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Although supporting and assessing the non-academic “impact” of research are not entirely new developments in higher education, academics and research institutions are under increasing pressure to produce work that has a measurable influence outside the academy. With a view to supporting the solution of complex societal issues with evidence and expertise, and against the background of increased emphasis on impact in the United Kingdom's 2021 Research Excellence Framework (REF2021) and a proliferation of impact guides and tools, this article offers a simple, easy to remember framework for designing impactful research. We call this framework “The 7Cs of Impact” – Context, Communities, Constituencies, Challenge, Channels, Communication and Capture.

Drawing on core elements of the Policy Institute at King's College London's Impact by Design training course and the authors' practical experience in supporting and delivering impact, this paper outlines how this framework can help address key aspects across the lifecycle of a research project and plan, from identifying the intended impact of research and writing it into grants and proposals, to engaging project stakeholders and assessing whether the project has had the desired impact.

While preparations for current and future REF submissions may benefit from using this framework, this paper sets out the “7Cs” with a more holistic view of impact in mind, seeking to aid researchers in identifying, capturing, and communicating how research projects can and do contribute to the improvement in society.

The study compares how distinct mechanisms that connect pre-established policy objectives to professionals' practices, and the health policy implementation context influenced different approaches to frontline staff participation. The authors analysed 26 teams in six cities from two Brazilian states, during the last cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ).

About 172 in-depth interviews were conducted with frontliners – community health workers (78), nurses (37), doctors (30) – and managers (27). Interview guides were based on key issues identified in the implementation and pay-for-performance (P4P) literature. Drawing on thematic analysis and synthesis of the literature, three types of participation mechanisms were identified: relational, motivational and incremental learning. They were analysed considering distinct contexts at the local level to understand how they influenced different forms of participation: mere adherence, result-oriented and transformative.

Administrations with stronger institutional organizational structures were able to control work processes and reduce professional discretion. However, sustained participation was more likely where there was greater integration between management and frontline health care teams. Motivation based only on financial incentives could not bring about transformative participation. This depended on the degree of professional's ideational motivation towards primary care. Finally, contexts with unfavourable working conditions tend to demotivate professionals, but incremental learning helps teams cope with these obstacles.

The study overcomes gaps in the literature in relation to PMAQ's implementation process. Overall, the study delves into which/how mechanisms alter frontliners participation in performance-oriented health programs.