A new pyramid of research knowledge for the NHS

Background: Although the research and development (R&D) initiative in the NHS clearly encompasses a wide range of research activities, existing guidance emphasizes efficacy (explanatory) research, namely the generation of new knowledge under rigorous scientific conditions. Aims: We argue that this needs to be counter-balanced with an equivalent emphasis on effectiveness (pragmatic) research, being those activities that improve the effects of new knowledge within the NHS. Method: Treating the efficacy framework for complex interventions as one half of a research knowledge pyramid, we set out a parallel effectiveness (service improvement/evaluation) framework. Results: With the aid of local examples, we show how this pyramid approach can facilitate R&D training, specifically in relation to clinical psychology. Conclusions: Our pyramid of research knowledge redresses the current emphasis on explanatory research and indicates how we can apply a more balanced model, hopefully aiding professionals who teach or practise effectiveness research. Declaration of interest: None.