026amp;D annual report.\u003c/p\u003e\u003cp\u003eIn general, many participants felt there was a lack of a formal organisational structures or systems in place for them to access research. A few middle-managers and front-line staff could not recall receiving any information about research. As one participant explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eIt isn't something that is easily accessed. If I currently was like, I'm really interested in X, I wouldn't know where to go\u0026hellip; you'd have to go through people and hope that they know where to look. There's no ease of access. I would say that is a problem.\u003c/em\u003e\u0026rdquo; (Middle manager).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA few participants who were relatively new to the organisation also highlighted that accessing and learning about research is not included in training for new staff.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI don't believe it sits alongside our training program at all \u0026hellip;We do a lot of virtual learning and training now, and most of it's about compliance and stuff. But there isn't really a lot of research in any of that.\u003c/em\u003e\u0026rdquo; (Middle manager).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2. Research engagement actions\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.1 Accessing research\u003c/h2\u003e\u003cp\u003eSome senior managers had actively searched for research to support their work, in particular those with a clinical background. However, they mentioned preferring to receive information rather than searching for it due to time constraints.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I love being pushed for information, I'm not great at trying to find it myself. That's probably more reflective of my workload and time.\u0026rdquo;\u003c/em\u003e (Senior manager).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis experience was shared among middle managers and front-line staff. Most had not actively searched for research because of time constraints or not knowing where to look. As one participant explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eYou just don't know where to look. Like, you don't have time to learn where all that stuff is. It's hard enough just learning where the [blood collection] resources are, let alone anything else to be honest.\u003c/em\u003e\u0026rdquo; (Front-line staff).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003e2.2 Appraising research\u003c/h3\u003e\n\u003cp\u003eOf those who had accessed research, most did not indicate appraising its relevance and quality. This may be attributed to a lack of understanding of the content and methods of the research:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eI would read, but a lot of the data goes over my head unless it's in a graph form that I can easily understand or a pie chart or something. But a lot of it's interesting, really interesting.\u003c/em\u003e\u0026rdquo; (Front-line staff)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Generating research or analysis\u003c/h2\u003e\u003cp\u003eSome senior managers indicated that they had partnered with researchers to conduct research. Two participants in particular highlighted collaborating with researchers to develop questionnaires and perform statistical analysis to evaluate an initiative.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I do work with researchers, and including researchers' help really and even statistical help and understanding the analysis and the reports. We've worked with researchers to set up survey questions and to get it done correctly.\u0026rdquo;\u003c/em\u003e (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe other senior managers rarely commissioned research activities and were often informed of research evidence without playing an active role in generating it. When asked about any barriers to generating research, one participant mentioned a lack of motivation in the department: \u003cem\u003e\u0026ldquo;I don't think there's a barrier. I think there needs to be more of an appetite for it.\u0026rdquo;\u003c/em\u003e (Senior manager). However, a potential method to overcome this barrier is to have someone actively championing the research:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eIf you put it on Connect [internal website], you put it on the R\u0026amp;D page or whatever, no one\u0026rsquo;s gonna see it, no one's gonna talk about it. The only time that you'll get investment from probably most of the businesses is if someone was leading and driving and communicating it.\u003c/em\u003e\u0026rdquo; (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Interacting with researchers\u003c/h2\u003e\u003cp\u003eExperiences of interacting with researchers was limited to senior managers and a few middle managers. All of the senior managers had regular interactions with researchers via meetings which would inform them about current research activities and findings. This exposure was seen as beneficial to be able to identify sources of information at a later date:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003e\u0026hellip;we can see what people are doing the research into, we can see the papers. And I think we know who to go to if we need more information.\u003c/em\u003e\u0026rdquo; (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHowever, one of the participants also highlighted that the timing of when the research is shared by the researcher and when it is needed by the end-user do not always align, demonstrating the need for other engagement strategies.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eWe will go looking for it, maybe not when you want to tell us but there'll be a time where we'll think, \"Oh, yeah. We heard about that. Let's go back and see what happened and what information we can find.\"\u003c/em\u003e\u0026rdquo; (Senior manager).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOne middle manager mentioned being part of a steering committee of a research project because she was interested in the topic and reached out to the research team to be involved. Other middle managers talked about facilitating research activities in their centres such as collecting extra blood samples.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We were taking extra blood sample tubes for someone to collect. I was across that. But if it wasn't my centre, I may not necessarily know that research is happening in the background.\u0026rdquo;\u003c/em\u003e (Middle manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3. Research use\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e3.1 Tactical\u003c/h2\u003e\u003cp\u003eThe most frequently reported use of research among senior managers was to support changes being made to policies and procedures. Senior managers reported they used research evidence to prepare papers for internal meetings to support a decision they would like to be made. They also indicated sharing this evidence in their communications to blood collection teams to encourage uptake of the change.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;For me, in my teams and our delivery of change or delivery of any program is there is science behind it, and you have to tell the people that. That's how you get their buy in.\u0026rdquo;\u003c/em\u003e (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHowever, the use of research in policy decisions was not always visible to middle managers and front-line staff. They expressed the desire to learn more about the research evidence that either informed or supported proposed changes. For example, when asked how important it was that changes were supported by research evidence, one participant responded: \u003cem\u003e\u0026ldquo;To me it's very important, because that's how I function, evidence-based practice. I want to know all that to make sure that I\u0026rsquo;m operating with integrity.\u0026rdquo;\u003c/em\u003e But when asked if the evidence behind a change is often shared, she responded: \u0026ldquo;\u003cem\u003eNo, not as much. If a change is implemented, it's just like, \u0026ldquo;heads up, this change is happening.\u0026rdquo; Often there's no why. So, people just go, \"Oh, another change. What\u0026rsquo;s happening?\" Whereas maybe if you had a why...\u0026rdquo;\u003c/em\u003e (Front-line staff).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Conceptual\u003c/h2\u003e\u003cp\u003eSenior managers recalled having used research conceptually to provide insights into issues the organisation was facing and using that research to inform policy changes. For example, one participant explained his view on the role of research:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Research is like the engine at the forefront of, like finding out why and then bring it to us and go well, this is what donors are saying or non-donors or lapsed donors are saying... Then we need to change it into ways our team can understand that research, turn into an operational BAU, and ensure that we communicate it to the team.\u0026rdquo;\u003c/em\u003e (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSimilarly, interventional research that was seen as too complicated and not fit for purpose had been used as inspiration for new procedures. For example, one senior manager described using a research study as inspiration to develop a new tool to improve collection success:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;[The research] was a little bit complicated and it didn\u0026rsquo;t work. But that was a springboard for me.\u0026rdquo;\u003c/em\u003e (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Instrumental\u003c/h2\u003e\u003cp\u003eTo a lesser extent, research was also reported to directly inform policy or practice changes. Participants mentioned using research evidence to inform changes to clinical practice such as donor selection criteria. As one participant explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eThe research that's happening and what we're seeing out there does cascade through into changes to [standard operating procedures] or instructions or how we go about doing our work.\u003c/em\u003e\u0026rdquo; (Senior manager)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Imposed\u003c/h2\u003e\u003cp\u003eNone of the participants indicated that the organisation required them to use research.\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examined the capacity and extent of research engagement of frontline staff, middle managers, and senior managers in one department within a blood collection agency with an embedded research team. Capacity to engage with research varied between senior managers and the other levels. Whilst research evidence was highly valued by all participants, middle managers and frontline staff described a lack of visibility of research within the organisation. Further, participants reported mixed knowledge and skills around engaging with research, influenced by their educational background and prior work settings. Senior managers most often reported more awareness of organisational tools and systems. They also reported more experiences engaging with research, such as accessing research evidence and interacting with researchers. However, almost all participants engaged with research evidence passively due to time and workload constraints. Research was mostly used by senior managers as evidence to support a predetermined decision, provide insights or generate ideas to manage blood collection issues, or to inform changes to blood collection policies. However, this use was often not visible to middle managers and frontline staff who expressed a desire to see more research evidence in communications about changes made to policies, procedures, and guidelines to increase their understanding of the change and motivate uptake.\u003c/p\u003e\u003cp\u003eTo our knowledge, this was the first study to examine research engagement among end-users in a blood donation setting. The experiences reported here, however, are similar to those noted in other health-related fields [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Barriers to research engagement, such as lack of time, poor access to research evidence and perceived lack of relevant research evidence, were also found in our study. Our recent review of the literature indicated that blood donor research literature is in the early stages of KT [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which may affect the availability of relevant research evidence to end-users. Further, research has shown that transfusion medicine researchers typically engage in traditional diffusion strategies and consult with end-users but to a lesser extent use tailored dissemination strategies and actively engage end-users in their research [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These actions by researchers may have affected the engagement actions and research use observed in our study.\u003c/p\u003e\u003cp\u003eA closer examination of determinants in the Capacity domain shows opportunities to strengthen research engagement as these determinants are potentially modifiable [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. At an individual level, research was valued. However, the confidence of participants to engage with research appeared to be dependent on their education and prior work experience regardless of their managerial level. Individual capacity can be built through training, or individual or team-based mentoring with a KT specialist or researcher, both of which have been shown to increase research engagement [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. At the organisational level, how research was used lacked visibility and gaps were identified around tools and systems to support research engagement. Research infrastructure might be improved through increasing awareness of and access to the internal library, an accessible research evidence database, and/or regular meetings highlighting relevant research accessible to all staff [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Further, how research has informed new or changes to existing policies or practices should be highlighted to increase visibility of research and encourage uptake among middle-managers and front-line staff [28]. Finally, dedicated KT positions, such as a senior leadership position for KT, could be introduced to champion research engagement and use through facilitating relationships between researchers and end-users, summarising relevant research, and providing research expertise to business priorities [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eIt is important to note the limitations of this study when considering the findings. First, our sample size was limited to fourteen participants. We achieved good representation of senior and middle managers within the single department targeted. However, we were only able to recruit three frontline staff from different centres due to recruitment occurring during frontline staff shortages. Further, we were limited in our recruitment to select blood collection centres due to organisational procedures. Whilst our participants provided great insights, a future survey study with a shorter time commitment could further explore some of these experiences among frontline staff. Second, due to the qualitative nature of this study, the information provided was subjective. The organisation could have more tools and systems in place to support research engagement than reported. Finally, the study was conducted within a single department of an organisation and additional work is needed to understand research engagement in other areas of the organisation and other blood collection agencies.\u003c/p\u003e\u003cp\u003eDespite these limitations, this study provides insights into research engagement capacity, actions, and use of research of end-users working in a department within an organisation with embedded researchers and identified opportunities to further strengthen the visibility and use of research evidence in practice.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKnowledge Translation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eR\u0026amp;D\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eResearch \u0026amp; Development\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This project has been approved by the University of Sydney Human Research Committee (2020/254) and the Australian Red Cross Lifeblood Ethics Committee (2020#14).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eAustralian governments fund the Australian Red Cross Lifeblood for the provision of blood, blood products and services to the Australian community.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAT, BM, TD, and AW designed and planned the study. AT was responsible for the study conduct including data collection. AT and AE analysed the data under guidance of AW. AT wrote the first draft of the manuscript. All authors have been involved in drafting the manuscript and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all the participants for participating in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data generated and/or analysed during the current study are not publicly available due privacy restrictions, but anonymised copies of original transcripts may are available from the corresponding author on reasonable request, subject to ethics and institutional approval.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWesterlund A, Nilsen P, Sundberg L. Implementation of Implementation Science Knowledge: The Research-Practice Gap Paradox. 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BMC Health Serv Res. 2020;20: 147. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-020-4999-8\u003c/span\u003e\u003cspan address=\"10.1186/s12913-020-4999-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"health-research-policy-and-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrps","sideBox":"Learn more about [Health Research Policy and Systems](http://health-policy-systems.biomedcentral.com/)","snPcode":"12961","submissionUrl":"https://submission.nature.com/new-submission/12961/3","title":"Health Research Policy and Systems","twitterHandle":"@HarpsJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"research use, research engagement, SPIRIT Action Framework, blood, evidence-informed policy making, front-line staff, middle managers, senior managers, policy makers","lastPublishedDoi":"10.21203/rs.3.rs-6979390/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6979390/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThere is a known disconnect between scientific knowledge and its application in routine practice, known as the research-practice gap. A potential strategy to encourage research engagement among end-users is embedding researchers within an organisation. This study set out to understand the views and experiences of senior managers, middle managers, and front-line staff in one department accessing and using research in a large organisation with embedded researchers. We also investigated staff capacity to engage with research to identify opportunities to strengthen the use of research-based evidence in practice.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted 14 semi-structured in-depth interviews between November 2022 and April 2023 with senior managers, middle managers, and front-line staff working in the blood collection department at Australian Red Cross Lifeblood. Directed qualitative content analysis and the SPIRIT Action Framework were used to interpret the data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCapacity to engage with and use research varied greatly between participants and appeared to be affected by their role, training, and prior work experience. Participants valued research highly. However, only a few felt confident in their knowledge and skills to engage with research. Participants described a lack of visibility of research within the organisation as well as systems and structures to access research. Experiences with accessing research, generating research, and interacting with researchers were mostly limited to senior managers. Research was chiefly used by senior managers to support changes, followed by understanding blood collection issues, and informing policy development. Although present, research use was often not visible to front-line staff.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eTo increase research engagement and use, organisations should invest in strengthening their tools and systems, providing opportunities to increase individual knowledge and skills to engage with research, and increase the visibility of research and how it has been used.\u003c/p\u003e","manuscriptTitle":"The use of research evidence in blood collection policy and practice: a qualitative study with front- line staff, middle managers, and senior managers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 08:10:56","doi":"10.21203/rs.3.rs-6979390/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-12T13:55:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T14:27:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30353277466970235349202378225423720172","date":"2025-09-24T07:56:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-21T10:43:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-28T03:44:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-28T03:42:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"Health Research Policy and Systems","date":"2025-06-26T04:11:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"health-research-policy-and-systems","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrps","sideBox":"Learn more about [Health Research Policy and Systems](http://health-policy-systems.biomedcentral.com/)","snPcode":"12961","submissionUrl":"https://submission.nature.com/new-submission/12961/3","title":"Health Research Policy and Systems","twitterHandle":"@HarpsJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2980d5f1-6059-4030-8c20-48f462bef8b0","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:07:57+00:00","versionOfRecord":{"articleIdentity":"rs-6979390","link":"https://doi.org/10.1186/s12961-025-01428-3","journal":{"identity":"health-research-policy-and-systems","isVorOnly":false,"title":"Health Research Policy and Systems"},"publishedOn":"2025-12-29 15:57:34","publishedOnDateReadable":"December 29th, 2025"},"versionCreatedAt":"2025-10-01 08:10:56","video":"","vorDoi":"10.1186/s12961-025-01428-3","vorDoiUrl":"https://doi.org/10.1186/s12961-025-01428-3","workflowStages":[]},"version":"v1","identity":"rs-6979390","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6979390","identity":"rs-6979390","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}