Evidence based primary care? A multi-tier, multiple stakeholder perspective from Chile

Evidence-based practice in Chile

Over the past few decades, the emergence of evidence-based practice medicine (EBP) has allowed a change in the integration of knowledge with policy making and health service development, and Chile has been influenced by EBP with no exemption. In this paper, we will describe the impact of the EBP model at different levels of the Chilean health system, including the development of national clinical guidelines, medical training and in-patient involvement in health awareness.

Stakeholder analysis for health research: case studies from low- and middle-income countries

OBJECTIVES

Future Health Systems: Innovations for Equity (FHS) is working in six partner countries in Asia and Africa, focusing on strengthening the research-policy interface in relation to specific health system research projects. These projects present an opportunity to study the influence of stakeholders on research and policy processes.

STUDY DESIGN

Qualitative stakeholder analysis.

METHODS

Stakeholder analysis was conducted in each FHS country using a structured approach. A cross-country evaluation was performed concentrating on six key areas: chosen research topic; type of intervention considered; inclusion/exclusion of stakeholder groups; general stakeholder considerations; power level, power type and agreement level of stakeholders; and classification of and approaches to identified stakeholders.

RESULTS

All six countries identified a range of stakeholders but each country had a different focus. Four of the six countries identified stakeholders in addition to the guidelines, while some of the stakeholder categories were not identified by countries. The mean power level of identified stakeholders was between 3.4 and 4.5 (1=very low; 5=very high). The percentage of classified stakeholders that were either drivers or supporters ranged from 60% to 91%.

CONCLUSION

Three important common areas emerge when examining the execution of the FHS country stakeholder analyses: clarity on the purpose of the analyses; value of internal vs external analysts; and the role of primary vs secondary analyses. This paper adds to the global body of knowledge on the utilization of stakeholder analysis to strengthen the research-policy interface in the developing world.

Macro practice teaching and curriculum development from an evidence-based perspective

This article contributes to the discourse around evidence-based practice (EBP) as an organizing principle and guiding framework for macro-practice education as it has developed in the George Warren Brown School of Social Work at Washington University in St. Louis. In examining the first five years of implementing evidence-based education at the macro level, some lessons learned are provided. This learning has opened the door for continuing the dialogue on surmounting the challenges around training macro social workers in evidence-based practices. The overarching challenge in integrating EBP into the curriculum lies in the complexity of the multi-dimensional conceptualization of evidence.

The role of research in a technical assistance agency: the case of the 'German Agency for Technical Co-operation'

Technical assistance agencies have a sustainable impact on the health systems of the countries they are operating in. As well as policy-makers at the national level, technical assistance agencies see themselves confronted that their interventions should be based on evidence, usually meaning the results of research. This study has the aim to analyse role of research in the implementation of technical assistance. We sent a questionnaire to all health project managers of the 'German Agency for Technical Co-operation' and performed a qualitative case study in one of the health projects. Forty-seven of 80 (58.8%) of the questionnaires were completed and sent back. The managers considered publications of International Organisations (IOs), scientific articles and local research as most important for their work. The case study showed application problems in the daily work. Research use not only depends on the relevance of the data but also on analytical skills, linguistic barriers and technical access to research by the potential users. The role of knowledge and information management has to be clearly defined in an organisation of technical assistance. The specific needs at the different levels have to be analysed so that skills and resources can be allocated adequately.

Research that influences policy and practice - characteristics of operational research to improve malaria control in Mpumalanga Province, South Africa

BACKGROUND

Much communicable disease control research has had little impact on local control programme policy and practice for want of an operational component. The operational research model - the systematic search for knowledge on interventions, tools or strategies that enhance programme effectiveness - is gaining recognition as an appropriate method for addressing perplexing questions within public health programmes.

METHODS

A series of operational research studies were conducted to refine malaria diagnosis in Mpumalanga Province, South Africa between 1995 and 1999. The grounded theory approach was used with groups of experienced Masters of Public Health students in South Africa and Australia to analyse a compilation of these studies for determining positive and negative attributes of operational research that affect its ability to influence communicable disease control policy and practice.

RESULTS

The principal positive attributes of the operational research studies were high local relevance, greater ability to convince local decision-makers, relatively short lag-time before implementation of findings, and the cost-effective nature of this form of research. Potential negative features elicited included opportunities forfeited by using scarce resources to conduct research and the need to adequately train local health staff in research methodology to ensure valid results and accurate interpretation of findings.

CONCLUSIONS

Operational research effectively influenced disease control policy and practice in rural South Africa, by providing relevant answers to local questions and engaging policy-makers. This resulted in accelerated inclusion of appropriate measures into a local communicable disease control programme.