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Kormos A, Lanzaro GC, Bier E, Dimopoulos G, Marshall JM, Pinto J, Aguiar dos Santos A, Bacar A, Sousa Pontes Sacramento Rompão H, James AA. Application of the Relationship-Based Model to Engagement for Field Trials of Genetically Engineered Malaria Vectors. Am J Trop Med Hyg 2021; 104:805-811. [PMID: 33350374 PMCID: PMC7941841 DOI: 10.4269/ajtmh.20-0868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/10/2020] [Indexed: 12/25/2022] Open
Abstract
The transition of new technologies for public health from laboratory to field is accompanied by a broadening scope of engagement challenges. Recent developments of vector control strategies involving genetically engineered mosquitoes with gene drives to assist in the eradication of malaria have drawn significant attention. Notably, questions have arisen surrounding community and regulatory engagement activities and of the need for examples of models or frameworks that can be applied to guide engagement. A relationship-based model (RBM) provides a framework that places stakeholders and community members at the center of decision-making processes, rather than as recipients of predetermined strategies, methods, and definitions. Successful RBM application in the transformation of healthcare delivery has demonstrated the importance of open dialogue and relationship development in establishing an environment where individuals are actively engaged in decision-making processes regarding their health. Although guidelines and recommendations for engagement for gene drives have recently been described, we argue here that communities and stakeholders should lead the planning, development, and implementation phases of engagement. The RBM provides a new approach to the development of ethical, transparent, and effective engagement strategies for malaria control programs.
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Affiliation(s)
- Ana Kormos
- Vector Genetics Laboratory, University of California, Davis, California;,Address correspondence to Ana Kormos, Department of Pathology, Microbiology and Immunology, University of California, Davis, 1089 Veterinary Medicine Dr., Davis, CA 95616. E-mail:
| | | | - Ethan Bier
- Section of Cell and Developmental Biology, University of California, San Diego, California;,Tata Institute for Genetics and Society (TIGS)-UCSD, San Diego, California
| | - George Dimopoulos
- Department of Molecular Microbiology and Immunology, Malaria Research Institute (JHMRI), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - John M. Marshall
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California;,Innovative Genomics Institute, Berkeley, California
| | - João Pinto
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Affane Bacar
- Ministry of Health, Programme Nationale de Lutte Contre le Paludisme, Moroni, Union of the Comoros
| | | | - Anthony A. James
- Department of Microbiology and Molecular Genetics, University of California, Irvine, California;,Department of Molecular Biology and Biochemistry, University of California, Irvine, California
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Murunga VI, Oronje RN, Bates I, Tagoe N, Pulford J. Review of published evidence on knowledge translation capacity, practice and support among researchers and research institutions in low- and middle-income countries. Health Res Policy Syst 2020; 18:16. [PMID: 32039738 PMCID: PMC7011245 DOI: 10.1186/s12961-019-0524-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to yield beneficial outcomes for society. Effective KT requires researchers to play an active role in promoting evidence uptake. This paper presents a systematised review of evidence on low- and middle-income country (LMIC) researchers' KT capacity, practice and interventions for enhancing their KT practice (support) with the aim of identifying gaps and informing future research and interventions. METHODS An electronic search for peer-reviewed publications focusing on LMIC researchers' KT capacity, practice and support across all academic fields, authored in English and from the earliest records available to February 2019, was conducted using PubMed and Scopus. Selected studies were appraised using the Mixed Methods Appraisal Tool, data pertaining to publication characteristics and study design extracted, and an a priori thematic analysis of reported research findings completed. RESULTS The search resulted in 334 screened articles, of which 66 met the inclusion criteria. Most (n = 43) of the articles presented original research findings, 22 were commentaries and 1 was a structured review; 47 articles reported on researchers' KT practice, 12 assessed the KT capacity of researchers or academic/research institutions and 9 reported on KT support for researchers. More than half (59%) of the articles focused on sub-Saharan Africa and the majority (91%) on health research. Most of the primary studies used the case study design (41%). The findings suggest that LMIC researchers rarely conduct KT and face a range of barriers at individual and institutional levels that limit their KT practice, including inadequate KT knowledge and skills, particularly for communicating research and interacting with research end-users, insufficient funding, and inadequate institutional guidelines, structures and incentives promoting KT practice. Furthermore, the evidence-base on effective interventions for enhancing LMIC researchers' KT practice is insufficient and largely of weak quality. CONCLUSIONS More high-quality research on researchers' KT capacity, practice and effective KT capacity strengthening interventions is needed. Study designs that extend beyond case studies and descriptive studies are recommended, including better designed evaluation studies, e.g. use of realist approaches, pragmatic trials, impact evaluations, implementation research and participatory action research.
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Affiliation(s)
- Violet Ibukayo Murunga
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX United Kingdom
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
- African Institute for Development Policy, 6th Floor, Block A, Westcom Point Bldg, Mahiga Mairu Ave Off Waiyaki Way, Westlands, Nairobi, Kenya
| | - Rose Ndakala Oronje
- African Institute for Development Policy, 6th Floor, Block A, Westcom Point Bldg, Mahiga Mairu Ave Off Waiyaki Way, Westlands, Nairobi, Kenya
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
| | - Nadia Tagoe
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Office of Grants and Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Justin Pulford
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
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Vanyoro KP, Hawkins K, Greenall M, Parry H, Keeru L. Local ownership of health policy and systems research in low-income and middle-income countries: a missing element in the uptake debate. BMJ Glob Health 2019; 4:e001523. [PMID: 31543986 PMCID: PMC6730582 DOI: 10.1136/bmjgh-2019-001523] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 11/05/2022] Open
Abstract
Health policy and systems researchers (HPSRs) in low-income and middle-income countries (LMICs) aim to influence health systems planning, costing, policy and implementation. Yet, there is still much that we do not know about the types of health systems evidence that are most compelling and impactful to policymakers and community groups, the factors that facilitate the research to decision-making process and the real-world challenges faced when translating research findings into practice in different contexts. Drawing on an analysis of HPSR from LMICs presented at the Fifth Global Symposium on Health Systems Research (HSR 2018), we argue that while there is a recognition in policy studies more broadly about the role of co-production, collective ownership and the value of localised HPSR in the evidence-to-policy discussion, ‘ownership’ of research at country level is a research uptake catalyst that needs to be further emphasised, particularly in the HPSR context. We consider embedded research, participatory or community-initiated research and emergent/responsive research processes, all of which are ‘owned’ by policymakers, healthcare practitioners/managers or community members. We embrace the view that ownership of HPSR by people directly affected by health problems connects research and decision-making in a tangible way, creating pathways to impact.
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Affiliation(s)
- Kudakwashe Paul Vanyoro
- African Centre for Migration & Society, University of the Witwatersrand School of Social Sciences, Johannesburg, South Africa
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Thizy D, Emerson C, Gibbs J, Hartley S, Kapiriri L, Lavery J, Lunshof J, Ramsey J, Shapiro J, Singh JA, Toe LP, Coche I, Robinson B. Guidance on stakeholder engagement practices to inform the development of area-wide vector control methods. PLoS Negl Trop Dis 2019; 13:e0007286. [PMID: 31022177 PMCID: PMC6483156 DOI: 10.1371/journal.pntd.0007286] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Delphine Thizy
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Claudia Emerson
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Ontario, Canada
| | - Johanna Gibbs
- Keystone Policy Center, Keystone, Colorado, United States of America
| | - Sarah Hartley
- Department of Science, Innovation, Technology, and Entrepreneurship, University of Exeter, Exeter, Devon, United Kingdom
| | - Lydia Kapiriri
- Department of Health, Ageing and Society, McMaster University, Hamilton, Ontario, Canada
| | - James Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Center for Ethics, Emory University, Atlanta, Georgia, United States of America
| | - Jeantine Lunshof
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janine Ramsey
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Julie Shapiro
- Keystone Policy Center, Keystone, Colorado, United States of America
| | - Jerome Amir Singh
- Center for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lea Pare Toe
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
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Edwards A, Zweigenthal V, Olivier J. Evidence map of knowledge translation strategies, outcomes, facilitators and barriers in African health systems. Health Res Policy Syst 2019; 17:16. [PMID: 30732634 PMCID: PMC6367796 DOI: 10.1186/s12961-019-0419-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/20/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The need for research-based knowledge to inform health policy formulation and implementation is a chronic global concern impacting health systems functioning and impeding the provision of quality healthcare for all. This paper provides a systematic overview of the literature on knowledge translation (KT) strategies employed by health system researchers and policy-makers in African countries. METHODS Evidence mapping methodology was adapted from the social and health sciences literature and used to generate a schema of KT strategies, outcomes, facilitators and barriers. Four reference databases were searched using defined criteria. Studies were screened and a searchable database containing 62 eligible studies was compiled using Microsoft Access. Frequency and thematic analysis were used to report study characteristics and to establish the final evidence map. Focus was placed on KT in policy formulation processes in order to better manage the diversity of available literature. RESULTS The KT literature in African countries is widely distributed, problematically diverse and growing. Significant disparities exist between reports on KT in different countries, and there are many settings without published evidence of local KT characteristics. Commonly reported KT strategies include policy briefs, capacity-building workshops and policy dialogues. Barriers affecting researchers and policy-makers include insufficient skills and capacity to conduct KT activities, time constraints and a lack of resources. Availability of quality locally relevant research was the most reported facilitator. Limited KT outcomes reflect persisting difficulties in outcome identification and reporting. CONCLUSION This study has identified substantial geographical gaps in knowledge and evidenced the need to boost local research capacities on KT practices in low- and middle-income countries. Evidence mapping is also shown to be a useful approach that can assist local decision-making to enhance KT in policy and practice.
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Affiliation(s)
- Amanda Edwards
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Virginia Zweigenthal
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Western Cape Government Health, Cape Town, South Africa
| | - Jill Olivier
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
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Baron D, Essien T, Pato S, Magongo M, Mbandazayo N, Scorgie F, Rees H, Delany‐Moretlwe S. Collateral benefits: how the practical application of Good Participatory Practice can strengthen HIV research in sub-Saharan Africa. J Int AIDS Soc 2018; 21 Suppl 7:e25175. [PMID: 30334610 PMCID: PMC6193316 DOI: 10.1002/jia2.25175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/20/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The Good Participatory Practice (GPP): Guidelines for Biomedical HIV Prevention Trials, second edition (2011) were developed to provide clinical trial sponsors and implementers with a formal stakeholder engagement framework. As one of the largest African research institutes, Wits Reproductive Health and HIV Institute (Wits RHI) became an early adopter of GPP by implementing its principles within large-scale national and regional clinical trials. This article examines Wits RHI's lessons learned from implementing GPP, its ongoing efforts to institutionalize GPP, and the yet to be realized potential in creating fully sustainable structures for meaningful stakeholder engagement in HIV prevention research, implementation science and beyond. DISCUSSION For the past seven years, Wits RHI has undertaken both centralized leadership roles in implementing GPP across multi-party regional research consortia as well as overseeing GPP for smaller investigator-driven trials. Through this iterative roll-out of GPP, key lessons have emerged. Obtaining upfront funding to support GPP activities throughout and between the research life cycle, and a trained multi-disciplinary team of GPP practitioners have helped facilitate an enabling environment for GPP implementation. We further recommend formally integrating stakeholder engagement into study documents, including monitoring and evaluation plans with indicators and performance metrics, to assist teams to track and refine their GPP strategies. Finally, institutionalizing resources and supporting organization-wide GPP along with ongoing support can help build efficiencies and maximize economies of scale toward a pragmatic and innovative application of the GPP Guidelines. CONCLUSIONS Thanks to a growing global network of GPP practitioners and a burgeoning GPP Community of Practice, there has been substantive progress in making GPP an integral component of clinical HIV prevention research. The Wits RHI experience highlights the possibilities and the challenges to translating the GPP principles into concrete practices within specific clinical trials and across a research institute. Realizing the full potential of GPP, including direct and indirect - 'collateral benefits' will require the collective buy-in and support from sponsors, implementers and community stakeholders across the research field. As the HIV prevention research field expands, however, a more conscious and systematic implementation of GPP is timely.
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Affiliation(s)
- Deborah Baron
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Health Behavior at the UNC Gillings School of Global Public HealthJohannesburgSouth Africa
| | | | - Sinazo Pato
- International Partnership for MicrobicidesJohannesburgSouth Africa
| | - Miliswa Magongo
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Fiona Scorgie
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Helen Rees
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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Uzochukwu B, Onwujekwe O, Mbachu C, Okwuosa C, Etiaba E, Nyström ME, Gilson L. The challenge of bridging the gap between researchers and policy makers: experiences of a Health Policy Research Group in engaging policy makers to support evidence informed policy making in Nigeria. Global Health 2016; 12:67. [PMID: 27809862 PMCID: PMC5095957 DOI: 10.1186/s12992-016-0209-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 10/20/2016] [Indexed: 11/26/2022] Open
Abstract
Background Getting research into policy and practice (GRIPP) is a process of going from research evidence to decisions and action. To integrate research findings into the policy making process and to communicate research findings to policymakers is a key challenge world-wide. This paper reports the experiences of a research group in a Nigerian university when seeking to ‘do’ GRIPP, and the important features and challenges of this process within the African context. Methods In-depth interviews were conducted with nine purposively selected policy makers in various organizations and six researchers from the universities and research institute in a Nigerian who had been involved in 15 selected joint studies/projects with Health Policy Research Group (HPRG). The interviews explored their understanding and experience of the methods and processes used by the HPRG to generate research questions and research results; their involvement in the process and whether the methods were perceived as effective in relation to influencing policy and practice and factors that influenced the uptake of research results. Results The results are represented in a model with the four GRIPP strategies found: i) stakeholders’ request for evidence to support the use of certain strategies or to scale up health interventions; ii) policymakers and stakeholders seeking evidence from researchers; iii) involving stakeholders in designing research objectives and throughout the research process; and iv) facilitating policy maker-researcher engagement in finding best ways of using research findings to influence policy and practice and to actively disseminate research findings to relevant stakeholders and policymakers. The challenges to research utilization in health policy found were to address the capacity of policy makers to demand and to uptake research, the communication gap between researchers, donors and policymakers, the management of the political process of GRIPP, the lack of willingness of some policy makers to use research, the limited research funding and the resistance to change. Conclusions Country based Health Policy and Systems Research groups can influence domestic policy makers if appropriate strategies are employed. The model presented gives some direction to potential strategies for getting research into policy and practice in the health care sector in Nigeria and elsewhere.
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Affiliation(s)
- Benjamin Uzochukwu
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu-campus, Nigeria. .,Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-campus, Nigeria. .,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu-campus, Nigeria.
| | - Obinna Onwujekwe
- Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-campus, Nigeria.,Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-campus, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu-campus, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-campus, Nigeria
| | - Chinenye Okwuosa
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-campus, Nigeria
| | - Enyi Etiaba
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu-campus, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu-campus, Nigeria
| | - Monica E Nyström
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Public Health and Clinical Medicine, Umeå university, 901 87, Umeå, Sweden
| | - Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Abstract
The lie has been presented as a performance that protects identities against moral judgment in the context of power imbalances. We explore this assertion from the perspective of a pre-exposure prophylaxis trial to prevent HIV for African women in South Africa, in which context biological evidence of widespread lying about product adherence was produced, resulting in a moral discourse that opposed altruistic and selfish motivations. In this article, we seek to understand the meaning of the lie from the perspective of women trial participants. Seeing the trial as representing a hopeful future, and perfect adherence as sustaining their investment in this, participants recited scripted accounts of adherence and performed the role of the perfect adherer, while identifying other participants as dishonest. Given that clinical trials create moral orders and adherence is key to this, we argue that women embraced the apparatus of the clinical trial to assert their moral subjectivities.
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Affiliation(s)
- Jonathan Stadler
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona Scorgie
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Eirik Saethre
- Department of Anthropology, University of Hawaii, Mānoa, Hawaii
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Hirose A, Hall S, Memon Z, Hussein J. Bridging evidence, policy, and practice to strengthen health systems for improved maternal and newborn health in Pakistan. Health Res Policy Syst 2015; 13 Suppl 1:47. [PMID: 26791789 PMCID: PMC4718025 DOI: 10.1186/s12961-015-0034-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Policy and decision making should be based on evidence, but translating evidence into policy and practice is often sporadic and slow. It is recognised that the relationship between research and policy uptake is complex and that dissemination of research findings is necessary, but insufficient, for policy uptake. Political, social, and economic context, use of (credible) data and dialogues between and across networks of researchers and policymakers play important roles in evidence uptake. Advocacy is the process of mobilising political and public opinions to achieve specific aims and its role is crucial in mobilising key actors to push for policy uptake. Advocacy and research groups (i.e. those who would like to see research evidence used by policymakers) may use different approaches and tools to stimulate the diffusion of research findings. The use of mass- and social media, communication with study participants, and the involvement of stakeholders at the early stages of research development are examples of the approaches that can be employed to stimulate diffusion of evidence and increase evidence uptake. The Research and Advocacy Fund (RAF) for Maternal and Newborn Health (MNH) worked within the health system context in Pakistan with the aim of espousing the principles of evidence, advocacy, and dissemination to improve MNH outcomes. The articles included in this special issue are outputs of RAF and highlight where RAF’s approaches contributed to MNH policy reforms. The papers discuss critical health system issues facing Pakistan, including service delivery components, demand creation, equitable access, transportation interventions for improved referrals, availability of medicines and equipment, and health workforce needs. In addition to these tangible elements, the health system ‘software’, i.e. the power and the political and social contexts, is also represented in the collection. These articles highlight three considerations for the future: the growing importance of implementation research, the crucial need for participation and ownership, and the recognition that policymaking can be ‘informed’ by rather than ‘based-on’ evidence. The future challenge will be to continue the momentum RAF has created and to welcome a new era of health, wealth, and growth for Pakistan.
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Affiliation(s)
- Atsumi Hirose
- Immpact, University of Aberdeen, Foresterhill, Health Sciences Building, Aberdeen, AB25 2ZD, UK.
| | - Sarah Hall
- Research and Advocacy Fund, Islamabad, Pakistan.
| | - Zahid Memon
- Research and Advocacy Fund, Islamabad, Pakistan. .,Greenstar Social Marketing, Karachi, Pakistan.
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Newman PA, Rubincam C, Slack C, Essack Z, Chakrapani V, Chuang DM, Tepjan S, Shunmugam M, Roungprakhon S, Logie C, Koen J, Lindegger G. Towards a Science of Community Stakeholder Engagement in Biomedical HIV Prevention Trials: An Embedded Four-Country Case Study. PLoS One 2015; 10:e0135937. [PMID: 26295159 PMCID: PMC4546590 DOI: 10.1371/journal.pone.0135937] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Broad international guidelines and studies in the context of individual clinical trials highlight the centrality of community stakeholder engagement in conducting ethically rigorous HIV prevention trials. We explored and identified challenges and facilitators for community stakeholder engagement in biomedical HIV prevention trials in diverse global settings. Our aim was to assess and deepen the empirical foundation for priorities included in the GPP guidelines and to highlight challenges in implementation that may merit further attention in subsequent GPP iterations. METHODS From 2008-2012 we conducted an embedded, multiple case study centered in Thailand, India, South Africa and Canada. We conducted in-depth interviews and focus groups with respondents from different trial-related subsystems: civil society organization representatives, community advocates, service providers, clinical trialists/researchers, former trial participants, and key HIV risk populations. Interviews/focus groups were recorded, and coded using thematic content analysis. After intra-case analyses, we conducted cross-case analysis to contrast and synthesize themes and sub-themes across cases. Lastly, we applied the case study findings to explore and assess UNAIDS/AVAC GPP guidelines and the GPP Blueprint for Stakeholder Engagement. RESULTS Across settings, we identified three cross-cutting themes as essential to community stakeholder engagement: trial literacy, including lexicon challenges and misconceptions that imperil sound communication; mistrust due to historical exploitation; and participatory processes: engaging early; considering the breadth of "community"; and, developing appropriate stakeholder roles. Site-specific challenges arose in resource-limited settings and settings where trials were halted. CONCLUSIONS This multiple case study revealed common themes underlying community stakeholder engagement across four country settings that largely mirror GPP goals and the GPP Blueprint, as well as highlighting challenges in the implementation of important guidelines. GPP guidance documents could be strengthened through greater focus on: identifying and addressing the community-specific roots of mistrust and its impact on trial literacy activities; achieving and evaluating representativeness in community stakeholder groups; and addressing the impact of power and funding streams on meaningful engagement and independent decision-making.
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Affiliation(s)
- Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Clara Rubincam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Slack
- HIV/AIDS Vaccines Ethics Group, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Zaynab Essack
- HIV/AIDS Vaccines Ethics Group, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Deng-Min Chuang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Suchon Tepjan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Surachet Roungprakhon
- Faculty of Science and Technology, Rajamangala University of Technology Phra Nakhon, Bangkok, Thailand
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Koen
- HIV/AIDS Vaccines Ethics Group, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Graham Lindegger
- HIV/AIDS Vaccines Ethics Group, School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Magazi B, Stadler J, Delany-Moretlwe S, Montgomery E, Mathebula F, Hartmann M, van der Straten A. Influences on visit retention in clinical trials: insights from qualitative research during the VOICE trial in Johannesburg, South Africa. BMC WOMENS HEALTH 2014; 14:88. [PMID: 25065834 PMCID: PMC4115485 DOI: 10.1186/1472-6874-14-88] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/22/2014] [Indexed: 01/17/2023]
Abstract
Background Although significant progress has been made in clinical trials of women-controlled methods of HIV prevention such as microbicides and Pre-exposure Prophylaxis (PrEP), low adherence to experimental study products remains a major obstacle to being able to establish their efficacy in preventing HIV infection. One factor that influences adherence is the ability of trial participants to attend regular clinic visits at which trial products are dispensed, adherence counseling is administered, and participant safety is monitored. We conducted a qualitative study of the social contextual factors that influenced adherence in the VOICE (MTN-003) trial in Johannesburg, South Africa, focusing on study participation in general, and study visits in particular. Methods The research used qualitative methodologies, including in-depth interviews (IDI), serial ethnographic interviews (EI), and focus group discussions (FGD) among a random sub-sample of 102 female trial participants, 18 to 40 years of age. A socio-ecological framework that explored those factors that shaped trial participation and adherence to study products, guided the analysis. Key codes were developed to standardize subsequent coding and a node search was used to identify texts relating to obstacles to visit adherence. Our analysis includes coded transcripts from seven FGD (N = 40), 41 IDI, and 64 serial EI (N = 21 women). Results Women’s kinship, social, and economic roles shaped their ability to participate in the clinical trial. Although participants expressed strong commitments to attend study visits, clinic visit schedules and lengthy waiting times interfered with their multiple obligations as care givers, wage earners, housekeepers, and students. Conclusions The research findings highlight the importance of the social context in shaping participation in HIV prevention trials, beyond focusing solely on individual characteristics. This points to the need to focus interventions to improve visit attendance by promoting a culture of active and engaged participation.
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Affiliation(s)
| | - Jonathan Stadler
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, PO Box 18512, Johannesburg, South Africa.
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Improving ethical and participatory practice for marginalized populations in biomedical HIV prevention trials: lessons from Thailand. PLoS One 2014; 9:e100058. [PMID: 24949864 PMCID: PMC4064984 DOI: 10.1371/journal.pone.0100058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/21/2014] [Indexed: 12/02/2022] Open
Abstract
Background This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired. Methods In-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP) guided this work. Results Fourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs). Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants' ability to exercise free will. Discussion Biomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical and participatory practice in other parts of the world where biomedical HIV prevention trials occur, and where clinical trials in marginalized populations continue.
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Stadler J, Dugmore C, Venables E, MacPhail C, Delany-Moretlwe S. Cognitive mapping: using local knowledge for planning health research. BMC Med Res Methodol 2013; 13:96. [PMID: 23890232 PMCID: PMC3726480 DOI: 10.1186/1471-2288-13-96] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive mapping is a participatory research methodology that documents, in visual form, a construct of the local environment in which people live and work. We adapted this method to provide detailed data about study locales to inform recruitment and retention strategies for HIV prevention community based clinical trials. METHODS Four cognitive mapping studies were undertaken between 2005 and 2010, in and around Johannesburg in Orange Farm, and Hillbrow. Participants included members of clinical trial Community Advisory Boards (CAB), young people recruited from schools in Hillbrow and an organization for out of school youth, and men recruited from a database of men in the community interested in taking part in research. These groups participated in reconnaissance walks and in depth interviews, and drew detailed sketch maps. RESULTS The cognitive maps defined the physical boundaries of the research locales, provided insights into their social histories, and identified important characteristics of the population such as movement, social and sexual networks, ethnic and other divisions. Important differences between the official cartographic maps and the cognitive maps were raised. The mapping data was applied by identifying key areas for recruitment that recruitment staff members were less familiar with and that may otherwise have been overlooked. CONCLUSIONS Cognitive mapping is an effective, rapid and low cost method that can be used to inform recruitment and retention strategies for community-based clinical trial research. The method also provides a means for clinical trial researchers to involve the local community in research and to familiarise them with the social setting.
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Affiliation(s)
- Jonathan Stadler
- Wits Reproductive Health and HIV Institute, School of Clinical Medicine, Witwatersrand University, PO Box 18512, Hillbrow, Johannesburg, 2038, South Africa.
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Abstract
While the disclosure of research findings is relevant to all types of biomedical research, it has garnered particular attention with respect to genetics and genomics research due to some of the unique aspects of the data and the high public profile of the field. In this chapter, we review the attitudes of stakeholders (research participants, policymakers, and researchers) to define areas of consensus regarding the issue of returning research results across and within groups. In addition to stakeholder attitudes about obligations and interest in research results, other major related issues related to returning research results, such as informed consent, communication of research results, and cost, are discussed. Given the consensus between stakeholders to return summary reports of a study's outcomes and individual research results of clinical significance, we conclude that the time has come to encourage, if not require, researchers to consider these issues in the developmental planning stages of a project and to plan and budget accordingly.
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Affiliation(s)
- Susanne B Haga
- Institute for Genome Sciences & Policy, Duke University, Durham, North Carolina, USA.
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Fernandez CV, Ruccione K, Wells RJ, Long JB, Pelletier W, Hooke MC, Pentz RD, Noll RB, Baker JN, O'Leary M, Reaman G, Adamson PC, Joffe S. Recommendations for the return of research results to study participants and guardians: a report from the Children's Oncology Group. J Clin Oncol 2012; 30:4573-9. [PMID: 23109703 DOI: 10.1200/jco.2012.45.2086] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Children's Oncology Group (COG) strongly supports the widely recognized principle that research participants should be offered a summary of study results. The mechanism by which to do so in a cooperative research group setting has not been previously described. METHODS On the basis of a review of the available empirical and theoretic literature and on iterative, multidisciplinary discussion, a COG Return of Results Task Force (RRTF) offered detailed recommendations for the return of results to research study participants. RESULTS The RRTF established guidelines for the notification of research participants and/or their parents/guardians about the availability of research results, a mechanism for and timing of sharing results via registration on the COG public Web site, the scope of the research to be shared, the target audience, and a process for creating and vetting lay summaries of study results. The RRTF recognized the challenges in adequately conveying complex scientific results to audiences with varying levels of health literacy and recommended that particularly sensitive or complex results be returned using direct personal contact. The RRTF also recommended evaluation of the cost, effectiveness, and impact of sharing results. CONCLUSION These recommendations provide a framework for the offering and returning of results to participants. They can be used by individual investigators, multi-investigator research collaboratives, and large cooperative groups.
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Affiliation(s)
- Conrad V Fernandez
- Izaak Walton Killam and Steven Joffe Health Centre, Dalhousie University, Halifax, Nova Scotia
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Theobald S, Tulloch O, Crichton J, Hawkins K, Zulu E, Mayaud P, Parkhurst J, Whiteside A, Standing H. Strengthening the research to policy and practice interface: exploring strategies used by research organisations working on sexual and reproductive health and HIV/AIDS. Health Res Policy Syst 2011; 9 Suppl 1:S2. [PMID: 21679383 PMCID: PMC3121133 DOI: 10.1186/1478-4505-9-s1-s2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This commentary introduces the HARPS supplement on getting research into policy and practice in sexual and reproductive health (SRH). The papers in this supplement have been produced by the Sexual Health and HIV Evidence into Practice (SHHEP) collaboration of international research, practitioner and advocacy organizations based in research programmes funded by the UK Department for International Development. The commentary describes the increasing interest from research and communication practitioners, policy makers and funders in expanding the impact of research on policy and practice. It notes the need for contextually embedded understanding of ways to engage multiple stakeholders in the politicized, sensitive and often contested arenas of sexual and reproductive health. The commentary then introduces the papers under their respective themes: (1) The theory and practice of research engagement (two global papers); (2) Applying policy analysis to explore the role of research evidence in SRH and HIV/AIDS policy (two papers with examples from Ghana, Malawi, Uganda and Zambia); (3) Strategies and methodologies for engagement (five papers on Kenya, South Africa, Ghana, Tanzania and Swaziland respectively); (4) Advocacy and engagement to influence attitudes on controversial elements of sexual health (two papers, Bangladesh and global); and (5) Institutional approaches to inter-sectoral engagement for action and strengthening research communications (two papers, Ghana and global). The papers illustrate the many forms research impact can take in the field of sexual and reproductive health. This includes discursive changes through carving out legitimate spaces for public debate; content changes such as contributing to changing laws and practices, procedural changes such as influencing how data on SRH are collected, and behavioural changes through partnerships with civil society actors such as advocacy groups and journalists. The contributions to this supplement provide a body of critical analysis of communication and engagement strategies across the spectrum of SRH and HIV/AIDS research through the testing of different models for the research-to-policy interface. They provide new insights on how researchers and communication specialists can respond to changing policy climates to create windows of opportunity for influence.
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Affiliation(s)
- Sally Theobald
- International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Sumner A, Crichton J, Theobald S, Zulu E, Parkhurst J. What shapes research impact on policy? Understanding research uptake in sexual and reproductive health policy processes in resource poor contexts. Health Res Policy Syst 2011; 9 Suppl 1:S3. [PMID: 21679384 PMCID: PMC3121134 DOI: 10.1186/1478-4505-9-s1-s3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Assessing the impact that research evidence has on policy is complex. It involves consideration of conceptual issues of what determines research impact and policy change. There are also a range of methodological issues relating to the question of attribution and the counter-factual. The dynamics of SRH, HIV and AIDS, like many policy arenas, are partly generic and partly issue- and context-specific. Against this background, this article reviews some of the main conceptualisations of research impact on policy, including generic determinants of research impact identified across a range of settings, as well as the specificities of SRH in particular. We find that there is scope for greater cross-fertilisation of concepts, models and experiences between public health researchers and political scientists working in international development and research impact evaluation. We identify aspects of the policy landscape and drivers of policy change commonly occurring across multiple sectors and studies to create a framework that researchers can use to examine the influences on research uptake in specific settings, in order to guide attempts to ensure uptake of their findings. This framework has the advantage that distinguishes between pre-existing factors influencing uptake and the ways in which researchers can actively influence the policy landscape and promote research uptake through their policy engagement actions and strategies. We apply this framework to examples from the case study papers in this supplement, with specific discussion about the dynamics of SRH policy processes in resource poor contexts. We conclude by highlighting the need for continued multi-sectoral work on understanding and measuring research uptake and for prospective approaches to receive greater attention from policy analysts.
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Affiliation(s)
- Andy Sumner
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Jo Crichton
- African Population and Health Research Center (APHRC), Kenya
| | | | - Eliya Zulu
- African Institute for Development Policy (AFIDEP), Kenya
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