• Trisha Greenhalgh and Nick Fahy.
• Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. trish.greenhalgh@phc.ox.ac.uk.
• Bmc Med. 2015 Sep 21; 13: 232.

BackgroundThe 2014 UK Research Excellence Framework (REF2014) generated a unique database of impact case studies, each describing a body of research and impact beyond academia. We sought to explore the nature and mechanism of impact in a sample of these.MethodsThe study design was manual content analysis of a large sample of impact case studies (producing mainly quantitative data), plus in-depth interpretive analysis of a smaller sub-sample (for qualitative detail), thereby generating both breadth and depth. For all 162 impact case studies submitted to sub-panel A2 in REF2014, we extracted data on study design(s), stated impacts and audiences, mechanisms of impact, and efforts to achieve impact. We analysed four case studies (selected as exemplars of the range of approaches to impact) in depth, including contacting the authors for their narratives of impact efforts.ResultsMost impact case studies described quantitative research (most commonly, trials) and depicted a direct, linear link between research and impact. Research was said to have influenced a guideline in 122 case studies, changed policy in 88, changed practice in 84, improved morbidity in 44 and reduced mortality in 25. Qualitative and participatory research designs were rare, and only one case study described a co-production model of impact. Eighty-two case studies described strong and ongoing linkages with policymakers, but only 38 described targeted knowledge translation activities. In 40 case studies, no active efforts to achieve impact were described. Models of good implementation practice were characterised by an ethical commitment by researchers, strong institutional support and a proactive, interdisciplinary approach to impact activities.ConclusionREF2014 both inspired and documented significant efforts by UK researchers to achieve impact. But in contrast with the published evidence on research impact (which depicts much as occurring indirectly through non-linear mechanisms), this sub-panel seems to have captured mainly direct and relatively short-term impacts one step removed from patient outcomes. Limited impacts on morbidity and mortality, and researchers' relatively low emphasis on the processes and interactions through which indirect impacts may occur, are concerns. These findings have implications for multi-stakeholder research collaborations such as UK National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care, which are built on non-linear models of impact.

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