Determinants of evidence use in public health policy making: Results from a study across six EU countries

Evidence-based decision-making in a climate of political expediency: insights from local government

AIMS

Local authorities in England are responsible for public health and health promotion. This article sought to explore how research and decision-making co-exist in a local authority in England.

METHODS

An Embedded Researcher was based within the local authority and used qualitative methodology to address the research aim. Interviews and focus groups were employed to ascertain a range of stakeholder views in the local authority. All transcripts were coded on NVivo 12 by the Embedded Researcher and two members of the research team cross-checked a sample for coding accuracy. Data were analysed using framework analysis.

RESULTS

The data suggest several barriers to using research to inform decision-making in health promotion and public health. The study shows that research is valued in local authorities, but not always privileged - this is due to cultural factors and practical political reasons which often means that decisions need to be made expediently. Participants outlined a juxtaposition between academic credibility; timeliness to complete the research and the financial cost associated with it; against the independence and credibility that independent academics could bring.

CONCLUSION

Policy formulation and delivery is an integral aspect of health promotion and critical to achieving improved population health and reductions in health inequalities. However, there exists tensions between gathering research evidence and making research-informed decisions. The article concludes by advocating the use of Embedded Researchers to fully understand how research is gathered and used to support public health and health promotion policymaking.

Improving the Usefulness and Use of Meta-Analysis to Inform Policy and Practice

This chapter begins with an overview of recent developments that have encouraged and facilitated greater use of research syntheses, including Meta-Analysis, to guide public policy and practice in education, workforce development, and social services. It discusses the role of Meta-Analysis for improving knowledge of the effectiveness of programs, policies, and practices and the applicability and generalizability of that knowledge to conditions other than those represented by the study samples and settings. The chapter concludes with recommendations for improving the potential of Meta-Analysis to accelerate knowledge development through changing how we design, conduct, and report findings of individual studies to maximize their usefulness in Meta-Analysis as well as how we produce and report Meta-Analysis findings. The paper includes references to resources supporting the recommendations.

Prescribing antibiotics prudently-A survey of policy implementation drivers among physicians and veterinarians

Background

As the antimicrobial resistance (AMR) problem accelerates, humans and animals are suffering from the consequences of infections with diminishing antimicrobial treatment options. Within the One Medicine and One Health mandate, which denotes a collaborative, multisectoral, and transdisciplinary approach to improve medicine and health across human and animal sectors, we investigate how human and veterinary medical practitioners apply their medical and policy knowledge in prescribing antimicrobials. Different regions and locations establish different intermediary policies and programs to support clinicians in that pursuit. In Hong Kong, there are locally adapted programs at governance and clinical levels in the human medical field. However, there is no locally adapted veterinary antibiotic prescription guideline or stewardship program, and veterinarians adopt overseas or international professions' antimicrobial use guidelines. Such a policy environment creates a natural experiment to compare local policy implementation conditions and clinicians' knowledge, perception, and practice.

Method

We construct the investigative survey tool by adaptation of Knowledge, Attitude, and Practice (KAP) and Capacity, Opportunity, and Motivation-Behavior (COM-B) models. We identify, compare and contrast factors that influence clinicians' antimicrobial prescription behavior. The factors are considered both intrinsically, such as personal attributes, and extrinsically, such as societal and professional norms.

Findings

The absence of locally adopted antimicrobial guidelines influences AMR stewardship program implementation in local Hong Kong veterinary community. As medical allies, physicians and veterinarians share similar demographic influence, organization considerations and perception of public awareness. Both cohorts prescribe more prudently with more years-in-practice, time available to communicate with patients or caretakers, and public awareness and support.

What is context in knowledge translation? Results of a systematic scoping review

Knowledge Translation (KT) aims to convey novel ideas to relevant stakeholders, motivating their response or action to improve people's health. Initially, the KT literature focused on evidence-based medicine, applying findings from laboratory and clinical research to disease diagnosis and treatment. Since the early 2000s, the scope of KT has expanded to include decision-making with health policy implications.This systematic scoping review aims to assess the evolving knowledge-to-policy concepts, that is, macro-level KT theories, models and frameworks (KT TMFs). While significant attention has been devoted to transferring knowledge to healthcare settings (i.e. implementing health policies, programmes or measures at the meso-level), the definition of 'context' in the realm of health policymaking at the macro-level remains underexplored in the KT literature. This study aims to close the gap.A total of 32 macro-level KT TMFs were identified, with only a limited subset of them offering detailed insights into contextual factors that matter in health policymaking. Notably, the majority of these studies prompt policy changes in low- and middle-income countries and received support from international organisations, the European Union, development agencies or philanthropic entities.

Politics-evidence conflict in national health policy making in Africa: a scoping review

BACKGROUND

Generally, public health policy-making is hardly a linear process and is characterized by interactions among politicians, institutions, researchers, technocrats and practitioners from diverse fields, as well as brokers, interest groups, financiers and a gamut of other actors. Meanwhile, most public health policies and systems in Africa appear to be built loosely on technical and scientific evidence, but with high political systems and ideologies. While studies on national health policies in Africa are growing, there seems to be inadequate evidence mapping on common themes and concepts across existing literature.

PURPOSE

The study seeks to explore the extent and type of evidence that exist on the conflict between politics and scientific evidence in the national health policy-making processes in Africa.

METHODS

A thorough literature search was done in PubMed, Cochrane Library, ScienceDirect, Dimensions, Taylor and Francis, Chicago Journals, Emerald Insight, JSTOR and Google Scholar. In total, 43 peer-reviewed articles were eligible and used for this review.

RESULT

We found that the conflicts to evidence usage in policy-making include competing interests and lack of commitment; global policy goals, interest/influence, power imbalance and funding, morals; and evidence-based approaches, self-sufficiency, collaboration among actors, policy priorities and existing structures. Barriers to the health policy process include fragmentation among actors, poor advocacy, lack of clarity on the agenda, inadequate evidence, inadequate consultation and corruption. The impact of the politics-evidence conflict includes policy agenda abrogation, suboptimal policy development success and policy implementation inadequacies.

CONCLUSIONS

We report that political interests in most cases influence policy-makers and other stakeholders to prioritize financial gains over the use of research evidence to policy goals and targets. This situation has the tendency for inadequate health policies with poor implementation gaps. Addressing these issues requires incorporating relevant evidence into health policies, making strong leadership, effective governance and a commitment to public health.

Why prescribe antibiotics? A systematic review of knowledge, tension, and motivation among clinicians in low-, middle- and high-income countries

Medical professionals such as physicians and veterinarians are responsible for appropriate antimicrobial prescription (AMP) and use. Although seemingly straightforward, the factors influencing antibiotic prescription, a category of antimicrobials, are complex. Many studies have been conducted in the past two decades on this subject. As a result, there is a plethora of empirical evidence regarding the factors influencing clinicians' AMP practices.

AIM

A systematic review of AMR studies on AMP was conducted, condensing findings according to a combination of the Knowledge, Attitude, and Practice (KAP) and Capacity, Opportunity, Motivation-Behavior (COM-B) models. Review findings were then synthesized and analyzed for policy implementation according to the Consolidated Framework for Implementation Research (CFIR).

DESIGN AND METHODOLOGY

A systematic literature review was conducted according to PRISMA guidelines to identify peer-reviewed papers indexed in pre-determined medical science, social sciences, and humanities databases that apply the KAP model in their investigations. Antimicrobial prescription factors were compared and contrasted among low- and middle-income countries (LMICs) and high-income countries (HICs).

FINDINGS

The KAP model is a heuristic and structured framework for identifying and classifying respondents' knowledge. However, other than medical knowledge, factors that influence prescription decision-making can be expanded to include attitudes, perception, personal affinities, professional circumstances, relational pressure, and social norms.

Living evidence and adaptive policy: perfect partners?

BACKGROUND

While there has been widespread global acceptance of the importance of evidence-informed policy, many opportunities to inform health policy with research are missed, often because of a mismatch between when and where reliable evidence is needed, and when and where it is available. 'Living evidence' is an approach where systematic evidence syntheses (e.g. living reviews, living guidelines, living policy briefs, etc.) are continually updated to incorporate new relevant evidence as it becomes available. Living evidence approaches have the potential to overcome a major barrier to evidence-informed policy, making up-to-date systematic summaries of policy-relevant research available at any time that policy-makers need them. These approaches are likely to be particularly beneficial given increasing calls for policy that is responsive, and rapidly adaptive to changes in the policy context. We describe the opportunities presented by living evidence for evidence-informed policy-making and highlight areas for further exploration.

DISCUSSION

There are several elements of living approaches to evidence synthesis that might support increased and improved use of evidence to inform policy. Reviews are explicitly prioritised to be 'living' by partnerships between policy-makers and researchers based on relevance to decision-making, as well as uncertainty of existing evidence, and likelihood that new evidence will arise. The ongoing nature of the work means evidence synthesis teams can be dynamic and engage with policy-makers in a variety of ways over time; and synthesis topics, questions and methods can be adapted as policy interests or contextual factors shift. Policy-makers can sign-up to be notified when relevant new evidence is found, and can be confident that living syntheses are up-to-date and contain all research whenever they access them. The always up-to-date nature of living evidence syntheses means producers can rapidly demonstrate availability of relevant, reliable evidence when it is needed, addressing a frequently cited barrier to evidence-informed policymaking.

CONCLUSIONS

While there are challenges to be overcome, living evidence provides opportunities to enable policy-makers to access up-to-date evidence whenever they need it and also enable researchers to respond to the issues of the day with up-to-date research; and update policy-makers on changes in the evidence base as they arise. It also provides an opportunity to build flexible partnerships between researchers and policy-makers to ensure that evidence syntheses reflect the changing needs of policy-makers.

A Multiphase Mixed Methods Study on the Integration of a Population Health Approach in Sexual Health Programs and Services in Ontario Public Health Units

PURPOSE

This study investigated the extent of and factors influencing implementation of a population health approach within sexual health programming in public health.

METHOD

This sequential multi-phase mixed methods study combined findings from a quantitative survey assessing the extent that a population health approach was implemented in sexual health programs in Ontario public health units and qualitative interviews with sexual health managers and/or supervisors. Interviews explored factors influencing implementation and were analyzed using directed content analysis.

RESULTS

Staff from fifteen of 34 public health units completed surveys and ten interviews were completed with sexual health managers/supervisors. From the 8 Population Health Key Elements Template, 6 elements were moderately implemented and 2 had low implementation. Qualitative findings focused on enablers and barriers to implementing a population health approach in sexual health programs and services and explained most of the quantitative results. However, some of the quantitative findings were not explained by qualitative data (e.g., low implementation of using the principles of social justice).

CONCLUSION

Qualitative findings revealed factors influencing the implementation of a population health approach. A lack of resources available to health units, differing priorities between health units and community stakeholders, and access to evidence around population-level interventions influenced implementation.

Priority setting to support a public health research agenda: a modified Delphi study with public health stakeholders in Germany

BACKGROUND

Research priority setting (RPS) studies are necessary to close the significant gap between the scientific evidence produced and the evidence stakeholders need. Their findings can make resource allocation in research more efficient. However, no general framework for conducting an RPS study among public health stakeholders exists. RPS studies in public health are rare and no such study has been previously conducted and published in Germany. Therefore, we aimed to investigate which research topics in public health are prioritised by relevant stakeholders in Germany.

METHODS

Our RPS study consisted of a scoping stage and a Delphi stage each split into two rounds. Firstly, we invited members of the German Public Health Association to gather expert insights during two initial workshops. Next, we defined the relevant stakeholder groups and recruited respondents. Thereafter, we collected research topics and assessment criteria with the respondents in the first Delphi round and aggregated the responses through content analysis. Finally, we asked the respondents to rate the research topics with the assessment criteria in the second Delphi round.

RESULTS

In total, 94 out of the 140 invited public health organisations nominated 230 respondents for the Delphi study of whom almost 90% participated in both Delphi rounds. We compiled a comprehensive list of 76 research topics that were rated and ranked by several assessment criteria. We split the research topics into two types, substantive research topics and methodological-theoretical research topics respectively, to ensure the comparability among the research topics. In both types of research topics-substantive research topics and methodological-theoretical research topics-the respective top five ranked research topics hardly differed between public health researchers and public health practitioners. However, clear differences exist in the priority ranking of many (non-top priority) research topics between the stakeholder groups.

CONCLUSIONS

This research demonstrates that it is possible, with limited resources, to prioritise research topics for public health at the national level involving a wide range of pertinent stakeholders. The results can be used by research funding institutions to initiate calls for research projects with an increased relevance for health and/or scientific progress.

Evidence use in the UK's COVID-19 Free School Meals Policy: a thematic content analysis

Free School Meals (FSM) are a well-recognised intervention for tackling food insecurity among school children. National school closures during the COVID-19 pandemic meant that there was a need to rapidly adapt the delivery of FSM. A range of food-assistance policies were implemented, but it is not clear if they were evidence-based. This study aimed to determine the transparency of evidence use and identify other competing influences in the UK's FSM policy decisions. Thematic content analysis was used to review 50 publicly available policy documents and debate transcripts on FSM policy published between March 2020-2021. This period covered the first national school closures (March 2020-July 2020), school holidays and the second national school closures (January 2021- March 2021). The Evidence Transparency Framework was used to assess the transparency of evidence use in policy documents. We found that overall transparency of evidence use was poor but was better for the Holiday Activities and Food (HAF) programme. The Government showed preference for replacing FSM with food parcels, rather than more agentic modes of food assistance such as cash-vouchers. This preference appeared to be closely aligned with ideological views on the welfare state. With an absence of evidence, value-based reasoning took precedent and was polarised by social media. This paper highlights the need for a formal review into FSM, one which includes a comparison of low and high agentic food assistance policies. Such a review would address the evidence gap, improve food assistance policy, and aid policymakers in future periods of uncertainty.

Systematic review of health promotion policies or regulations with CCAT theory

One of the five Ottawa Charter's means of action is the concept of "healthy public policy," which is an approach to health promotion that is integrated with public policy. This concept can be used as an approach/method in solving health problems at the broader policy level and involving all sectors comprehensively, not just health promotion at the community level and the partial health sector, so that public health problems can be resolved properly. We conducted a systematic review of health promotion policies or regulations using CCAT theory. The purpose of this study is to find the state of the art of research related to stakeholder synergy in online game addiction prevention policies in adolescents. References and literature for this systematic review were collected from the Proquest, ScienceDirect, Pubmed, and Google Scholar databases. The search uses the boolean phrases "OR" and "AND." Keywords: policy or regulation, health promotion, and community coalition action theory. The results of the systematic review conducted by the researchers showed that of the twenty selected articles, three articles used the coalition/partnership dimension from the CCAT theory, four articles used the stakeholder dimension, two articles used the collaboration dimension, five articles discussed school health policies, policies related to gaming disorders. One article on the analysis of the juvenile contraceptive law, one article on the prevention of mental health disorders, one article on health promotion interventions, and two articles on risk factors and self-regulation focus on online gaming addiction in adolescents. This study concludes that in the future, further research is needed regarding health promotion policies to prevent online game addiction in adolescents to develop specific policy recommendations related to preventing online game addiction in adolescents.

Improving institutional platforms for evidence-informed decision-making: getting beyond technical solutions

Purely technical interventions aimed at enhancing evidence-informed decision-making (EIDM) have rarely translated into organizational institutionalization or systems change. A panel of four presentations at the Health Systems Global 2020 conference provides a basis for inference about contextual factors that influence the establishment and sustainability of institutional platforms to support EIDM. These cases include local structures such as citizen panels in Uganda, regional knowledge translation structures such as the West African Health Organization, global multilateral initiatives such as the "One Health" Quadrapartite and regional public health networks in South-East Asia. They point to the importance of political economy as well as technical capability determinants of evidence uptake and utilization at institutional, organizational and individual levels. The cases also lend support to evidence that third-party (broker and intermediary) supportive institutions can facilitate EIDM processes. The involvement of third-party supranational organizations, however, poses challenges in terms of legitimacy and accountability.

“You Can’t Look at an Orange and Draw a Banana”: Using Research Evidence to Develop Relevant Health Policy in Ghana

We explored inhibitors and enablers of using health policy and systems research to inform the policy process in Ghana. The findings suggest a myriad of factors influencing evidence-based policy development, including the strength of the relationships between policy makers and research producers.

We examined factors that either enabled or inhibited the process of evidence-based decision making regarding health policy in Ghana. We conducted qualitative interviews with 2 major groups of stakeholders: health policy and systems research producers (research producers [RPs]) and policy makers (PMs). In-depth interviews were conducted with 12 RPs, who were representatives from 11 health policy and systems research institutions; and 12 PMs working in various national health-related agencies, ministries, and departments. We analyzed the data using the thematic analysis approach. Interview results showed 5 recurring themes in their discussion of enablers and inhibitors of the evidence-to-policy process: (1) the quality, relevance, and quantity of available research evidence; (2) how findings are communicated to PMs; (3) the strength of relationships between RPs and PMs; (4) available structures that promote evidence-based policy making; and (5) the political context in which research and policy making occurs. These findings point to some specific areas for further collaboration and communication among Ghanaian stakeholders to ensure that appropriate health policies are developed from an evidence base.

Health policy analysis in Eastern Mediterranean region using a health policy triangle framework: Historical and ethical insights from a systematic review

Background

Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization.

Methods

To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program checklist was used.

Results

We selected 30 studies, conducted between 2011 and 2020. According to the findings of these studies, in the Eastern Mediterranean region, organization region, and the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited, and health research systems in Eastern Mediterranean region organization are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making.

Discussion

Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities.

Mapping Chilean clinical research: a protocol for a scoping review and multiple evidence gap maps

INTRODUCTION

Clinical research broadly aims to influence decision-making in order to promote appropriate healthcare. Funding agencies should prioritise research projects according to needed research topics, methodological and cost-effectiveness considerations, and expected social value. In Chile, there is no local diagnosis regarding recent clinical research that might inform prioritisation for future research funding. This research aims to comprehensively identify and classify Chilean health research studies, elaborating evidence gap maps for the most burdensome local conditions.

METHODS AND ANALYSIS

We will search in electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, LILACS and WoS) and perform hand searches to retrieve, identify and classify health research studies conducted in Chile or by authors whose affiliations are based in Chile, from 2000 onwards. We will elaborate evidence matrices for the 20 conditions with the highest burden in Chile (according to the Global Burden of Disease 2019) selected from those defined under the General Regime of the Health Guarantees Act. To elaborate the evidence gap maps, we will consider prioritised interventions and core outcome sets. To identify knowledge gaps and estimate redundant research, we will contrast these gap maps with the available international evidence of high or moderate certainty of evidence, for each specific clinical question. For this purpose, we will search systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

ETHICS AND DISSEMINATION

No ethical approval is required to conduct this project. We will submit our results in both peer-reviewed journals and scientific conferences. We will aim to disseminate our findings through different academic platforms, social media, local press, among others. The final results will be communicated to local funding agencies and government stakeholders.

DISCUSSION

We aim to provide an accurate and up-to-date picture of the research gaps-to be filled by new future findings-and the identification of redundant research, which will constitute relevant information for local decision-makers.

Research can be integrated into public health policy-making: global lessons for and from Spanish economic evaluations

WHO promotes the use of research in policy-making to drive improvements in health, including in achieving Sustainable Development Goals such as tobacco control. The European Union’s new €95 billion Horizon Europe research framework programme parallels these aims, and also includes commitments to fund economic evaluations. However, researchers often express frustration at the perceived lack of attention to scientific evidence during policy-making. For example, some researchers claim that evidence regarding the return on investment from optimal implementation of evidence-based policies is frequently overlooked. An increasingly large body of literature acknowledges inevitable barriers to research use, but also analyses facilitators encouraging such use. This opinion piece describes how some research is integrated into policy-making. It highlights two recent reviews. One examines impact assessments of 36 multi-project research programmes and identifies three characteristics of projects more likely to influence policy-making. These include a focus on healthcare system needs, engagement of stakeholders, and research conducted for organizations supported by structures to receive and use evidence. The second review suggests that such characteristics are likely to occur as part of a comprehensive national health research system strategy, especially one integrated into the healthcare system. We also describe two policy-informing economic evaluations conducted in Spain. These examined the most cost-effective package of evidence-based tobacco control interventions and the cost-effectiveness of different strategies to increase screening coverage for cervical cancer. Both projects focused on issues of healthcare concern and involved considerable stakeholder engagement. The Spanish examples reinforce some lessons from the global literature and, therefore, could help demonstrate to authorities in Spain the value of developing comprehensive health research systems, possibly following the interfaces and receptor model. The aim of this would be to integrate needs assessment and stakeholder engagement with structures spanning the research and health systems. In such structures, economic evaluation evidence could be collated, analysed by experts in relation to healthcare needs, and fed into both policy-making as appropriate, and future research calls. The increasingly large local and global evidence base on research utilization could inform detailed implementation of this approach once accepted as politically desirable. Given the COVID-19 pandemic, increasing the cost-effectiveness of healthcare systems and return on investment of public health interventions becomes even more important.

PROTOCOL: Systematic review of methods to reduce risk of bias in knowledge translation interventional studies in health-related issues

BACKGROUND

Review studies have reported on the low quality of study methodologies and poor reporting of knowledge translation (KT) interventional studies. This flaw cause the result of such studies to become misleading.

OBJECTIVES

The present review is designed to evaluate the effect of methodological factors on the results of interventional studies that aimed to evaluate KT strategies at the policy level.

SEARCH METHODS

Bibliographic databases and grey literature databases will be searched. The retrieved studies will be recorded in Covidence. After screening titles and abstracts, the full texts of selected studies will be assessed against the inclusion criteria. Disagreements will be resolved through discussion or by consultation with a third author.

SELECTION CRITERIA

Primary studies are studies that aimed to estimate the efficacy of KT strategies to improve evidence-informed policymaking. Study participants include policymakers and the intervention is a KT strategy. The main outcome is the desired changes in policy-makers towards evidence-informed decision-making.

DATA COLLECTION AND ANALYSIS

The main effect sizes will be expressed as standard mean difference and its variance for the main efficacy outcome of KT strategies in primary studies. Forest plot meta-analysis will be used to synthesize the effect of each group of KT strategies. The contribution of ROB to the efficacy of KT interventions will be assessed via Meta-epidemiology analysis. The overall estimate will be calculated using inverse-variance random-effects meta-analysis with a 95% confidence interval for the estimate.

Implementing living evidence to inform health decisions: A strategy for building capacity in health sector (Protocol)

Every day important healthcare decisions are made with incomplete or outdated information about the effects of the healthcare interventions available, what delivers the best value for the health system and where more research is needed. It is necessary to invest in strategies that allow access to reliable and updated evidence on which to base health decisions. The objective is to develop and evaluate a strategy for building the capacity among different actors of a country's health system to implement the model known as "Living Evidence" [LE] in the evidence synthesis and dissemination of knowledge transfer [KT] products to inform health decisions. The study will involve professional members of health system organizations in charge of developing KT products to inform health decisions. The project will be developed in three complementary phases: 1) LE-implementation framework development through review of the literature, brainstorming meetings, user testing, and expert consultation; 2) training in LE tools and strategies; 3) developing LE synthesis for KT products by applying the framework to real-life diverse situations. To achieve the capacity-building strategy assessment goal, several surveys and interviews will take place during the process to assess: 1) the LE-implementation framework for the incorporation of LE synthesis in the development of KT products; 2) the training workshops; 3) the whole capacity-building strategy used for health system organizations be able of implementing the LE as part of the KT products they regularly produce. The expected results are an effective capacity-building strategy for health system organizations to implement the living evidence model in different KT products; a LE-implementation framework to be applicable to any country or region to incorporate LE in the KT products; LE synthesis for KT products directly applicable to the real-setting situations; integration of Epistemonikos-L.OVE platform for keeping the LE process in the development and updating of KT products.

Influences on the uptake of a population health approach to sexual health programs in Ontario public health units: a qualitative descriptive study

Aim

Population-level prevention initiatives are the cornerstone of public health practice. However, despite this normative practice, sexual health programming within public health has not utilized this approach to the same extent as other public health programs. Understanding requirements to put a population-level approach into practice is needed. The objective of this study was to explore the barriers and facilitators experienced by sexual health programs and services within public health when implementing a population health approach.

Subject design and methods

The principles of qualitative description guided all sampling, data collection and analysis decisions. Data collection involved in-depth semi-structured interviews with 12 sexual health managers and/or supervisors from ten Ontario public health units. Directed content analysis was used to code and synthesize the data. Data collection and analysis was guided using constructs from the Consolidated Framework for Implementation Research.

Results

Factors that served as either barriers and facilitators to implementing a population health approach, were mainly in the inner and outer setting domains of the Consolidated Framework for Implementation Research. Participants identified the presence of community partnerships, adequate staff training on population health, and access to data on population health served as facilitators. In comparison, barriers to implementation included a lack of resources (human, financial) and clinicians' value of and preferences for delivering services at the individual clinic level.

Conclusion

Some clear barriers and facilitators influenced if staff in sexual health programs and services could implement a population health approach. Results indicate where public health resources need to be enhanced to move toward a population health approach and provide insight into what worked and should be considered by public health organizations.

Knowledge translation and evidence generation to increase the impact of vector control in Burkina Faso, Cameroon and Malawi

Lack of context-specific evidence and inadequate evidence-use for decision-making contribute to poor health. This paper reports on our work aimed at addressing the knowledge translation (KT) gap between evidence generators and users. We present our experiences of strengthening KT via technical advisory groups (TAGs) in parallel with increasing evidence generation through research fellowships and operational research. Vectorborne diseases (VBDs) impose substantial health and economic burdens in sub-Saharan Africa despite being preventable with vector control. The Partnership for Increasing the Impact of Vector Control aimed to reduce the burden of VBDs in Burkina Faso, Cameroon, Malawi and at regional and global levels. TAGs can promote evidence-use in policy and practice by engaging relevant stakeholders in both research and policy processes. TAGs and related activities are best facilitated by a coordinator with skills in research and policy. Contextual factors should influence the design and governance of TAGs, which will likely evolve over time. Relevant national stakeholders should be included in TAGs and be actively involved in developing research agendas to increase the relevance and acceptability of research findings for decision-making. The countries present three differing contexts with longer-term research and evaluation necessary to draw lessons on impact.

A comprehensive monitoring and evaluation framework for evidence to policy networks

OBJECTIVE

To describe the development of a framework for monitoring and evaluating knowledge translation (KT) networks.

METHOD

The framework was developed using mixed methods over four phases, including i) a targeted literature review of KT networks, activities and indicators, ii) two scoping reviews to further enhance the set of indicators, iii) peer-reviews by international KT experts and an online expert consultation, and iv) piloting.

RESULTS

A comprehensive theory of change (ToC) and indicators, both for the Network Secretariat and its participating member countries, were identified to develop the monitoring and evaluation framework. The framework includes (i) a ToC, including three key indicator domains across the results chain (outputs, short term outcomes, intermediate outcomes), and (ii) indicators for the three key domains, that can be selected depending on the stage of network maturity, along with suggested data collection methods. The three key indicator domains are 1) KT capacity and skill building; 2) network (structure, governance and leadership); and 3) KT/evidence-informed policy value and culture.

CONCLUSION

The monitoring and evaluation framework that links KT activities with policy and health outcomes fills an important gap in optimizing KT procedures, generating lessons learned and increasing accountability of major multipartner KT networks.

Public Compliance Matters in Evidence-Based Public Health Policy: Evidence from Evaluating Social Distancing in the First Wave of COVID-19

When the unprecedented COVID-19 pandemic first spread, governments could implement a wide range of measures to tackle the outbreaks. Conventional wisdom holds that public health policy should be made on the basis of empirical demonstrations, while little research has probed on how to safeguard the expected policy utility in the case of evidence shortage on novel contagious diseases. In particular, the fight against COVID-19 cannot succeed without public compliance as well as the support of people who have not tested positive. Based on the data from the first wave of COVID-19, by using a random effect estimator, fixed effect method, and hierarchical technique, we specified the efficiency of particular social distancing policies by contextualizing multiple factors. We found that adopting gathering restrictions decreased new case growth but were conditional on its interaction with population density, while mitigation effects constantly corresponded to policy magnitude in a given time; for which the effective patterns varied from three days to sixty days. Overall, policies encouraging social distancing exerted a positive effect on mitigating the first wave of COVID-19. Both the enforcing duration and public compliance constrained the expected impact of nonpharmaceutical intervention according to degrees of policy level. These findings suggest that, when evidence is incomplete, the effectiveness of public health crisis management depends on the combination of policy appropriateness and, accordingly, public compliance.

Modeling the Development of Local Health-Enhancing Physical Activity Policies from Empirical Data and Policy Science Theories

Physical inactivity is considered a pandemic, requiring strong policy responses to address this major health issue. However, research on the development of Health-Enhancing Physical Activity policies (HEPA) remains scarce, particularly at the local level. There is a need to produce evidence to better understand the process to develop local HEPA policies. This study aims to model the development of HEPA policy promotion in French municipalities from empirical data and policy science theories. This research was undertaken in three steps: (1) assess the level of development of HEPA policies from 10 French municipalities using a local HEPA analysis tool, (2) provide a brief overview of core political science theories applied in health promotion, and (3) from these empirical and theoretical perspectives, model a conceptual framework to better understand the development of HEPA policy promotion in French municipalities. Based on empirical data and the Multiple Streams, policy cycles and Institutional Rational Choice theories, a conceptual framework of the development of municipal HEPA policy promotion was modeled. This conceptual framework is comprised of five stages describing the development of municipal HEPA policies. This paper contributes to a better understanding of the development of municipal HEPA policies.

Policy options for strengthening evidence-informed health policy-making in Iran: overall SASHA project findings

Background

The institutionalization of evidence-informed health policy-making (EIHP) is complex and complicated. It is complex because it has many players and is complicated because its institutionalization will require many changes that will be challenging to make. Like many other issues, strengthening EIHP needs a road map, which should consider challenges and address them through effective, harmonized and contextualized strategies. This study aims to develop a road map for enhancing EIHP in Iran based on steps of planning.

Methods

This study consisted of three phases: (1) identifying barriers to EIHP, (2) recognizing interventions and (3) measuring the use of evidence in Iran's health policy-making. A set of activities was established for conducting these, including foresight, systematic review and policy dialogue, to identify the current and potential barriers for the first phase. For the second phase, an evidence synthesis was performed through a scoping review, by searching the websites of benchmark institutions which had good examples of EIHP practices in order to extract and identify interventions, and through eight policy dialogues and two broad opinion polls to contextualize the list of interventions. Simultaneously, two qualitative-quantitative studies were conducted to design and use a tool for assessing EIHP in the third phase.

Results

We identified 97 barriers to EIHP and categorized them into three groups, including 35 barriers on the “generation of evidence” (push side), 41 on the “use of evidence” (pull side) and 21 on the “interaction between these two” (exchange side). The list of 41 interventions identified through evidence synthesis and eight policy dialogues was reduced to 32 interventions after two expert opinion polling rounds. These interventions were classified into four main strategies for strengthening (1) the education and training system (6 interventions), (2) the incentives programmes (7 interventions), (3) the structure of policy support organizations (4 interventions) and (4) the enabling processes to support EIHP (15 interventions).

Conclusion

The policy options developed in the study provide a comprehensive framework to chart a path for strengthening the country’s EIHP considering both global practices and the context of Iran. It is recommended that operational plans be prepared for road map interventions, and the necessary resources provided for their implementation. The implementation of the road map will require attention to the principles of good governance, with a focus on transparency and accountability.

A retrospective cohort study of outcomes in hospitalised COVID-19 patients during the first pandemic wave in Ireland

Aim

Describe the epidemiology, resource use and adverse outcomes of COVID-19 patients hospitalised during wave 1 of the COVID-19 pandemic in Ireland. Use this data to identify specific cohorts at high risk of adverse outcomes and to inform acute hospital requirements for future COVID-19 waves in Ireland.

Methods

The Health Service Executive’s (HSE) Hospital Inpatient Enquiry (HIPE) system produced a daily database of COVID-19 discharge episodes from the onset of the COVID-19 pandemic in Ireland. This study analysed data on episodes of COVID-19 hospitalisation recorded between February 29 and July 31, 2020. A deterministic record linkage process transformed records from episode to patient level. Logistic regression modelling identified factors associated with long length of stay (LLOS), intensive care unit (ICU) admission and inhospital mortality.

Results

Median length of stay was 9 days; 12.8% of patients had ICU admission and 16.6% died in hospital. Male patients were more likely to have ICU admission and die in hospital. Likelihood of LLOS and inhospital mortality increased with age. Obesity, hypertension and diabetes were associated with ICU admission while chronic kidney disease and chronic obstructive pulmonary disease were associated with inhospital mortality. Nursing home residents were less likely to be admitted to ICU and more likely to die in hospital compared to patients admitted from home.

Conclusion

This study provides patient-level epidemiological characterisation of hospitalisations during the first COVID-19 pandemic wave in Ireland. The higher risk of adverse outcomes in older age groups supports the age-based prioritisation of COVID-19 vaccinations currently used in Ireland.

Policymakers' Research Capacities, Engagement, and Use of Research in Public Health Policymaking

The use of research in public health policymaking is one of the prerequisites for successfully implemented health policies which have better population health as an outcome. This policy process is influenced by the actors involved under the policy umbrella, with inter-related contextual factors and specific structural and institutional circumstances. Our study investigates how policymakers’ research capacities influence the use of research in the health policy process and identify areas where capacity-building interventions give the most meaning and impact. Furthermore, we investigate policymakers’ research engagement and use this to inform public health policy in the public sector in Denmark. We collect and report data using Seeking, Engaging with, and Evaluation Research (SEER) methodology. Policymakers are reported to have research capacity, but it is questionable how those competences have actually been used in policymaking. Decision-makers were often not aware or did not know about the existing organizational tools and systems for research engagement and use and two third of respondents had not been part of any research activities or had any collaboration with researchers. Overall, research use in public health policymaking and evaluation was limited. As a conclusion, we propose that capacity-building interventions for increasing research use and collaboration in EIPM should be context-oriented, measurable, and sustainable in developing individual and organizational competences.

Developing a tool to monitor knowledge translation in the health system: results from an international Delphi study

BACKGROUND

It is generally accepted that evidence-informed decision making contributes to better health system performance and health outcomes, yet we are lacking benchmarks to monitor the impact of national health information systems (HIS) in policy and practice. Hence in this study, we have aimed to identify criteria for monitoring Knowledge Translation (KT) capacity within countries.

METHODS

We conducted a web-based Delphi with over 120 public health professionals from 45 countries to reach agreement on criteria to monitor KT at the level of national HIS. Public health professionals participated in three survey rounds, in which they ranked 85 preselected criteria and could suggest additional criteria.

RESULTS

Experts working in national (public) health agencies and statistical offices, as well as in health policy and care agreed on 29 criteria which constitute the Health Information (HI)-Impact Index. The criteria cover four essential domains of evaluation: the production of high-quality evidence, broad access and dissemination, stakeholder engagement and knowledge integration across sectors and in civil society. The HI-Impact Index was pretested by officials working in ministries of health and public health agencies in eight countries; they found the tool acceptable and user-friendly.

CONCLUSIONS

The HI-Impact Index provides benchmarks to monitor KT so that countries can assess whether high-quality evidence can be easily accessed and used by the relevant stakeholders in health policy and practice, by civil society and across sectors. Next steps include further refining the procedure for conducting the assessment in routine, and sharing experiences from HIS evaluations using the HI-Impact Index.

Application of Big Data to Support Evidence-Based Public Health Policy Decision-Making for Hearing

Ideally, public health policies are formulated from scientific data; however, policy-specific data are often unavailable. Big data can generate ecologically-valid, high-quality scientific evidence, and therefore has the potential to change how public health policies are formulated. Here, we discuss the use of big data for developing evidence-based hearing health policies, using data collected and analyzed with a research prototype of a data repository known as EVOTION (EVidence-based management of hearing impairments: public health pOlicy-making based on fusing big data analytics and simulaTION), to illustrate our points. Data in the repository consist of audiometric clinical data, prospective real-world data collected from hearing aids and an app, and responses to questionnaires collected for research purposes. To date, we have used the platform and a synthetic dataset to model the estimated risk of noise-induced hearing loss and have shown novel evidence of ways in which external factors influence hearing aid usage patterns. We contend that this research prototype data repository illustrates the value of using big data for policy-making by providing high-quality evidence that could be used to formulate and evaluate the impact of hearing health care policies.

Tailored communication methods as key to implementation of evidence-based solutions in primary child health care

Background

Evidence-based policies should underpin successful implementation of innovations within child health care. The EU-funded Models of Child Health Appraised project enabled research into effective methods to communicate research evidence. The objective of this study was to identify and categorize methods to communicate evidence-based research recommendations and means to tailor this to stakeholder audiences.

Methods

We conducted an online survey among national stakeholders in child health. Analysis of the most effective strategies to communicate research evidence and reach the target audience was carried out in order to ensure implementation of optimal child health care models at a national level.

Results

Representatives of stakeholders from 21 of the then 30 EU MS and EEA countries responded to the questionnaire. Three main approaches in defining the strategies for effective communication of research recommendations were observed, namely: dissemination of information, involvement of stakeholders and active attitude towards change expressed in actions. The target audience for communicating recommendations was divided into two layers: proximal, which includes those who are remaining in close contact with the child, and distal, which contains those who are institutionally responsible for high quality of child health services. They should be recipients of evidence-based results communicated by different formats, such as scientific, administrative, popular and personal.

Conclusions

Influential stakeholders impact the process of effective research dissemination and guide necessary actions to strengthen the process of effective communication of recommendations. Communication of evidence-based results should be targeted to each audience’s profile, both professional and non-professionals, by adjusting appropriate communication formats.

Policy options to increase motivation for improving evidence-informed health policy-making in Iran

BACKGROUND

Current incentive programmes are not sufficient to motivate researchers and policy-makers to use research evidence in policy-making. We conducted a mixed-methods design to identify context-based policy options for strengthening motivations among health researchers and policy-makers to support evidence-informed health policy-making (EIHP) in Iran.

METHODS

This study was conducted in 2019 in two phases. In the first phase, we conducted a scoping review to extract interventions implemented or proposed to strengthen motivations to support EIHP. Additionally, we employed a comparative case study design for reviewing the performance evaluation (PE) processes in Iran and other selected countries to determine the current individual and organizational incentives to encourage EIHP. In the second phase, we developed two policy briefs and then convened two policy dialogues, with 12 and 8 key informants, respectively, where the briefs were discussed. Data were analysed using manifest content analysis in order to propose contextualized policy options.

RESULTS

The policy options identified to motivate health researchers and policy-makers to support EIHP in Iran were: revising the criteria of academic PE; designing appropriate incentive programmes for nonacademic researchers; developing an indicator for the evaluation of research impact on policy-making or health outcomes; revising the current policies of scientific journals; revising existing funding mechanisms; presenting the knowledge translation plan when submitting a research proposal, as a mandatory condition; encouraging and supporting mechanisms for increasing interactions between policy-makers and researchers; and revising some administrative processes (e.g. managers and staff PEs; selection, appointment, and changing managers and reward mechanisms).

CONCLUSIONS

The current individual or organizational incentives are mainly focused on publications, rather than encouraging researchers and policy-makers to support EIHP. Relying more on incentives that consider the other impacts of research (e.g. impacts on health system and policy, or health outcomes) is recommended. These incentives may encourage individuals and organizations to be more involved in conducting research evidence, resulting in promoting EIHP.

TRIAL REGISTRATION

NA.

The Action Scales Model: A conceptual tool to identify key points for action within complex adaptive systems

BACKGROUND

Systems thinking is integral to working effectively within complex systems, such as those which drive the current population levels of overweight and obesity. It is increasingly recognised that a systems approach - which corrals public, private, voluntary and community sector organisations to make their actions and efforts coherent - is necessary to address the complex drivers of obesity. Identifying, implementing and evaluating actions within complex adaptive systems is challenging, and may differ from previous approaches used in public health.

METHODS

Within this conceptual article, we present the Action Scales Model (ASM). The ASM is a simple tool to help policymakers, practitioners and evaluators to conceptualise, identify and appraise actions within complex adaptive systems. We developed this model using our collective expertise and experience in working with local government authority stakeholders on the Public Health England Whole Systems Obesity programme. It aligns with, and expands upon, previous models such as the Intervention Level Framework, the Iceberg Model and Donella Meadows' 12 places to intervene within a system.

RESULTS

The ASM describes four levels (synonymous with leverage points) to intervene within a system, with deeper levels providing greater potential for changing how the system functions. Levels include events, structures, goals and beliefs. We also present how the ASM can be used to support practice and policy, and finish by highlighting its utility as an evaluative aid.

DISCUSSION

This practical tool was designed to support those working at the front line of systems change efforts, and while we use the population prevalence of obesity as an outcome of a complex adaptive system, the ASM and the associated principles can be applied to other issues. We hope that the ASM encourages people to think differently about the systems that they work within and to identify new and potentially more impactful opportunities to leverage change.

Systematic review and policy dialogue to determine challenges in evidence-informed health policy-making: findings of the SASHA study

Background

Various interventions have been undertaken in Iran to promote evidence-informed health policy-making (EIHP). Identifying the challenges in EIHP is the first step toward strengthening EIHP in each country through the design of tailored interventions. Therefore, the current study was conducted to synthesize the results of earlier studies and to finalize the list of barriers to EIHP in Iran.

Methods

To identify the barriers to EIHP in Iran, two steps were taken: a systematic review and policy dialogue. To conduct the systematic review, three Iranian databases and PubMed, Health Systems Evidence (HSE), Embase, and Scopus were searched. The reference lists of included papers and documentation from some local organizations were hand-searched. Upon conducting the systematic review, given the significance of stakeholders in clarifying the problem of EIHP, policy dialogue was used to complete the list previously extracted and to do advocacy. Selection criteria for the stakeholders included influential and informed individuals from knowledge-producing, knowledge-utilizing, and knowledge-brokering organizations. Semi-structured interviews were held with three important absent stakeholders.

Results

Challenges specific to Iran that were identified included the lack of integration of the health ministry and the medical universities, lack of ties between health knowledge utilization organizations, failure to establish long-term research plans, neglect of national research needs at the time of recruiting human resources in knowledge-producing organizations, and duplication and lack of coordination in routine data obtained from surveillance systems, disease registration systems, and censuses. It seems that some challenges are common across countries, including neglecting the importance of inter- and intra-disciplinary studies, the capacity of policy-makers and managers to utilize evidence, the criteria for evaluating the performance of policy-makers, managers, and academic members, the absence of long-term programmes in knowledge-utilizing organizations, the rapid replacement of policy-makers and managers, and lack of use of evaluation studies.

Conclusions

In this study, we tried to identify the challenges regarding EIHP in Iran using a systematic review and policy dialogue approach. This is the first step toward determining the best interventions to improve evidence-informed policy-making in each country, because these challenges are contextual and need to be investigated contextually.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00717-x.

A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners

BACKGROUND

Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens.

METHODS

We conducted a secondary analysis of the interventions included in the Cochrane Review on "Interventions for Preventing Obesity in Children", published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity.

RESULTS

The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years).

CONCLUSIONS

This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity.

Use of a quantitative data report in a hypothetical decision scenario for health policymaking: a computer-assisted laboratory study

BACKGROUND

Quantitative data reports are widely produced to inform health policy decisions. Policymakers are expected to critically assess provided information in order to incorporate the best available evidence into the decision-making process. Many other factors are known to influence this process, but little is known about how quantitative data reports are actually read. We explored the reading behavior of (future) health policy decision-makers, using innovative methods.

METHODS

We conducted a computer-assisted laboratory study, involving starting and advanced students in medicine and health sciences, and professionals as participants. They read a quantitative data report to inform a decision on the use of resources for long-term care in dementia in a hypothetical decision scenario. Data were collected through eye-tracking, questionnaires, and a brief interview. Eye-tracking data were used to generate 'heatmaps' and five measures of reading behavior. The questionnaires provided participants' perceptions of understandability and helpfulness as well as individual characteristics. Interviews documented reasons for attention to specific report sections. The quantitative analysis was largely descriptive, complemented by Pearson correlations. Interviews were analyzed by qualitative content analysis.

RESULTS

In total, 46 individuals participated [students (85%), professionals (15%)]. Eye-tracking observations showed that the participants spent equal time and attention for most parts of the presented report, but were less focused when reading the methods section. The qualitative content analysis identified 29 reasons for attention to a report section related to four topics. Eye-tracking measures were largely unrelated to participants' perceptions of understandability and helpfulness of the report.

CONCLUSIONS

Eye-tracking data added information on reading behaviors that were not captured by questionnaires or interviews with health decision-makers.

Challenges for developing health-care knowledge in the digital age

Purpose

Health-care knowledge is dispersed among different departments in a health care organization, which makes it difficult at times to provide quality care services to patients. Therefore, this study aims to identify the main challenges in adopting health information technology (HIT).

Design/methodology/approach

This study surveyed 148 stakeholders in 4 key categories [patients, health-care providers, United Arab Emirates (UAE) citizens and foresight experts] to identify the challenges they face in adopting health care technologies. Responses were analyzed using exploratory (EFA) and confirmatory factor analysis (CFA).

Findings

EFA revealed four key latent factors predicting resistance to HIT adoption, namely, organizational strategy (ORGS); technical barriers; readiness for big data and the internet of things (IoT); and orientation (ORI). ORGS accounted for the greatest amount of variance. CFA indicated that readiness for big data and the IoT was only moderately correlated with HIT adoption, but the other three factors were strongly correlated. Specific items relating to cost, the effectiveness and usability of the technology and the organization were strongly correlated with HIT adoption. These results indicate that, in addition to financial considerations, effective HIT adoption requires ensuring that technologies will be easy to implement to ensure their long-term use.

Research limitations/implications

The results indicate that readiness for big data and the IoT-related infrastructure poses a challenge to HIT adoption in the UAE context. Respondents believed that the infrastructure of big data can be helpful in more efficiently storing and sharing health-care information. On the technological side, respondents felt that they may experience a steep learning curve. Regarding ORI, stakeholders expected many more such initiatives from health-care providers to make it more knowledge-specific and proactive.

Practical implications

This study has implications for knowledge management in the health -care sector for information technologies. The HIT can help firms in creating a knowledge eco-system, which is not possible in a dispersed knowledge environment. The utilization of the knowledge base that emerged from the practices and data can help the health care sector to set new standards of information flow and other clinical services such as monitoring the self-health condition. The HIT can further influence the actions of the pharmaceutical and medical device industry.

Originality/value

This paper highlights the challenges in HIT adoption and the most prominent factors. The conceptual model was empirically tested after the collection of primary data from the UAE using stakeholder theory.

How can we monitor the impact of national health information systems? Results from a scoping review

Background

National health information (HI) systems provide data on population health, the determinants of health and health system performance within countries. The evaluation of these systems has traditionally focused on statistical practices and procedures, and not on data use or reuse for policy and practice. This limits the capacity to assess the impact of HI systems on healthcare provision, management and policy-making. On the other hand, the field of Knowledge Translation (KT) has developed frameworks to guide evidence into practice.

Methods

A scoping review of the KT literature to identify the essential mechanisms and determinants of KT that could help monitor the impact of HI systems.

Results

We examined 79 publications and we identified over 100 different KT frameworks but none of these were focused on HI systems per se. There were specific recommendations on disseminating evidence to stakeholders at the institutional and organizational level, and on sustaining the use of evidence in practice and the broader community setting.

Conclusions

We developed a new model, the HI-Impact framework, in which four domains are essential for mapping the impact of national HI systems: (i) HI Evidence Quality, (ii) HI System Responsiveness, (iii) Stakeholder Engagement and (iv) Knowledge Integration. A comprehensive impact assessment of HI systems requires addressing the use of HI in public health decision-making, health service delivery and in other sectors which might have not been considered previously. Monitoring Stakeholder Engagement and Knowledge Integration certifies that the use of HI in all policies is an explicit point of assessment.

Evaluation of the performance and achievements of the WHO Evidence-informed Policy Network (EVIPNet) Europe

Background

The Evidence-informed Policy Network (EVIPNet) is one of the key mechanisms introduced by WHO to reduce the research-to-policy gap. EVIPNet Europe was launched in 2012. We evaluated the performance and achievements of EVIPNet Europe with the overall aims (1) to inform future developments and strategic planning of EVIPNet Europe and (2) to contribute to the evidence base for organisational knowledge translation activities by sharing the lessons learnt.

Methods

The evaluation covered the WHO Secretariat of EVIPNet Europe and its 21 member countries, from its inception to mid-2018. A mixed methods design was used to assess changes in three domains, including triangulation of quantitative and qualitative methods, based on the EVIPNet Europe Monitoring & Evaluation framework and theory of change. Data were collected between August and October 2018. Data collection comprised documentary review, social media analysis, online country evaluation, key informant interviews and validated tools. Two case studies were also developed.

Results

The evaluation showed promising results as well as lessons to guide the future development of EVIPNet in the WHO European Region and other regions of the world. EVIPNet Europe appears to be filling a niche in promoting the capacity of Network member countries for evidence-informed policy-making. There is evidence that EVIPNet Europe’s capacity-building programme of work is improving knowledge and skills at the individual level. There has been an increase in activity and outputs since its establishment and evidence has been used to inform new policies in some member countries. However, the speed at which member countries are developing or publishing products varies greatly and no formalised knowledge translation platforms have yet been created. Financial and human resources are limited and staff turnover is a cause for concern, both at the WHO Secretariat and country team levels.

Conclusions

Six years since the launch of EVIPNet Europe, the Network has grown quickly, is clearly valued and has had some successes. However, more work and support are needed if it is to achieve its vision of a Europe in which high-quality, context-sensitive evidence routinely informs health decision-making processes that ultimately serve to strengthen health outcomes across the Region.

Powerful numbers: Exemplary quantitative studies of science that had policy impact

Much scientometric research aims to be relevant to policy, but such research only rarely has a notable policy impact. In this paper, we examine four exemplary cases of policy impact from quantitative studies of science. The cases are analyzed in light of lessons learned about the use of evidence in policy making in health services, which provides very thorough explorations of the problems inherent in policy use of academic research. The analysis highlights key dimensions of the examples, which offer lessons for those aspiring to influence policy with quantitative studies of science.

Are current clinical guidelines on the use of Peripheral Intravenous Cannula for blood draws supported by evidence? An organizational case study

Aim

To examine the quality of evidence used to inform health policies. Policies on peripheral intravenous cannulas were used as exemplars.

Design

An organizational case study design was used, using the STROBE reporting guidelines.

Methods

Policy guidelines were sourced between June and September 2018 from health departments in Australia. Seven documents were compared regarding intravenous cannula dwell times and blood collection use. Evidence used in the documents was critiqued using assessment guideline from the Oxford Centre for Evidence Based Medicine.

Results

Large variations exist between policies regarding blood sampling and dwell time. Evidence used a variety of sources. Few references received an A evidence rating and policies differed in their interpretation of evidence.

Stakeholders' experiences of the public health research process: time to change the system?

BACKGROUND

The importance of engaging stakeholders in the research process is well recognised. Whilst engagement is important, guidelines and practices vary for how stakeholders should be involved in research and how to facilitate effective collaborative relationships.

METHODS

This study aimed to explore the perspectives and experiences of stakeholders involved in the policy and practice area of outdoor space and non-communicable disease prevention. Stakeholders interviewed included academics, practitioners, policy-makers, knowledge brokers and a funder.

RESULTS

The findings suggest that stakeholders had positive experiences when engaged meaningfully in the research process, where research projects were carefully planned and managed with attention to context and culture, and where the research team was effective, respectful and communicative. These factors help to facilitate the translation of research into policy and practice. However, multiple challenges of collaborative research were identified which related to structural and systemic challenges, building and maintaining relationships, use and collection of data and information, cultural perceptions of research and research generation, and getting evidence into action. Participants felt that changing the funding system, exploring more collaborative research methodologies, improved research translation, and more effective collaborative relationships at all stages of the research process could address some of these challenges.

CONCLUSIONS

The findings highlight that, whilst stakeholder engagement in research was considered important, structural, cultural and individual practices impacted how this worked in practice. Identifying and testing solutions to address these challenges could improve synergies between research, policy, and practice and lead to the production of impactful research that reduces wastage of public funding, improves implementation of findings and ultimately improves public health outcomes.

Organizational Supports for Research Evidence Use in State Public Health Agencies: A Latent Class Analysis

OBJECTIVE

Use of research evidence in public health decision making can be affected by organizational supports. Study objectives are to identify patterns of organizational supports and explore associations with research evidence use for job tasks among public health practitioners.

DESIGN

In this longitudinal study, we used latent class analysis to identify organizational support patterns, followed by mixed logistic regression analysis to quantify associations with research evidence use.

SETTING

The setting included 12 state public health department chronic disease prevention units and their external partnering organizations involved in chronic disease prevention.

PARTICIPANTS

Chronic disease prevention staff from 12 US state public health departments and partnering organizations completed self-report surveys at 2 time points, in 2014 and 2016 (N = 872).

MAIN OUTCOME MEASURES

Latent class analysis was employed to identify subgroups of survey participants with distinct patterns of perceived organizational supports. Two classify-analyze approaches (maximum probability assignment and multiple pseudo-class draws) were used in 2017 to investigate the association between latent class membership and research evidence use.

RESULTS

The optimal model identified 4 latent classes, labeled as "unsupportive workplace," "low agency leadership support," "high agency leadership support," and "supportive workplace." With maximum probability assignment, participants in "high agency leadership support" (odds ratio = 2.08; 95% CI, 1.35-3.23) and "supportive workplace" (odds ratio = 1.74; 95% CI, 1.10-2.74) were more likely to use research evidence in job tasks than "unsupportive workplace." The multiple pseudo-class draws produced comparable results with odds ratio = 2.09 (95% CI, 1.31-3.30) for "high agency leadership support" and odds ratio = 1.74 (95% CI, 1.07-2.82) for "supportive workplace."

CONCLUSIONS

Findings suggest that leadership support may be a crucial element of organizational supports to encourage research evidence use. Organizational supports such as supervisory expectations, access to evidence, and participatory decision making may need leadership support as well to improve research evidence use in public health job tasks.

Impact of capacity building interventions on individual and organizational competency for HPSR in endemic disease control in Nigeria: a qualitative study

BACKGROUND

The need to build capacity for health policy and systems research (HPSR) in low- and middle-income countries has been underscored as this encompasses the processes of decision-making at all levels of the health system. This implementation research project was undertaken in Southeast Nigeria to evaluate whether the capacity-building intervention improves the capacity to produce and use research evidence for decision making in endemic disease control.

METHODS

Three training workshops were organized for purposively selected participants comprising "producers of evidence" such as health research scientists in three universities and "users of evidence" such as policy makers, program managers, and implementers in the public health sector. Participants also held step-down workshops in their organizations. The last workshop was used to facilitate the formation of knowledge networks comprising of both producers and users, which is a critical step for getting research into policy and practice (GRIPP). Three months after the workshops, a subset, 40, of workshop participants was selected for in-depth interviews. Information was collected on (i) perceptions of usefulness of capacity-building workshops, (ii) progress with proposed research and research uptake activities, (iii) effects of these activities on evidence-informed decision making, and (iv) constraints and enablers to implementation of proposed activities.

RESULTS

Most participants felt the workshops provided them with new competencies and skills in one or more of research priority setting, evidence generation, communication, and use for the control of endemic diseases. Participants were at different stages of planning and implementing their proposed research and research uptake activities, and were engaging across professional and disciplinary boundaries to ensure relevance and usefulness of outputs for decision making. Key enablers of successful implementation of activities were positive team dynamics, good balance of competencies, effective communication and engagement within teams, team leader's capacity to innovate, and personal interests such as career progress. Lack of funding, limited decision space, organizational bureaucracies, and poor infrastructure were the key constraints to the implementation of proposed activities. Lack of mentorship and continuous support from trainers delayed progress with implementing proposed activities.

CONCLUSIONS

The capacity-building interventions contributed to the development of a critical mass of research scientists, policy makers, and practitioners who have varying levels of competencies in HPSR for endemic disease control and would require further support in carrying out their medium and long-term goals.

Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States: a qualitative case study

BACKGROUND

Public health agencies are responsible for implementing effective, evidence-based public health programs and policies to reduce the burden of chronic diseases. Evidence-based public health can be facilitated by modifiable administrative evidence-based practices (A-EBPs) (e.g., workforce development, organizational climate), yet little is known about how practitioners view A-EBPs. Thus, the purpose of this qualitative study was to understand state health department practitioners' perceptions about how A-EBPs are implemented and what facilitators and barriers exist to using A-EBPs.

METHODS

Chronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors were recruited to participate in telephone interviews using a snowball sampling technique. Interviews were transcribed verbatim, and transcripts were analyzed using a common codebook and the a priori method in NVivo.

RESULTS

Twenty seven interviews were conducted with practitioners in four states (5-8 interviews per state). All practitioners felt that their work unit culture is positive and that leadership encouraged and expected staff to use evidence-based processes. Participants discussed the provision of trainings and technical assistance as key to workforce development and how leaders communicate their expectations. Access to evidence, partnerships, and funding restrictions were the most commonly discussed barriers to the use of A-EBPs and EBDM.

CONCLUSIONS

Results of this study highlight practitioners' perspectives on promoting evidence-based public health in their departments. Findings can inform the development and refinement of resources to improve A-EBP use and organizational and leadership capacity of state health departments.

Is patient-centred care for women a priority for policy-makers? Content analysis of government policies

BACKGROUND

Considerable research shows that women experience gendered disparities in healthcare access and quality. Patient-centred care (PCC) could reduce inequities by addressing the patient's clinical and personal needs. Healthcare policies can influence service delivery to optimise patient outcomes. This study assessed whether and how government policies recognise and promote PCC for women (PCCW).

METHODS

We analysed the content of English-language policies published in Canada from 2010 to 2018 on depression and cardiac rehabilitation - conditions featuring known gendered inequities - that were identified on government websites. We extracted data and used summary statistics to enumerate mentions of PCC and women's health.

RESULTS

We included 30 policies (20 depression, 10 cardiac rehabilitation). Of those, 20 (66.7%) included any content related to PCC (median 1.0, range 0.0 to 5.0), most often exchanging information (14, 46.7%) and making decisions (13, 43.3%). Less frequent domains were enabling self-management (8, 26.7%), addressing emotions (6, 20.0%) and fostering the relationship (4, 13.3%). No policies included content for the domain of managing uncertainty. A higher proportion of cardiac rehabilitation guidelines included PCC content. Among the 30 policies, 7 (23.3%) included content related to at least one women's health domain (median 0.0, range 0.0 to 3.0). Most frequently included were social determinants of health (4, 13.3%). Fewer policies mentioned any issues to consider for women (2, 28.6%), issues specific to subgroups of women (2, 28.6%) or distinguished care for women from men (2, 28.6%). No policies included mention of abuse or violence, or discrimination or stigma. The policies largely pertained to depression. Despite mention of PCC or women's health, policies offered brief, vague guidance on how to achieve PCCW; for example, "Patients value being involved in decision-making" and "Women want care that is collaborative, woman- and family-centered, and culturally sensitive."

CONCLUSIONS

Despite considerable evidence of need and international recommendations, most policies failed to recognise gendered disparities or promote PCC as a mitigating strategy. These identified gaps represent opportunities by which government policies could be developed or strengthened to support PCCW. Future research should investigate complementary strategies such as equipping policy-makers with the evidence and tools required to develop PCCW-informed policies.

[#CienciaenelParlamento: the need for a parliamentary office of science and technology advice]

One of the aims of the citizen's initiative #CienciaenelParlamento is helping to establishing a parliamentary office of scientific and technological advice in the Spanish parliament. Said office would be in charge of fostering networking spaces between scientific knowledge and public policies and of triggering public debate between policy-makers, experts and the general public. In this article, we first review the main parliamentary mechanisms of scientific advice, with special attention to one in particular: parliamentary offices of scientific and technological advice. These offices exist in 22 parliaments worldwide, but there are none in Spain. Second, we describe the activity undertaken by #CienciaenelParlamento in its collaboration with the Congress of Deputies during the 12th Spanish Legislature. This collaboration reached its peak with a two-day networking event in November 2018 with over 200 scientists and almost 100 deputies, who all debated twelve topics of social interest and the most up-to-date scientific knowledge. Thanks to this collaboration, the Congress has taken the first steps towards officially establishing a parliamentary science advice office. Lastly, we enumerate some examples about how these parliamentary offices in other countries have contributed with other stakeholders to better public debate and processing of public policies in public health and other areas. To conclude, we at #CienciaenelParlamento believe that a parliamentary science advice office would help to enhance the science-policy ecosystem in Spain.

Organisational factors that facilitate research use in public health policy-making: a scoping review

Background

Although important syntheses and theoretical works exist in relation to understanding the organisational factors that facilitate research use, these contributions differ in their scope and object of study as well as their theoretical underpinnings. Therefore, from an exploratory angle, it may be useful to map out the current literature on organisational factors of research use in public health policy-making when revisiting existing theories and frameworks to gain further theoretical insights.

Methods

Herein, a scoping review technique and thematic content analysis were used to bring together findings from both synthesised and empirical studies of different types to map out the organisational factors that facilitate research use in public health policy-making.

Results

A total of 14 reviews and 40 empirical studies were included in the analysis. These were thematically coded and the intra-organisational factors reported as enabling research use were examined. Five main categories of organisational factors that advance research use in policy organisations – (1) individual factors, (2) the management of research integration, (3) organisational systems and infrastructures of research use, (4) institutional structures and rules for policy-making, and (5) organisational characteristics – were derived as well as 18 subcategories and a total of 64 specific factors, where 27 factors were well supported by research.

Conclusions

Using a scoping review methodology, the intra-organisational factors influencing research use in policy-making (including individual factors) were systematically mapped and the theories applied in this area of research were assessed. The review findings confirm the importance of an intra-organisational perspective when exploring research use, showing that many organisational factors are critical facilitators of research use but also that many factors and mechanisms are understudied. The synthesis shows a lack of studies on politicians and the need for more theoretically founded research. Despite increased efforts to update the existing evidential and theoretical basis of research use, we still need frameworks that combine different approaches and theories to help us grasp the complex organisational mechanisms that facilitate research use in policy settings.

Tradução do Conhecimento e os desafios contemporâneos na área da saúde: uma revisão de escopo

RESUMO A implementação das melhores evidências científicas nos serviços de saúde ainda não ocorre de forma satisfatória. Diante dessa problemática, o objetivo deste estudo foi investigar os desafios da Tradução do Conhecimento (TC) na área da saúde na atualidade. A metodologia desta revisão foi desenvolvida de acordo com os propósitos da revisão de escopo. Para tanto, as palavras-chave ‘translational medical research’ e ‘knowledge translation’ foram consultadas nos bancos de dados de periódicos da PubMed, Scopus e Web of Science. Foram incluídos os estudos publicados a partir do ano de 2008 até abril de 2018. Entre os 1.677 estudos encontrados, 839 artigos eram duplicados, e 818 não atendiam plenamente ao objetivo desta revisão; assim, 20 estudos foram submetidos à apreciação desse escopo. De acordo com as análises dos estudos, o desafio da TC advém de dois fatores: por um lado, a falta de coesão entre a comunidade científica e os tomadores de decisão em saúde; por outro, a inabilidade dos profissionais em traduzir e aplicar novos conhecimentos, além da omissão de apoio e de incentivos das instituições de saúde. Outrossim, esta revisão aborda um corpo significativo de diversos outros aspectos que limitam e/ou dificultam a TC área da saúde.

Using narratives to impact health policy-making: a systematic review

BACKGROUND

There is increased interest in using narratives or storytelling to influence health policies. We aimed to systematically review the evidence on the use of narratives to impact the health policy-making process.

METHODS

Eligible study designs included randomised studies, non-randomised studies, process evaluation studies, economic studies, qualitative studies, stakeholder analyses, policy analyses, and case studies. The MEDLINE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), WHO Global Health Library, Communication and Mass Media Complete, and Google Scholar databases were searched. We followed standard systematic review methodology for study selection, data abstraction and risk of bias assessment. We synthesised the findings narratively and presented the results stratified according to the following stages of the policy cycle: (1) agenda-setting, (2) policy formulation, (3) policy adoption, (4) policy implementation and (5) policy evaluation. Additionally, we presented the knowledge gaps relevant to using narrative to impact health policy-making.

RESULTS

Eighteen studies met the eligibility criteria, and included case studies (n = 15), participatory action research (n = 1), documentary analysis (n = 1) and biographical method (n = 1). The majority were of very low methodological quality. In addition, none of the studies formally evaluated the effectiveness of the narrative-based interventions. Findings suggest that narratives may have a positive influence when used as inspiration and empowerment tools to stimulate policy inquiries, as educational and awareness tools to initiate policy discussions and gain public support, and as advocacy and lobbying tools to formulate, adopt or implement policy. There is also evidence of undesirable effects of using narratives. In one case study, narrative use led to widespread insurance reimbursement of a therapy for breast cancer that was later proven to be ineffective. Another case study described how the use of narrative inappropriately exaggerated the perceived risk of a procedure, which led to limiting its use and preventing a large number of patients from its benefits. A third case study described how optimistic 'cure' or 'hope' stories of children with cancer were selectively used to raise money for cancer research that ignored the negative realities. The majority of included studies did not provide information on the definition or content of narratives, the theoretical framework underlying the narrative intervention or the possible predictors of the success of narrative interventions.

CONCLUSION

The existing evidence base precludes any robust inferences about the impact of narrative interventions on health policy-making. We discuss the implications of the findings for research and policy.

TRIAL REGISTRATION

The review protocol is registered in PROSPERO International prospective register of systematic reviews (ID =  CRD42018085011 ).