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Farran D, Salloum RG, El Jardali F, Abla R, Abu Rmeileh N, Al Sheyab N, Awaw-da S, Chalak A, Jawad M, Khader Y, Mostafa A, Nakkash R. From knowledge production to knowledge translation: Waterpipe tobacco control research in the Eastern Mediterranean Region. Tob Prev Cessat 2024; 10:TPC-10-03. [PMID: 38250221 PMCID: PMC10797642 DOI: 10.18332/tpc/175953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Waterpipe tobacco smoking (WTS) rates in the Eastern Mediterranean Region (EMR) are the highest worldwide, particularly among young people. Although fiscal policies to curb tobacco use have been recommended by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), implementation has been suboptimal. The Eastern Mediterranean Consortium on the Economics of Waterpipe Tobacco Smoking (ECON-WTS) was formed in response to this need to produce knowledge on the economics of WTS in the EMR and apply a comprehensive Knowledge translation (KT) framework. The KT framework comprised priority setting, evidence synthesis, knowledge translation, and knowledge uptake. In this article, we discuss the approaches followed in applying the KT framework to WTS control, providing examples and noting challenges and lessons learned where possible.
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Affiliation(s)
- Dina Farran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Fadi El Jardali
- Health Management and Policy Department, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Niveen Abu Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Nihaya Al Sheyab
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Sameera Awaw-da
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
- Economics Department, Faculty of Business and Economics, Birzeit University, Birzeit, Palestine
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Lebanon
- Global and Community Health Department, George Mason University, Virginia, USA
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Semahegn A, Manyazewal T, Hanlon C, Getachew E, Fekadu B, Assefa E, Kassa M, Hopkins M, Woldehanna T, Davey G, Fekadu A. Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review. Health Res Policy Syst 2023; 21:131. [PMID: 38057873 PMCID: PMC10699029 DOI: 10.1186/s12961-023-01084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023] Open
Abstract
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.
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Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | | | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
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Chandhiok N, Goudar SS, Kavi A, Somannavar MS, Silver RM. Connecting the dots: Adoption of maternal, newborn and child health research evidence in policy and practice. BJOG 2023; 130 Suppl 3:168-171. [PMID: 37530407 DOI: 10.1111/1471-0528.17599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/24/2023] [Indexed: 08/03/2023]
Affiliation(s)
| | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Avinash Kavi
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Manjunath S Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
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El-Jardali F, Fadlallah R, Bou Karroum L, Akl EA. Evidence synthesis to policy: development and implementation of an impact-oriented approach from the Eastern Mediterranean Region. Health Res Policy Syst 2023; 21:40. [PMID: 37264415 DOI: 10.1186/s12961-023-00989-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Despite the importance of evidence syntheses in informing policymaking, their production and use remain limited in the Eastern Mediterranean region (EMR). There is a lack of empirical research on approaches to promote and use policy-relevant evidence syntheses to inform policymaking processes in the EMR. OBJECTIVE This study sought to describe the development of an impact-oriented approach to link evidence synthesis to policy, and its implementation through selected case studies in Lebanon, a middle-income country in the EMR. METHODS This study followed a multifaceted and iterative process that included (i) a review of the literature, (ii) input from international experts in evidence synthesis and evidence-informed health policymaking, and (iii) application in a real-world setting (implementation). We describe four selected case studies of implementation. Surveys were used to assess policy briefs, deliberative dialogues, and post-dialogue activities. Additionally, Kingdon's stream theory was adopted to further explain how and why the selected policy issues rose to the decision agenda. RESULTS The approach incorporates three interrelated phases: (1) priority setting, (2) evidence synthesis, and (3) uptake. Policy-relevant priorities are generated through formal priority setting exercises, direct requests by policymakers and stakeholders, or a focusing event. Identified priorities are translated into focused questions that can be addressed via evidence synthesis (phase 1). Next, a scoping of the literature is conducted to identify existing evidence syntheses addressing the question of interest. Unless the team identifies relevant, up-to-date and high-quality evidence syntheses, it proceeds to conducting SRs addressing the priority questions of interest (phase 2). Next, the team prepares knowledge translation products (e.g., policy briefs) for undertaking knowledge uptake activities, followed by monitoring and evaluation (phase 3). There are two prerequisites to the application of the approach: enhancing contextual awareness and capacity strengthening. The four case studies illustrate how evidence produced from the suites of activities was used to inform health policies and practices. CONCLUSIONS To our knowledge, this is the first study to describe both the development and implementation of an approach to link evidence synthesis to policy in the EMR. We believe the approach will be useful for researchers, knowledge translation platforms, governments, and funders seeking to promote evidence-informed policymaking and practice.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Mirzoev T, Topp SM, Afifi RA, Fadlallah R, Obi FA, Gilson L. Conceptual framework for systemic capacity strengthening for health policy and systems research. BMJ Glob Health 2022; 7:bmjgh-2022-009764. [PMID: 35922082 PMCID: PMC9353002 DOI: 10.1136/bmjgh-2022-009764] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
Health policy and systems research (HPSR) is critical in developing health systems to better meet the health needs of their populations. The highly contextualised nature of health systems point to the value of local knowledge and the need for context-embedded HPSR. Despite such need, relatively few individuals, groups or organisations carry out HPSR, particularly in low-income and middle-income countries. Greater effort is required to strengthen capacity for, and build the field of, HPSR by capturing the multilevel and nuanced representation of HPSR across contexts. No comprehensive frameworks were found that inform systemic HPSR capacity strengthening. Existing literature on capacity strengthening for health research and development tends to focus on individual-level capacity with less attention to collective, organisational and network levels. This paper proposes a comprehensive framework for systemic capacity strengthening for HPSR, uniquely drawing attention to the blurred boundaries and amplification potential for synergistic capacity strengthening efforts across the individual, organisational and network levels. Further, it identifies guiding values and principles that consciously acknowledge and manage the power dynamics inherent to capacity strengthening work. The framework was developed drawing on available literature and was peer-reviewed by the Board and Thematic Working Groups of Health Systems Global. While the framework focuses on HPSR, it may provide a useful heuristic for systemic approaches to capacity strengthening more generally; facilitate its mainstreaming within organisations and networks and help maintain a focused approach to, and structure repositories of resources on, capacity strengthening.
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Affiliation(s)
- Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK .,Capacity Strengthening Working Group, Health Systems Global, Ottawa, Ontario, Canada
| | - Stephanie M Topp
- Capacity Strengthening Working Group, Health Systems Global, Ottawa, Ontario, Canada.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Rima A Afifi
- Capacity Strengthening Working Group, Health Systems Global, Ottawa, Ontario, Canada.,Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Racha Fadlallah
- Capacity Strengthening Working Group, Health Systems Global, Ottawa, Ontario, Canada.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Felix Abrahams Obi
- Capacity Strengthening Working Group, Health Systems Global, Ottawa, Ontario, Canada.,Nigeria Country Office, Results for Development Institute, Abuja, Nigeria.,Health Policy Research Group, University of Nigeria-Enugu Campus, Enugu, Nigeria
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Capacity Strengthening Working Group, Health Systems Global, Ottawa, Ontario, Canada.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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BEHZADIFAR MASOUD, GHANBARI MAHBOUBEHKHATON, RAVAGHI HAMID, BAKHTIARI AHAD, SHAHABI SAEED, DOSHMANGIR LEILA, ALIDOOST SAEIDE, AZARI SAMAD, MARTINI MARIANO, EHSANZADEH SEYEDJAFAR, BRAGAZZI NICOLALUIGI. Health policy analysis in Eastern Mediterranean region using a health policy triangle framework: Historical and ethical insights from a systematic review. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E351-E373. [PMID: 35968073 PMCID: PMC9351417 DOI: 10.15167/2421-4248/jpmh2022.63.2.2450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Background Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization. Methods To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program checklist was used. Results We selected 30 studies, conducted between 2011 and 2020. According to the findings of these studies, in the Eastern Mediterranean region, organization region, and the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited, and health research systems in Eastern Mediterranean region organization are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making. Discussion Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities.
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Affiliation(s)
- MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - HAMID RAVAGHI
- School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
- Correspondence: Hamid Ravaghi, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran. E-mail: ;
| | - AHAD BAKHTIARI
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - LEILA DOSHMANGIR
- Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - SAEIDE ALIDOOST
- School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - SAMAD AZARI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - SEYED JAFAR EHSANZADEH
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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Barriers and Facilitators of Pharmacoeconomic Studies: A Review of Evidence from the Middle Eastern Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137862. [PMID: 35805521 PMCID: PMC9265831 DOI: 10.3390/ijerph19137862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
The world is facing a continuous increase in medical costs. Due to the surge in disease prevalence, medical science is becoming more sensitive to the economic impact of medications and drug therapies. This brings about the importance of pharmacoeconomics, which is concerned with the effective use of health resources to optimize the efficiency and costs of medications of treatment for the best outcomes. This review was conducted to find out the potential barriers and facilitators to implementing pharmacoeconomic studies in the Middle Eastern region having both high- and low-income countries. The varying economies in the region depict diverse healthcare systems where implementation of pharmacoeconomics faces a large number of challenges and is also aided by numerous facilitators that contribute to the growth of its implementation. In this context, we have reviewed the status of pharmacoeconomics in Middle Eastern countries in research databases (Google Scholar, MEDLINE, Science Direct and Scopus) using keywords (“pharmacoeconomics”, “barriers”, “facilitators”, “Middle East”). The study reported that Yemen, Syria, Palestine, Iran, Iraq, Jordan and Lebanon are the lowest-income countries in the Middle East and the implementation of pharmacoeconomics is the poorest in these states. The UAE, Saudi Arabia and Israel are high-income rich states where economic aspects were comparatively better but still a large number of barriers hinder the way to its effective implementation. These include the absence of national governing bodies, the lack of data on the effectiveness of medications, the absence of sufficient pharmacoeconomic experts and the lack of awareness of the importance of pharmacoeconomics. The main facilitators were the availability of pharmacoeconomic guidelines, the encouragement of pharmacoeconomic experts and the promotion of group discussions and collaborations between researchers and policymakers. Cost-benefit analysis is still evolving in Middle Eastern countries, and there is a great need for improvement so that states can effectively benefit from cost analysis tools and utilize their health resources. In this regard, governments should develop national governing bodies to evaluate, implement pharmacoeconomics at the local and state levels and bring about innovation in the field through further research and development incorporating all sectors of pharmacy and pharmaceutics. The data presented in this research can further be extended in future studies to cover the various domains of pharmacoeconomics including cost-minimization analysis, cost-effectiveness analysis and cost-benefit analysis and their applications within the healthcare sectors of Middle Eastern countries.
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Roohi G, Jahani MA, Farhadi Z, Mahmoudi G. A knowledge implementation model in health system management based on the PARIHS model. Health Res Policy Syst 2022; 20:66. [PMID: 35710382 PMCID: PMC9205052 DOI: 10.1186/s12961-022-00874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Ghanbar Roohi
- Healthcare Services Management, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Ali Jahani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zeynab Farhadi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ghahraman Mahmoudi
- Hospital Administration Research Center, Sari Branch, Islamic Azad University, Sari, Iran.
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Martin-Fernandez J, Aromatario O, Prigent O, Porcherie M, Ridde V, Cambon L. Evaluation of a knowledge translation strategy to improve policymaking and practices in health promotion and disease prevention setting in French regions: TC-REG, a realist study. BMJ Open 2021; 11:e045936. [PMID: 34593485 PMCID: PMC8487168 DOI: 10.1136/bmjopen-2020-045936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This paper presents the results of a realist evaluation of a knowledge translation (KT) intervention implemented in the field of health promotion and disease prevention at the local level in France. DESIGN Realist evaluation study. SETTING The target population comprised decision-makers and field professionals working in prevention and public health services operating in regions of France (ie, ARS (Agence Régionale de Santé: regional health agency), IREPS (Instance Régionale d'Education et de Promotion de la Santé pour tous: regional organisation for health promotion and education) and their partners). PARTICIPANTS This evaluation was based on data collected from 2 seminars, 82 interviews, 18 observations and 4 focus groups over 18 months. INTERVENTION The TC-REG intervention aimed to increase the use of evidence in cancer prevention, health promotion and disease prevention across four geographical regions in France. The intervention combined various activities: Supporting access to and adaptation of usable evidence, strengthening professionals' skills in analysing, adopting and using policy briefs, and facilitating the use of evidence in organisations and processes. RESULTS The collected data was used to define favourable/unfavourable contexts for the use of scientific data and mechanisms to be activated to encourage the use of scientific knowledge. From these raw results eight final refined middle-range theories were defined. Organised around the mechanisms to be activated, these middle-range theories illustrate how to activate knowledge and under what conditions. These analyses provided a basis for the production of seven operational and contextualised recommendations to develop KT to inform regional policymaking regarding health promotion and disease prevention. CONCLUSION The results obtained from the analyses led us to formulate two perspectives of an operational nature for the benefit of those involved in prevention and health promotion.
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Affiliation(s)
- Judith Martin-Fernandez
- INSERM Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, Bordeaux, France
- Prevention Department, CHU de Bordeaux, Bordeaux, Aquitaine, France
- University of Bordeaux, ISPED, Bordeaux, France
| | - Olivier Aromatario
- INSERM Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Bordeaux, France
| | - Ollivier Prigent
- INSERM Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Bordeaux, France
| | - Marion Porcherie
- Arènes-Rennes, UMR CNRS 6051, Ecole des Hautes Etudes en Sante Publique, Rennes, France
| | - Valéry Ridde
- IRD-Université de Paris, ERL INSERM SAGESUD, CEPED, Institute for Research on Sustainable Development, Paris, France
| | - Linda Cambon
- INSERM Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, Bordeaux, France
- University of Bordeaux, ISPED, Bordeaux, France
- Chaire de prévention, University of Bordeaux, Isped, SPF, Bordeaux, Aquitaine, France
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10
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AlKhaldi M, Meghari H, Jillson IA, Alkaiyat A, Tanner M. State of Research Quality and Knowledge Transfer and Translation and Capacity Strengthening Strategies for Sound Health Policy Decision-Making in Palestine. Int J Public Health 2021; 66:620425. [PMID: 34408619 PMCID: PMC8366493 DOI: 10.3389/ijph.2021.620425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Over the last 2 decades, the World Health Organization (WHO) has proposed a global strategy and initiatives to establish a Health Research System (HRS) focusing on Health Research Quality and Standardization (HRQS), Health Research Knowledge Transfer and Dissemination (HRKTD), and Health Research Translation and Utilization into Health Care Decisions and Policies (HRTUDP). Despite the increase in health research productivity over the past several decades, HRS Capacity (HRSC) in Palestine and in the Middle East and North Africa (MENA) region has rarely been objectively evaluated. This study aims at eliciting the perceptions of HRS performers in Palestine in order to understand the status of HRSC, identify gaps, and generate policies and solutions capable of strengthening HRSC in Palestine. Methods: Key informants from three sectors, namely government, academia, and local and international organizations, were selected purposively based on different sampling methods: criterion, critical case, snowball, and homogeneous sampling. Fifty-two in-depth interviews with key informants and a total of fifty-two individuals, participating in six focus groups, were conducted by the principal investigator in Palestine. Data were analyzed by using MAXQDA 12. Results: The overall pattern of the Palestinian HRSC is relatively weak. The key findings revealed that while HR productivity in Palestine is improving, HRQS is at an average level and quality guidelines are not followed due to paucity of understanding, policies, and resources. HRKTD is a central challenge with both a dearth of conceptualization of translational science and inadequate implementation. The factors related to inadequate HRKTD include lack of awareness on the part of the researchers, inadequate regulatory frameworks and mechanisms for both communication and collaboration between and among researchers and policy-makers and clinicians, and lack of availability of, and credibility in, systematized and reliable HR data. Despite the limited knowledge translation, in general, HRTUDP is not considered an essential decision-making methodology mainly due to the lack of interface between knowledge producers (researchers) and users (policymakers), understanding level, HR credibility and availability of applied research, and governance, resources, and political fluctuations. Recommendations to strengthen HRS in Palestine include: a consolidated research regulatory framework and an effective capacity strengthening strategy overseen by Palestinian authorities; the promotion of HRQS and concepts and practices of translational science; and, most importantly, the use of findings for evidence-based policies and practice. Conclusion: Strengthening HRSC is both an imperative step and an opportunity to improve the Palestinian health system and ensure it is based on research evidence and knowledge. Building a successful HRS characterized by capacities of high-quality research and well-disseminated and translated knowledge is a prerequisite to effective health systems and services. This can be achieved by political commitment to support such strengthening, a consolidated leadership and governance structure, and a strong operational capacity strengthening strategy.
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Affiliation(s)
- Mohammed AlKhaldi
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Faculty of Medicine, McGill University, Montreal, QC, Canada.,Council on Health Research for Development, Geneve, Switzerland.,Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hamza Meghari
- University College London (UCL), London, United Kingdom
| | - Irene Anne Jillson
- School of Medicine, Georgetown University, Washington, DC, United States
| | - Abdulsalam Alkaiyat
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Council on Health Research for Development, Geneve, Switzerland
| | - Marcel Tanner
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
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11
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Sajadi HS, Majdzadeh R, Ehsani-Chimeh E, Yazdizadeh B, Nikooee S, Pourabbasi A, Lavis J. Policy options to increase motivation for improving evidence-informed health policy-making in Iran. Health Res Policy Syst 2021; 19:91. [PMID: 34098971 PMCID: PMC8186173 DOI: 10.1186/s12961-021-00737-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community-Based Participatory-Research Center, Knowledge Utilization Research Center, and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ehsani-Chimeh
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ata Pourabbasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - John Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
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12
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Almazrou SH, Alaujan SS, Al-Aqeel SA. Barriers and facilitators to conducting economic evaluation studies of Gulf Cooperation Council (GCC) countries: a survey of researchers. Health Res Policy Syst 2021; 19:71. [PMID: 33933093 PMCID: PMC8088636 DOI: 10.1186/s12961-021-00721-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background The number of published economic evaluations of Gulf Cooperation Council (GCC) countries is notably scarce. Limited local evidence could have a major impact on the implementation of economic evaluation recommendations in the decision-making process in GCC countries. Little is known about the factors affecting researchers who seek to conduct economic evaluations. Therefore, we aimed to assess researcher barriers and facilitators in conducting such studies of GCC countries. Methods A cross-sectional survey of health economic researchers working in GCC countries was conducted online between January and February 2020. The survey instrument collected researchers’ perceived barriers and facilitators and demographic information. For barriers, respondents rated their agreement on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree”. For facilitators, respondents rated the importance of each facilitator on a six-point scale ranging from “extremely important” to “not very important”. Then, participants were asked to select the three most important barriers and facilitators from the lists. The data collected were examined using descriptive analysis. Results Fifty-one researchers completed the survey (37% response rate). The majority of participants (more than 80%) agreed that lack of quality of effectiveness data and restricted access to unit cost data are the main barriers to conducting economic research. Availability of relevant local data was reported as an important facilitator, followed by collaboration between health economic researchers, policy-makers and other stakeholders. Conclusions The results of this study provide an exploratory view of the issues faced by health economics researchers in GCC countries. Recommendations to GCC countries based on international experiences, such as to use real-world data in economic evaluation research, were provided.
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Affiliation(s)
- Saja H Almazrou
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
| | - Shiekha S Alaujan
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sinaa A Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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13
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Structural barriers to knowledge transfer and exchange among men and women in low-, middle- and high-income countries: an international cross-sectional study with vaccine researchers in 44 countries. Health Res Policy Syst 2021; 19:64. [PMID: 33845824 PMCID: PMC8042701 DOI: 10.1186/s12961-021-00712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, women constitute 30% of researchers. Despite an increasing proportion of women in research, they are still less likely to have international collaborations. Literature on barriers to knowledge transfer and exchange (KTE) between men and women remains limited. This study aimed to assess perceived gender barriers to KTE activities in vaccination-related research in low-, middle- and high-income countries. METHODS This was a cross-sectional data assessment from a self-administered questionnaire distributed to researchers in the field of vaccination research. The administered questionnaire was developed and validated by WHO and McMaster University. Descriptive statistics were carried out. Structural factors of KTE were assessed using 12 statements measured with a five-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). An index ranging from 12 to 60 points was created to assess structural factors of KTE, with higher score indicating fewer perceived barriers. Multivariable linear regression modelling was applied to examine the association between KTE barriers and gender. RESULTS A total of 158 researchers were included in the analysis. Regardless of gender and country of affiliation, researchers experienced challenges with respect to KTE activities; particularly factors related to the availability of human and financial resources and level of technical expertise among their target audience. We were also able to identify perceived facilitators among men and women, such as the presence of structures that link researchers and target audiences, the investment of target audiences in KTE efforts and the presence of stable contacts among target audiences. Our linear regression analysis showed that women perceived more barriers than men (R2 = 0.014; B = -1.069; 95% CI -4.035; 1.897). CONCLUSIONS Men and women shared common perspectives on barriers to KTE. KTE activities could be strengthened by improving structural efforts to reduce gender differences and increase collaborations between researchers and their target audience.
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14
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Almazrou SH, Alsubki LA, Alsaigh NA, Aldhubaib WH, Ghazwani SM. Assessing the Quality of Clinical Practice Guidelines in the Middle East and North Africa (MENA) Region: A Systematic Review. J Multidiscip Healthc 2021; 14:297-309. [PMID: 33603389 PMCID: PMC7881789 DOI: 10.2147/jmdh.s284689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/18/2020] [Indexed: 01/09/2023] Open
Abstract
Aim Clinical practice guidelines (CPGs) have progressively become a popular tool for making optimal clinical decisions. The literature shows that the poor quality of CPGs can form a barrier against adhering to them, resulting in a suboptimal level of healthcare. The objective of this systematic review is to evaluate the quality of CPGs in the Middle East and North Africa (MENA) region using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. Methods The authors searched in the MEDLINE and EMBASE databases through the Ovid interface on May 25, 2019. Keywords relating to CPGs and MENA countries were combined using Boolean search operators. The search was not limited to specific diseases. The quality of guidelines was appraised by two reviewers independently using the AGREE II Instrument. Discrepancies within a group were resolved through the involvement of a principle investigator. Results A total of 61 CPGs were appraised. These guidelines were mainly from Saudi Arabia, and the most covered disease topic was cancer. Among the six domains of the AGREE II Instrument, CPGs scored the highest on clarity of presentation (mean 82%), while the lowest score was granted to the rigor of development domain (mean 28%). This indicates substantial deficiencies in reporting the developmental processes of CPGs and the resources used for the synthesis of evidence. Conclusion From this review, it was found that the number of retrieved guidelines published in the MENA region is limited considering the large geographical area of the MENA region. The main domains that have higher quality scores were clarity of presentation and scope and purpose, whereas domains with the lowest scores were rigor of development and applicability. The authors’ findings will help policymakers identify areas for improvement in CPGs, which can lead them to implement strategies such as the training of individuals and recruitment of international experts to ultimately develop high-quality CPGs.
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Affiliation(s)
- Saja H Almazrou
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Layan A Alsubki
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Norah A Alsaigh
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Wadha H Aldhubaib
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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15
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Strengthening health policy development and management systems in low- and middle- income countries: South Africa's approach. HEALTH POLICY OPEN 2020. [DOI: 10.1016/j.hpopen.2020.100010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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16
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Abdul-Khalek RA, Abu-Sitta G, El Achi N, Kayyal W, Elamine A, Noubani A, Menassa M, Ahmed F, Sullivan R, Mukherji D. Mapping breast cancer journal publications in conflict settings in the MENA region: a scoping review. Ecancermedicalscience 2020; 14:1129. [PMID: 33209120 PMCID: PMC7652545 DOI: 10.3332/ecancer.2020.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background Breast cancer is a major cause of cancer-related morbidity and mortality among women in the the Middle East and North Africa (MENA) region. Conflict and political instability in the region may affect medical research output, including that on breast cancer. This scoping review aims to systematically identify and map breast cancer publications across different stages of the cancer care pathway and across conflict-affected countries within the MENA region. The findings of this work will highlight the impact of conflict on cancer research that could be mitigated with the proper contextualised capacity strengthening intervention. Methods We followed the PRISMA-Scr methodology. We searched for peer-reviewed publications on topics related to breast cancer in 11 databases: Medline, PubMed, EMBASE, Web of Science, PROQUEST, CINAHL, Global Index Medicus, Arab World Searches Complete, Popline, Scopus and Google Scholar using both controlled vocabulary and keywords. Publication abstracts and full-text versions were screened for duplicates and included in our study based on pre-specified eligibility criteria: focused on breast cancer, related to the specific country of analysis and human or health system studies. We used a structured data extraction form to extract information related to the article, its methodology and the cancer care pathway being studied. Results A total of 19,215 citations were retrieved from our search. After removing duplicates, a total of 8,622 articles remained. Title and abstract screening retained 1,613 articles. Publications with first author affiliations to Turkey were consistently the highest across all categories of the cancer care pathway. Trends show an increase in articles from Lebanon, Jordan and Palestine after 2015. Early exploratory and epidemiological studies represented the majority of breast cancer research, followed by policy and implementation research and lastly experimental research. Most research conducted followed an observational study design. Important gaps were identified in the research output related to advanced breast cancer and palliative care (Libya, Syria and Yemen), mental health (Libya), and knowledge and education of breast cancer (Libya and Syria). Conclusion This scoping review has identified key areas in breast cancer research that lack significant research activity in conflict MENA settings. These areas, including but are not limited to palliative care, mental health, and education, can be prioritised and developed through regional collaboration and contextualised capacity strengthening initiatives.
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Affiliation(s)
- Rima A Abdul-Khalek
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ghassan Abu-Sitta
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nassim El Achi
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Walaa Kayyal
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ahmad Elamine
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Aya Noubani
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Fahad Ahmed
- Institute of Oncology, Hacettepe University, Ankara, Turkey
| | - Richard Sullivan
- King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, King's College London, London, UK
| | - Deborah Mukherji
- Conflict Medicine Program Global Health Institute, American University of Beirut, Beirut, Lebanon
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17
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Partridge ACR, Mansilla C, Randhawa H, Lavis JN, El-Jardali F, Sewankambo NK. Lessons learned from descriptions and evaluations of knowledge translation platforms supporting evidence-informed policy-making in low- and middle-income countries: a systematic review. Health Res Policy Syst 2020; 18:127. [PMID: 33129335 PMCID: PMC7603785 DOI: 10.1186/s12961-020-00626-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) platforms are organisations, initiatives and networks that focus on supporting evidence-informed policy-making at least in part about the health-system arrangements that determine whether the right programmes, services and products get to those who need them. Many descriptions and evaluations of KT platforms in low- and middle-income countries have been produced but, to date, they have not been systematically reviewed. METHODS We identified potentially relevant studies through a search of five electronic databases and a variety of approaches to identify grey literature. We used four criteria to select eligible empirical studies. We extracted data about seven characteristics of included studies and about key findings. We used explicit criteria to assess study quality. In synthesising the findings, we gave greater attention to themes that emerged from multiple studies, higher-quality studies and different contexts. RESULTS Country was the most common jurisdictional focus of KT platforms, EVIPNet the most common name and high turnover among staff a common infrastructural feature. Evidence briefs and deliberative dialogues were the activities/outputs that were the most extensively studied and viewed as helpful, while rapid evidence services were the next most studied but only in a single jurisdiction. None of the summative evaluations used a pre-post design or a control group and, with the exception of the evaluations of the influence of briefs and dialogues on intentions to act, none of the evaluations achieved a high quality score. CONCLUSIONS A large and growing volume of research evidence suggests that KT platforms offer promise in supporting evidence-informed policy-making in low- and middle-income countries. KT platforms should consider as next steps expanding their current, relatively limited portfolio of activities and outputs, building bridges to complementary groups, and planning for evaluations that examine 'what works' for 'what types of issues' in 'what types of contexts'.
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Affiliation(s)
- Arun C R Partridge
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Cristián Mansilla
- McMaster Health Forum and Health Policy PhD Program, McMaster University, Hamilton, Canada
| | - Harkanwal Randhawa
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - John N Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Fadi El-Jardali
- Knowledge to Policy Center and Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Nelson K Sewankambo
- Clinical Epidemiology and Biostatistics Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
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Ashcraft LE, Quinn DA, Brownson RC. Strategies for effective dissemination of research to United States policymakers: a systematic review. Implement Sci 2020; 15:89. [PMID: 33059748 PMCID: PMC7560305 DOI: 10.1186/s13012-020-01046-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/14/2020] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Laura Ellen Ashcraft
- University of Pittsburgh School of Social Work, 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
| | - Deirdre A Quinn
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, University Drive C, Building 30, Pittsburgh, PA, 15240, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA
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Brdarić D, Samardžić S, Huskić IM, Dritsakis G, Sessa J, Śliwińska-Kowalska M, Pawlaczyk-Łuszczyńska M, Basdekis I, Spanoudakis G. A Data-informed Public Health Policy-Makers Platform. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3271. [PMID: 32392883 PMCID: PMC7246532 DOI: 10.3390/ijerph17093271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/17/2022]
Abstract
Hearing loss is a disease exhibiting a growing trend due to a number of factors, including but not limited to the mundane exposure to the noise and ever-increasing size of the older population. In the framework of a public health policymaking process, modeling of the hearing loss disease based on data is a key factor in alleviating the issues related to the disease and in issuing effective public health policies. First, the paper describes the steps of the data-driven policymaking process. Afterward, a scenario along with the part of the proposed platform responsible for supporting policymaking are presented. With the aim of demonstrating the capabilities and usability of the platform for the policy-makers, some initial results of preliminary analytics are presented in the framework of a policy-making process. Ultimately, the utility of the approach is validated throughout the results of the survey which was presented to the health system policy-makers involved in the policy development process in Croatia.
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Affiliation(s)
- Dario Brdarić
- Department for Disinfection, Disinsection and Deratization, Institute of Public Health for the Osijek Baranya County, 31000 Osijek, Croatia; (D.B.); (S.S.); (I.M.H.)
- Department of Public Health, Humanities and Social Sciences in Biomedicine, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Senka Samardžić
- Department for Disinfection, Disinsection and Deratization, Institute of Public Health for the Osijek Baranya County, 31000 Osijek, Croatia; (D.B.); (S.S.); (I.M.H.)
| | - Ivana Mihin Huskić
- Department for Disinfection, Disinsection and Deratization, Institute of Public Health for the Osijek Baranya County, 31000 Osijek, Croatia; (D.B.); (S.S.); (I.M.H.)
| | | | - Jadran Sessa
- Dipartimento di Informatica, Università degli Studi di Milano, 20133 Milano, Italy
| | - Mariola Śliwińska-Kowalska
- Department of Physical Hazard, Nofer Institute of Occupational Medicine, 91-348 Łódź, Poland; (M.Ś.-K.); (M.P.-Ł.)
| | | | - Ioannis Basdekis
- Department of Computer Science, City University of London, London EC1V 0HB, UK; (I.B.); (G.S.)
| | - George Spanoudakis
- Department of Computer Science, City University of London, London EC1V 0HB, UK; (I.B.); (G.S.)
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El-Harakeh A, Lotfi T, Ahmad A, Morsi RZ, Fadlallah R, Bou-Karroum L, Akl EA. The implementation of prioritization exercises in the development and update of health practice guidelines: A scoping review. PLoS One 2020; 15:e0229249. [PMID: 32196520 PMCID: PMC7083273 DOI: 10.1371/journal.pone.0229249] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background The development of trustworthy guidelines requires substantial investment of resources and time. This highlights the need to prioritize topics for guideline development and update. Objective To systematically identify and describe prioritization exercises that have been conducted for the purpose of the de novo development, update or adaptation of health practice guidelines. Methods We searched Medline and CINAHL electronic databases from inception to July 2019, supplemented by hand-searching Google Scholar and the reference lists of relevant studies. We included studies describing prioritization exercises that have been conducted during the de novo development, update or adaptation of guidelines addressing clinical, public health or health systems topics. Two reviewers worked independently and in duplicate to complete study selection and data extraction. We consolidated findings in a semi-quantitative and narrative way. Results Out of 33,339 identified citations, twelve studies met the eligibility criteria. All included studies focused on prioritizing topics; none on questions or outcomes. While three exercises focused on updating guidelines, nine were on de novo development. All included studies addressed clinical topics. We adopted a framework that categorizes prioritization into 11 steps clustered in three phases (pre-prioritization, prioritization and post-prioritization). Four studies covered more than half of the 11 prioritization steps across the three phases. The most frequently reported steps for generating initial list of topics were stakeholders’ input (n = 8) and literature review (n = 7). The application of criteria to determine research priorities was used in eight studies. We used and updated a common framework of 22 prioritization criteria, clustered in 6 domains. The most frequently reported criteria related to the health burden of disease (n = 9) and potential impact of the intervention on health outcomes (n = 5). All the studies involved health care providers in the prioritization exercises. Only one study involved patients. There was a variation in the number and type of the prioritization exercises’ outputs. Conclusions This review included 12 prioritization exercises that addressed different aspects of priority setting for guideline development and update that can guide the work of researchers, funders, and other stakeholders seeking to prioritize guideline topics.
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Affiliation(s)
- Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Lotfi
- Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ali Ahmad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rami Z. Morsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Racha Fadlallah
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie A. Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
- * E-mail:
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Supporting the use of research evidence in decision-making in crisis zones in low- and middle-income countries: a critical interpretive synthesis. Health Res Policy Syst 2020; 18:21. [PMID: 32070370 PMCID: PMC7027202 DOI: 10.1186/s12961-020-0530-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/21/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Decision-makers in crisis zones are faced with the challenge of having to make health-related decisions under limited time and resource constraints and in light of the many factors that can influence their decisions, of which research evidence is just one. To address a key gap in the research literature about how best to support the use of research evidence in such situations, we conducted a critical interpretive synthesis approach to develop a conceptual framework that outlines the strategies that leverage the facilitators and address the barriers to evidence use in crisis zones. METHODS We systematically reviewed both empirical and non-empirical literature and used an interpretive analytic approach to synthesise the results and develop the conceptual framework. We used a 'compass' question to create a detailed search strategy and conducted electronic searches in CINAHL, EMBASE, MEDLINE, SSCI and Web of Science. A second reviewer was assigned to a representative sample of articles. We purposively sampled additional papers to fill in conceptual gaps. RESULTS We identified 21 eligible papers to be analysed and purposively sampled an additional 6 to fill conceptual gaps. The synthesis resulted in a conceptual framework that focuses on evidence use in crisis zones examined through the lens of four systems - political, health, international humanitarian aid and health research. Within each of the four systems, the framework identifies the most actionable strategies that leverage the facilitators and address the barriers to evidence use. CONCLUSIONS This study presents a new conceptual framework that outlines strategies that leverage the facilitators and address the barriers to evidence use in crisis zones within different systems. This study expands on the literature pertaining to evidence-informed decision-making.
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Mirzoev T, Poudel AN, Gissing S, Doan TTD, Ferdous T, Regmi S, Duong MD, Baral S, Chand O, Huque R, Hoang VM, Elsey H. Is evidence-informed urban health planning a myth or reality? Lessons from a qualitative assessment in three Asian cities. Health Policy Plan 2019; 34:773-783. [PMID: 31603206 PMCID: PMC6913712 DOI: 10.1093/heapol/czz097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2019] [Indexed: 11/23/2022] Open
Abstract
City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself. We collected qualitative data between August 2017 and October 2018 using: in-depth interviews with key actors, document review and observations of planning events. Framework approach guided the data analysis. Health is one of competing priorities with multiple plans being produced within each city, using combinations of top-down, bottom-up and fragmented planning approaches. Mostly data from government information systems are used, which were perceived as good quality though often omits the urban poor and migrants. Key common influences on data use include constrained resources and limitations of current planning approaches, alongside data duplication and limited co-ordination within Dhaka's pluralistic system, limited opportunities for data use in Hanoi and inadequate and incomplete data in Pokhara. City governments have the potential to act as a hub for multi-sectoral planning. Our results highlight the tensions this brings, with health receiving less attention than other sector priorities. A key emerging issue is that data on the most marginalized urban poor and migrants are largely unavailable. Feasible improvements to evidence-informed urban health planning include increasing availability and quality of data particularly on the urban poor, aligning different planning processes, introducing clearer mechanisms for data use, working within the current systemic opportunities and enhancing participation of local communities in urban health planning.
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Affiliation(s)
- Tolib Mirzoev
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Ak Narayan Poudel
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Stefanie Gissing
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Thi Thuy Duong Doan
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Tarana Ferdous
- ARK Foundation, C4, House 6, Road 109, Gulshan 2, Dhaka-1212, Bangladesh
| | - Shophika Regmi
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Minh Duc Duong
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Sushil Baral
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Obindra Chand
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Rumana Huque
- ARK Foundation, C4, House 6, Road 109, Gulshan 2, Dhaka-1212, Bangladesh
| | - Van Minh Hoang
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Helen Elsey
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
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Implementing health technology assessment in Kuwait: a qualitative study of perceived barriers and facilitators. Int J Technol Assess Health Care 2019; 35:422-426. [PMID: 31771676 DOI: 10.1017/s0266462319000710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study sought to explore main barriers and facilitators to implementing health technology assessment (HTA) in Kuwait from the perspective of key stakeholders. METHODS Semi-structured qualitative interviews were conducted with ten key stakeholders: seven healthcare providers working at various departments of the Kuwaiti Ministry of Health (MOH), and three academics with substantial experience in teaching HTA or related fields. Interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Data were analyzed using an inductive thematic approach. RESULTS Participating stakeholders reported several factors that might act as a barrier to building HTA in Kuwait: minimal awareness of HTA, lack of institutional and human capacity, a fragmented healthcare system, poor communication between researchers and policy makers, the country's wealth, politics, as well as data quality, availability, and sharing. Institutionalizing HTA as a politically empowered body, enforcing its recommendation by law, and benefiting from neighboring countries' experiences were suggested as possible ways to move forward. CONCLUSION Studies exploring the unique challenges that high-income developing countries may face in implementing HTA are still scarce. The results of this study are consistent with evidence coming from other developing countries, while also suggesting that the abundance of financial resources in the country is a double-edged sword; it has the potential to facilitate the development of HTA capacity, but also hinders recognizing the need for it.
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Edalati S, Omidvar N, Haghighian Roudsari A, Ghodsi D, Zargaraan A. Development and implementation of nutrition labelling in Iran: A retrospective policy analysis. Int J Health Plann Manage 2019; 35:e28-e44. [PMID: 31709620 DOI: 10.1002/hpm.2924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/23/2019] [Accepted: 10/05/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Nutrition labelling is a strategy to promote healthy eating and combat non-communicable diseases (NCDs). The present study aimed to provide an analysis of the nutrition labelling policy and its opportunities to improve in Iran. METHODS Data were collected by 1) reviewing relevant documents and 2) semi-structured interviews with stakeholders through purposive and snowball sampling, continued until data saturation was achieved. A deductive content analysis was used by applying the policy triangulation framework and the Kingdon multiple stream theory. MAXQDA software was used to manage data analysis. RESULTS Iran, is the first country in the Eastern Mediterranean region which has accomplished to implement nutrition traffic light labelling. The main contextual factors that affected nutrition labelling policy to become a national included health, political commitment, and international factors. Poor involvement of media for public awareness of nutrition traffic labeling, the inconsistency of nutrition traffic light color ranking using food standard guidelines, lack of consistency between nutrition traffic light colors and the healthy/unhealthy nature of some food products and the absence of a comprehensive evaluation plan were among the policy challenges identified. CONCLUSIONS Strengthening the governance for a healthy food environment is recommended to improve the program. Also, establishing national portion sizes for food labelling, initiating public awareness campaigns, evaluation of the policy effect and public perception of the labels and their application are recommended.
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Affiliation(s)
- Sareh Edalati
- Student Research Committee, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Haghighian Roudsari
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Delaram Ghodsi
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azizollaah Zargaraan
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Fadlallah R, Bou-Karroum L, El-Jardali F, Hishi L, Al-Akkawi A, Tsolakian IG, Hemadi N, Hamadeh RS, AbuAlRub R, Hamadeh RR, Arfa C. Quality, safety and performance management in primary health care: from scoping review to research priority setting and implementation plan in the Eastern Mediterranean Region. BMJ Glob Health 2019; 4:e001477. [PMID: 31478023 PMCID: PMC6703301 DOI: 10.1136/bmjgh-2019-001477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/12/2019] [Accepted: 05/11/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Strong primary health care (PHC) leads to better health outcomes, improves health equity and accelerates progress towards universal health coverage (UHC). The Astana Declaration on PHC emphasised the importance of quality care to achieve UHC. A comprehensive understanding of the quality paradigm of PHC is critical, yet it remains elusive in countries of the Eastern Mediterranean Region (EMR). This study used a multistep approach to generate a policy-relevant research agenda for strengthening quality, safety and performance management in PHC in the EMR. METHODS A multistep approach was adopted, encompassing the following steps: scoping review and generation of evidence and gap maps, validation and ranking exercises, and development of an approach for research implementation. We followed Joanna Briggs Institute guidelines for conducting scoping reviews and a method review of the literature to build the evidence and gap maps. For the validation and ranking exercises, we purposively sampled 55 high-level policy-makers and stakeholders from selected EMR countries. We used explicit multicriteria for ranking the research questions emerging from the gap maps. The approach for research implementation was adapted from the literature and subsequently tailored to address the top ranked research question. RESULTS The evidence and gap maps revealed limited production of research evidence in the area of quality, safety and performance management in PHC by country and by topic. The priority setting exercises generated a ranked list of 34 policy-relevant research questions addressing quality, safety and performance management in PHC in the EMR. The proposed research implementation plan involves collaborative knowledge generation with policy-makers along with knowledge translation and impact assessment. CONCLUSION Study findings can help inform and direct future plans to generate, disseminate and use research evidence to enhance quality, safety and performance management in PHC in EMR and beyond. Study methodology can help bridge the gap between research and policy-making.
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Affiliation(s)
- Racha Fadlallah
- Health Management and Policy Department, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Health Management and Policy Department, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Health Management and Policy Department, American University of Beirut, Beirut, Lebanon
| | - Lama Hishi
- Health Management and Policy Department, American University of Beirut, Beirut, Lebanon
| | - Alaa Al-Akkawi
- Health Management and Policy Department, American University of Beirut, Beirut, Lebanon
| | | | - Nour Hemadi
- Health Management and Policy Department, American University of Beirut, Beirut, Lebanon
| | - Randa S. Hamadeh
- Primary Healthcare Department, Minstry of Public Health, Beirut, Lebanon
| | - Raeda AbuAlRub
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Randah R. Hamadeh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | - Chokri Arfa
- National Institute of Labor and Social Studies (INTES), University of Carthage, Tunis, Tunisia
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26
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Sajadi HS, Majdzadeh R, Yazdizadeh B, Mohtasham F, Mohseni M, Doshmangir L, Lavis J. A roadmap for strengthening evidence-informed health policy-making in Iran: protocol for a research programme. Health Res Policy Syst 2019; 17:50. [PMID: 31101047 PMCID: PMC6525369 DOI: 10.1186/s12961-019-0455-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/16/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many initiatives have been taken in the Islamic Republic of Iran to promote evidence-informed health policy-making (EIHP). However, these initiatives are not systematic. Since the implementation of EIHP is not consistent and the interventions in this regard are complex, a comprehensive plan could be a useful tool for employing initiatives to achieve and promote EIHP. Hence, this study aims to develop a roadmap for strengthening EIHP over a 3-year period in Iran. METHODS Nine projects will be conducted to define the roadmap for strengthening EIHP. These projects include two reviews and a stakeholder analysis to identify the factors that facilitate or hinder achieving EIHP. The next study will be a qualitative study to prioritise the challenges and outline the main causes. The following steps will be a review of reviews to extract global experiences on interventions used for strengthening EIHP and two qualitative studies to examine the adoption of these interventions and develop an operational plan for strengthening EIHP in Iran. The research will be completed through conducting two qualitative-quantitative studies to design a tool for measuring EIHP and assessing EIHP in Iran at baseline. DISCUSSION This national EIHP roadmap will surely be able to identify the gaps and bumps that might exist in the implementation plan for establishing EIHP and eliminate them as needed in the future. This roadmap can be a step in moving towards transparency and accountability in the health system and as thus towards good governance and improvement of the health system's performance. Although the plan can be a good model for developing countries and may promote the use of evidence in health policy-making, we should assume that there are some critical contextual factors that could potentially hinder the complete and successful implementation of EIHP. Thus, to enhance EIHP in these countries with a policy-making context that does not fully support the use of evidence, it is crucial to think about not only those interventions that directly address the EIHP barriers, but also some long-term strategies to make required changes in the context, both beyond and within the health system.
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Affiliation(s)
- Haniye Sadat Sajadi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Mohseni
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - John Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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27
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Akhras KS, Alsheikh-Ali AA, Kabbani S. Use of real-world evidence for healthcare decision-making in the Middle East: practical considerations and future directions. Expert Rev Pharmacoecon Outcomes Res 2019; 19:245-250. [PMID: 30626231 DOI: 10.1080/14737167.2019.1568243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Real-world evidence (RWE) is increasingly being used in coverage, reimbursement and formulary decisions for medicines globally. Areas covered: The Middle East (ME) region is significantly behind in generating and using RWE in health policy decisions due to several factors that shaped the health sector over the past few decades. The trend, however, is changing due to several factors that are shaping the future of the healthcare industry in the region. Among other factors, rising healthcare cost, changing population and disease demographics, increased focus on the quality of healthcare, digitization of medical data, increased demand for local clinical and economic data, and overall greater influence of global trends in the healthcare industry. For the region to realize the benefit of RWE in healthcare decisions, it needs to overcome several challenges including embracing the value that RWE brings to healthcare decisions, building trust between stakeholders, establishing reliability and validity of databases used to generate RWE, enhancing technical capabilities, investing in local data generation, and conducting high-quality RWE studies while maintaining patients' confidentiality. Expert commentary: We believe that the next decade will witness significant increase in RWE generation in the region, and will play a key role in driving efficiency in healthcare delivery.
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Affiliation(s)
- Kasem S Akhras
- a Director, Government Affairs and Market Access , Middle East and Africa Region, AstraZeneca , 2nd Floor Block D Building 27, Dubai Healthcare City, P.O. Box 505070, Dubai , UAE
| | - Alawi A Alsheikh-Ali
- b Dean - College of Medicine and Professor of Cardiovascular Medicine , Mohammed Bin Rashid University of Medicine and Health Sciences , Dubai , UAE
| | - Samer Kabbani
- c Associate Professor of Medicine, College of Medicine , Lebanese American University Medical Center , Beirut , Lebanon
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28
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Bou-Karroum L, Daou KN, Nomier M, El Arnaout N, Fouad FM, El-Jardali F, Akl EA. Health Care Workers in the setting of the "Arab Spring": a scoping review for the Lancet-AUB Commission on Syria. J Glob Health 2018; 9:010402. [PMID: 30410745 PMCID: PMC6207103 DOI: 10.7189/jogh.09.010402] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background "Health Care Workers in Conflict Areas" emerged as one of the priority themes for a Lancet Commission addressing health in conflict. The objective of our study was to conduct a scoping review on health workers in the setting of the Syrian conflict, addressing four topics of interest: violence against health care workers, education, practicing in conflict setting, and migration. Methods Considering the likelihood of scarcity of data, we broadened the scope of the scoping review to include indirect evidence on health care workers from other countries affected by the "Arab Spring". We electronically searched six electronic databases. We conducted descriptive analysis of the general characteristics of the included papers. We also used the results of this scoping review to build an evidence gap map. Results Out of the 11 165 identified citations, 136 met our eligibility criteria. The majority of the articles tackled the issue of violence against health care workers (63%) followed by practicing in conflict setting (19%), migration (17%) and education (10%). Countries in focus of most articles were: Syria (35%), Iraq (33%), and Bahrain (29%). News, editorials, commentaries and opinion pieces made up 81% of all included papers, while primary studies made up only 9%. All the primary studies identified in this review were conducted on Iraq. Most of the articles about violence against health care workers were on Bahrain, followed by Syria and Iraq. The first and corresponding authors were most frequently affiliated with institutions from non-Arab countries (79% and 79% respectively). Conclusions Research evidence on health care workers in the setting of the "Arab Spring" is scarce. This review and the gap map can inform the research agendas of funders and researchers working in the field of health care workers in conflict setting. More well-designed primary studies are needed to inform the decisions of policymakers and other interested parties.
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Affiliation(s)
- Lama Bou-Karroum
- Center for Systematic Reviews for Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Karim N Daou
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohamed Nomier
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fouad M Fouad
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Refugee Health Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Center for Systematic Reviews for Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Elie A Akl
- Center for Systematic Reviews for Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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29
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Nakkash RT, Torossian L, El Hajj T, Khalil J, Afifi RA. The passage of tobacco control law 174 in Lebanon: reflections on the problem, policies and politics. Health Policy Plan 2018; 33:633-644. [PMID: 29635414 DOI: 10.1093/heapol/czy023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/13/2022] Open
Abstract
Progress in tobacco control policy making has occurred worldwide through advocacy campaigns involving multiple players- civil society groups, activists, academics, media and policymakers. The Framework Convention on Tobacco Control (FCTC)-the first ever global health treaty-outlines evidence-based tobacco control policies. Lebanon ratified the FCTC in 2005, but until 2011, tobacco control policies remained rudimentary and not evidence-based. Beginning in 2009, a concerted advocacy campaign was undertaken by a variety of stakeholders with the aim of accelerating the process of adopting a strong tobacco control policy. The campaign was successful, and Law 174 passed the Lebanese Parliament in August 2011. In this article, we analyse the policy making process that led to the adoption of Law 174 using Kingdon's model. The analysis relies on primary and secondary data sources including historical records of key governmental decisions, documentation of the activities of the concerted advocacy campaign and in-depth interviews with key stakeholders. We describe the opening of a window of opportunity as a result of the alignment of the problem, policy and politics streams. Furthermore, findings revealed that despite the challenge of persistent tobacco industry interference and established power relations between the industry, its allies and policymakers; policy entrepreneurs succeeded in supporting the alignment of the streams, and influencing the passage of the law. Kingdon's multiple stream approach was useful in explaining how tobacco control became an emerging policy issue at the front of the policy agenda in Lebanon.
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Affiliation(s)
- R T Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - L Torossian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - T El Hajj
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Watipa, CIC, London, UK
| | - J Khalil
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - R A Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Yazdizadeh B, Mohtasham F. Assessment of research systems in universal health coverage-related organizations. Med J Islam Repub Iran 2018; 32:15. [PMID: 30159266 PMCID: PMC6108238 DOI: 10.18869/mjiri.32.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Universal health coverage (UHC) is the desired goal of achieving universal access to health services without having to endure pain and financial difficulties. Multiple factors can help steer countries toward UHC. One of the most important factors is the production of valid quality evidence that can be achieved through research. The present study aimed at outlining the status of research systems in UHC–related organizations and identifying the barriers faced by research.
Methods: The key individuals and organizations that could provide rich, relevant, and diverse data in response to the research question were purposively selected for the interviews. Thematic analysis was used to analyze the interviews. Categories and subcategories were deductively extracted from the text based on research system performance as follows: resource provision, production and utilization of knowledge, existing resources, and stewardship. Then, the themes were inductively extracted from the interviews.
Results: Many barriers existed for performing research in UHC–related organizations. The stewardship barrier seemed to play a key role such that structural changes in organizations affected the production & utilization of evidence. Limited financial and human resources were evident in most of the organizations. Research questions were not comprehensively identified. The conducted studies either were not designed to answer the relevant questions and/or were not appropriately reported to policy makers. As a result, their implementation in decision- making did not reach the ideal status.
Conclusion: Research utilization aimed at achieving UHC will come to realize only when and if research is conducted to produce evidence required for decision–making and implementation. Therefore, in addition to the interventions recommended by the World Health Organization, we should design and implement interventions tailored to the local barriers and needs of UHC–related organizations.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Haq Z, Hafeez A, Zafar S, Ghaffar A. Dynamics of evidence-informed health policy making in Pakistan. Health Policy Plan 2018; 32:1449-1456. [PMID: 29045672 PMCID: PMC5886137 DOI: 10.1093/heapol/czx128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 01/06/2023] Open
Abstract
Incorporating evidence is fundamental to maintaining the general acceptance and efficiency in public policies. In Pakistan, different actors—local and global—strive to facilitate the development of evidence-informed health policies. Effective involvement however, requires knowledge of the country-context, i.e. knowing the intricacies of how policies are formulated in Pakistan. Obtaining this knowledge is one of the key steps to making interventions impactful. We carried out a qualitative study to explore the environment of evidence-informed health policy in Pakistan. The study involved 89 participants and comprised three phases including: (1) literature review followed by a consultative meeting with key informants to explore the broad contours of policy formulation, (2) in-depth interviews with participants belonging to various levels of health system to discuss these contours and (3) a roundtable with experts to share and solidify the findings. Policy development is a slow, non-linear process with variable room for incorporation of evidence. Political actors dominate decisions that impact all aspects of policy, i.e. context, process and content. Research contributions are mostly influenced by the priorities of donor agencies—the usual proponents and sponsors of the generation of evidence. Since the devolution of health system in 2012, Pakistan’s provinces continue to follow the same processes as before 2012, with little capacity to generate evidence and incorporate it into health policy. This study highlights the non-systematic, nearly ad hoc way of developing health policy in the country, overly dominated by political actors. Health advocates need to understand the policy process and the actors involved if they are to identify points of impact where their interaction with policy brings the maximum leverage. Moreover, an environment is needed where generation of data gains the importance it deserves and where capacities are enhanced for communicating and understanding evidence, as well as its incorporation into policy.
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Affiliation(s)
- Zaeem Haq
- Department of Health, Behavior and Society, Johns Hopkins Center for Communication Programs, Islamabad, Pakistan
| | | | | | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Jessani NS, Siddiqi SM, Babcock C, Davey-Rothwell M, Ho S, Holtgrave DR. Factors affecting engagement between academic faculty and decision-makers: learnings and priorities for a school of public health. Health Res Policy Syst 2018; 16:65. [PMID: 30045730 PMCID: PMC6060478 DOI: 10.1186/s12961-018-0342-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/22/2018] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Nasreen S Jessani
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America.
| | - Sameer M Siddiqi
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| | - Carly Babcock
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| | - Melissa Davey-Rothwell
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| | - Shirley Ho
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| | - David R Holtgrave
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
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Ellen ME, Lavis JN, Horowitz E, Berglas R. How is the use of research evidence in health policy perceived? A comparison between the reporting of researchers and policy-makers. Health Res Policy Syst 2018; 16:64. [PMID: 30029647 PMCID: PMC6053732 DOI: 10.1186/s12961-018-0345-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/22/2018] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Moriah E Ellen
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel. .,McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S-4L6, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S-4L6, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, L8S-4L6, Canada.,Department of Political Science, McMaster University, 1280 Main Street West, Hamilton, ON, L8S-4L6, Canada.,Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States of America
| | - Einav Horowitz
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel
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Makkar SR, Haynes A, Williamson A, Redman S. Organisational capacity and its relationship to research use in six Australian health policy agencies. PLoS One 2018. [PMID: 29513669 PMCID: PMC5841661 DOI: 10.1371/journal.pone.0192528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
There are calls for policymakers to make greater use of research when formulating policies. Therefore, it is important that policy organisations have a range of tools and systems to support their staff in using research in their work. The aim of the present study was to measure the extent to which a range of tools and systems to support research use were available within six Australian agencies with a role in health policy, and examine whether this was related to the extent of engagement with, and use of research in policymaking by their staff. The presence of relevant systems and tools was assessed via a structured interview called ORACLe which is conducted with a senior executive from the agency. To measure research use, four policymakers from each agency undertook a structured interview called SAGE, which assesses and scores the extent to which policymakers engaged with (i.e., searched for, appraised, and generated) research, and used research in the development of a specific policy document. The results showed that all agencies had at least a moderate range of tools and systems in place, in particular policy development processes; resources to access and use research (such as journals, databases, libraries, and access to research experts); processes to generate new research; and mechanisms to establish relationships with researchers. Agencies were less likely, however, to provide research training for staff and leaders, or to have evidence-based processes for evaluating existing policies. For the majority of agencies, the availability of tools and systems was related to the extent to which policymakers engaged with, and used research when developing policy documents. However, some agencies did not display this relationship, suggesting that other factors, namely the organisation's culture towards research use, must also be considered.
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Affiliation(s)
- Steve R. Makkar
- The Sax Institute, Ultimo, New South Wales, Australia
- * E-mail:
| | - Abby Haynes
- The Sax Institute, Ultimo, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | | | - Sally Redman
- The Sax Institute, Ultimo, New South Wales, Australia
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Hlongwana KW, Sartorius B, Tsoka-Gwegweni J. Malaria programme personnel's experiences, perceived barriers and facilitators to implementing malaria elimination strategy in South Africa. Malar J 2018; 17:21. [PMID: 29316916 PMCID: PMC5761101 DOI: 10.1186/s12936-017-2154-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has set an ambitious goal targeting to eliminate malaria by 2018, which is consistent with the United Nations Sustainable Development Goals' call to end the epidemic of malaria by 2030 across the globe. There are conflicting views regarding the feasibility of malaria elimination, and furthermore studies investigating malaria programme personnel's perspectives on strategy implementation are lacking. METHODS The study was a cross-sectional survey conducted in 2014 through a face-to-face investigator-administered semi-structured questionnaire to all eligible and consenting malaria programme personnel (team leader to senior manager levels) in three malaria endemic provinces (KwaZulu-Natal, Mpumalanga, and Limpopo) of South Africa. RESULTS The overall response rate was 88.6% (148/167) among all eligible malaria personnel. The mean age of participants was 47 years (SD 9.7, range 27-70), and the mean work experience of 19.4 years (SD 11.1, range 0-42). The majority were male (78.4%), and 66.9% had secondary level education. Awareness of the malaria elimination policy was high (99.3%), but 89% contended that they were never consulted when the policy was formulated and few had either seen (29.9%) or read (23%) the policy, either in full or in part. Having read the policy was positively associated with professional job designations (managers, EHPs and entomologists) (p = 0.010) and tertiary level education (p = 0.042). There was a sentiment that the policy was neither sufficiently disseminated to all key healthcare workers (76.4%) nor properly adapted (68.9%) for the local operational context in the elimination strategy. Most (89.1%) participants were not optimistic about eliminating malaria by 2018, as they viewed the elimination strategy in South Africa as too theoretical with unrealistic targets. Other identified barriers included inadequate resources (53.5%) and high cross-border movements (19.8%). CONCLUSIONS Most participants were not positive that South Africa could achieve the malaria elimination goal by 2018, citing the high cross-border movements and lack of resources as key barriers. The National and relevant Provincial Departments of Health should consider investing more time and resources in further stakeholder engagement for more effective implementation of malaria elimination strategy in South Africa.
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Affiliation(s)
- Khumbulani Welcome Hlongwana
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, King George Avenue, Durban, South Africa.
| | - Benn Sartorius
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, King George Avenue, Durban, South Africa
| | - Joyce Tsoka-Gwegweni
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, King George Avenue, Durban, South Africa
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Zida A, Lavis JN, Sewankambo NK, Kouyate B, Ouedraogo S. Evaluating the Process and Extent of Institutionalization: A Case Study of a Rapid Response Unit for Health Policy in Burkina Faso. Int J Health Policy Manag 2018; 7:15-26. [PMID: 29325399 PMCID: PMC5745864 DOI: 10.15171/ijhpm.2017.39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 03/15/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Good decision-making requires gathering and using sufficient information. Several knowledge translation platforms have been introduced in Burkina Faso to support evidence-informed decision-making. One of these is the rapid response service for health. This platform aims to provide quick access for policy-makers in Burkina Faso to highquality research evidence about health systems. The purpose of this study is to describe the process and extent of the institutionalization of the rapid response service. METHODS A qualitative case study design was used, drawing on interviews with policy-makers, together with documentary analysis. Previously used institutionalization frameworks were combined to guide the analysis. RESULTS Burkina Faso's rapid response service has largely reached the consolidation phase of the institutionalization process but not yet the final phase of maturity. The impetus for the project came from designated project leaders, who convinced policy-makers of the importance of the rapid response service, and obtained resources to run a pilot. During the expansion stage, additional policy-makers at national and sub-national levels began to use the service. Unit staff also tried to improve the way it was delivered, based on lessons learned during the pilot stage. The service has, however, stagnated at the consolidation stage, and not moved into the final phase of maturity. CONCLUSION The institutionalization process for the rapid response service in Burkina Faso has been fluid rather than linear, with some areas developing faster than others. The service has reached the consolidation stage, but now requires additional efforts to reach maturity.
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Affiliation(s)
- Andre Zida
- Clinical Epidemiology and Biostatistics Unit, College of Health Sciences, Makerere University, Kampala, Uganda
- Ministry of Health, Ouagadougou, Burkina Faso
| | - John N. Lavis
- McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, and Department of Political Science, McMaster University, Hamilton, ON, Canada
| | - Nelson K. Sewankambo
- Clinical Epidemiology and Biostatistics Unit, College of Health Sciences, Makerere University, Kampala, Uganda
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Katowa-Mukwato P, Mwape L, Siwale MC, Musenge EM, Maimbolwa M. Use of Research Evidence in Policy and Decision-Making: Views, Attitudes and Practices of Health Policy Makers in Lusaka Province of Zambia. Health (London) 2018. [DOI: 10.4236/health.2018.104040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. Improving maternal and child health policymaking processes in Nigeria: an assessment of policymakers' needs, barriers and facilitators of evidence-informed policymaking. Health Res Policy Syst 2017; 15:48. [PMID: 28722554 PMCID: PMC5516839 DOI: 10.1186/s12961-017-0217-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Nigeria, interest in the evidence-to-policy process is gaining momentum among policymakers involved in maternal, newborn and child health (MNCH). However, numerous gaps exist among policymakers on use of research evidence in policymaking. The objective of this study was to assess the perception of MNCH policymakers regarding their needs and the barriers and facilitators to use of research evidence in policymaking in Nigeria. METHODS The study design was a cross-sectional assessment of perceptions undertaken during a national MNCH stakeholders' engagement event convened in Abuja, Nigeria. A questionnaire designed to assess participants' perceptions was administered in person. Group consultations were also held, which centred on policymakers' evidence-to-policy needs to enhance the use of evidence in policymaking. RESULTS A total of 40 participants completed the questionnaire and participated in the group consultations. According to the respondents, the main barriers to evidence use in MNCH policymaking include inadequate capacity of organisations to conduct policy-relevant research; inadequate budgetary allocation for policy-relevant research; policymakers' indifference to research evidence; poor dissemination of research evidence to policymakers; and lack of interaction fora between researchers and policymakers. The main facilitators of use of research evidence for policymaking in MNCH, as perceived by the respondents, include capacity building for policymakers on use of research evidence in policy formulation; appropriate dissemination of research findings to relevant stakeholders; involving policymakers in research design and execution; and allowing policymakers' needs to drive research. The main ways identified to promote policymakers' use of evidence for policymaking included improving policymakers' skills in information and communication technology, data use, analysis, communication and advocacy. CONCLUSION To improve the use of research evidence in policymaking in Nigeria, there is a need to establish mechanisms that will facilitate the movement from evidence to policy and address the needs identified by policymakers. It is also imperative to improve organisational initiatives that facilitate use of research evidence for policymaking.
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Affiliation(s)
- Chigozie J Uneke
- Knowledge Translation Platform, African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria.
| | - Issiaka Sombie
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Namoudou Keita
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Virgil Lokossou
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Ermel Johnson
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Pierre Ongolo-Zogo
- Hopital Central Yaounde, CDBPH Lawrence VERGNE Building 2nd Floor, Avenue Henry Dunant Messa, Yaoundé, Cameroon
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Sibai AM, Rizk A, Costanian C, Beard JR. Landscape of Research on Older Adults' Health in the Arab Region: Is It Demography-Driven or Development-Dependent? J Gerontol B Psychol Sci Soc Sci 2017; 72:680-687. [PMID: 27514399 DOI: 10.1093/geronb/gbw099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 07/25/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives To describe the quantity, methods, themes, and collaboration profiles of research on older adults' health in the Arab world, and map research productivity against demographic, economic, and development indicators. Methods A scoping review of research on older adults' health drawing from 7 databases and covering the period 1994-2013. Results Aging research output has increased 6-fold over the study period, with middle-income countries showing the sharpest rise. The majority of the reviewed publications are descriptive in nature, oriented toward examining the extent of disease or factors associated with various morbidity and mortality outcomes (88.5%). Despite the increasing regional instability, there is a dearth of studies on "seniors in emergencies." Collaboration with international coauthors (16.0%) has been more frequent than with regional coauthors (4.2%). Correlation analysis suggests that research production has been more strongly influenced by literacy rates than by population aging indicators, Gross Domestic Product, or government investment in research and development. Discussion This study lays the basis for a "roadmap" for research on older adults' health in the Arab region. It calls for cooperation among various stakeholders to produce a targeted and well-informed research agenda that is more responsive to emerging and context-specific needs of older adults in the region.
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Affiliation(s)
- Abla Mehio Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon.,Center for Studies on Aging (CSA), Beirut, Lebanon
| | - Anthony Rizk
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Christy Costanian
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - John Roland Beard
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
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Makkar SR, Howe M, Williamson A, Gilham F. Impact of tailored blogs and content on usage of Web CIPHER - an online platform to help policymakers better engage with evidence from research. Health Res Policy Syst 2016; 14:85. [PMID: 27905937 PMCID: PMC5134066 DOI: 10.1186/s12961-016-0157-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 11/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need to develop innovations that can help bridge the gap between research and policy. Web CIPHER is an online tool designed to help policymakers better engage with research in order to increase its use in health policymaking. The aim of the present study was to test interventions in order to increase policymakers' usage of Web CIPHER. Namely, the impact of posting articles and blogs on topics relevant to the missions and scope of selected policy agencies in the Web CIPHER community. METHODS Five policy agencies were targeted for the intervention. Web CIPHER usage data was gathered over a 30-month period using Google Analytics. Time series analysis was used to evaluate whether publication of tailored articles and blogs led to significant changes in usage for all Web CIPHER members from policy agencies, including those from the five target agencies. We further evaluated whether these users showed greater increases in usage following publication of articles and blogs directly targeted at their agency, and if these effects were moderated by the blog author. RESULTS Web CIPHER usage gradually increased over time and was significantly predicted by the number of articles but not blogs that were posted throughout the study period. Publication of articles on sexual and reproductive health was followed by sustained increases in usage among all users, including users from the policy agency that targets this area. This effect of topic relevance did not occur for the four remaining target agencies. Finally, page views were higher for articles targeted at one's agency compared to other agencies. This effect also occurred for blogs, particularly when the author was internal to one's agency. CONCLUSION The findings suggest that Web CIPHER usage in general was motivated by general interest, engagement and appeal, as opposed to the agency specificity of content and work relevance. Blogs in and of themselves may not be effective at promoting usage. Thus, in order to increase policymakers' engagement with research through similar online platforms, a potentially effective approach would be to post abundant, frequently updated, engaging, interesting and widely appealing content irrespective of form.
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Affiliation(s)
- Steve R Makkar
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia.
| | - Megan Howe
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia
| | - Anna Williamson
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia
| | - Frances Gilham
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia
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Moore JE, Uka S, Vogel JP, Timmings C, Rashid S, Gülmezoglu AM, Straus SE. Navigating barriers: two-year follow up on recommendations to improve the use of maternal health guidelines in Kosovo. BMC Public Health 2016; 16:987. [PMID: 27633514 PMCID: PMC5025590 DOI: 10.1186/s12889-016-3641-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there are a growing number of initiatives aimed at supporting guideline implementation in resource-constrained settings, few studies assess progress on achieving next steps and goals after the initial activities are completed and the initial funding period has ended. The aim of the current study was to conduct a qualitative process evaluation of progress, barriers, facilitators, and proposed solutions to operationalize nine recommendations to prepare Kosovo to implement the 2012 World Health Organization (WHO) prevention and treatment of postpartum haemorrhage guideline. METHODS/DESIGN In 2012, we co-created nine recommendations designed to support implementing the WHO's guideline on the prevention and treatment of postpartum haemorrhage in Kosovo. The current study uses a realist evaluation approach to assess activities and progress two years after the recommendations were developed. The study involved conducting qualitative focus groups and one-on-one interviews with participants from the first meeting to evaluate the activities and progress on the nine recommendations. RESULTS Forty-three participants provided insights into the barriers and opportunities experienced to date and proposed future directions. Although progress has been made towards implementation of a number of the recommendations, scaling up has been limited by barriers, such as lack of awareness, limited resources, and evaluation challenges. Participants proposed addressing these barriers by building within- and between-country partnerships to facilitate guideline implementation. In addition, participants reported less progress on implementing recommendations related to broader cultural changes, which indicates a need for specific and actionable recommendations to operationalize implementation efforts. CONCLUSIONS In the two years since the initial meeting, there has been mixed progress on the recommendations. Based on participant feedback, we refined the recommendations so that they can be operationalized by health care system stakeholders in Kosovo to further support implementation efforts. It is beneficial to share these lessons learned throughout the implementation process to inform next steps in Kosovo and offer ideas for use in other settings.
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Affiliation(s)
- Julia E. Moore
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Sami Uka
- World Health Organization Country Office, Pristina, Kosovo
| | - Joshua P. Vogel
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Caitlyn Timmings
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Shusmita Rashid
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - A. Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Toronto, ON M5S 1A8 Canada
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Ellen ME, Lavis JN, Shemer J. Examining the use of health systems and policy research in the health policymaking process in Israel: views of researchers. Health Res Policy Syst 2016; 14:66. [PMID: 27585630 PMCID: PMC5009503 DOI: 10.1186/s12961-016-0139-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All too often, health policy and management decisions are made without making use of or consulting with the best available research evidence, which can lead to ineffective and inefficient health systems. One of the main actors that can ensure the use of evidence to inform policymaking is researchers. The objective of this study is to explore Israeli health systems and policy researchers' views and perceptions regarding the role of health systems and policy research (HSPR) in health policymaking and the barriers and facilitators to the use of evidence in the policymaking process. METHODS A survey of researchers who have conducted HSPR in Israel was developed. The survey consisted of a demographics section and closed questions, which focused on support both within the researchers' organisations and the broader environment for KTE activities, perceptions on the policymaking process, and the potential influencing factors on the process. The survey was sent to all health systems and policy researchers in Israel from academic institutions, hospital settings, government agencies, the four health insurance funds, and research institutes (n = 107). All responses were analyzed using descriptive statistics. For close-ended questions about level of agreement we combined together the two highest categories (agree or strongly agree) for analysis. RESULTS Thirty-seven respondents participated in the survey. While many respondents felt that the use of HSPR may help raise awareness on policy issues, the majority of respondents felt that the actual use of HSPR was hindered for many reasons. While facilitators do exist to support the use of research evidence in policymaking, numerous barriers hinder the process such as challenges in government/provider relations, policymakers lacking the expertise for acquiring, assessing, and applying HSPR and priorities in the health system drawing attention away from HSPR. Furthermore, it is perceived by a majority of respondents that the health insurance funds and the physician organisations exert a strong influence in the policymaking process. CONCLUSIONS Health system and policy researchers in Israel need to be introduced to the benefits and potential advantages of evidence-informed policy in an organised and systematic way. Future research should examine the perceptions of policymakers in Israel and thus we can gain a broader perspective on where the actual issues lie.
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Affiliation(s)
- Moriah E Ellen
- Jerusalem College of Technology, Ha-Va'ad ha-Le'umi Street 21, Jerusalem, 93721, Israel. .,Israeli Center for Technology Assessment in Health Care, Gertner Institute, Sheba Medical Center, Tel Hashomer, 52621, Israel. .,McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada.,Department of Political Science, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada.,Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States of America
| | - Joshua Shemer
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Sheba Medical Center, Tel Hashomer, 52621, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel
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Ellen ME, Horowitz E, Vaknin S, Lavis JN. Views of health system policymakers on the role of research in health policymaking in Israel. Isr J Health Policy Res 2016; 5:24. [PMID: 27330738 PMCID: PMC4915086 DOI: 10.1186/s13584-016-0088-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background The use of research evidence in health policymaking is an international challenge. Health systems, including that of Israel, are usually characterized by scarce resources and the necessity to make rapid policy decisions. Knowledge transfer and exchange (KTE) has emerged as a paradigm to start bridging the “know-do” gap. The purpose of this study was to explore the views of health system policymakers and senior executives involved in the policy development process in Israel regarding the role of health systems and policy research (HSPR) in health policymaking, the barriers and facilitators to the use of evidence in the policymaking process, and suggestions for improving the use of HSPR in the policymaking process. Methods A survey and an interview were verbally administered in a single face-to-face meeting with health system policymakers and senior executives involved in the policy development process in Israel. The data collection period was from July to October 2014. The potential participants included members of Knesset, officials from Israel’s Ministry of Health, Ministry of Finance, health services organizations, and other stakeholder organizations (i.e., National Insurance Institute). The close-ended questions were based on previous surveys that had been conducted in this field. Interviews were tape recorded and transcribed. Descriptive statistics were conducted for close ended survey-questions and thematic analysis was conducted for open-ended interview questions. Results There were 32 participants in this study. Participants felt that the use of HSPR helps raise awareness on policy issues, yet the actual use of HSPR was hindered for many reasons. Facilitators do exist to support the use of HSPR in the policymaking process, such as a strong foundation of relationships between researchers and policymakers. However, many barriers exist such as the lack of relevance and timeliness of much of the currently available research to support decision-making and the paucity of funding to support research use. Suggestions to improve the use of HSPR focused on improving dissemination of research findings and ensuring that the research was more relevant and timely. Conclusions This research demonstrated that health systems policymakers in Israel perceive having strong relationships and collaborations with researchers however there is room for improvement, e.g. partnering in research projects to ensure relevance and use. Furthermore, health system policymakers seem to be interested in receiving relevant research in a more useable format and are open to using research in decision making.
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Affiliation(s)
- Moriah E Ellen
- Jerusalem College of Technology, Ha-Va'ad ha-Le'umi St 21, Jerusalem, 93721 Israel ; Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel ; McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L6 Canada ; Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6 Canada
| | - Einav Horowitz
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - Sharona Vaknin
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L6 Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Department of Political Science, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Department of Global Health and Population, Harvard School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115-6018 USA
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Tancred TM, Schleiff M, Peters DH, Balabanova D. Health policy and systems research training: global status and recommendations for action. Bull World Health Organ 2016; 94:491-500. [PMID: 27429488 PMCID: PMC4933139 DOI: 10.2471/blt.15.162818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 01/05/2016] [Accepted: 01/25/2016] [Indexed: 01/13/2023] Open
Abstract
Objective To investigate the characteristics of health policy and systems research training globally and to identify recommendations for improvement and expansion. Methods We identified institutions offering health policy and systems research training worldwide. In 2014, we recruited participants from identified institutions for an online survey on the characteristics of the institutions and the courses given. Survey findings were explored during in-depth interviews with selected key informants. Findings The study identified several important gaps in health policy and systems research training. There were few courses in central and eastern Europe, the Middle East, North Africa or Latin America. Most (116/152) courses were instructed in English. Institutional support for courses was often lacking and many institutions lacked the critical mass of trained individuals needed to support doctoral and postdoctoral students. There was little consistency between institutions in definitions of the competencies required for health policy and systems research. Collaboration across disciplines to provide the range of methodological perspectives the subject requires was insufficient. Moreover, the lack of alternatives to on-site teaching may preclude certain student audiences such as policy-makers. Conclusion Training in health policy and systems research is important to improve local capacity to conduct quality research in this field. We provide six recommendations to improve the content, accessibility and reach of training. First, create a repository of information on courses. Second, establish networks to support training. Third, define competencies in health policy and systems research. Fourth, encourage multidisciplinary collaboration. Fifth, expand the geographical and language coverage of courses. Finally, consider alternative teaching formats.
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Affiliation(s)
- Tara M Tancred
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, England
| | - Meike Schleiff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - David H Peters
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Dina Balabanova
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, England
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Angulo-Tuesta A, Santos LMP, Natalizi DA. Impact of health research on advances in knowledge, research capacity-building and evidence-informed policies: a case study on maternal mortality and morbidity in Brazil. SAO PAULO MED J 2016; 134:153-62. [PMID: 27224280 PMCID: PMC10496541 DOI: 10.1590/1516-3180.2015.01530211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/02/2015] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE National health research systems aim to generate high-quality knowledge so as to maintain and promote the population's health. This study aimed to analyze the impact of maternal mortality/morbidity research funded by the Brazilian Ministry of Health and institutional partners, on the dimensions: advancing in knowledge, research capacity-building and informing decision-making, within the framework of the Canadian Academy of Health Sciences. DESIGN AND SETTING Descriptive study based on secondary data, conducted at a public university. METHODS The advancing in knowledge dimension was estimated from the principal investigators' publication counts and h-index. Data on research capacity-building were obtained from the Ministry of Health's information system. The informing decision-making dimension was analyzed from citations in Stork Network (Rede Cegonha) documents. RESULTS Between 2002 and 2010, R$ 21.6 million were invested in 128 maternal mortality/morbidity projects. Over this period, the principal investigators published 174 articles, resulting in an h-index of 35, thus showing progress in the advancing in knowledge dimension. Within the research capacity-building dimension, training of 71 students (undergraduate/postgraduate) was observed. Progress in the informing decision-making dimension was modest: 73.5% of the 117 citations in the Stork Network documents were institutional documents and norms. One of the projects funded, the 2006/7 National Demography and Health Survey, was cited in program documents. CONCLUSION Impacts were shown in the advancing in knowledge and research capacity-building dimensions. The health research system needs to incorporate research for evidence-informed policies.
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Affiliation(s)
- Antonia Angulo-Tuesta
- PhD. Associate Professor, Faculdade da Ceilândia, Universidade de Brasília, Brasília, DF, Brazil.
| | - Leonor Maria Pacheco Santos
- PhD. Associate Professor and Head of Department of Public Health, Universidade de Brasília, Brasília, DF, Brazil.
| | - Daniel Alves Natalizi
- MSc. Postgraduate Student in Human Nutrition Program, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, Brazil.
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Valinejadi A, Sadoughi F, Salehi M. Diabetes Knowledge Translation Status in Developing Countries: A Mixed Method Study Among Diabetes Researchers in Case of Iran. Int J Prev Med 2016; 7:33. [PMID: 26955462 PMCID: PMC4763462 DOI: 10.4103/2008-7802.175992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/07/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite considerable investment in research, the existing research evidence is frequently not implemented and/or leads to useless or detrimental care in healthcare. The knowledge-practice gap proposed as one of the main causes of not achieving the treatment goals in diabetes. Iran also is facing a difference between the production and utilization of the knowledge of diabetes. The aim of this study was to assess the status of diabetes knowledge translation (KT) in Iran. METHODS This was a survey that executed in 2015 by concurrent mixed methods approach in a descriptive, cross-sectional method. The research population was 65 diabetes researchers from 14 diabetes research centers throughout Iran. The research was carried out via the self-assessment tool for research institutes (SATORI), a valid and reliable tool. Focus group discussions were used to complete this tool. The data were analyzed using quantitative (descriptive method by Excel software) and qualitative approaches (thematic analysis) based on SATORI-extracted seven themes. RESULTS The mean of scores "the question of research," "knowledge production," "knowledge transfer," "promoting the use of evidence," and all aspects altogether were 2.48, 2.80, 2.18, 2.06, and 2.39, respectively. The themes "research quality and timeliness" and "promoting and evaluating the use of evidence" received the lowest (1.91) and highest mean scores (2.94), respectively. Except for the theme "interaction with research users" with a relatively mediocre scores (2.63), the other areas had scores below the mean. CONCLUSIONS The overall status of diabetes KT in Iran was lower than the ideal situation. There are many challenges that require great interventions at the organizational or macro level. To reinforce diabetes KT in Iran, it should hold a more leading and centralized function in the strategies of the country's diabetes research system.
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Affiliation(s)
- Ali Valinejadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Salehi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Makkar SR, Turner T, Williamson A, Louviere J, Redman S, Haynes A, Green S, Brennan S. The development of ORACLe: a measure of an organisation's capacity to engage in evidence-informed health policy. Health Res Policy Syst 2016; 14:4. [PMID: 26769570 PMCID: PMC4712550 DOI: 10.1186/s12961-015-0069-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 12/04/2015] [Indexed: 12/27/2022] Open
Abstract
Background Evidence-informed policymaking is more likely if organisations have cultures that promote research use and invest in resources that facilitate staff engagement with research. Measures of organisations’ research use culture and capacity are needed to assess current capacity, identify opportunities for improvement, and examine the impact of capacity-building interventions. The aim of the current study was to develop a comprehensive system to measure and score organisations’ capacity to engage with and use research in policymaking, which we entitled ORACLe (Organisational Research Access, Culture, and Leadership). Method We used a multifaceted approach to develop ORACLe. Firstly, we reviewed the available literature to identify key domains of organisational tools and systems that may facilitate research use by staff. We interviewed senior health policymakers to verify the relevance and applicability of these domains. This information was used to generate an interview schedule that focused on seven key domains of organisational capacity. The interview was pilot-tested within four Australian policy agencies. A discrete choice experiment (DCE) was then undertaken using an expert sample to establish the relative importance of these domains. This data was used to produce a scoring system for ORACLe. Results The ORACLe interview was developed, comprised of 23 questions addressing seven domains of organisational capacity and tools that support research use, including (1) documented processes for policymaking; (2) leadership training; (3) staff training; (4) research resources (e.g. database access); and systems to (5) generate new research, (6) undertake evaluations, and (7) strengthen relationships with researchers. From the DCE data, a conditional logit model was estimated to calculate total scores that took into account the relative importance of the seven domains. The model indicated that our expert sample placed the greatest importance on domains (2), (3) and (4). Conclusion We utilised qualitative and quantitative methods to develop a system to assess and score organisations’ capacity to engage with and apply research to policy. Our measure assesses a broad range of capacity domains and identifies the relative importance of these capacities. ORACLe data can be used by organisations keen to increase their use of evidence to identify areas for further development. Electronic supplementary material The online version of this article (doi:10.1186/s12961-015-0069-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steve R Makkar
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, Sydney, NSW, 2007, Australia.
| | - Tari Turner
- World Vision Australia, 1 Vision Drive, Burwood East, Melbourne, Victoria, 3151, Australia.
| | - Anna Williamson
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, Sydney, NSW, 2007, Australia.
| | - Jordan Louviere
- Institute for Choice, University of South Australia, Level 13, 140 Arthur Street, North Sydney, NSW, 2060, Australia.
| | - Sally Redman
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, Sydney, NSW, 2007, Australia.
| | - Abby Haynes
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, Sydney, NSW, 2007, Australia. .,Sydney School of Public Health, University of Sydney, Edward Ford Building, Fisher Road, Sydney, NSW, 2006, Australia.
| | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Sue Brennan
- School of Public Health and Preventive Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
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Rizk A, Kronfol NM, Moffatt S, Zaman S, Fares S, Sibai AM. A survey of knowledge-to-action pathways of aging policies and programs in the Arab region: the role of institutional arrangements. Implement Sci 2015; 10:170. [PMID: 26653779 PMCID: PMC4676156 DOI: 10.1186/s13012-015-0360-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 12/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While population aging challenges Arab governments to ensure well-being in old age, knowledge translation is gaining support worldwide in evidence-based policymaking and service provision. This study examines the status of existing knowledge translation efforts of aging-related research in Arab countries and evaluates the additional role that institutional arrangements (such as ministry departments, national committees, etc.) play in the relationship between knowledge creation and social and health policies and programs. METHODS Data were triangulated from two regional surveys and a supplementary desk review of academic, civil society, ministry, and UN documents. Using a set of indicators, standardized summative indices (out of 100) were generated for five constructs, namely knowledge creation, institutional arrangements, knowledge translation, and health and social policies and programs. Correlations were assessed using Spearman's rank correlation (r s), and bootstrap multiple linear regression models were used. RESULTS Arab countries scored highest on the institutional arrangements index (median = 69.5), followed by the knowledge creation index (median = 45.9), and lowest on the knowledge translation index (median = 30.2). Both institutional arrangements and knowledge creation significantly correlated with social and health policies and programs. However, when adjusted for knowledge translation, only institutional arrangements retained a significant association with both outcomes (r s = 0.63, p value =0.009 and r s = 0.69, p value =0.01, respectively). Adjusting for institutional arrangements and knowledge creation, the association of knowledge translation with social and health policies and programs was attenuated and non-significant (r s = 0.08, p value =0.671 and r s = 0.12, p value =0.634, respectively). CONCLUSIONS There are two key messages from this study. Firstly, institutional arrangements play a central role in aging social and health policy and program development in the Arab region. Secondly, knowledge translation paradigms in Arab countries may be deficient in factors pertinent for promoting evidence-based decision-making and policy-relevant research. These findings call for the need of strengthening institutional arrangements on aging and for promoting knowledge production that meets policy-relevant priorities.
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Affiliation(s)
- Anthony Rizk
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Nabil M Kronfol
- Lebanese Health Care Management Association, Beirut, Lebanon. .,Center for Studies on Aging (CSA), Beirut, Lebanon.
| | - Suzanne Moffatt
- Institute of Health & Society, Newcastle University, Newcastle, UK.
| | - Shahaduz Zaman
- Institute of Health & Society, Newcastle University, Newcastle, UK.
| | - Souha Fares
- Rafic Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
| | - Abla Mehio Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. .,Center for Studies on Aging (CSA), Beirut, Lebanon.
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Evidence-Based Decision Making in Public Health: Capacity Building for Public Health Students at King Saud University in Riyadh. BIOMED RESEARCH INTERNATIONAL 2015; 2015:576953. [PMID: 26779537 PMCID: PMC4686631 DOI: 10.1155/2015/576953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/30/2015] [Accepted: 11/02/2015] [Indexed: 11/27/2022]
Abstract
Translation of research evidence into public health programs is lagging in Eastern Mediterranean Region. Graduate level public health curriculum at King Saud University (KSU), College of Medicine, Riyadh, is designed to equip students to integrate best available evidence in public health decision making. The objectives of study were to explore students' opinion about the evidence based public health (EBPH) courses and to survey the knowledge, opinion, and attitude of the students towards EBPH and perceived barriers for implementation of EBPH in decision making in public health. EBPH courses are designed based on a sequential framework. A survey was conducted at the completion of EBPH courses. Forty-five graduate students were invited to complete a validated self-administered questionnaire. It included questions about demography, opinion, and attitude towards EBPH and perceived barriers towards implementation of EBPH in the work environment. The response rate was 73%. Mean age of students was 30.1 (SD 2.3) years, and 51% were males. More than 80% had sound knowledge and could appreciate the importance of EBPH. The main perceived barriers to incorporate EBPH in decision making were lack of system of communication between researchers and policy makers and scarcity of research publications related to the public health problems.
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El-Jardali F, Saleh S, Khodor R, Abu Al Rub R, Arfa C, Ben Romdhane H, Hamadeh RR. An institutional approach to support the conduct and use of health policy and systems research: The Nodal Institute in the Eastern Mediterranean Region. Health Res Policy Syst 2015; 13:40. [PMID: 26428084 PMCID: PMC4591730 DOI: 10.1186/s12961-015-0032-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/10/2015] [Indexed: 01/20/2023] Open
Abstract
Background The use of health policy and systems research (HPSR) to support decision making in health systems is limited in the Eastern Mediterranean Region (EMR). This is partly due to the lack of effective initiatives to strengthen regional HPSR capacities and promote its use in decision making. This paper offers a structured reflection on the establishment and core functioning of a HPSR Nodal Institute for the EMR with specific focus on the approach used to support the conduct and use of HPSR. It seeks to gain better understanding of the activities conducted by the Nodal Institute, the methods by which the Nodal Institute implemented these activities, and the outcomes of these activities. Methods A multi-faceted approach was implemented by the Nodal Institute in collaboration with regional academic/research institutions, Sub-Nodes. The overall approach was a phased one that included the selection of Sub-Nodes, mapping of academic/research institutions in the EMR, stakeholders’ meetings, and HPSR capacity building workshops, and culminated with a regional meeting. Results The mapping of academic/research institutions in the EMR resulted in the identification of 50 institutions, of which only 32 were engaged in HPSR. These institutions have the highest HPSR involvement in information/evidence (84%) and the lowest in human resources for health (34%). Their main HPSR focus areas included quality of healthcare services, patient safety, management of non-communicable diseases, and human resources for health. Regional HPSR challenges among these institutions were identified. The validation and ranking questionnaires resulted in the identification of country-specific HPSR priorities according to stakeholders in three countries. From these results, cross-cutting HPSR priorities among the countries related to primary healthcare, non-communicable diseases, human resources for health, as well as cross-cutting HPSR priorities among stakeholders and according to stakeholders of the countries, were extracted. Conclusion The Nodal Institute in the EMR is a promising initiative to support the conduct and use of HPSR in health policies. The approach and findings reported in this paper allow for the development of opportunities towards the building of capacity for HPSR in the region and other countries and provide a roadmap for academic/research institutions interested in HPSR in the region.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon. .,Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon. .,Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon. .,Research, Advocacy and Public Policy-making, Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-209, 1280 Main St. West, Hamilton, ON, L8S 4 K1, Canada.
| | - Shadi Saleh
- Department of Health Management and Policy, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon. .,Collaborative for Leadership and Innovation in Health Systems, Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Rawya Khodor
- Department of Health Management and Policy, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Raeda Abu Al Rub
- College of Nursing, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Chokri Arfa
- National Institute of Labor and Social Studies (INTES), University of Carthage, Tunis, Tunisia.
| | - Habiba Ben Romdhane
- Cardiovascular Diseases Research Laboratory, University of Tunis El Manar, Tunis, Tunisia.
| | - Randah R Hamadeh
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
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