Evidence based policy: proceed with care

Assistive technology needs, access and coverage, and related barriers and facilitators in the WHO European region: a scoping review

PURPOSE

Globally, assistive technology (AT) is used by over 1 billion people, but the prevalence of needs and access to AT in specific countries or regions is largely unknown. This scoping review summarises the evidence available on the prevalence of needs, access and coverage of AT in the World Health Organisation European Region and the barriers and facilitators to its use.

METHODS

Relevant publications were identified using a combination of two strategies: 1) a systematic search for AT publications in five scientific literature databases; and 2) consultations with 76 of the Region's AT experts.

RESULT

The search strategies yielded 103 publications, 62 of them identified by the systematic search. The included publications were predominantly from six countries, and 18 countries were unrepresented. Information on AT use for specific functional impairments was present in 57 publications: AT for hearing impairment in 14 publications; vision in 12; mobility, 12; communication, 11; self-care, 6; and cognition, 2. AT needs for vision and hearing impairment were more likely to be met (1-87% and 5-90%, respectively) compared with communication and cognition impairments (10-60% and 58%, respectively). The barriers and facilitators to AT access described were linked to accessibility, affordability and acceptability.

CONCLUSION

Data on AT prevalence and coverage are limited in both quantity and quality. Agreed-upon definitions of functional impairment and assistive product categories and standards for data collection are needed to facilitate data comparisons and to build a more representative picture of AT needs and coverage.Implications for rehabilitationComprehensive and disaggregated data concerning the prevalence of needs and coverage of AT is needed to enable the development of responsive policies and actions.The literature available on the prevalence of needs and coverage of AT in the WHO European Region is primarily focussed on a small subset of countries and comparisons between studies are limited due to the use of different data collection strategies.Evidence concerning barriers and facilitators to AT access across countries is more consistent and can be organised across the key themes of accessibility, affordability and acceptability of AT.There is a need for consensus among multiple AT actors on standardised definitions for functional impairment and assistive product categories and standards for data collection to enable a more representative picture to be built of AT needs and coverage across the WHO European Region and globally.

Stakeholders, Relationships, and Coordination: 2015 Baseline Study of Needed Enablers for Bridging Agriculture-Nutrition Gaps in Nigeria

BACKGROUND

Renewed efforts by the Nigerian government to address malnutrition have led to nutrition actions by several sectors, including the agriculture sector. However, the success of these actions depends on the characteristics of the stakeholders involved, including their relationships and coordination.

OBJECTIVE

This article reports a 2015 study of nutrition-sensitive agricultural stakeholders in Nigeria that assessed what the stakeholders do, where they work and how they are organized to improve nutrition. The study provides a baseline for assessing progress and measuring stakeholder and coordination changes in the Nigerian nutrition-sensitive agriculture landscape.

METHODS

Semi-structured interviews (n = 17) and focus group discussions (n = 2) were held with federal, state, and local government level stakeholders; reviews of stakeholder program documents were also conducted.

RESULTS

The study identified 7 groups of nutrition-sensitive agriculture stakeholders and several coordination challenges. Political leadership, advocacy and provision of material and human resource support by nongovernmental organizations, and donor interest and funding have been vital for mobilizing nutrition-sensitive agriculture. Still, although stakeholders frequently highlighted that nutrition was an important consideration in their interventions, nutrition goals and activities and/or indicators to measure outcomes were not regularly communicated. Also, while coordination mechanisms existed, there appeared to be minimal actual cross-sectoral partnerships because of inadequate trust, competition, and conflicts over institutional turf and mandates.

CONCLUSIONS

Needed enablers for improving nutrition-sensitive agriculture in Nigeria included improved stakeholder nutrition literacy, as well as enhanced stakeholder engagement facilitated by role definition, clarification, and consensus. Exploring different approaches to coordination may also be necessary.

Optimizing the roles of health workers to improve access to health services in Africa: an implementation framework for task shifting and sharing for policy and practice

BACKGROUND

Globally, countries are taking actions to ensure that their population have improved access to people-centred and integrated health services. Attaining this requires improved access to health workers at all levels of health service delivery and equitably distributed by geographical location. Due to the persistent health worker shortages, countries have resorted to implementing task shifting and task sharing in various settings to optimally utilize existing health workers to improve access to health services. There are deliberations on the need for an implementation framework to guide the adoption and operationalization of task shifting and task sharing as a key strategy for optimally utilizing the existing health workforce towards the achievement of UHC. The objective of this study was to develop an implementation framework for task shifting and task sharing for policy and practice in Africa.

METHODS

A sequential multimethod research design supported by scoping reviews, and qualitative descriptive study was employed in this study. The evidence generated was synthesized into an implementation framework that was evaluated for applicability in Africa by 36 subject matter experts.

RESULTS

The implementation framework for task shifting and task sharing has three core components - context, implementation strategies and intended change. The implementation strategies comprise of iterative actions in the development, translation, and sustainment phases that to achieve an intended change. The implementation strategies in the framework include mapping and engagement of stakeholders, generating evidence, development, implementation and review of a road map (or action plan) and national and/or sub-national policies and strategies, education of health workers using manuals, job aids, curriculum and clinical guidelines, and monitoring, evaluation, reviews and learning.

CONCLUSION

The implementation framework for task shifting and task sharing in Africa serves as a guide on actions needed to achieve national, regional and global goals based on contextual evidence. The framework illustrates the rationale and the role of a combination of factors (enablers and barriers) in influencing the implementation of task shifting and task sharing in Africa.

Contextual influences on the role of evidence in e-cigarette recommendations: a multi-method analysis of international and national jurisdictions

Background

E-cigarette policy has varied across jurisdictions, contrasting with the previous coordinated approach of international tobacco control communities.

Aims and objectives

A multi-method case study approach was used to understand the role of evidence and external and internal contextual factors in the development of public health recommendations across four purposively selected jurisdictions (WHO, UK, Australia and USA).

Methods

Informed by Dobrow et al.'s (2004) conceptual framework for context-based evidencebased decision-making, four data sources were drawn upon: 1) 15 public health bodies' e-cigarette recommendation documents, 2) seven development documents produced by the public health bodies, 3) sources of evidence cited in the public health bodies' recommendation documents and 4) 15 qualitative interviews with experts. Thematic analysis and citation analysis were conducted to aid triangulation of evidence.

Findings

We found a complex interplay between internal and external factors which influence the role and use of evidence in the development of e-cigarette recommendations. For example, recommendation documents' remit (internal factor) was influenced by various external factors such as epidemiology and policy history, with decisions made over time having reshaped the external context. Considering the findings with respect to evidence utilisation, we propose a modified version of Dobrow et al.'s (2004) framework, highlighting the important interplay between internal and external contextual factors.

Discussion and conclusion

This research suggest internal and external contextual factors mutually interact and influence how evidence is incorporated into recommendations. This dynamic interplay of contextual factors may help explain the why different policy approaches are pursued concerning public health topics, particularly e-cigarettes.

Quantifying the robustness of causal inferences: Sensitivity analysis for pragmatic social science

Social scientists seeking to inform policy or public action must carefully consider how to identify effects and express inferences because actions based on invalid inferences may not yield the intended results. Recognizing the complexities and uncertainties of social science, we seek to inform inevitable debates about causal inferences by quantifying the conditions necessary to change an inference. Specifically, we review existing sensitivity analyses within the omitted variables and potential outcomes frameworks. We then present the Impact Threshold for a Confounding Variable (ITCV) based on omitted variables in the linear model and the Robustness of Inference to Replacement (RIR) based on the potential outcomes framework. We extend each approach to include benchmarks and to fully account for sampling variability represented by standard errors as well as bias. We exhort social scientists wishing to inform policy and practice to quantify the robustness of their inferences after utilizing the best available data and methods to draw an initial causal inference.

How relevant is climate change research for climate change policy? An empirical analysis based on Overton data

Climate change is an ongoing topic in nearly all areas of society since many years. A discussion of climate change without referring to scientific results is not imaginable. This is especially the case for policies since action on the macro scale is required to avoid costly consequences for society. In this study, we deal with the question of how research on climate change and policy are connected. In 2019, the new Overton database of policy documents was released including links to research papers that are cited by policy documents. The use of results and recommendations from research on climate change might be reflected in citations of scientific papers in policy documents. Although we suspect a lot of uncertainty related to the coverage of policy documents in Overton, there seems to be an impact of international climate policy cycles on policy document publication. We observe local peaks in climate policy documents around major decisions in international climate diplomacy. Our results point out that IGOs and think tanks–with a focus on climate change–have published more climate change policy documents than expected. We found that climate change papers that are cited in climate change policy documents received significantly more citations on average than climate change papers that are not cited in these documents. Both areas of society (science and policy) focus on similar climate change research fields: biology, earth sciences, engineering, and disease sciences. Based on these and other empirical results in this study, we propose a simple model of policy impact considering a chain of different document types: The chain starts with scientific assessment reports (systematic reviews) that lead via science communication documents (policy briefs, policy reports or plain language summaries) and government reports to legislative documents.

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.

A Novel Method to Assess the Impact of a Government’s Water Strategy on Research: A Case Study of Azraq Basin, Jordan

Water scarcity drives governments in arid and semi-arid regions to promote strategies for improving water use efficiency. Water-related research generally also plays an important role in the same countries and for the same reason. However, it remains unclear how to link the implementation of new government strategies and water-related research. This article’s principal objective is to present a novel approach that defines water-related research gaps from the point of view of a government strategy. The proposed methodology is based on an extensive literature review, followed by a systematic evaluation of the topics covered both in grey and peer-reviewed literature. Finally, we assess if and how the different literature sources contribute to the goals of the water strategy. The methodology was tested by investigating the impact of the water strategy of Jordan’s government (2008–2022) on the research conducted in the Azraq Basin, considering 99 grey and peer-reviewed documents. The results showed an increase in the number of water-related research documents from 37 published between 1985 and 2007 to 62 published between 2008 and 2018. This increase should not, however, be seen as a positive impact of increased research activity from the development of Jordan’s water strategy. In fact, the increase in water-related research activity matches the increasing trend in research production in Jordan generally. Moreover, the results showed that only about 80% of the documents align with the goals identified in the water strategy. In addition, the distribution of the documents among the different goals of the strategy is heterogeneous; hence, research gaps can be identified, i.e., goals of the water-strategy that are not addressed by any of the documents sourced. To foster innovative and demand-based research in the future, a matrix was developed that linked basin-specific research focus areas (RFAs) with the MWI strategy topics. In doing so, the goals that are not covered by a particular RFA are highlighted. This analysis can inspire researchers to develop and apply new topics in the Azraq Basin to address the research gaps and strengthen the connection between the RFAs and the strategy topics and goals. Moreover, the application of the proposed methodology can motivate future research to become demand-driven, innovative, and contribute to solving societal challenges.

Primary Care Research - Influencing and Implementing Into Policy

This editorial describes how research in primary health care can be used to influence policy. It draws on previous literature to give an example from the UK of how research in one part of primary care, the health-visiting service, has endeavoured to use evidence to influence policy and practice. The editorial considers frameworks for policy implementation such as Bardach's eight phase approach and concepts that can inform policy implementation such as Lipsky's Street-Level Bureaucrat approach.

Analysis for policy to overcome barriers to reducing the prevalence of vitamin a deficiency among children (15-23 months) in Iran

BACKGROUND

About 30% of children < 5 years old are estimated to experience vitamin A deficiency worldwide. Globally, vitamin A deficiency can be reduced by five major interventions: supplementation, dietary modification, fortification, promotion of both public health, and breastfeeding. This prospective policy analysis (Prospective policy analysis focuses on the future outcomes of a proposed policy. Adapted from Patton, CV, and Sawicki DS. Basic Methods of Policy Analysis and Planning, Prentice-Hall, Inc. New Jersey,1993). (Patton A, Carl V, and David S. Basic methods of policy analysis and planning, prentice-hall, 3th ed. 2012) aimed to identify evidence-based policy options to minimize prevalence (VAD) among 15-23 months-children in Iran.

METHODS

Thirty-eight semi-structured face-to-face interviews were held with experts at high, middle, and low managerial levels in Iran's health system, as well as at Schools of Nutrition Sciences and dietetics, using purposive and snowball sampling. All interviews were recorded by a digital voice recorder and then transcribed, codified, and eventually analyzed using a mixed approach (inductive-deductive) by MAXQDA software version 10.

RESULTS

Most policies related to VAD reduction in this age group are supplementation, expansion of education, and awareness. Three main factors affecting VAD reduction policies emerged from the analysis: basic factors (governance, infrastructure, and organization), underlying factors (social factors, economy), and immediate factors (services). Due to its cross-sectoral nature, evaluating the results of the implementation of this policy requires strong and coherent inter-sectoral cooperation. The existing primary healthcare network (PHC) is a crucial means for successful implementation of policies to address VAD in Iran.

CONCLUSIONS

In addition to supplementation and assistance in this age group, other policies should be also planned to reduce VAD in various regions. In addition to the Ministry of Health & Medical Education (MoHME), other actors need to be involved, we advocate, throughout the entire policymaking process of policy-making to reduce VAD in Iran.

Evidence-Based Decision Making 6: Administrative Databases as Secondary Data Source for Epidemiologic and Health Service Research

Health-care systems require reliable information on which to base health-care planning and make decisions, as well as to evaluate their policy impact. Administrative data, predominantly captured for non-research purposes, provide important information about health services use, expenditures, and clinical outcomes and may be used to assess quality of care. With increased digitalization and accessibility of administrative databases, this data is more readily available for health service research purposes, aiding evidence-based decision making. This chapter discusses the utility of administrative data for population-based studies of health and health care.

Uterine transplant: an ethical framework analysis from a Middle Eastern perspective

BACKGROUND

Significant advances in infertility treatment have been achieved over the past several decades, but women with uterine dysfunction, anomaly, or agenesis still need support to carry a pregnancy to term. Recently, advancements in surgical, anesthetic and immunosuppressive therapy have brought the idea of successful uterine transplant closer to reality, but many challenges must be overcome before uterine transplant can become more common, including ethical challenges related to the study and the conduct of this procedure.

METHODS

This was an updated ethical analysis of uterine transplant from a Middle Eastern perspective, using an established ethical framework that has been adapted for the analysis of research in non-Western cultures and developing countries.

RESULTS

Using the ethical framework, this analysis explored research developments in uterine transplant to date, using the following categories: collaborative partnership, social value, scientific validity, a fair selection of study population, favorable risk-benefit ratio, independent review, informed consent, and respect for recruited participants. The analysis revealed a significant need for region- and religion-specific ethical guidelines for uterine transplant procedures.

CONCLUSIONS

The horizons of research need to expand by addressing and researching the ethical issues related to uterine transplant trials and clinical procedures.

LIMITATIONS

Limitations included the challenges related to applying ethical analyses to work in developing countries, and the fact that this analysis was based on the views and interpretations of a single researcher.

Can periodontal treatment reduce the risk of pneumonia? Time to consider modifying healthcare delivery protocols

Data sources The Longitudinal Health Insurance Database 2010 (LHID2010).Data extraction and synthesis This retrospective cohort study elicited data from the LHID2010 database with a sample of 98,800 patients from 2001 to 2012. To assess the correlation between the exposure (periodontal treatment versus individuals without periodontal disease) and the outcome (pneumonia), Cox proportional-hazards regression analysis was adopted. Propensity score matching was conducted according to age, gender, monthly income, urbanisation and comorbidities to further adjust the comparison group (individuals without periodontal disease) for potential baseline predictor variables.Results Patients who received periodontal treatment had a significantly lower cumulative incidence of pneumonia compared to the individuals in the comparison group throughout the 12-year follow-up period (log-rank test, p <0.001). Further sign-mapping of the data regarding the type of periodontal treatment indicated that scaling (compared to no periodontal treatment) is associated with a significant reduction in the risk of pneumonia (adjusted HR: 0.70; 95%CI: 0.66-0.75). Additionally, intensive periodontal treatment (for example, flap surgery) could lower the pneumonia risk by about 66% compared to no periodontal treatment (adjusted HR: 0.34; 95%CI: 0.19-0.62).Conclusions Conducting periodontal treatment is associated with a reduced risk of pneumonia. When looked at from a healthcare delivery perspective, this nationwide study can present further evidence that providing patients with thorough oral and dental examinations, and following periodontal treatment if necessary, might reduce the incidence of subsequent pneumonia events.

Conceptualising characteristics of resources withdrawal from medical services: a systematic qualitative synthesis

BACKGROUND

Terms used to describe government-led resource withdrawal from ineffective and unsafe medical services, including 'rationing' and 'disinvestment', have tended to be used interchangeably, despite having distinct characteristics. This lack of descriptive precision for arguably distinct terms contributes to the obscurity that hinders effective communication and the achievement of evidence-based decision-making. The objectives of this study are to (1) identify the various terms used to describe resource withdrawal and (2) propose definitions for the key or foundational terms, which includes a clear description of the unique characteristics of each.

METHODS

This is a systematic qualitative synthesis of characteristics and terms found through a search of the academic and grey literature. This approach involved identifying commonly used resource withdrawal terms, extracting data about resource withdrawal characteristics associated with each term and conducting a comparative analysis by categorising elements as antecedents, attributes or outcomes.

RESULTS

Findings from an analysis of 106 documents demonstrated that terms used to describe resource withdrawal are inconsistently defined and applied. The characteristics associated with these terms, mainly antecedents and attributes, are used interchangeably by many authors but are differentiated by others. Our analysis resulted in the development of a framework that organises these characteristics to demonstrate the unique attributes associated with each term. To enhance precision, these terms were classified as either policy options or patient health outcomes and refined definitions for rationing and disinvestment were developed. Rationing was defined as resource withdrawal that denies, on average, patient health benefits. Disinvestment was defined as resource withdrawal that results in, on average, improved or no change in health benefits.

CONCLUSION

Agreement on the definition of various resource withdrawal terms and their key characteristics is required for transparent government decision-making regarding medical service withdrawal. This systematic qualitative synthesis presents the proposed definitions of resource withdrawal terms that will promote consistency, benefit public policy dialogue and enhance the policy-making process for health systems.

What prevents health policy being 'evidence-based'? New ways to think about evidence, policy and interventions in health

BACKGROUND

Evidence-based policy decision-making is a dominant paradigm in health but realizing this ideal has proven challenging.

SOURCES OF DATA

This paper conceptually maps health policy, policy studies and social science literature critically engaged with evidence and decision-making. No new data were generated or analysed in support of this review.

AREAS OF AGREEMENT

Barriers to evidence-based policy have been documented, with efforts made to increase the uptake of evidence.

AREAS OF CONTROVERSY

Evident complexities have been regarded as a problem of translation. However, this assumes that policy-making is a process of authoritative choice, and that 'evidence' is inherently valuable policy knowledge, which has been critiqued.

GROWING POINTS

Alternative accounts urge consideration of how evidence comes to bear on decisions made within complex systems, and what counts as evidence.

AREAS TIMELY FOR DEVELOPING RESEARCH

An 'evidence-making intervention' approach offers a framework for conceptualizing how evidence and interventions are made relationally in practices, thus working with the politics and contingencies of implementation and policy-making.

Understanding the policy dynamics of COVID-19 in the UK: Early findings from interviews with policy makers and health care professionals

The UK government response to COVID-19 has been heavily criticised. We report witnesses’ perceptions of what has shaped UK policies and how these policies have been received by healthcare workers. Such studies are usually affected by hindsight. Here we deploy a novel prospective approach to capture real-time information.

We are historians, social scientists and biomedical researchers who study how societies cope with infectious disease. In February 2020 we began regular semi-structured calls with prominent members of policy communities, and health care professionals, to elicit their roles in, and reactions to, the pandemic response.

We report witnesses’ perceptions that personal protective equipment (PPE) stocks were too small, early warnings have not led to sufficiently rapid policy decisions, and a lack of transparency is sapping public trust. Significant successes include research mobilisation. The early experiences and reactions of our witnesses suggest important issues for investigation, notably a perception of delay in decision making.

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UK coronavirus response delayed after the alarm was raised.

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Politicians abdicated responsibility by their early ‘follow the science’ rhetoric.

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Science advice to policy making needs people who bridge the two worlds.

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Centralised responses wasted valuable local public health skills.

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Pandemic response needs to move faster than the infectious disease.

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.

Bias and Misrepresentation of Science Undermines Productive Discourse on Animal Welfare Policy: A Case Study

Simple Summary

Creating good animal welfare-related laws, regulations, and policies depends on accurate knowledge. To that end, scientific reviews that explain and contextualize the relevant research can be powerful tools for informing decision-makers, assuming these reviews represent the state of the scientific knowledge accurately and objectively. In this commentary, we examine the major flaws, biases, and misrepresentations of the scientific literature in one such recent review regarding the welfare and care of captive killer whales. Such pervasive problems, in this or any review, make it impossible to determine the true state of knowledge of the relevant issues, and can ultimately result in misinformed, arbitrary, or even harmful decisions about animals and their care.

Abstract

Reliable scientific knowledge is crucial for informing legislative, regulatory, and policy decisions in a variety of areas. To that end, scientific reviews of topical issues can be invaluable tools for informing productive discourse and decision-making, assuming these reviews represent the target body of scientific knowledge as completely, accurately, and objectively as possible. Unfortunately, not all reviews live up to this standard. As a case in point, Marino et al.’s review regarding the welfare of killer whales in captivity contains methodological flaws and misrepresentations of the scientific literature, including problematic referencing, overinterpretation of the data, misleading word choice, and biased argumentation. These errors and misrepresentations undermine the authors’ conclusions and make it impossible to determine the true state of knowledge of the relevant issues. To achieve the goal of properly informing public discourse and policy on this and other issues, it is imperative that scientists and science communicators strive for higher standards of analysis, argumentation, and objectivity, in order to clearly communicate what is known, what is not known, what conclusions are supported by the data, and where we are lacking the data necessary to draw reliable conclusions.

Figure Interpretation Assessment Tool-Health (FIAT-health) 2.0: from a scoring instrument to a critical appraisal tool

BACKGROUND

Statistics are frequently used in health advocacy to attract attention, but are often misinterpreted. The Figure Interpretation Assessment Tool-Health (FIAT-Health) 1.0 was developed to support systematic assessment of the interpretation of figures on health and health care. This study aimed to test and evaluate the FIAT-Health 1.0 amongst its intended user groups, and further refine the tool based on our results.

METHODS

Potential users (N = 32) were asked to assess one publicly reported figure using the FIAT-Health 1.0, and to justify their assessments and share their experience in using the FIAT-Health. In total four figures were assessed. For each figure, an expert on the specific topic (N = 4) provided a comparative assessment. The consistency of the answers was calculated, and answers to the evaluation questions were qualitatively analysed. A qualitative comparative analysis of the justifications for assessment by the experts and potential users was made. Based on the results, a new version of the FIAT-Health was developed and tested by employees (N = 27) of the National Institute for Public Health and the Environment (RIVM), and approved by the project's advisory group. In total sixty-three participants contributed.

RESULTS

Potential users using the FIAT-Health 1.0 and experts gave similar justifications for their assessments. The justifications provided by experts aligned with the items of the FIAT-Health. Seventeen out of twenty-six dichotomous questions were consistently answered by the potential users. Numerical assessment questions showed inconsistencies in how potential users responded. In the evaluation, potential users most frequently mentioned that thanks to its structured approach, the FIAT-Health contributed to their awareness of the main characteristics of the figure (n = 14), but they did find the tool complex (n = 11). The FIAT-Health 1.0 was revised from a scoring instrument into a critical appraisal tool: the FIAT-Health 2.0, which was tested and approved by employees of the RIVM and the advisory group.

CONCLUSION

The tool was refined according to the results of the test and evaluation, transforming the FIAT-Health from a quantitative scoring instrument into an online qualitative appraisal tool that has the potential to aid the better interpretation and public reporting of statistics on health and healthcare.

Statistics in Dutch policy debates on health and healthcare

Background

The notion of ‘fact-free politics’ is debated in Europe and the United States of America and has particular relevance for the use of evidence to underpin health and healthcare policies. To better understand how evidence on health and healthcare is used in the national policy-making process in the Netherlands, we explore how different statistics are used in various policy debates on health and healthcare in the Dutch government and parliament.

Methods

We chose eight ongoing policy debates as case studies representing the subject categories of morbidity, lifestyle, healthcare expenditure and healthcare outcomes, including (1) breast cancer screening rates, prevalence and incidence, (2) dementia prevalence and incidence, (3) prevalence of alcohol use by pregnant women, (4) mobility and school sports participation in children, (5) costs of smoking, (6) Dutch national healthcare expenditure, (7) hospital mortality rates, and (8) bedsore prevalence. Using selected keywords for each policy debate case, we performed a document search to identify documentation of the debates (2014–2016) on the websites of the Dutch government and parliament. We retrieved 163 documents and examined the policy debate cases through a content analyses approach.

Results

Sources of the statistics used in policy debates were primarily government funded. We identified two distinct functions, i.e. rhetorical and managerial use of statistics. The function of the debate is rhetorical when the specific statistic is used for agenda-setting or to convince the reader of the importance of a topic. The function of the debate is managerial when statistics determine planning, monitoring or evaluation of policy. When evaluating a specific policy, applied statistics were mostly the result of routine or standardised data collection. When policy-makers use statistics for a managerial function, the policy debate mirrors terms derived from scientific debates.

Conclusion

While statistics used for rhetorical functions do not seem to invite critical reflection, when the function of the debate is managerial, i.e. to plan, monitor or evaluate healthcare, their construction does receive attention. Considering the current role of statistics in rhetorical and managerial debates, there is a need to be cautious of too much leniency towards the technocratic process in exchange for the democratic debate.

Electronic supplementary material

The online version of this article (10.1186/s12961-019-0461-y) contains supplementary material, which is available to authorized users.

The Role of Integrated Knowledge Translation in Intervention Research

There is widespread recognition across the full range of applied research disciplines, including health and social services, about the challenges of integrating scientifically derived research evidence into policy and/or practice decisions. These "disconnects" or "knowledge-practice gaps" between research production and use have spawned a new research field, most commonly known as either "implementation science" or "knowledge translation." The present paper will review key concepts in this area, with a particular focus on "integrated knowledge translation" (IKT)-which focuses on researcher-knowledge user partnership-in the area of mental health and prevention of violence against women and children using case examples from completed and ongoing work. A key distinction is made between the practice of KT (disseminating, communicating, etc.), and the science of KT, i.e., research regarding effective KT approaches. We conclude with a discussion of the relevance of IKT for mental health intervention research with children and adolescents.

Research evidence supports cancer policymaking but is insufficient for change: Findings of key informant interviews from five countries

Evidence-based policymaking values the use of research in the process of developing, implementing and evaluating policy. However, there is limited research attempting to understand how cancer policymaking occurs and the role of evidence in this process. Our study aimed to provide a deeper understanding of levers and challenges to the development and implementation of large-scale, health service policies or programs in cancer care. Within a realist framework, we conducted a thematic analysis of interviews with 13 key informants from five countries: Australia, Canada, Scotland, Denmark and New Zealand. Results identified a complex array of program mechanisms and contextual factors influencing cancer health-service policymaking. Research evidence was important and could form a rationale for change, such as by identifying unwarranted variation in cancer outcomes across or within countries. However, other factors were equally important in driving policy change, including advocacy, leadership, stakeholder collaboration, program adaptability, clinician and consumer involvement, and the influential role of context. These findings resonate with political science theories and health service reform literature, while offering novel insight into specific factors that influence policymaking in cancer care, namely clinical engagement, consumer input and policy context. Although research evidence supports policymaking, the complex ways in which cancer policies are developed and implemented requires recognition and should be considered when designing new programs and promoting the use of evidence in policymaking.

A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach

BACKGROUND

Nepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal's perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulation processes that shape the potential to reduce in-country health inequities. This paper provides a critical account of the main policy documents relevant to perinatal survival in Nepal.

METHODS

Six key policy documents covering the period 2000-2015 were reviewed using an adapted framework and were analyzed through qualitative content analysis.

RESULTS

The analysis shows that the policies focused mainly on the system: improvement in provision of birthing facilities; targeting staff (Skilled Birth Attendants) and health service users by providing cash incentives to staff for bringing patients to services, and to users (pregnant women) to attend health institutions. Despite a growing focus on saving women and newborn babies, there is a poor policy focus and direction on preventing stillbirth. The policy documents were found to emphasize tensions between birthing at home and at health institutions on the one hand, and between strategies to provide culturally appropriate, woman-centered care in communities and medically orientated services on the other. Policies acknowledge the need to provide and address woman-centered care, equity, social inclusion, and a rights-based approach, and identify the community based approach as the mode of service delivery. Over and above this, all policy documents are aimed at the national level, and there is no specific policy direction for the separate ecological, cultural or geographic regions such as the mountainous region, which continues to exhibit higher mortality rates and has different cultural and demographic characteristics to the rest of Nepal.

CONCLUSIONS

To better address the continuing high perinatal mortality rates, particularly in disadvantaged areas, national health policies should pay more attention to the inequity in healthcare access and in perinatal outcomes by integrating both stillbirth prevention and neonatal survival as policy agenda items. To ensure effective translation of policy into practice, it is imperative to tailor the strategies according to acknowledged policy values such as rights, inclusion and socio-cultural identity.

Role of a hospital accreditation program in developing a process management system

Purpose

The purpose of this paper is to clarify the effects of the Iranian Hospital Accreditation Program (IHAP) on hospital processes from the viewpoint of the staff charged with establishing the program.

Design/methodology/approach

This qualitative study is based on the data collected in semi-structured interviews conducted in 2016, which involved eight questions. Interviews were held with 70 staff members at 14 hospitals. Managerial staff were purposively interviewed based on their familiarity and involvement with the program. The hospitals were divided into five groups, comprising public, private, charity, military and social service hospitals. A thematic analysis was carried out using the collected data.

Findings

Three themes emerged from the data, which together comprise a process management cycle: the establishment, implementation, and control phases of the program. For each phase, various positive trends, as well as hurdles for establishing the program, declared which were framed two sub-themes as positive effects and challenges.

Originality/value

The findings contribute to the body of evidence used by policy-makers and hospital managers to improve the change management processes related to the Iranian IHAP. Although positive changes in the process management cycles at Iranian hospitals were noted, successful implementation of the program demands a thorough assessment of the hospitals’ technical and financial needs (taking into account disparities between hospitals), and there is an urgent requirement for a plan to meet these needs.

A patient-centred intervention to improve the management of multimorbidity in general practice: the 3D RCT

Background

People with multimorbidity experience impaired quality of life, poor health and a burden from treatment. Their care is often disease-focused rather than patient-centred and tailored to their individual needs.

Objective

To implement and evaluate a patient-centred intervention to improve the management of patients with multimorbidity in general practice.

Design

Pragmatic, cluster randomised controlled trial with parallel process and economic evaluations. Practices were centrally randomised by a statistician blind to practice identifiers, using a computer-generated algorithm.

Setting

Thirty-three general practices in three areas of England and Scotland.

Participants

Practices had at least 4500 patients and two general practitioners (GPs) and used the EMIS (Egton Medical Information Systems) computer system. Patients were aged ≥ 18 years with three or more long-term conditions.

Interventions

The 3D (Dimensions of health, Depression and Drugs) intervention was designed to offer patients continuity of care with a named GP, replacing separate reviews of each long-term condition with comprehensive reviews every 6 months. These focused on individualising care to address patients’ main problems, attention to quality of life, depression and polypharmacy and on disease control and agreeing treatment plans. Control practices provided usual care.

Outcome measures

Primary outcome – health-related quality of life (assessed using the EuroQol-5 Dimensions, five-level version) after 15 months. Secondary outcomes – measures of illness burden, treatment burden and patient-centred care. We assessed cost-effectiveness from a NHS and a social care perspective.

Results

Thirty-three practices (1546 patients) were randomised from May to December 2015 [16 practices (797 patients) to the 3D intervention, 17 practices (749 patients) to usual care]. All participants were included in the primary outcome analysis by imputing missing data. There was no evidence of difference between trial arms in health-related quality of life {adjusted difference in means 0.00 [95% confidence interval (CI) –0.02 to 0.02]; p = 0.93}, illness burden or treatment burden. However, patients reported significant benefits from the 3D intervention in all measures of patient-centred care. Qualitative data suggested that both patients and staff welcomed having more time, continuity of care and the patient-centred approach. The economic analysis found no meaningful differences between the intervention and usual care in either quality-adjusted life-years [(QALYs) adjusted mean QALY difference 0.007, 95% CI –0.009 to 0.023] or costs (adjusted mean difference £126, 95% CI –£739 to £991), with wide uncertainty around point estimates. The cost-effectiveness acceptability curve suggested that the intervention was unlikely to be either more or less cost-effective than usual care. Seventy-eight patients died (46 in the intervention arm and 32 in the usual-care arm), with no evidence of difference between trial arms; no deaths appeared to be associated with the intervention.

Limitations

In this pragmatic trial, the implementation of the intervention was incomplete: 49% of patients received two 3D reviews over 15 months, whereas 75% received at least one review.

Conclusions

The 3D approach reflected international consensus about how to improve care for multimorbidity. Although it achieved the aim of providing more patient-centred care, this was not associated with benefits in quality of life, illness burden or treatment burden. The intervention was no more or less cost-effective than usual care. Modifications to the 3D approach might improve its effectiveness. Evaluation is needed based on whole-system change over a longer period of time.

Trial registration

Current Controlled Trials ISRCTN06180958.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 5. See the NIHR Journals Library website for further project information.

Just Enough Cooks in the Kitchen: Key Ingredients for International Collaboration

Research approaches that cross disciplinary silos, industry sectors, and political borders are now increasingly prioritized for tackling issues of global concern. Nevertheless, team science can be challenging. The goal of this article is to help researchers proactively consider factors influencing conflicts and successes with an emphasis on the health sciences.

Defining 'evidence' in public health: a survey of policymakers' uses and preferences

Background

Public health (PH) policymakers are encouraged to use evidence in the decision-making process. However, little is known about what types of evidence policymakers working in local settings prefer to use. This study aims to evaluate policymakers' needs and sources of information, at regional and local levels. An electronic survey with telephone follow-up was carried out among PH policymakers and evidence producers ( n = 152) working in a large UK city. Respondents were asked which types of evidence they used regularly, found most useful and what were their main sources of information. Semi-structured interviews ( n = 23) added were analysed quantitatively in addition to the categorical data generated by the survey. Policymakers use a much greater range of evidence and information than is often indicated in the literature on evidence-based policy. Local data were by far the most used ( n = 95%) and most valued ( n = 85%) type of information, followed by practice guidelines. The main sources of information were Government websites (84%), followed by information obtained through personal contacts (71%), including PH professionals, council officers and politicians. Academics were rarely consulted and research evidence was rarely seen as directly relevant. Conclusions: Policymakers use a wider range of evidence types than previously discussed in the literature. Although local data were most valued by policymakers, results suggest that these were accessed through personal contacts, rather than specialized organizations. Systems to provide local high-quality evidence for PH policy should be supported.

Exploring political influences on evidence-based non-communicable disease prevention across four countries

Implementation of evidence-based practices can improve efficiency and effectiveness of public health efforts. Few studies have explored the political contextual factors that impact implementation of evidence-based non-communicable disease prevention (EBNCDP). This study aimed to do so in Australia, Brazil, China and the United States. Investigators conducted 10-13 qualitative, semi-structured interviews of public health practitioners working in functionally similar public health organizations in each country (total N = 50). Study participants were identified through purposive sampling and interviews were structured around an interview guide covering six domains related to EBNCDP. Interviewees from all four countries identified funding as the primary politically-influenced barrier to implementing EBNCDP. Similarly widespread barriers included government funding priorities that shift based on who is in power and the difficulty of convincing policy-makers and funders that non-communicable disease prevention is a wise investment of political capital. Policymakers who are not evidence-driven was another common barrier even in the United States and Australia, where EBNCDP is more established. Findings suggest that political contextual factors influence EBNCDP and vary to an extent by country, though certain factors seem to be universal. This can aid public health practitioners, political leaders, and policymakers in advocating for conditions and policies that encourage evidence-based practice.

Improving interpretation of publically reported statistics on health and healthcare: the Figure Interpretation Assessment Tool (FIAT-Health)

BACKGROUND

Policy-makers, managers, scientists, patients and the general public are confronted daily with figures on health and healthcare through public reporting in newspapers, webpages and press releases. However, information on the key characteristics of these figures necessary for their correct interpretation is often not adequately communicated, which can lead to misinterpretation and misinformed decision-making. The objective of this research was to map the key characteristics relevant to the interpretation of figures on health and healthcare, and to develop a Figure Interpretation Assessment Tool-Health (FIAT-Health) through which figures on health and healthcare can be systematically assessed, allowing for a better interpretation of these figures.

METHODS

The abovementioned key characteristics of figures on health and healthcare were identified through systematic expert consultations in the Netherlands on four topic categories of figures, namely morbidity, healthcare expenditure, healthcare outcomes and lifestyle. The identified characteristics were used as a frame for the development of the FIAT-Health. Development of the tool and its content was supported and validated through regular review by a sounding board of potential users.

RESULTS

Identified characteristics relevant for the interpretation of figures in the four categories relate to the figures' origin, credibility, expression, subject matter, population and geographical focus, time period, and underlying data collection methods. The characteristics were translated into a set of 13 dichotomous and 4-point Likert scale questions constituting the FIAT-Health, and two final assessment statements. Users of the FIAT-Health were provided with a summary overview of their answers to support a final assessment of the correctness of a figure and the appropriateness of its reporting.

CONCLUSIONS

FIAT-Health can support policy-makers, managers, scientists, patients and the general public to systematically assess the quality of publicly reported figures on health and healthcare. It also has the potential to support the producers of health and healthcare data in clearly communicating their data to different audiences. Future research should focus on the further validation of the tool in practice.

Designing evaluation studies to optimally inform policy: what factors do policy-makers in China consider when making resource allocation decisions on healthcare worker training programmes?

BACKGROUND

In light of the gap in evidence to inform future resource allocation decisions about healthcare provider (HCP) training in low- and middle-income countries (LMICs), and the considerable donor investments being made towards training interventions, evaluation studies that are optimally designed to inform local policy-makers are needed. The aim of our study is to understand what features of HCP training evaluation studies are important for decision-making by policy-makers in LMICs. We investigate the extent to which evaluations based on the widely used Kirkpatrick model - focusing on direct outcomes of training, namely reaction of trainees, learning, behaviour change and improvements in programmatic health indicators - align with policy-makers' evidence needs for resource allocation decisions. We use China as a case study where resource allocation decisions about potential scale-up (using domestic funding) are being made about an externally funded pilot HCP training programme.

METHODS

Qualitative data were collected from high-level officials involved in resource allocation at the national and provincial level in China through ten face-to-face, in-depth interviews and two focus group discussions consisting of ten participants each. Data were analysed manually using an interpretive thematic analysis approach.

RESULTS

Our study indicates that Chinese officials not only consider information about the direct outcomes of a training programme, as captured in the Kirkpatrick model, but also need information on the resources required to implement the training, the wider or indirect impacts of training, and the sustainability and scalability to other settings within the country. In addition to considering findings presented in evaluation studies, we found that Chinese policy-makers pay close attention to whether the evaluations were robust and to the composition of the evaluation team.

CONCLUSIONS

Our qualitative study indicates that training programme evaluations that focus narrowly on direct training outcomes may not provide sufficient information for policy-makers to make decisions on future training programmes. Based on our findings, we have developed an evidence-based framework, which incorporates but expands beyond the Kirkpatrick model, to provide conceptual and practical guidance that aids in the design of training programme evaluations better suited to meet the information needs of policy-makers and to inform policy decisions.

A simple filter model to guide the allocation of healthcare resources for improving the treatment of depression among cancer patients

Background

Depression is highly prevalent yet often poorly detected and treated among cancer patients. In light of the move towards evidence-based healthcare policy, we have developed a simple tool that can assist policy makers, organisations and researchers to logically think through the steps involved in improving patient outcomes, and to help guide decisions about where to allocate resources.

Methods

The model assumes that a series of filters operate to determine outcomes and cost-effectiveness associated with depression care for cancer patients, including: detection of depression, provider response to detection, patient acceptance of treatment, and effectiveness of treatment provided. To illustrate the utility of the model, hypothetical data for baseline and four scenarios in which filter outcomes were improved by 15% were entered into the model.

Results

The model provides outcomes including: number of people successfully treated, total costs per scenario, and the incremental cost-effectiveness ratio per scenario compared to baseline. The hypothetical data entered into the model illustrate the relative effectiveness (in terms of the number of additional incremental successes) and relative cost-effectiveness (in terms of cost per successful outcome and total cost) of making changes at each step or filter.

Conclusions

The model provides a readily accessible tool to assist decision makers to think through the steps involved in improving depression outcomes for cancer patents. It provides transparent guidance about how to best allocate resources, and highlights areas where more reliable data are needed. The filter model presents an opportunity to improve on current practice by ensuring that a logical approach, which takes into account the available evidence, is applied to decision making.

Clinical research ethics review process in Lebanon: efficiency and functions of research ethics committees - results from a descriptive questionnaire-based study

Background

Clinical trials conducted in Lebanon are increasing. However, little is known about the performance of research ethics committees (RECs) in charge of reviewing the research protocols. This study aimed to assess the level of adherence to the ethics surrounding the conduct of clinical trials and perceptions of team members regarding roles of the RECs during the conduct of clinical trials in Lebanon. The research question was: Are RECs adherent to the ethics surrounding the conduct of clinical trials (chapters II and IV in ‘Standards and Operational Guidance for Ethics Review of Health-related Research with Human Participants’ in Lebanon?’

Methods

This was a quantitative and descriptive questionnaire-based study conducted among RECs of university hospitals in Lebanon. The questionnaire had to be completed online and included general questions in addition to items reflecting the different aspects of a REC performance and effectiveness. All the questionnaire was assigned a total score of 175 points. General information and questions assigned point values/scores were analysed using descriptive statistics: frequency and percentage, mean score ± standard deviation.

Results

Ten RECs participated in the study (52 persons: four chairs, one vice-president, 47 ordinary members). Forty-seven (90.4%) had previous experience with clinical research and 30 (57.7%) had a diploma or had done a training in research ethics. Forty-one percent confirmed that they were required to have a training in research ethics. All RECs had a policy for disclosing and managing potential conflicts of interest for its members, but 71.8% of participants reported the existence of such a policy for researchers. Thirty-three point three percent reported that the RECs had an anti-bribery policy. The questionnaire mean score was 129.6 ± 22.3/175 points reflecting thus an excellent adherence to international standards.

Conclusion

Inadequate training of REC members and the lack of anti-bribery policies should be resolved to improve their performance.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2397-2) contains supplementary material, which is available to authorized users.

An integrated care programme in London: qualitative evaluation

PURPOSE

A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment.

DESIGN/METHODOLOGY/APPROACH

Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes.

FINDINGS

The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of "successes", "challenges" and "lessons learnt".

RESEARCH LIMITATIONS/IMPLICATIONS

Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit.

PRACTICAL IMPLICATIONS

Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation.

ORIGINALITY/VALUE

Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.

Development of a framework to improve the utilisation of malaria research for policy development in Malawi

BACKGROUND

The existing gap between research evidence and public health practice has attributed to the unmet Millennium Development Goals in Africa and consequently, has stimulated the development of frameworks to enhance knowledge translation. These efforts aim at maximising health research utilisation in policy and practice to address the world's disease burdens, including malaria. This study aimed at developing a contextual framework to improve the utilisation of malaria research for policy development in Malawi.

METHODS

The study used two approaches including: two case studies of policy analysis exploring the policy-making process in Malawi, utilisation of local malaria research, and the role of key stakeholders in policy formulation process; and the assessment of facilitating factors and barriers to malaria research utilisation for policy-making in Malawi.

RESULTS

From the case studies' lessons and elements identified during the assessment of facilitating factors and barriers, a framework is developed to promote an integrated approach to knowledge translation. In this framework the Ministry of Health is considered as the main user of knowledge from research through the demand created by the research directorate and the National Malaria Control Programme. Key documents identified as being particularly relevant to the Ministry of Health for purposes of knowledge translation include the National Health Research Agenda, Guidelines for Policy Development and Analysis, and Guidelines for Evidence Use in Policy-making. Institutions conducting academic and policy-relevant malaria research in Malawi are identified and a consolidation of their linkages with the users of research is established through the Knowledge Translation Unit, the Evidence Informed decision-making Centre, and the African Institute for Development Policy. Equally, key players in this framework are the funding partners for both research and programmes that need to see accountability and impact of their support. Independent advisors, partners, and consultants also have their vital role in the process.

CONCLUSION

The framework offers a practical basis for the factors identified and their linkages to promote a co-ordinated approach to malaria research utilisation in policy-making. Its applicability and success hinges on its wider dissemination and ownership by the government through the National Malaria Control Programme.

The research-policy-deliberation nexus: a case study approach

Background

Decision-makers tend to make connections with researchers far too late in the game of public policy, expecting to find a retail store in which researchers are busy filling shop-front shelves with a comprehensive set of all possible relevant studies that a decision-maker might some day drop by to purchase. This linear type of relation between research and policy needs to be replaced by a more interactive model that facilitates both researchers obtaining a better understanding of policy processes and policymakers being more aware and involved in the conceptualisation and conduct of research. This paper explores the role of governance in facilitating the research–policy nexus, testing a typology of research utilisation based on Murray’s (Soc Policy Society 10(4):459–70, 2011) analysis that considers various degrees of researcher–policymaker deliberation in decision-making processes. The projects were all part of various evaluation efforts carried out by the researchers to explore the use of governance in health promotion activities.

Methods

Three case studies were chosen to provide some specific examples that illustrate each level of Murray’s typology. The examples involve intersectoral health promotion collaborations that combine evidence-based research in health policy initiatives with various levels of researcher involvement. For all three projects, interview data was collated in the same way, coded thematically and analysed to consider the relationship between researchers and policymakers.

Results

Comparing the three models and their applicability to health promotion interventions, it could be observed that all programmes demonstrated successful examples of research translation. Strong governance imperatives structuring relationships led to more successful outcomes, whereby research was successfully translated into a public policy initiative that also led to improved health outcomes. The key idea across all of these models was that strong governance arrangements mitigated some of the barriers evidenced by the varying degrees of deliberation and researcher involvement in processes.

Conclusions

The paper demonstrates that successful research utilisation is related to strong governance agendas and that early and ongoing involvement of relevant decision-makers and researchers in the governance processes, that is both the conceptualisation and conduct of a study, tend to be the best predictors of success.

A Qualitative Study of Challenges and Opportunities in Mobilizing Research Knowledge on Violence Against Women

Background Effective delivery of interventions by health and social services requires research-based knowledge which identifies the causes and consequences of violence against women. Methods to effectively share new knowledge with violence against women decision-makers remain under studied. Purpose This paper examines how new research-based knowledge-namely, the lack of efficacy of health-care screening for exposure to intimate partner violence against women-is received by stakeholders in the violence against women field. Methods Data from 10 stakeholder group discussions ( N = 86) conducted during a knowledge-sharing forum were analyzed to assess how stakeholders responded to the new knowledge. Results Participant reactions ranged from full acceptance to significant resistance to the research findings. We suggest themes that help explain these reactions, including the context and content of our findings and their epistemological match to participants' experiences and beliefs, and the perceived value of research evidence, compared to other forms of knowledge. Conclusions Violence against women is a complex psycho-social phenomenon, and people with an interest in this field bring diverse and even conflicting perspectives regarding its causes, consequences, and potential solutions.

Enhancing the use of research in health-promoting, anti-racism policy

BACKGROUND

The Localities Embracing and Accepting Diversity (LEAD) programme was established to improve the health of ethnic minority communities through the reduction of racial discrimination. Local governments in the state of Victoria, Australia, were at the forefront of LEAD implementation in collaboration with leading state and national organisations. Key aims included expanding the available evidence regarding effective anti-racism interventions and facilitating the uptake of this evidence in organisational policies and practices.

METHODS

One rural and one metropolitan local government areas were selected to participate in LEAD. Key informant interviews and discussions were conducted with individuals who had participated in LEAD implementation and members of LEAD governance structures. Data were also collected on programme processes and implementation, partnership formation and organisational assessments.

RESULTS

The LEAD model demonstrated both strengths and weaknesses in terms of facilitating the use of evidence in a complex, community-based health promotion initiative. Representation of implementing, funding and advisory bodies at different levels of governance enabled the input of technical advice and guidance alongside design and implementation. The representation structure assisted in ensuring the development of a programme that was acceptable to all partners and informed by the best available evidence. Simultaneous evaluation also enhanced perceived validity of the intervention, allowed for strategy correction when necessary and supported the process of double-loop organisational learning. However, due to the model's demand for simultaneous and intensive effort by various organisations, when particular elements of the intervention were not functional, there was a considerable loss of time and resources across the partner organisations. The complexity of the model also presented a challenge in ensuring clarity regarding roles, functions and the direction of the programme.

CONCLUSIONS

The example of LEAD provides guidance on mechanisms to strengthen the entry of evidence into complex community-based health promotion programmes. The paper highlights some of the strengths and weaknesses of the LEAD model and implications for practical collaboration between policymakers, implementers and researchers.

Effectively engaging stakeholders and the public in developing violence prevention messages

Background

Preventing family violence requires that stakeholders and the broader public be involved in developing evidence-based violence prevention strategies. However, gaps exist in between what we know (knowledge), what we do (action), and the structures supporting practice (policy).

Discussion

We discuss the broad challenge of mobilizing knowledge-for-action in family violence, with a primary focus on the issue of how stakeholders and the public can be effectively engaged when developing and communicating evidence-based violence prevention messages. We suggest that a comprehensive approach to stakeholder and public engagement in developing violence prevention messages includes: 1) clear and consistent messaging; 2) identifying and using, as appropriate, lessons from campaigns that show evidence of reducing specific types of violence; and 3) evidence-informed approaches for communicating to specific groups. Components of a comprehensive approach must take into account the available research evidence, implementation feasibility, and the context-specific nature of family violence.

Summary

While strategies exist for engaging stakeholders and the public in messaging about family violence prevention, knowledge mobilization must be informed by evidence, dialogue with stakeholders, and proactive media strategies. This paper will be of interest to public health practitioners or others involved in planning and implementing violence prevention programs because it highlights what is known about the issue, potential solutions, and implementation considerations.

Knowledge and power in policy-making for child survival in Niger

Calls to enhance the use of scientific evidence in international health and development policy have increased in recent years; however, analytic frameworks for understanding evidence use focus narrowly on scientific research and were created using data and observations nearly exclusively from Western countries. We examine processes of health policy development in a case study of Niger, a low-income West African country that adopted integrated community case management of childhood illness (iCCM) beginning in 2007, resulting in measurable declines in child mortality. Data collection included in-depth interviews with policy actors in Niger (N = 32), document review (N = 103) and direct observation of policy forums (N = 3). Data analysis used process tracing methodology and applied an Aristotelian definition of "knowledge" as 1) episteme (facts), 2) techne (skills) and 3) phronesis (practical wisdom), while also using a critical perspective to understand issues of power. We found sharp differentials in policy-makers' possession and use of codified forms of knowledge (episteme), with Nigerien policy officers' access highly mediated by actors at international agencies. Government policy-makers possessed skills and capacities (techne) to negotiate with donors and deliberate and weigh conflicting considerations; however they lacked capacity and resources to formally evaluate and document programs and thus reliably draw lessons from them. Practical wisdom (phronesis) emerged as key to the iCCM policy enterprise, particularly among Nigerien government actors, who used logical and ethical arguments to make decisions later found to be critical to iCCM's success. While codified knowledge confers power on members of policy discussions who can access it, this represents only one form of knowledge used in the policy process and perhaps not the most important. Future research on evidence-based policy should use broader definitions of evidence or knowledge, examine on how power conditions the use of knowledge, and examine challenges specific to low-resource policy environments.

Health services research and development in practice: An Australian experience

While there is a growing literature on how health services research can inform health policy decisions, the practical challenge is for health services researchers to develop an effective interface with health policy-making processes and to produce outputs that lead to outcomes. The experience of the Centre for Health Service Development at the University of Wollongong, Australia, is used to illustrate the issues so commonly described in the literature and to reflect on our experience of trying to remain viable while producing relevant and valid research. A case study in a specific policy area - namely, the development of case-mix classifications and information systems to inform policy and funding in the subacute and non-acute hospital and community care sectors - is used as a practical example of the research-policy interface.

Describing the impact of health services and policy research

Objectives

In an essentially applied area of research, there are particular pressures on health services and policy researchers to describe the impact of their work. However, specialized research impact assessments often require skills and resources beyond those available to individual researchers, and ad hoc accounts impose a considerable burden to generate. Further, these idiosyncratic accounts may not facilitate comparative analysis to inform research management, practice and assessment. This paper describes an initial attempt to develop a methodical approach to identify and describe research impact.

Methods

A Research Impact Framework was developed, drawing on the literature and interviews with researchers at the London School of Hygiene and Tropical Medicine, and was used to structure impact narratives of selected research projects. These narratives were based on semi-structured interviews with principal investigators and documentary analysis of the projects.

Results

Using the framework as a guide, researchers were relatively easily and methodically able to identify and present impacts of their work. Researchers’ narratives contained verifiable evidence and highlighted a wide range of areas in which health services and policy research has impact. The standardized structure of the narratives also facilitated analysis across projects. Factors thought to positively influence the impact of research included researchers’ continued involvement in research and policy networks, established track records in the field, and the ability to identify and use key influencing events, such as ‘policy windows’.

Conclusions

The framework helped develop research impact narratives and facilitated comparisons across projects, highlighting issues for research management and assessment.