American Academy of Nursing on Policy

The mechanics of writing a policy briefRosanna DeMarco, PhD, RN, PHCNS-BC, APHN-BC, ACRN, FAANa,*,

Kimberly Adams Tufts, DNP, WHNP-BC, FAANb

aDepartment of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MAbCommunity and Global Initiatives, School of Nursing, College of Health Sciences, Old Dominion University, Norfolk, VA

According to Nannini and Houde (2010), reportsaddressing the interests and needs of policy makersare frequently referred to as policy briefs. These reportsare intended to be short and easy to use, containinginformation that can be reviewed quickly by policymakers. The contents of these reports are based onsystematic reviews of the literature addressingrefereed, rigorously evaluated science to advance pol-icy making based on the best evidence. In a veryimportant way, policy briefs give policymakers contextto the issues that are intended to be addressed in theirroles. Policy brief writers typically used this genre ofcommunicating ideas and opinions when they argue aspecific solution to a problem while addressing theaudience outside of their organization or commonworldview. Today, policy briefs have become populartools for corporations and professional organizations,especially on the Internet but also in other readilyaccessible written formats, in that they promote themission and vision of organizations through publicsharing of ideas based on compelling evidence (Colby,Quinn, Williams, Bilhelmer, & Goodell, 2008).

Typically, the purpose of a policy brief is to create ashort document providing findings and recommenda-tions to an audience who may not be experts in an areaof interest. The brief serves as a vehicle for providingpolicy advice; it advocates for the desired solution to aparticular problem or challenge. The audience for a pol-icy brief can be the general public or particular entities ofinterest that seek solutions to problems or needs or whomay require to be convinced of a different way of lookingat an area of interest (i.e., exposure to a new paradigm).In order to persuade the targeted audience, the briefmust focus on their needs. If the brief addresses prob-lems that readers want to solve, they will read the policybrief looking for a newway to view a solution. Otherwise,the policy brief may not be read and may even beignored. It is important to emphasize the readers’ in-terests rather than those of the writer when composingthis type of document while supplying credible evidenceto support change in policy (Pick, 2008).

Students in policy courses, professional organiza-tions, policy institutes (i.e., “think tanks”), and

* Corresponding author: Rosanna DeMarco, 100 Morrissey Boulevard,ton, Boston, MA 02135.

E-mail address: rosanna.demarco@umb.edu (R. DeMarco).

0029-6554/$ - see front matter � 2014 Elsevier Inc. All rights reservedhttp://dx.doi.org/10.1016/j.outlook.2014.04.002

legislators are among those who most often writepolicy briefs for the purpose of giving succinct evidenceto support actions that ideally should be taken toaddress an issue. The main purpose of giving the evi-dence in a succinct form is to make a convincingargument to inform policy making while consideringall the salient aspects of an issue from a position ofexpertise. Policy briefs are written to inform others of aspecific viewpoint, to frame discussions, and to showcredibility and expertise on a certain subject matter(Chaffee, 2007).

There are many examples of policy briefs. We focuson one policy brief that was produced by the AmericanAcademy of Nursing’s expert panel addressingemerging and infectious diseases (DeMarco, BradleySpringer, Gallagher, Jones, & Visk, 2012) (Figure 1).Other examples are readily available outside of theAmerican Academy of Nursing and can be accessed forcomparison, such as a policy brief on the consolidationof school districts that was written by the NationalEducation and Policy Center (Howley, Johnson, & Petrie,2011) and a policy brief that was generated as the endproduct of a funded research project addressing ruralconsiderations related to globalization (DERREG, 2011).Each of these policy briefs shows the structure of atypical brief with some key variations that will beaddressed and explained. What is often lacking in theliterature is guidance on how one creates effective pol-icy briefs (i.e., the structure and mechanics of devel-oping the brief itself) and how there may be differencesin the physical presentation across business and pro-fessional groups aswell as national versus internationalapproaches. This article highlights the overall frame-work for crafting an effective policy brief by using thethree briefs mentioned previously as examples.

Step 1: Considerations before Writing a PolicyBrief

The informed writer of a policy brief gives attentionto two major considerations before drafting the brief:

301-22 Science Center Building, University of Massachusetts Bos-

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Figure 1 e Excerpts from Executive Summary, Background and Significance, and Position Statement (DeMarcoet al., 2012).

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(1) the interests and expertise of the target audienceand (2) the timing of delivery for the brief. Consider-ationmust be given to the target audience for the briefso that the level of writing, explanations, and exam-ples will be geared to the needs of that group. Forexample, a policy brief focusing on infectious diseasetransmission that is directed to a nonscientific groupinterested in volunteerism will require more expla-nation of terms than would be the case with a scien-tific research group. Do research to determine howknowledgeable the group is about the topic. Thisresearch is highly significant because if readers arehighly knowledgeable, simplified concepts may beinterpreted as patronizing. The writer must considerhow much persuasion is needed in order to convincethe reader of the policy brief to take the endorsedapproach and/or action. The readermay bemore open

to the message and the message viewed as more ur-gent during times of crisis (e.g., gun control when anepisode of gun violence has made national news). Atother times, the writer may need to provide moreevidence and more carefully consider alternativeperspectives.

This approach is highlighted in the examples pre-sented in this article. In Figure 1, the authors discussHIV testing at a critical point wherein the Centers forDisease Control and Prevention had recently releasedinformation about transmission trends and relatedthose trends to individuals who did not know theirstatus and therefore might be transmitting infectiousdiseases unknowingly. Thus, there was a perceivedimmediate need to protect individuals from height-ened vulnerability and to decrease the prospectivehealth and personal costs related to chronic disease

Figure 1 e (continued).

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care through policy change. Finally, a balanced briefshows both sides of a complex issue. Including thebenefits and advantages or barriers and facilitators to asolution is very important as can be seen in Figure 1. Itunderscores the position but also embodies a sense offairness in putting forth that position.

Step 2: Four Sections to a Policy Brief

Generally, there are four sections to a policy brief: (1) anexecutive summary; (2) background and significance;(3) a position statement highlighting the actions thereader should take; and (4) a timely, reputable refer-ence list. One of the challenging issues of writing apolicy brief is that it should be brief. A policy briefshould be a “stand-alone” document focused on asingle topic that is no more than two to four pages inlength or 1,500 words (International Development

Research Center, 2013) (Figure 2). The example inFigure 1 (DeMarco et al., 2012) is a good example of howto achieve brevity.

Executive Summary

This section represents the distillation of the policybrief. It provides an overview for busy readers andshould be written last. The executive summary issimilar to an abstract. It should be a paragraph or twoand only take up half of a double-spaced page. Itshould stand alone and help the reader to understandthe background, significance, and position taken in ashort brief statement. The executive summary shouldanswer the following question: What is the policybrief really about? In Figure 1, in the case of universaltesting for HIV, the authors include statements thatsummarize the need for testing from the perspectiveof not knowing one’s testing status and howdangerous this is while explaining the difficulty in

Figure 1 e (continued).

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harnessing real data regarding the incidence andprevalence of infection and coinfections (DeMarcoet al., 2012).

Background and Significance

This section creates curiosity for the rest of the brief. Itexplains the importance and urgency of the issue andanswers “why?” In addition, it describes issues andcontext and should not be overly technical. The rule ofthumb is to progress from the general to the specific.

The purpose and/or focus of the policy brief mustimmediately be apparent to the reader. This is essen-tial to crafting an effective and persuasive brief.Therefore, limiting the supporting evidence to one ortwo paragraphs is critical as shown in Figure 1.

If available, it is also important to include referencesfrom lay publications with a wide sphere of influence(e.g., The New York Times, The Washington Post, and soon). The use of such references informs the reader thatthe topic is current and in the public purview. Usingcurrent references defines the challenge and facilitates

Figure 2 e Key elements of a policy brief.

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an understanding of the extent of the challenge. Cur-rent references also elucidate why this challenge isperhaps more important than other challenges. Usingstatistics from respected published sources that arecurrent, reputable, and peer reviewed is an effectiveway to accomplish this. Statistics are frequently usedin the examples in Figure 1. These data highlight thatmany people are affected or potentially affected bythese infections, and particular health care costs areeither mentioned or identified by naming states thathave instituted changes in these areas of interest. Inthe examples, the Centers for Disease Control andPrevention and the European Commission are quotedas foundational national and international authorities.After presenting the context and background in theopening paragraphs, the writer can then move on to“bring home the point” by highlighting the key con-cerns surrounding the issue in the next section of thedocument.

Highlight the key concerns via bulleted points(Figure 1). This is the place to illustrate the broadimpact of the issue to focus attention on multifaceted

aspects. The impact of an issue, whether it be positiveor negative, is rarely limited to one facet. The ramifi-cations are frequently multifaceted, with health, theeconomy, professional autonomy of providers, humanrights of care recipients, environmental consider-ations, and social implications being among them.Consider the case for promoting universal testing forHIV infection. Although universal testing for HIV willresult in increased numbers of persons being awarethey are infected, lead to decreased community levelsof HIV because of decreased transmission, and facili-tate earlier enrollment in HIV care and treatment(DeMarco et al., 2012; Figure 1), there are also otherimplications in addition to the impact on health out-comes. A more persuasive argument might alsoinclude information about increased labor productivityand quality of life. A well-written policy brief presentsa variety of consequences related to the issue at hand.Hence, clearly explicated key concerns are easilylinked to the writer’s recommendations for addressingthe issue (i.e., position statement). The position state-ment constitutes the third section of the policy brief.

Position Statement Directing Policy

This section expresses ideas that are balanced anddefensible but with strong assertions. One of the keyapproaches is to let the reader know what couldhappen if something does not change. In every case,this section needs to be supported by evidence and bereplete with referenced sources. The position state-ment sectionmust also be clear and concise and is bestwritten without inflammatory language (Chaffee,2007). The writer should use the active voice. Activelanguage can be quite persuasive, giving the impres-sion that this issue is important. Keeping the focus ofthe statement narrow also facilitates its effectivenessby avoiding a potential dilution of the issue (Foley,2007). Parsimony is a must; white space and bulletsare very useful techniques.

The position statement section of a policy briefhighlights the writer’s recommendations using clear,concise, appropriate, and directly actionable language.If writing a policy brief that is directed to a policymaker(e.g., a congressman, city council member, and so on),speak their language. Use policy-related languagewhen drafting recommendations for action. Forexample, “write new guidelines to oversee the practiceof advanced practice nurses” might be more effectivelywritten as “promulgate new rules to regulate thepractice of advanced practice nurses.” For recommen-dations that are directly actionable (Longest, 2010), onemight write, “Ensure that all FDA [Food and DrugAdministration]-approved prescription medicationsmust be available on all insurance company formularylists.” The term ensure leaves a lot to interpretation.How might the availability of medications be ensured?Will the availability be ensured by asserting pressureon employers who provide insurance coverage, byenlisting the assistance of consumers, or via

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authoritative agency oversight? A clearer and moredirective recommendationmight read, “Draft new CMS[Centers for Medicare & Medicaid Services] regulationsmandating that all FDA-approved prescription medi-cations be made available on all insurance companyformulary lists.”

Reference List

The formatting and style of references should also beconsidered. The use of superscripts saves room in thetext of a policy brief, and sequential numeric refer-encing in the reference list allows for an easy review ofthe references as the reader examines the contents ofthe brief. Figure 1 gives examples of the use of super-scripts with sequential referencing to maximize space.

In addition to a reference list that encompassescited sources, an effective position statement shouldbe accompanied by an extensive bibliography. This iswhere the writer of the statement is able to show his orher in-depth grasp of the background for, context of,and trends related to the issue. The bibliographyshould be comprised of entries from journals, news-papers, and books in addition to online sources.Including this section goes a long way in creatinggoodwill with staffers and agency personnel. A diverseand comprehensive bibliography is especially helpful ifthe recipient of the policy brief decides to investigatethe issue and potentially take action.

Design Choices

As has been discussed earlier, the use of bullets toemphasize key sections of the policy brief, such asspecific policy suggestions made in the position state-ment section, enables the reader to focus. However, thebullets must express a complete thought and not be soabbreviated that it is difficult to understand the pointbeing made (Figure 1). Using subtitles to break up textor bold, underlined, or shaded/color-highlighted fontenhancements is also helpful. Boxing in areas toemphasize examples or issues can create a focus in thedocument as will using graphs and figures if they areeasy to read and labeled accurately. All verbs need to bedynamic and allow the reader to feel propelled to dosomething or think in a different way (Figure 1).

Conclusion

A well-written policy brief is a very effective advocacytool. Nurses are credible and respected authorities

who enjoy the public’s trust and confidence. Har-nessing that expertise and using it to draft policybriefs is a fantastic strategy for impacting health carepolicy and health outcomes. Essentially, a well-craftedpolicy brief takes a position, backs up that positionwith solid evidence, is clear and succinct, and speaksto potential objections before they surface (Chaffee,2007). Hence, the policy brief is an excellent tool forexerting influence in the increasingly complex healthpolicy arena.

Acknowledgments

The authors gratefully acknowledge themembers of theAmerican Academy of Nursing Emerging & InfectiousDiseases Expert Panel for their guidance and assistance.

r e f e r e n c e s

Chaffee, M. W. (2007). Communication skills for political success.In D. M. Mason, J. K. Leavitt, & M. W. Chaffee (Eds.), Policy &politics in nursing and health care (pp. 121e134). St. Louis, MO:Saunders Elsevier.

Colby, D. C., Quinn, B. C., Williams, C. H., Bilhelmer, L. T., &Goodell, S. (2008). Research glut and information famine:Making research evidence more useful for policymakers.Health affairs, 27, 1177e1182.

DeMarco, R. F., Bradley Springer, L., Gallagher, D., Jones, S. G., &Visk, J. (2012). Recommendations and reality: Perceived patient,provider, and policy barriers to implementing routineHIV-screening and proposed solutions. Nursing Outlook, 60,72e80.

DERREG (Developing Europe’s Rural Regions in the Era ofGlobalization). (2011). European Commission, EuropeanResearch Area, Social Sciences and Humanities. Retrievedfrom http://www.derreg.eu/.

Foley, M. (2007). Lobbying policymakers: Individual and collectivestrategies. In D. M. Mason, J. K. Leavitt, & M. W. Chaffee (Eds.),Policy & politics in nursing and health care (pp. 747e759). St Louis,MO: Saunders Elsevier.

Howley, C., Johnson, J., & Petrie, J. (2011). Consolidation of schools anddistricts: What the research says and what it means. Boulder, CO:National Education Policy Center. Retrieved from http://nepc.colorado.edu/publication/consolidation-schools-districts.

International Development Research Center (IDRC). (2013).Toolkit for researchers: How to write a policy brief. Retrievedfrom http://www.idrc.ca/EN/Resources/Tools_and_Training/Documents/how-to-write-a-policy-brief.pdf.

Longest, B. B. (2010). Health policymaking in the United States (5th ed.)Chicago: Health Administration Press.

Nannini, A., & Houde, S. C. (2010). Translating evidence fromsystematic reviews for policy makers. Journal of GerontologicalNursing, 36, 22e26.

Pick, W. (2008). Lack of evidence hampers human-resourcespolicy making. Lancet, 371, 629e630.