Increasing the use of evidence in health policy: practice and views of policy makers and researchers

Research evidence communication for policy-makers: a rapid scoping review on frameworks, guidance and tools, and barriers and facilitators

BACKGROUND

Communication is a multifaceted process, ranging from linear, one-way approaches, such as transmitting a simple message, to continuous exchanges and feedback loops among stakeholders. In particular the COVID-19 pandemic underscored the critical need for timely, effective and credible evidence communication to increase awareness, levels of trust, and evidence uptake in policy and practice. However, whether to improve policy responses in crises or address more commonplace societal challenges, comprehensive guidance on evidence communication to decision-makers in health policies and systems remains limited. Our objective was to identify and systematize the global evidence on frameworks, guidance and tools supporting effective communication of research evidence to facilitate knowledge translation and evidence-informed policy-making processes, while also addressing barriers and facilitators.

METHODS

We conducted a rapid scoping review following the Joanna Briggs Manual. Literature searches were performed across eight indexed databases and two sources of grey literature, without language or time restrictions. The methodological quality of included studies was assessed, and a narrative-interpretative synthesis was applied to present the findings.

RESULTS

We identified 16 documents presenting either complete frameworks or framework components, including guidance and tools, aimed at supporting evidence communication for policy development. These frameworks outlined strategies, theoretical models, barriers and facilitators, as well as insights into policy-makers' perspectives, communication needs, and preferences. Three primary evidence communication strategies, comprising eleven sub-strategies, emerged: "Health information packaging", "Targeting and tailoring messages to the audience", and "Combined communication strategies". Based on the documented barriers and facilitators at micro, meso and macro levels, critical factors for successful communication of evidence to policy-makers were identified.

CONCLUSIONS

Effective communication is indispensable for facilitating knowledge translation and evidence-informed policy-making. Nonetheless gaps persist in frameworks designed to enhance research communication to policy-makers, particularly regarding the effectiveness of multiple communication strategies. To advance in this field, the development of comprehensive frameworks incorporating implementation strategies is warranted. Additionally, barriers and facilitators to implementing effective communication must be recognized and addressed taking diverse contexts into consideration. Registration https://zenodo.org/record/5578550.

How should non-emergency EMS presentations be managed? A thematic analysis of politicians', policymakers', clinicians' and consumers' viewpoints

OBJECTIVE

In 2023, Australian government emergency medical services (EMS) responded to over 4 million consumers, of which over 56% were not classified as an 'emergency', at the cost of AU$5.5 billion. We explored the viewpoints of politicians, policymakers, clinicians and consumers on how these non-emergency requests should be managed.

DESIGN

A realist framework was adopted; a multidisciplinary team (including paramedicine, medicine and nursing) was formed; data were collected via semistructured focus groups or interviews, and thematic analysis was performed.

SETTING AND PARTICIPANTS

56 participants were selected purposefully and via open advertisement: national and state parliamentarians (n=3); government heads of healthcare disciplines (n=3); government policymakers (n=5); industry policymakers in emergency medicine, general practice and paramedicine (n=6); EMS chief executive officers, medical directors and managers (n=7); academics (n=8), frontline clinicians in medicine, nursing and paramedicine (n=8); and consumers (n=16).

RESULTS

Three themes emerged: first, the reality of the EMS workload (theme titled 'facing reality'); second, perceptions of what direction policy should take to manage this ('no silver bullet') and finally, what the future role of EMS in society should be ('finding the right space'). Participants provided 16 policy suggestions, of which 10 were widely supported: increasing public health literacy, removing the Medical Priority Dispatch System, supporting multidisciplinary teams, increasing 24-hour virtual emergency departments, revising undergraduate paramedic university education to reflect the reality of the contemporary role, increasing use of management plans for frequent consumers, better paramedic integration with the healthcare system, empowering callers by providing estimated wait times, reducing ineffective media campaigns to 'save EMS for emergencies' and EMS moving away from hospital referrals and towards community care.

CONCLUSIONS

There is a need to establish consensus on the role of EMS within society and, particularly, on whether the scope should continue expanding beyond emergency care. This research reports 16 possible ideas, each of which may warrant consideration, and maps them onto the standard patient journey.

Researchers' views on and practices of knowledge translation: an international survey of transfusion medicine researchers

BACKGROUND

Health research is often driven by the desire to improve the care and health of the community; however, the translation of research evidence into policy and practice is not guaranteed. Knowledge translation (KT) activities, such as dissemination and end-user engagement by researchers, are important to achieving this goal. This study examined researchers' views on and practices of KT in the field of transfusion medicine.

METHODS

An anonymous, cross-sectional survey was distributed to transfusion medicine researchers in May 2022 by emailing corresponding authors of papers in four major blood journals, emailing grant recipients, posting on social media, and through international blood operator networks. Comparative analyses were conducted for career stage, work setting, research type, and KT training.

RESULTS

The final sample included 117 researchers from 33 countries. Most participants reported that research translation was important (86%) and felt it was their responsibility (69%). Fewer than half felt they had the skills to translate their research (45%) or knew which strategies to employ (45%). When examining how research findings are shared, most reported using diffusion activities (86%), including publishing in peer-reviewed journals (74%), or presenting at academic conferences (72%). Fewer used dissemination methods (60%), such as developing educational materials (29%) or writing plain language summaries (30%). Greater use of tailored dissemination strategies was seen among researchers with KT training, whilst traditional diffusion strategies were used more by those working in an academic setting. Most participants had engaged end-users in their research (72%), primarily to consult on a research component (47%) or to involve them in the research process (45%). End-user engagement was greater among researchers with established careers, working in both academic and applied settings, and with KT training.

CONCLUSIONS

Whilst participating researchers acknowledged the importance of KT, they typically focused on traditional diffusion strategies. This is despite well-established knowledge of the limited impact of these strategies in achieving KT. Those with KT training were more likely to use tailored dissemination strategies and engage end-users in their research. This demonstrates the value of sharing knowledge from the KT field with health researchers to facilitate KT.

Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review

BACKGROUND

An estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review.

METHODS

The scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question.

RESULTS

A total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms.

CONCLUSION

Important barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.

Disseminating health research to public health policy-makers and practitioners: a survey of source, message content and delivery modality preferences

BACKGROUND

Understanding the views of policy-makers and practitioners regarding how best to communicate research evidence is important to support research use in their decision-making.

AIM

To quantify and describe public health policy-makers and practitioners' views regarding the source, content and form of messages describing public health research findings to inform their decision-making. We also sought to examine differences in preferences between public health policy-makers and practitioners.

METHODS

A cross sectional, value-weighting survey of policy-makers and practitioners was conducted. Participants were asked to allocate a proportion of 100 points across different (i) sources of research evidence, (ii) message content and (iii) the form in which evidence is presented. Points were allocated based on their rating of influence, usefulness and preference when making decisions about health policy or practice.

RESULTS

A total of 186 survey responses were received from 90 policy-makers and 96 practitioners. Researchers and government department agencies were the most influential source of research evidence based on mean allocation of points, followed by knowledge brokers, professional peers and associations. Mean point allocation for perceived usefulness of message content was highest for simple summary of key findings and implications, and then evidence-based recommendations and data and statistical summaries. Finally, based on mean scores, policy-makers and practitioners preferred to receive research evidence in the form of peer-reviewed publications, reports, evidence briefs and plain language summaries. There were few differences in scores between policy-makers and practitioners across source, message content or form assessments or those with experience in different behavioural areas.

CONCLUSIONS

The findings should provide a basis for the future development and optimization of dissemination strategies to this important stakeholder group.

The who, what, where, when and why of engaging with policymakers: A critical reflection

Improving relationships between researchers and policymakers is one element of knowledge mobilisation that has proven to increase the translation of research into policy. However, researchers report they find it difficult to engage policymakers with research. In this article, a personal narrative approach was used to analyse my experience, as a PhD candidate, when engaging policymakers to participate in a qualitative research study. A total of 93 contacts were made in an attempt to recruit policymakers; these contacts consisted of both policymakers and knowledge brokers. The experience of contacting and engaging with policymakers identified barriers other researchers may experience and offers enablers to assist when engaging policymakers. This reflective approach resulted in the development of the five following themes: who you know, what ifs, when is it enough, where is the research going and why value is important. These five themes can act as a guide for researchers when preparing to engage policymakers into research.

The relationship between methodological quality and the use of retracted publications in evidence syntheses

BACKGROUND

Evidence syntheses cite retracted publications. However, citation is not necessarily endorsement, as authors may be criticizing or refuting its findings. We investigated the sentiment of these citations-whether they were critical or supportive-and associations with the methodological quality of the evidence synthesis, reason for the retraction, and time between publication and retraction.

METHODS

Using a sample of 286 evidence syntheses containing 324 citations to retracted publications in the field of pharmacy, we used AMSTAR-2 to assess methodological quality. We used scite.ai and a human screener to determine citation sentiment. We conducted a Pearson's chi-square test to assess associations between citation sentiment, methodological quality, and reason for retraction, and one-way ANOVAs to investigate association between time, methodological quality, and citation sentiment.

RESULTS

Almost 70% of the evidence syntheses in our sample were of critically low quality. We found that these critically low-quality evidence syntheses were more associated with positive statements while high-quality evidence syntheses were more associated with negative citation of retracted publications. In our sample of 324 citations, 20.4% of citations to retracted publications noted that the publication had been retracted.

CONCLUSION

The association between high-quality evidence syntheses and recognition of a publication's retracted status may indicate that best practices are sufficient. However, the volume of critically low-quality evidence syntheses ultimately perpetuates the citation of retracted publications with no indication of their retracted status. Strengthening journal requirements around the quality of evidence syntheses may lessen the inappropriate citation of retracted publications.

Experiences of knowledge translation among researchers in transfusion medicine: Findings from an international survey study

BACKGROUND

Translation of research knowledge is critical to ensure transfusion medicine policies and practices reflect current evidence and so effectively support the health of blood donors and recipients, as well as ensuring ongoing blood supply. The aim of this study was to investigate the barriers and facilitators of knowledge translation (KT) among transfusion medicine researchers and determine what KT supports are needed.

STUDY DESIGN AND METHODS

An anonymous, cross-sectional survey was distributed by emailing corresponding authors of papers in four major blood journals, emailing grant recipients in the area of transfusion medicine, posting on social media, and through an international blood operator network.

RESULTS

The final sample included 105 researchers. Participants had a positive orientation toward KT, with few perceiving KT as not relevant to their research or beneficial for their careers. However, many reported facing difficulties practicing KT due to time constraints, competing priorities, or lack of funds or resources. Fostering relationships with stakeholders was seen as a key facilitator of KT but a number of researchers expressed difficulties engaging and communicating with them. Collaboration opportunities, protected time for KT, and access to KT resources were some of the supports researchers felt were required to help their KT efforts.

CONCLUSION

To minimize the knowledge to practice gap in transfusion medicine and ensure findings from research lead to improved outcomes, organizations need to support researchers in their KT efforts and facilitate interactions between researchers and research end-users.

Health promotion and disease prevention registries in the EU: a cross country comparison

BACKGROUND

Health promotion and disease prevention programme registries (HPPRs), also called 'best practice portals', serve as entry points and practical repositories that provide decision-makers with easy access to (evidence-based) practices. However, there is limited knowledge of differences or overlaps of howe current national HPPRs in Europe function, the context and circumstances in which these HPPRs were developed, and the mechanisms utilised by each HPPR for the assessment, classification and quality improvement of the included practices. This study prepared an overview of different approaches in several national HPPRs and the EU Best Practice Portal (EU BPP) as well as identified commonalities and differences among the core characteristics of the HPPRs.

METHODS

We conducted a descriptive comparison - that focused on six European countries with existing or recently developed/implemented national HPPR and the EU BPP -to create a comparative overview. We used coding mechanisms to identify commonalities and differences; we performed data management, collection and building consensus during EuroHealthNet Thematic Working Group meetings.

RESULTS

All HPPRs offer a broad range of health promotion and disease-prevention practices and serve to support practitioners, policymakers and researchers in selecting practices. Almost all HPPRs have an assessment process in place or planned, requiring the application of assessment criteria that differ among the HPPRs. While all HPPRs collect and share recommendable practices, others have implemented further measures to improve the quality of the submitted practices. Different dissemination tools and strategies are employed to promote the use of the HPPRs, including social media, newsletters and publications as well as capacity building workshops for practice owners or technical options to connect citizens/patients with local practices.

CONCLUSIONS

Collaboration between HPPRs (at national and EU level) is appreciated, especially regarding the use consistent terminology to avoid misinterpretation, facilitate cross-country comparison and enable discussions on the adaption of assessment criteria by national HPPRs. Greater efforts are needed to promote the actual implementation and transfer of practices at the national level to address public health challenges with proven and effective practices.

Dissemination of public health research to prevent non-communicable diseases: a scoping review

BACKGROUND

Dissemination is a critical element of the knowledge translation pathway, and a necessary step to ensure research evidence is adopted and implemented by key end users in order to improve health outcomes. However, evidence-based guidance to inform dissemination activities in research is limited. This scoping review aimed to identify and describe the scientific literature examining strategies to disseminate public health evidence related to the prevention of non-communicable diseases.

METHODS

Medline, PsycInfo and EBSCO Search Ultimate were searched in May 2021 for studies published between January 2000 and the search date that reported on the dissemination of evidence to end users of public health evidence, within the context of the prevention of non-communicable diseases. Studies were synthesised according to the four components of Brownson and colleagues' Model for Dissemination of Research (source, message, channel and audience), as well as by study design.

RESULTS

Of the 107 included studies, only 14% (n = 15) directly tested dissemination strategies using experimental designs. The remainder primarily reported on dissemination preferences of different populations, or outcomes such as awareness, knowledge and intentions to adopt following evidence dissemination. Evidence related to diet, physical activity and/or obesity prevention was the most disseminated topic. Researchers were the source of disseminated evidence in over half the studies, and study findings/knowledge summaries were more frequently disseminated as the message compared to guidelines or an evidence-based program/intervention. A broad range of dissemination channels were utilised, although peer-reviewed publications/conferences and presentations/workshops predominated. Practitioners were the most commonly reported target audience.

CONCLUSIONS

There is a significant gap in the peer reviewed literature, with few experimental studies published that analyse and evaluate the effect of different sources, messages and target audiences on the determinants of uptake of public health evidence for prevention. Such studies are important as they can help inform and improve the effectiveness of current and future dissemination practices in public health contexts.

Evidence in decision-making in the context of COVID-19 in Latin America

Background

The pace of the COVID-19 pandemic poses an unprecedented challenge to the evidence-to-decision process. Latin American countries have responded to COVID-19 by introducing interventions to both mitigate the risk of infection and to treat cases. Understanding how evidence is used to inform government-level decision-making at a national scale is crucial for informing country and regional actors in ongoing response efforts.

Objectives

This study was undertaken between February-May 2021 and aims to characterise the best available evidence (BAE) and assess the extent to which it was used to inform decision-making in 21 Latin American countries, in relation to pharmaceutical (PI) and non-pharmaceutical interventions (NPI) related to COVID-19, including the use of therapeutics (corticosteroids, hydroxychloroquine/chloroquine and ivermectin), facemask use in the community setting and the use of diagnostic tests as a requirement for international travel.

Method

A three-phase methodology was used to; (i) characterise the BAE for each intervention using an umbrella review, (ii) identify government-level decisions for each intervention through a document review and (iii) assess the use of evidence to inform decisions using a novel adapted framework analysis.

Findings

The BAE is characterized by 17 living and non-living systematic reviews as evolving, and particularly uncertain for NPIs. 107 country-level documents show variation in both content and timing of decision outcomes across intervention types, with the majority of decisions taken at a time of evidence uncertainty, with only 5 documents including BAE. Seven out of eight key indicators of an evidence-to-decision process were identified more frequently among PIs than either NPI of facemask use or testing prior to travel. Overall evidence use was reported more frequently among PIs than either NPI of facemask use or travel testing (92%, 28% and 29%, respectively).

Interpretation

There are limitations in the extent to which evidence use in decision-making is reported across the Latin America region. Institutionalising this process and grounding it in existing and emerging methodologies can facilitate the rapid response in an emergency setting.

Funding

No funding was sourced for this work.

Researchers’ perspective of real-world impact from UK public health research: A qualitative study

Research funded by the National Institute for Health Research Public Health Research Programme is being undertaken in a complex system which brings opportunities and challenges for researchers to maximise the impact of their research. This study seeks to better understand the facilitators, challenges and barriers to research impact and knowledge mobilisation from the perspective of UK public health researchers. A qualitative study using semi-structured interviews, informed by the Payback Framework, with public health researchers who held a research award with the National Institute for Health Research Public Health Research programme up to March 2017 was conducted. Following a thematic analysis, three strongly interlinked themes were extracted from the data and three key factors were highlighted as important for facilitating knowledge mobilisation and impact in UK public health research: (1) Public health researcher’s perception of the purpose of the research (2) Approaches to undertaking Knowledge mobilisation activities (3) The complex nature of public health research in the wider research context. These have been reflected onto the Payback framework. Public health researchers can maximise the likelihood for impact by being aware of the context in which they are undertaking research, using different methods, and employing several strategies to take advantage of opportunities. There is a need to support researchers with knowledge mobilisation activities and for funders to identify their expectations of the impact resulting from research. Our findings have relevance to public health researchers and funders interested in increasing the benefit that research brings to society.

A knowledge implementation model in health system management based on the PARIHS model

BACKGROUND

The gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran.

METHODS

The present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software.

RESULTS

 The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model.

CONCLUSION

 The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.

Health workforce policy and plan implementation in the context of universal health coverage in the Africa Region

Several countries in Africa have developed human resources for health (HRH) policies and strategies to synergise efforts in setting priorities, directions and means to address the major challenges around leadership and governance, production, recruitment, management, motivation and retention and coordination. In this paper, we present information on the availability, quality and implementation of national HRH policies and strategic plans in the WHO Africa Region. Information was obtained using a questionnaire completed by the head of HRH departments in the Ministries of Health of 47 countries in the WHO Africa Region. Of the 47 countries in the Region, 57% (27 countries) had HRH policies and 11% (5 countries) were in the process of developing one. Thirty-two countries (68%) had national strategic plans for HRH with 12 (26%) being in the process of developing a strategic plan, and 28 countries reporting the implementation of their strategic plans. On the quality of the policies and strategic plans, 28 countries (88%) linked their plans to the national development plan, 30 countries (94%) informed their policy and plan using the national health policy and strategic plans. Evidence-based HRH policies and plans guide the actions of actors in strengthening health systems. Countries need to invest in developing quality HRH policies and plans through an intersectoral approach and based on contextual evidence. This is vital in ensuring that equitably distributed, well-regulated and motivated HRH are available to deliver people-centred health services to the population.

Approaches to prioritising primary health research: a scoping review

Objective

To systematically identify and describe approaches to prioritise primary research topics in any health-related area.

Methods

We searched Medline and CINAHL databases and Google Scholar. Teams of two reviewers screened studies and extracted data in duplicate and independently. We synthesised the information across the included approaches by developing common categorisation of relevant concepts.

Results

Of 44 392 citations, 30 articles reporting on 25 approaches were included, addressing the following fields: health in general (n=9), clinical (n=10), health policy and systems (n=10), public health (n=6) and health service research (n=5) (10 addressed more than 1 field). The approaches proposed the following aspects to be addressed in the prioritisation process: situation analysis/ environmental scan, methods for generation of initial list of topics, use of prioritisation criteria, stakeholder engagement, ranking process/technique, dissemination and implementation, revision and appeal mechanism, and monitoring and evaluation. Twenty-two approaches proposed involving stakeholders in the priority setting process. The most commonly proposed stakeholder category was ‘researchers/academia’ (n=17, 77%) followed by ‘healthcare providers’ (n=16, 73%). Fifteen of the approaches proposed a list of criteria for determining research priorities. We developed a common framework of 28 prioritisation criteria clustered into nine domains. The criterion most frequently mentioned by the identified approaches was ‘health burden’ (n=12, 80%), followed by ‘availability of resources’ (n=11, 73%).

Conclusion

We identified and described 25 prioritisation approaches for primary research topics in any health-related area. Findings highlight the need for greater participation of potential users (eg, policy-makers and the general public) and incorporation of equity as part of the prioritisation process. Findings can guide the work of researchers, policy-makers and funders seeking to conduct or fund primary health research. More importantly, the findings should be used to enhance a more coordinated approach to prioritising health research to inform decision making at all levels.

A framework of evidence-based decision-making in health system management: a best-fit framework synthesis

Background

Scientific evidence is the basis for improving public health; decision-making without sufficient attention to evidence may lead to unpleasant consequences. Despite efforts to create comprehensive guidelines and models for evidence-based decision-making (EBDM), there isn`t any to make the best decisions concerning scarce resources and unlimited needs. The present study aimed to develop a comprehensive applied framework for EBDM.

Methods

This was a Best-Fit Framework (BFF) synthesis conducted in 2020. A comprehensive systematic review was done via six main databases including PUBMED, Scopus, Web of Science, Science Direct, EMBASE, and ProQuest using related keywords. After the evidence quality appraisal, data were extracted and analyzed via thematic analysis. Results of the thematic analysis and the concepts generated by the research team were then synthesized to achieve the best-fit framework applying Carroll et al. (2013) approach.

Results

Four thousand six hundred thirteen studies were retrieved, and due to the full-text screening of the studies, 17 final articles were selected for extracting the components and steps of EBDM in Health System Management (HSM). After collecting, synthesizing, and categorizing key information, the framework of EBDM in HSM was developed in the form of four general scopes. These comprised inquiring, inspecting, implementing, and integrating, which included 10 main steps and 47 sub-steps.

Conclusions

The present framework provided a comprehensive guideline that can be well adapted for implementing EBDM in health systems and related organizations especially in underdeveloped and developing countries where there is usually a lag in updating and applying evidence in their decision-making process. In addition, this framework by providing a complete, well-detailed, and the sequential process can be tested in the organizational decision-making process by developed countries to improve their EBDM cycle.

Individual and institutional capacity-building for evidence-informed health policy-making in Iran: a mix of local and global evidence

Background

Providing valid evidence to policy-makers is a key factor in the development of evidence-informed policy-making (EIPM). This study aims to review interventions used to promote researchers’ and knowledge-producing organizations’ knowledge and skills in the production and translation of evidence to policy-making and explore the interventions at the individual and institutional level in the Iranian health system to strengthen EIPM.

Methods

The study was conducted in two main phases: a systematic review and a qualitative study. First, to conduct the systematic review, the PubMed and Scopus databases were searched. Quality appraisal was done using the Joanna Briggs Institute checklists. Second, semi-structured interviews and document review were used to collect local data. Purposive sampling was used and continued until data saturation. A qualitative content analysis approach was used for data analysis.

Results

From a total of 11,514 retrieved articles, 18 papers were eligible for the analysis. Based on the global evidence, face-to-face training workshops for researchers was the most widely used intervention for strengthening researchers’ capacity regarding EIPM. Target audiences in almost all of the training programmes were researchers. Setting up joint training sessions that helped empower researchers in understanding the needs of health policy-makers had a considerable effect on strengthening EIPM. Based on the local collected evidence, the main interventions for individual and institutional capacity-building were educational and training programmes or courses related to the health system, policy-making and policy analysis, and research cycle management. To implement the individual and institutional interventions, health system planners and authorities and the community were found to have a key role as facilitating factors.

Conclusion

The use of evidence-based interventions for strengthening research centres, such as training health researchers on knowledge translation and tackling institutional barriers that can prevent well-trained researchers from translating their knowledge, as well as the use of mechanisms and networks for effective interactions among policy-makers at the macro and meso (organizational) level and the research centre, will be constructive for individual and institutional capacity-building. The health system needs to strengthen its strategic capacity to facilitate an educational and training culture in order to motivate researchers in producing appropriate evidence for policy-makers.

A new measure to understand the role of science in US Congress: lessons learned from the Legislative Use of Research Survey (LURS)

BACKGROUND

There is growing interest in and recognition of the need to use scientific evidence to inform policymaking. However, many of the existing studies on the use of research evidence (URE) have been largely qualitative, and the majority of existing quantitative measures are underdeveloped or were tested in regional or context-dependent settings. We are unaware of any quantitative measures of URE with national policymakers in the US.

AIMS AND OBJECTIVES

Explore how to measure URE quantitatively by validating a measure of congressional staff's attitudes and behaviors regarding URE, the Legislative Use of Research Survey (LURS), and by discussing the lessons learned through administering the survey.

METHODS

A 68-item survey was administered to 80 congressional staff to measure their reported research use, value of research, interactions with researchers, general information sources, and research information sources. Confirmatory factor analyses were conducted on each of these five scales. We then trimmed the number of items, based on a combination of poor factor loadings and theoretical rationale, and ran the analyses on the trimmed subscales.

FINDINGS

We substantially improved our model fits for each scale over the original models and all items had acceptable factor loadings with our trimmed 35-item survey. We also describe the unique set of challenges and lessons learned from surveying congressional staff.

DISCUSSION AND CONCLUSIONS

This work contributes to the transdisciplinary field of URE by offering a tool for studying the mechanisms that can bridge research and policy and shedding light into best practices for measuring URE with national policymakers in the US.

An Intervention Mapping Study: Developing the Choosing Health digital weight loss and maintenance intervention (Preprint)

Background

Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are widely accessible, personalized, and theory- and evidence-based are still limited.

Objective

This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use these to provide tailored support.

Methods

We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research—including 4 focus groups (n=40), expert consultations (n=12), and interviews (n=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector).

Results

Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources.

Conclusions

The use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs.

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2020-040183

Getting Evidence From Health Policy and Systems Research Into Policy and Practice for Controlling Endemic Tropical Diseases in Nigeria: Assessing Knowledge, Capacity, and Use

Background

Getting evidence from Health Policy and Systems Research (HPSR) into policy and practice for effective control of neglected tropical diseases (NTDs) is essential for providing better service delivery because evidence-informed decision-making improves the effectiveness of a health system and health outcomes. The paper provides new knowledge on the policy-/decision-makers’ level of knowledge, capacity to use, and how evidence from HPSR has been used in decision-making for the control of endemic tropical diseases (ETDs), especially the NTDs and malaria in Nigeria.

Methods

A cross-sectional qualitative study of decision-makers was undertaken in Anambra and Enugu states, southeast Nigeria. Data was collected through in-depth interviews (n=22) of purposively selected decision-makers to assess how HPSR evidence is translated into policy and practice for controlling ETDs. The respondents were selected based on their job description, roles, and involvement in the control of ETDs. Data were analyzed using the thematic content approach.

Results

There is a considerable level of knowledge on HPSR and its relationship with evidence-informed policy- and decision-making towards control of ETDs and health system strengthening. Organizational capacity to use HPSR evidence in decision-making was found to be weak due to various reasons such as no embedded structure for translating research evidence to policy and practice, lack of decision-making autonomy by individuals, and politically driven decisions. Few respondents have either ever used or are currently using HPRS evidence for developing/reviewing and implementing strategies for ETDs programs. Majority of the respondents reported that their main source of evidence was routine data from health information management system, which they found useful due to its representativeness and completeness. Main enabler for using HPSR evidence for decision-making is existing collaborations between researchers and policy-/decision-makers.

Conclusion

There is a high level of awareness about evidence from HPSR and the usefulness of such evidence in decision-making. However, this awareness does not translate to optimal use of evidence for decision-making due to weak organizational capacity and other constraints. There is the need to invest in capacity-building activities to develop a critical mass of users of evidence (policy-/decision-makers) to facilitate enhanced uptake of high-quality evidence into policy decisions for better control of ETDs.

Opportunities and disconnects in the use of primary research on schistosomiasis and soil-transmitted helminths for policy and practice: results from a survey of researchers

Even with efforts to facilitate use of evidence in health policy and practice, limited attention has been paid to researchers' perspectives on use of their research in informing public health policy and practice at local, national, and global levels. We conducted a systematic literature search to identify published primary research related to schistosomiasis or soil-transmitted helminths, or both. We then surveyed corresponding authors. Results indicate differences by locations of authors and in conduct of research, especially for research conducted in low- and middle-income countries. Our findings exemplify disparities in research leadership discussed elsewhere. Researchers' perspectives on the use of their work suggest limited opportunities and 'disconnects' that hinder their engagement with policy and other decision-making processes. These findings highlight a need for additional efforts to address structural barriers and enable engagement between researchers and decision-makers.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

NA.

Preferred Child Obesity Message Frames and Their Perceived Strength among State Policymakers

Background: Health message framing, including gain or loss frames, can influence perceptions of child health messaging. It is unknown how characteristics such as political party and education may impact policymakers' message frame preference and perceived strength of child obesity messages. The purpose of this study was to examine preferred child obesity message frame, perceived strength of child obesity messages, and group differences among state policymakers. Methods: A cross-sectional online survey was administered in-person to state representatives and senators via electronic tablet between February and May, 2019, at a midwest State Capitol building. Participants were asked their message frame preference and perceived strength of child obesity messages related to long-term health, school, geographic region, military readiness, cost-savings, and the workforce. They were also asked who was responsible for preventing child obesity and strategies to prevent it. Data were analyzed descriptively and via chi-square tests for group differences. Results: One hundred fifteen state policymakers completed the survey. Participants overall favored gain-framed messages, which were perceived as stronger than loss-framed. Parents were viewed as most responsible overall for preventing child obesity, with Republicans (vs. Democrats; χ² = 8.54; p = 0.008) and those with less education (vs. more; χ² = 5.97; p = 0.029) perceiving them as more responsible (χ² = 8.54; p = 0.008). Democrats viewed the food industry as more responsible (χ² = 11.4; p = 0.001) than Republicans. Increasing physical activity, nutrition education, and fresh fruits and vegetables in schools were the most preferred prevention strategies. Conclusions: Child health advocates should consider using gain-framed messages related to child obesity when communicating with policymakers, and targeting their preferred strategies may enhance policy development.

The how and why of producing policy relevant research: perspectives of Australian childhood obesity prevention researchers and policy makers

BACKGROUND

Understanding why research is conducted may help address the under-utilisation of research. This study examined the reasons for childhood obesity prevention knowledge production in New South Wales (NSW), Australia, and the factors influencing research choices from the perspective of the researchers and health policy agencies contributing to the research.

METHODS

A literature search of SCOPUS and ISI Web of Knowledge (affiliation and key word searches) was conducted to compile a database of NSW childhood obesity research outputs, published between 2000 and 2015 (n = 543). Descriptive statistics were used to quantify outputs by research type, differentiating measurement, descriptive, and intervention research, systematic reviews and other publications. Interviews were conducted with a sample of researchers drawn from the database (n = 13) and decision makers from health policy agencies who funded and contributed to childhood obesity research in NSW (n = 15). Researcher interviews examined views about societal impacts, why and under what circumstances the research was conducted. Decision-maker interviews examined policy agency research investment and how research was used in decision making. Content analysis and a thematic approach was used to analyse the interview transcripts.

RESULTS

The research in this case was conducted for mix of reasons including those traditionally associated with academic inquiry, as well as intentions to influence policy and practice. Differences in funding mechanisms, administrative and employment arrangements, and 'who' initiated the research, created differing incentives and perspectives for knowledge production. Factors associated with the characteristics and experience of the individuals involved also influenced goals, as did the type of research conducted. Policy agencies played a role in directing research to address policy needs.

CONCLUSIONS

The findings of this study confirm that researchers are strongly influenced by their working environment. Funding schemes and other incentives to support policy relevant knowledge production are important. Contextual factors such as policy priorities, policy-driven research funding and the embedded nature or strong connections between some researchers and the policy agencies involved, are likely to have influenced the extent to which policy goals were reported in this study.

Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens' Jury

BACKGROUND

Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked 'What considerations are important to include in a model of care of brain injury rehabilitation?'

METHODS

Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days.

RESULTS

Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made.

CONCLUSION

Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term.

PATIENT AND PUBLIC CONTRIBUTION

As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.

Strategies for effective dissemination of research to United States policymakers: a systematic review

BACKGROUND

Research has the potential to influence US social policy; however, existing research in this area lacks a coherent message. The Model for Dissemination of Research provides a framework through which to synthesize lessons learned from research to date on the process of translating research to US policymakers.

METHODS

The peer-reviewed and grey literature was systematically reviewed to understand common strategies for disseminating social policy research to policymakers in the United States. We searched Academic Search Premier, PolicyFile, SocINDEX, Social Work Abstracts, and Web of Science from January 1980 through December 2019. Articles were independently reviewed and thematically analyzed by two investigators and organized using the Model for Dissemination of Research.

RESULTS

The search resulted in 5225 titles and abstracts for inclusion consideration. 303 full-text articles were reviewed with 27 meeting inclusion criteria. Common sources of research dissemination included government, academic researchers, the peer reviewed literature, and independent organizations. The most frequently disseminated research topics were health-related, and legislators and executive branch administrators were the most common target audience. Print materials and personal communication were the most common channels for disseminating research to policymakers. There was variation in dissemination channels by level of government (e.g., a more formal legislative process at the federal level compared with other levesl). Findings from this work suggest that dissemination is most effective when it starts early, galvanizes support, uses champions and brokers, considers contextual factors, is timely, relevant, and accessible, and knows the players and process.

CONCLUSIONS

Effective dissemination of research to US policymakers exists; yet, rigorous quantitative evaluation is rare. A number of cross-cutting strategies appear to enhance the translation of research evidence into policy.

REGISTRATION

Not registered.

Scaling up population health interventions from decision to sustainability - a window of opportunity? A qualitative view from policy-makers

Background

While known efficacious preventive health interventions exist, the current capacity to scale up these interventions is limited. In recent years, much attention has focussed on developing frameworks and methods for scale-up yet, in practice, the pathway for scale-up is seldom linear and may be highly dependent on contextual circumstances. Few studies have examined the process of scaling up from decision to implementation nor examined the sustainability of scaled-up interventions. This study explores decision-makers’ perceptions from real-world scaled-up case studies to examine how scale-up decisions were made and describe enablers of successful scale-up and sustainability.

Methods

This qualitative study included 29 interviews conducted with purposively sampled key Australian policy-makers, practitioners and researchers experienced in scale-up. Semi-structured interview questions obtained information regarding case studies of scaled-up interventions. The Framework Analysis method was used as the primary method of analysis of the interview data to inductively generate common and divergent themes within qualitative data across cases.

Results

A total of 31 case studies of public health interventions were described by interview respondents based on their experiences. According to the interviewees’ perceptions, decisions to scale up commonly occurred either opportunistically, when funding became available, or when a deliberate decision was made and funding allocated. The latter scenario was more common when the intervention aligned with specific political or strategic goals. Decisions to scale up were driven by a variety of key actors such as politicians, senior policy-makers and practitioners in the health system. Drivers of a successful scale-up process included good governance, clear leadership, and adequate resourcing and expertise. Establishing accountability structures and appropriate engagement mechanisms to encourage the uptake of interventions were also key enablers. Sustainability was influenced by evidence of impact as well as good acceptability among the general or target population.

Conclusions

Much like Kingdon’s Multiple Streams Theory of ‘policy windows’, there is a conceptually similar ‘window for scale-up’, driven by a complex interplay of factors such as political need, strategic context, funding and key actors. Researchers and policy-makers need to consider scalability from the outset and prepare for when the window for scale-up opens. Decision-makers need to provide longer term funding for scale-up to facilitate longer term sustainability and build on the resources already invested for the scale-up process.

Review of published evidence on knowledge translation capacity, practice and support among researchers and research institutions in low- and middle-income countries

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.

Integrating evidence from research into decision-making for controlling endemic tropical diseases in South East Nigeria: perceptions of producers and users of evidence on barriers and solutions

Background

Endemic tropical diseases (ETDs) constitute a significant health burden in resource-poor countries. Weak integration of research evidence into policy and practice poses a major challenge to the control of ETDs. This study was undertaken to explore barriers to the use of research evidence in decision-making for controlling ETDs. It also highlights potential strategies for addressing these barriers, including the gaps in research generation and utilisation in the context of endemic disease control.

Methods

Information on barriers and solutions to integrating research evidence into decision-making for controlling ETDs in Anambra State, Nigeria, was collected from 68 participants (producers and users of evidence) during structured discussions in a workshop. Participants were purposively selected and allocated to groups based on their current involvement in endemic disease control and expertise. Discussions were facilitated with a topic guide and detailed notes were taken by an appointed recorder. Outputs from the discussions were synthesised and analysed manually.

Results

Cross-cutting barriers include a weak research linkage between producers and users of evidence and weak capacity to undertake health policy and systems research (HPSR). Producers of evidence were purported to conceptualise and frame their research questions based on their academic interests and funders’ focus without recourse to the decision-makers. Conversely, poor demand for research evidence was reported among users of evidence. Another user barrier identified was moribund research units of the Department of Planning Research and Statistics within the State Ministry of Health. Potential solutions for addressing these barriers include creation of knowledge networks and partnerships between producers and users of evidence, institutionalisation of sustainable capacity-building of both parties in HPSR and revival of State research units.

Conclusions

Evidence-informed decision-making for controlling ETDs is limited by constraints in the interactions of some factors between the users (supply side) and producers (demand side) of evidence. These constraints could be solved through stronger research collaborations, institutionalisation of HPSR, and frameworks for getting research into policy and practice.

Experience of Health Leadership in Partnering With University-Based Researchers in Canada - A Call to "Re-imagine" Research

BACKGROUND

Emerging evidence that meaningful relationships with knowledge users are a key predictor of research use has led to promotion of partnership approaches to health research. However, little is known about health system experiences of collaborations with university-based researchers, particularly with research partnerships in the area of health system design and health service organization. The purpose of the study was to explore the experience and perspectives of senior health managers in health service organizations, with health organization-university research partnerships.

METHODS

In-depth, semi-structured interviews (n = 25) were conducted with senior health personnel across Canada to explore their perspectives on health system research; experiences with health organization-university research partnerships; challenges to partnership research; and suggested actions for improving engagement with knowledge users and promoting research utilization. Participants, recruited from organizations with regional responsibilities, were responsible for system-wide planning and support functions.

RESULTS

Research is often experienced as unhelpful or irrelevant to decision-making by many within the system. Research, quality improvement (QI) and evaluation are often viewed as separate activities and coordinated by different responsibility areas. Perspectives of senior managers on barriers to partnership differed from those identified in the literature: organizational stress and restructuring, and limitations in readiness of researchers to work in the fast-paced healthcare environment, were identified as major barriers. Although the need for strong executive leadership was emphasized, "multi-system action" is needed for effective partnerships.

CONCLUSION

Common approaches to research and knowledge translation are often not appropriate for addressing issues of health service design and health services organization. Nor is the research community providing expertise to many important activities that the healthcare system is taking to improve health services. A radical rethinking of how we prepare health service researchers; position research within the health system; and fund research activities and infrastructure is needed if the potential benefits of research are to be achieved. Lack of response to health system needs may contribute to research and 'evidence-informed' practice being further marginalized from healthcare operations. Interventions to address barriers must respond to the perspectives and experience of health leadership.

Comitê Gestor da Pesquisa como dispositivo estratégico para uma pesquisa de implementação em saúde mental

RESUMO Os objetivos do presente estudo foram identificar e analisar as contribuições do Comitê Gestor da Pesquisa para o acesso aos desfechos relacionados à implementação, em uma pesquisa conduzida no campo da saúde mental. Trata-se de um estudo qualitativo que adotou como recurso metodológico a realização de grupo focal e o levantamento dos dados registrados nas atas dos encontros promovidos pelo Comitê. Por meio do estudo, foi possível identificar que o Comitê Gestor da Pesquisa favoreceu a participação das partes interessadas em diversos aspectos da pesquisa; possibilitou a avaliação e o monitoramento do sentido e da viabilidade da pesquisa para o campo de estudo, sob a ótica de quem vive a experiência do cotidiano do trabalho e do cuidado; e favoreceu o acesso a alguns desfechos da pesquisa de implementação de forma contínua e mais significativa para aqueles que se beneficiariam dela. Neste sentido, sugere-se aos pesquisadores e às agências envolvidas nesse tipo de estudo a adoção dessa ferramenta como uma possibilidade de tornar a pesquisa um processo mais dialógico e potencialmente transformador.

Policy analysis of the Iranian Health Transformation Plan in primary healthcare

BACKGROUND

Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran.

METHODS

Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson's policy triangle model incorporating the stages heuristic model was used to guide data analysis.

RESULTS

The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development - a gap that occurred because politicians were in a great haste to fulfil a campaign promise.

CONCLUSIONS

Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives.

Evidence, Emotion and Eminence: A Qualitative and Evaluative Analysis of Doctors' Skills in Macroallocation

In this analysis of the ethical dimensions of doctors' participation in macroallocation we set out to understand the skills they use, how they are acquired, and how they influence performance of the role. Using the principles of grounded moral analysis, we conducted a semi-structured interview study with Australian doctors engaged in macroallocation. We found that they performed expertise as argument, bringing together phronetic and rhetorical skills founded on communication, strategic thinking, finance, and health data. They had made significant, purposeful efforts to gain skills for the role. Our findings challenge common assumptions about doctors' preferences in argumentation, and reveal an unexpected commitment to practical reason. Using the ethics of Paul Ricoeur in our analysis enabled us to identify the moral meaning of doctors' skills and learning. We concluded that Ricoeur's ethics offers an empirically grounded matrix for ethical analysis of the doctor's role in macroallocation that may help to establish norms for procedure.

An inductive exploration of the implementation knowledge of research funders

Background

Healthcare research funders may undertake various roles to facilitate implementation of research findings. Their ability to enact such roles depends on several factors, knowledge of implementation being one essential requirement. However, previous studies do not assess the type or level of knowledge about implementation that research funders possess. This paper therefore presents findings from a qualitative, inductive study of the implementation knowledge of research funders. Three aspects of this knowledge are explored, namely how research funders define implementation, their level of self-assessed implementation knowledge and the factors influencing their self-assessment of implementation knowledge.

Methods

Research funders (n = 18) were purposefully selected from a sample of research funding organisations in Sweden (n = 10). In-depth semi-structured interviews were conducted, recorded and transcribed verbatim. An inductive method using a systematic coding procedure was employed to derive the findings.

Results

The research funders defined implementation as either an outcome or a process, with the majority believing that implementation of healthcare research results demands a process, although its complexity varied in the research funders’ view. They perceived their own level of implementation knowledge as either limited or substantial, with a majority regarding it as limited. Clinical research experience, clinical experience and task relevance were singled out as the clearest factors affecting the self-assessment of their own implementation knowledge.

Conclusions

This study, the first to focus on implementation knowledge of research funders, demonstrates that they are a category of policy-makers who may possess knowledge, based on their previous professional experience, that is comparable to some important findings from implementation research. Consequently, the findings not only pinpoint the relevance of professional experience, but also reveal a lack of awareness and knowledge of the results of implementation research among research funders in charge of healthcare research.

Electronic supplementary material

The online version of this article (10.1186/s12961-019-0472-8) contains supplementary material, which is available to authorized users.

How are evidence generation partnerships between researchers and policy-makers enacted in practice? A qualitative interview study

Background

Evidence generation partnerships between researchers and policy-makers are a potential method for producing more relevant research with greater potential to impact on policy and practice. Little is known about how such partnerships are enacted in practice, however, or how to increase their effectiveness. We aimed to determine why researchers and policy-makers choose to work together, how they work together, which partnership models are most common, and what the key (1) relationship-based and (2) practical components of successful research partnerships are.

Methods

Semi-structured qualitative interviews were conducted with 18 key informants largely based in New South Wales, Australia, who were (1) researchers experienced in working in partnership with policy in health or health-related areas or (2) policy and programme developers and health system decision-makers experienced in working in partnership with researchers. Data was analysed thematically by two researchers.

Results

Researcher-initiated and policy agency-initiated evidence generation partnerships were common. While policy-initiated partnerships were thought to be the most likely to result in impact, researcher-initiated projects were considered important in advancing the science and were favoured by researchers due to greater perceived opportunities to achieve key academic career metrics. Participants acknowledged that levels of collaboration varied widely in research/policy partnerships from minimal to co-production. Co-production was considered a worthy goal by all, conferring a range of benefits, but one that was difficult to achieve in practice. Some participants asserted that the increased time and resources required for effective co-production meant it was best suited to evaluation and implementation projects where the tacit, experiential knowledge of policy-makers provided critical nuance to underpin study design, implementation and analysis. Partnerships that were mutually considered to have produced the desired outcomes were seen to be underpinned by a range of both relationship-based (such as shared aims and goals and trust) and practical factors (such as sound governance and processes).

Conclusions

Our findings highlight the important role of policy-makers in New South Wales in ensuring the relevance of research. There is still much to understand about how to initiate and sustain successful research/policy partnerships, particularly at the highly collaborative end.

Electronic supplementary material

The online version of this article (10.1186/s12961-019-0441-2) contains supplementary material, which is available to authorized users.

Fostering access to and use of contextualised knowledge to support health policy-making: lessons from the Policy Information Platform in Nigeria

Background

Contextualising evidence to inform policy-making is increasingly recognised as key to developing and implementing effective health policies. Creating a one-stop shop for evidence is an approach that can facilitate timely access to the best evidence to inform policy decisions. We report outcomes after implementation of the Policy Information Platform (PIP), a pilot one-stop evidence repository in Nigeria designed to alleviate barriers to accessing policy-relevant knowledge.

Methods

This cross-sectional study involved five phases, namely (1) consultation with Nigerian policy-makers to identify priority policy issues, areas of health policy information needs, and challenges and capacity constraints in accessing evidence for policy-making; (2) a stakeholder engagement workshop to formally launch the PIP; (3) extraction of data and other information from scientific articles, policy briefs, evaluation reports, grey literature and health policy documents relevant to policy-making in Nigeria (identified by Google and PubMed searches and by examination of websites of relevant Nigerian government ministries, agencies and parastatals), for use in developing the PIP website; (4) promotion of the PIP in national and state health policy meetings; and (5) evaluation of the PIP using a stakeholder survey questionnaire distributed via email and critical appraisal of the grey literature included in the PIP using the authority, accuracy, coverage, objectivity, date and significance (AACODS) checklist.

Results

Priority policy areas identified by policy-makers were disease control and prevention, population health issues and health administration. Challenges identified by policy-makers were a lack of adequate capacity to access policy-relevant evidence and transform the evidence into policy. Policy-makers suggested using systematic reviews, policy briefs and rapid response mechanisms and involving policy-makers in research as ways of increasing evidence uptake for policy. A total of 126 policy-relevant, peer-reviewed scientific articles, 85 health policy documents and 201 policy-relevant grey literature documents were selected for inclusion in the PIP. Of the 195 individuals contacted via email to evaluate the PIP, 31 (15.9%) provided a response. Respondents noted that the PIP facilitated access to information based on local evidence and context-sensitive data. Barriers identified included lack of knowledge about the PIP and limited capacity of end-users to use the data compiled in the platform.

Conclusion

An easily accessible one-stop shop of policy-relevant evidence can considerably improve policy-makers’ access to evidence for use in policy-making and practice.

Electronic supplementary material

The online version of this article (10.1186/s12961-019-0431-4) contains supplementary material, which is available to authorized users.

Decision makers' experience of participatory dynamic simulation modelling: methods for public health policy

BACKGROUND

Systems science methods such as dynamic simulation modelling are well suited to address questions about public health policy as they consider the complexity, context and dynamic nature of system-wide behaviours. Advances in technology have led to increased accessibility and interest in systems methods to address complex health policy issues. However, the involvement of policy decision makers in health-related simulation model development has been lacking. Where end-users have been included, there has been limited examination of their experience of the participatory modelling process and their views about the utility of the findings. This paper reports the experience of end-user decision makers, including senior public health policy makers and health service providers, who participated in three participatory simulation modelling for health policy case studies (alcohol related harm, childhood obesity prevention, diabetes in pregnancy), and their perceptions of the value and efficacy of this method in an applied health sector context.

METHODS

Semi-structured interviews were conducted with end-user participants from three participatory simulation modelling case studies in Australian real-world policy settings. Interviewees were employees of government agencies with jurisdiction over policy and program decisions and were purposively selected to include perspectives at different stages of model development.

RESULTS

The 'co-production' aspect of the participatory approach was highly valued. It was reported as an essential component of building understanding of the modelling process, and thus trust in the model and its outputs as a decision-support tool. The unique benefits of simulation modelling included its capacity to explore interactions of risk factors and combined interventions, and the impact of scaling up interventions. Participants also valued simulating new interventions prior to implementation in the real world, and the comprehensive mapping of evidence and its gaps to prioritise future research. The participatory aspect of simulation modelling was time and resource intensive and therefore most suited to high priority complex topics with contested options for intervening.

CONCLUSION

These findings highlight the value of a participatory approach to dynamic simulation modelling to support its utility in applied health policy settings.

Knowledge mobilisation for chronic disease prevention: the case of the Australian Prevention Partnership Centre

Background

Cross-sectoral, multidisciplinary partnership research is considered one of the most effective means of facilitating research-informed policy and practice, particularly for addressing complex problems such as chronic disease. Successful research partnerships tend to be underpinned by a range of features that enable knowledge mobilisation (KMb), seeking to connect academic researchers with decision-makers and practitioners to improve the nature, quality and use of research. This paper contributes to the growing discourse on partnership approaches by illustrating how knowledge mobilisation strategies are operationalised within the Australian Prevention Partnership Centre (the Centre), a national collaboration of academics, policy-makers and practitioners established to develop systems approaches for the prevention of lifestyle-related chronic diseases.

Methods

We undertook interviews with key academics, policy, and practice partners and funding representatives at the mid-point of the Centre’s initial 5-year funding cycle. We aimed to explore how the Centre is functioning in practice, to develop a conceptual model of KMb within the Centre for use in further evaluation, and to identify ways of strengthening our approach to partnership research. Inductive and deductive thematic analysis was used to identify the key mechanisms underpinning the Centre’s KMb approach.

Results

Six key mechanisms appeared to facilitate KMb within our Centre, namely Engagement, Partnerships, Co-production, Capacity and Skills, Knowledge Integration, and Adaptive Learning and Improvement. We developed a conceptual model that articulated these mechanisms in relation to the structures and processes that support them, as well as the Centre’s goals. Findings also informed adaptations designed to strengthen the Centre.

Conclusions

Findings provide insights into the practical realities of operationalising KMb strategies within a research partnership. Overall, the centre is perceived to be progressing towards its KMb goals, but challenges include stakeholders from different settings understanding each other’s contexts and working together effectively, and ensuring knowledge generated across different projects within the Centre is integrated into a more comprehensive understanding of chronic disease prevention policy and practice. Our conceptual model is now informing ongoing developmental evaluation activities within the Centre, where it is being tested and refined.

Closing the gaps in opioid use disorder research, policy and practice: conference proceedings

Drug overdose deaths involving opioids have surged in recent years and the economic cost of the opioid epidemic is estimated to be over $500 billion annually. In the midst of calls for declaring a national emergency, health policy decision makers are considering the best ways to allocate resources to curb the epidemic. On June 9, 2017, 116 invited health researchers, clinicians, policymakers, health system leaders, and other stakeholders met at the University of Pennsylvania to discuss approaches to address the gaps in evidence-based substance use disorder policy and practice, with an emphasis on the opioid epidemic. The conference was sponsored by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), a NIDA-funded National Center of Excellence, and hosted by the Leonard Davis Institute of Health Economics of the University of Pennsylvania. The conference aims were to: (1) foster new relationships between researchers and policymakers through a collaborative work process and (2) generate evidence-based policy recommendations to address the opioid epidemic. The conference concluded with an interactive work session during which attendees self-identified as researchers or policymakers and were divided equally among 13 tables. These groups met to develop and present policy recommendations based on an opioid use disorder case study. Thirteen policy recommendations emerged across four themes: (1) quality of treatment, (2) continuity of care, (3) opioid prescribing and pain management, and (4) consumer engagement. This conference serves as a proposed model to develop equitable, working relationships among researchers, clinicians, and policymakers.

A review of the process of knowledge transfer and use of evidence in reproductive and child health in Ghana

Background

The paper carries out a situational analysis to examine the production, dissemination and utilisation of reproductive and child health-related evidence to inform policy formulation in Ghana’s health sector.

Methods

The study used Wald’s model of knowledge production, transfer and utilisation as a conceptual model to collect relevant data via interviews and administration of questionnaire to a network of persons who either previously or currently hold policy-relevant positions in Ghana’s health sector. Additional data was also gathered through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and child health policies, protocols and guidelines and information available on the websites of relevant institutions in Ghana’s health sector.

Results

The findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities (access to major donors who have the resources to fund good quality research and access to both local and international networks for collaborative research). What remains a challenge, however, is the absence of a robust institutional-wide mechanism for collating research needs and communicating these to researchers, communicating research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research into the budget of the health sector.

Conclusion

The study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing strengths and opportunities to address the identified challenges.

Reporting of Financial and Non-financial Conflicts of Interest in Systematic Reviews on Health Policy and Systems Research: A Cross Sectional Survey

Background: Systematic reviews are increasingly used to inform health policy-making. The conflicts of interest (COI) of the authors of systematic reviews may bias their results and influence their conclusions. This may in turn lead to misguided public policies and systems level decisions. In order to mitigate the adverse impact of COI, scientific journals require authors to disclose their COIs. The objective of this study was to assess the frequency and different types of COI that authors of systematic reviews on health policy and systems research (HSPR) report.

Methods: We conducted a cross sectional survey. We searched the Health Systems Evidence (HSE) database of McMaster Health Forum for systematic reviews published in 2015. We extracted information regarding the characteristics of the systematic reviews and the associated COI disclosures. We conducted descriptive analyses.

Results: Eighty percent of systematic reviews included authors’ COI disclosures. Of the 160 systematic reviews that included COI disclosures, 15% had at least one author reporting at least one type of COI. The two most frequently reported types of COI were individual financial COI and individual scholarly COI (11% and 4% respectively). Institutional COIs were less commonly reported than individual COIs (3% and 15% respectively) and non-financial COIs were less commonly reported than financial COIs (6% and 14% respectively). Only one systematic review reported the COI disclosure by editors, and none reported disclosure by peer reviewers. All COI disclosures were in the form of a narrative statement in the main document and none in an online document.

Conclusion: A fifth of systematic reviews in HPSR do not include a COI disclosure statement, highlighting the need for journals to strengthen and/or better implement their COI disclosure policies. While only 15% of identified disclosure statements report any COI, it is not clear whether this indicates a low frequency of COI versus an underreporting of COI, or both.

Factors affecting engagement between academic faculty and decision-makers: learnings and priorities for a school of public health

Background

Schools of public health (SPHs) are increasingly being recognised as important contributors of human, social and intellectual capital relevant to health policy and decision-making. Few studies within the implementation science literature have systematically examined knowledge exchange experiences within this specific organisational context. The purpose of this study was therefore to elicit whether documented facilitators and barriers to engaging with government decision-makers resonates within an academic SPH context. We sought to understand the variations in such experiences at four different levels of government decision-making. Furthermore, we sought to elicit intervention priorities as identified by faculty.

Methods

Between May and December 2016, 211 (34%) of 627 eligible full-time faculty across one SPH in the United States of America participated in a survey on engagement with decision-makers at the city, state, federal and global government levels. Surveys were administered face-to-face or via Skype. Descriptive data as well as tests of association and logistic regression analyses were conducted using STATA.

Results

Over three-quarters of respondents identified colleagues with ties to decision-makers, institutional affiliation and conducting policy-relevant research as the highest facilitators. Several identified time constraints, academic incentives and financial support as important contributors to engagement. Faculty characteristics, such as research areas of expertise, career track and faculty rank, were found to be statistically significantly associated with facilitators. The top three intervention priorities that emerged were (1) creating incentives for engagement, (2) providing funding for engagement and (3) inculcating an institutional culture around engagement.

Conclusions

The data suggest that five principal categories of factors – individual characteristics, institutional environment, relational dynamics, research focus and funder policies – affect the willingness and ability of academic faculty to engage with government decision-makers. This study suggests that SPHs could enhance the relevance of their role in health policy decision-making by (1) periodically measuring engagement with decision-makers; (2) enhancing individual capacity in knowledge translation and communication, taking faculty characteristics into account; (3) institutionalising a culture that supports policies and practices for engagement in decision-making processes; and (4) creating a strategy to expand and nurture trusted, relevant networks and relationships with decision-makers.

How is the use of research evidence in health policy perceived? A comparison between the reporting of researchers and policy-makers

Background

The use of health policy and systems research (HPSR) to inform health policy-making is an international challenge. Incorporating HPSR into decision-making primarily involves two groups, namely researchers (knowledge producers) and policy-makers (knowledge users). The purpose of this study was to compare the perceptions of Israeli health systems and policy researchers and health services policy-makers regarding the role of HPSR, factors influencing its uses and potential facilitators and barriers to HPSR, and implementation of knowledge transfer and exchange (KTE) activities.

Methods

A cross-sectional survey was administered to researchers and policy-makers in Israel. The survey consisted of seven closed questions. Descriptive analyses were carried out for closed-ended questions and comparative analysis were conducted between groups using the χ² test.

Results

A total of 37 researchers and 32 policy-makers responded to the survey. While some views were in alignment, others showed differences. More policy-makers than researchers perceived that the use of HPSR in policy was hindered by practical implementation constraints, whereas more researchers felt that its use was hindered by a lack of coordination between knowledge producers and users. A larger percentage of policy-makers, as compared to researchers, reported that facilitators to the KTE process are in place and a larger percentage of researchers perceived barriers within the KTE environment. A larger percentage of policy-makers perceived KTE activities were in place as compared to researchers. Results also showed large differences in the perceptions of the two groups regarding policy formulation and which organisations they perceived as exerting strong influence on policy-making.

Conclusions

This research demonstrated that there are differences in the perceptions of knowledge producers and users about the process of KTE. Future work should focus on minimising the challenges highlighted here and implementing new KTE activities. These activities could include making the researchers aware of the most effective manner in which to package their results, providing training to policy-makers and assuring that policy-makers have technical access to appropriate databases to search for HPSR. These results underscore the need for the groups to communicate and clarify to each other what they can offer and what they require.

Electronic supplementary material

The online version of this article (10.1186/s12961-018-0345-6) contains supplementary material, which is available to authorized users.