Knowledge brokering between researchers and policymakers in Fiji to develop policies to reduce obesity: a process evaluation

Developing, implementing, and monitoring tailored strategies for integrated knowledge translation in five sub-Saharan African countries

BACKGROUND

Integrated knowledge translation (IKT) through strategic, continuous engagement with decision-makers represents an approach to bridge research, policy and practice. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA +), comprising research institutions in Ethiopia, Malawi, Rwanda, South Africa, Uganda and Germany, developed and implemented tailored IKT strategies as part of its multifaceted research on prevention and care of non-communicable diseases and road traffic injuries. The objective of this article is to describe the CEBHA + IKT approach and report on the development, implementation and monitoring of site-specific IKT strategies.

METHODS

We draw on findings derived from the mixed method IKT evaluation (conducted in 2020-2021), and undertook document analyses and a reflective survey among IKT implementers. Quantitative data were analysed descriptively and qualitative data were analysed using content analysis. The authors used the TIDieR checklist to report results in a structured manner.

RESULTS

Preliminary IKT evaluation data (33 interviews with researchers and stakeholders from policy and practice, and 31 survey responses), 49 documents, and eight responses to the reflective survey informed this article. In each of the five African CEBHA + countries, a site-specific IKT strategy guided IKT implementation, tailored to the respective national context, engagement aims, research tasks, and individuals involved. IKT implementers undertook a variety of IKT activities at varying levels of engagement that targeted a broad range of decision-makers and other stakeholders, particularly during project planning, data interpretation, and output dissemination. Throughout the project, the IKT teams continued to tailor IKT strategies informally and modified the IKT approach by responding to ad hoc engagements and involving non-governmental organisations, universities, and communities. Challenges to using systematic, formalised IKT strategies arose in particular with respect to the demand on time and resources, leading to the modification of monitoring processes.

CONCLUSION

Tailoring of the CEBHA + IKT approach led to the inclusion of some atypical IKT partners and to greater responsiveness to unexpected opportunities for decision-maker engagement. Benefits of using systematic IKT strategies included clarity on engagement aims, balancing of existing and new strategic partnerships, and an enhanced understanding of research context, including site-specific structures for evidence-informed decision-making.

Evidence attack in public health: Diverse actors' experiences with translating controversial or misrepresented evidence in health policy and systems research

Bringing evidence into policy and practice discussions is political; more so when evidence from health studies or programme data are deemed controversial or unexpected, or when results are manipulated and misrepresented. Furthermore, opinion and misinformation in recent years has challenged our notions about how to achieve evidence-informed decision-making (EIDM). Health policy and systems (HPS) researchers and practitioners are battling misrepresentation that only serves to detract from important health issues or, worse, benefit powerful interests. This paper describes cases of politically and socially controversial evidence presented by researchers, practitioners and journalists during the Health Systems Research Symposium 2020. These cases cut across global contexts and range from public debates on vaccination, comprehensive sexual education, and tobacco to more inward debates around performance-based financing and EIDM in refugee policy. The consequences of engaging in controversial research include threats to commercial profit, perceived assaults on moral beliefs, censorship, fear of reprisal, and infodemics. Consequences for public health include research(er) hesitancy, contribution to corruption and leakage, researcher reflexivity, and ethical concerns within the HPS research and EIDM fields. Recommendations for supporting researchers, practitioners and advocates include better training and support structures for responding to controversy, safe spaces for sharing experiences, and modifying incentive structures.

Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project

BACKGROUND

SASHA, which stands for "evidence-informed health policy-making (EIHP)" in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidence-based and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran.

METHODS

This was a qualitative study, which was informed by a literature review of pull efforts' capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method.

RESULTS

We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context.

CONCLUSION

To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.

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

Background

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

Methods

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

Results

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

Conclusion

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

Understanding the dynamics of obesity prevention policy decision-making using a systems perspective: A case study of Healthy Together Victoria

INTRODUCTION

Despite global recommendations for governments to implement a comprehensive suite of policies to address obesity, policy adoption has been deficient globally. This paper utilised political science theory and systems thinking methods to examine the dynamics underlying decisions regarding obesity prevention policy adoption within the context of the Australian state government initiative, Healthy Together Victoria (HTV) (2011-2016). The aim was to understand key influences on policy processes, and to identify potential opportunities to increase the adoption of recommended policies.

METHODS

Data describing government processes in relation to the adoption of six policy interventions considered as part of HTV were collected using interviews (n = 57), document analyses (n = 568) and field note observations. The data were analysed using multiple political science theories. A systematic method was then used to develop a Causal Loop Diagram (CLD) for each policy intervention. A simplified meta-CLD was generated from synthesis of common elements across each of the six policy interventions.

RESULTS

The dynamics of policy change could be explained using a series of feedback loops. Five interconnected balancing loops served to reduce the propensity for policy change. These pertained to an organisational norm of risk aversion, and the complexity resulting from a whole-of-government policy approach and in-depth stakeholder consultation. However, seven virtuous reinforcing loops helped overcome policy resistance through policy actor capabilities that were improved over time as policy actors gained experience in advocating for change.

CONCLUSION

Policy processes for obesity prevention are complex and resistant to change. In order to increase adoption of recommended policies, several capabilities of policy actors, including policy skills, political astuteness, negotiation skills and consensus building, should be fostered and strengthened. Strategies to facilitate effective and broad-based consultation, both across and external to government, need to be implemented in ways that do not result in substantial delays in the policy process.

Engaged scholarship and public policy decision-making: a scoping review

BACKGROUND

Engaged scholarship includes the coproduction and use of research by partnerships that blend research, policy and/or practice perspectives. This way of doing research attempts to bridge-the-gap between knowledge and its application. Recent reviews have described practices that support engagement and involve the community in research and patients in healthcare but there is less known about how to engage individuals working to inform public policy.

AIMS AND OBJECTIVES

The purpose of this research was to articulate the actions and context that support the coproduction and use of research to inform public policy decisions. The study focuses on partnerships between researchers and stakeholders working in public policy across different levels and sectors of government.

METHODS

A scoping review methodology was used. Relevant articles were identified from six electronic bibliographic databases of peer-reviewed literature.

FINDINGS

A total of 9904 articles were screened and 375 full-text articles were assessed for eligibility. The included 11 studies were from research partnerships internationally and described actions and contextual factors contributing to the coproduction and use of research to inform public policy. Key actions included facilitating frequent interactions with public policy stakeholders, joint planning for research, and collaboration to execute data collection and analysis. Contextual factors included clarity in responsibilities, prior relationships, and mutual respect for partner priorities and perspectives.

CONCLUSIONS

Key actions and contextual factors were identified in this review and warrant further study to strengthen research-policy partnerships and their outcomes.

Indicators to evaluate organisational knowledge brokers: a scoping review

BACKGROUND

Knowledge translation (KT) is currently endorsed by global health policy actors as a means to improve outcomes by institutionalising evidence-informed policy-making. Organisational knowledge brokers, comprised of researchers, policy-makers and other stakeholders, are increasingly being used to undertake and promote KT at all levels of health policy-making, though few resources exist to guide the evaluation of these efforts. Using a scoping review methodology, we identified, synthesised and assessed indicators that have been used to evaluate KT infrastructure and capacity-building activities in a health policy context in order to inform the evaluation of organisational knowledge brokers.

METHODS

A scoping review methodology was used. This included the search of Medline, Global Health and the WHO Library databases for studies regarding the evaluation of KT infrastructure and capacity-building activities between health research and policy, published in English from 2005 to 2016. Data on study characteristics, outputs and outcomes measured, related indicators, mode of verification, duration and/or frequency of collection, indicator methods, KT model, and targeted capacity level were extracted and charted for analysis.

RESULTS

A total of 1073 unique articles were obtained and 176 articles were qualified to be screened in full-text; 32 articles were included in the analysis. Of a total 213 indicators extracted, we identified 174 (174/213; 81.7%) indicators to evaluate the KT infrastructure and capacity-building that have been developed using methods beyond expert opinion. Four validated instruments were identified. The 174 indicators are presented in 8 domains based on an adaptation of the domains of the Lavis et al. framework of linking research to action - general climate, production of research, push efforts, pull efforts, exchange efforts, integrated efforts, evaluation and capacity-building.

CONCLUSION

This review presents a total of 174 method-based indicators to evaluate KT infrastructure and capacity-building. The presented indicators can be used or adapted globally by organisational knowledge brokers and other stakeholders in their monitoring and evaluation work.

Understanding the LiveLighter® obesity prevention policy processes: An investigation using political science and systems thinking

The health and economic burden associated with overweight and obesity warrants comprehensive policy action; however, to date, there has been limited policy progress globally. This study sought to advance obesity prevention policy research and practice by applying theories of the policy process to study decision-making processes involved in the adoption of the contentious LiveLighter® social marketing campaign by the Victorian government in Australia. Through analysis of documents and interviews with policy makers, this qualitative study aimed to gain a better understanding of the dynamic influences on policy decision-making. Multiple theories of the policy process were used to elucidate policy drivers and Causal Loop Diagramming methods were used to illustrate the LiveLighter® policy decision-making systems. Findings highlighted a number of key influences including: various external events, evidence of the problem and intervention effectiveness, resistance from various stakeholders and the political capabilities of central policy makers. The policy systems map provided insight into the difficulties experienced by policy actors in achieving policy change, as well as to develop a conceptual framework for identifying potential leverage points to influence future obesity prevention policy decisions. Together the findings can inform future advocacy efforts for improving the implementation of obesity prevention policy action.

Development and implementation of nutrition labelling in Iran: A retrospective policy analysis

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.

Increasing the capacity of policy agencies to use research findings: a stepped-wedge trial

BACKGROUND

This paper describes the trial of a novel intervention, Supporting Policy In health with evidence from Research: an Intervention Trial (SPIRIT). It examines (1) the feasibility of delivering this kind of programme in practice; (2) its acceptability to participants; (3) the impact of the programme on the capacity of policy agencies to engage with research; and (4) the engagement with and use of research by policy agencies.

METHODS

SPIRIT was a multifaceted, highly tailored, stepped-wedge, cluster-randomised, trial involving six health policy agencies in Sydney, Australia. Agencies were randomly allocated to one of three start dates to receive the 1-year intervention programme. SPIRIT included audit, feedback and goal setting; a leadership programme; staff training; the opportunity to test systems to facilitate research use in policies; and exchange with researchers. Outcome measures were collected at each agency every 6 months for 30 months.

RESULTS

Participation in SPIRIT was associated with significant increases in research use capacity at staff and agency levels. Staff reported increased confidence in research use skills, and agency leaders reported more extensive systems and structures in place to support research use. Self-report data suggested there was also an increase in tactical research use among agency staff. Given the relatively small numbers of participating agencies and the complexity of their contexts, findings suggest it is possible to effect change in the way policy agencies approach the use of research. This is supported by the responses on the other trial measures; while these were not statistically significant, on 18 of the 20 different measures used, the changes observed were consistent with the hypothesised intervention effect (that is, positive impacts).

CONCLUSIONS

As an early test of an innovative approach, SPIRIT has demonstrated that it is possible to increase research engagement and use in policy agencies. While more work is needed to establish the replicability and generalisability of these findings, this trial suggests that building staff skills and organisational structures may be effective in increasing evidence use.

Impact of an organization-wide knowledge translation strategy to support evidence-informed public health decision making

Background

The public health sector is moving toward adopting evidence-informed decision making into practice, but effort is still required to effectively develop capacity and promote contextual factors that advance and sustain it. This paper describes the impact of an organization-wide knowledge translation intervention delivered by knowledge brokers on evidence-informed decision making knowledge, skills and behaviour.

Methods

A case study design was implemented with the intervention and data collection tailored to the unique needs of each case (health department). A knowledge broker provided training workshops and mentored small groups through a seven step process of evidence-informed decision making. The intervention was delivered over 22 months; data related to evidence-informed decision making knowledge, skills and behaviour were collected at baseline and follow-up. Mixed effects regression models were developed to assess the impact of involvement in the intervention on the evidence-informed decision making outcomes.

Results

Data from a total of 606 health department staff were collected during baseline: 207 (33%) staff from Case A, 304 (28%) from Case B, and 95 (47%) from Case C. There were a total of 804 participants at follow-up: 258 (42%) from Case A, 391 from Case B (37%), and 155 (50%) from Case C. Statistically significant increases in knowledge and skills were observed overall, and in all three health departments. An increase in evidence-informed decision making behaviour was observed among those intensively involved in the intervention from all cases (statistically significant in Case A). The organizational characteristics of strategic priority, leadership, readiness, and choice of staff emerged as important factors in the change process.

Conclusions

Knowledge brokering is a promising organizational knowledge translation intervention to support evidence-informed decision making. The intervention appeared to have the greatest impact on those who became actively engaged with the knowledge broker in the intervention. Active participation in face-to-face training activities with a knowledge broker, focused specifically on evidence-informed decision making skill development, led to the greatest impact on associated behaviours, knowledge, and skills. Several organizational factors emerged as integral to success of the knowledge translation intervention.

Understanding Health Promotion Policy Processes: A Study of the Government Adoption of the Achievement Program in Victoria, Australia

Despite the growing health and economic burden associated with overweight and obesity, preventive policy progress has been deficient globally. This study investigated the policy process involved in the adoption of the Achievement Program, a settings-based health promotion intervention that was a key pillar of the Healthy Together Victoria obesity prevention initiative. The qualitative study utilised multiple theories of the policy process, as well as Causal Loop Diagramming (CLD) methods, to understand the policy systems underlying the decision to adopt the Achievement Program. Factors that impacted this obesity prevention policy adoption included problem prioritisation at Federal and state government levels; political risks regarding policy action and inaction, and framing used by policy advocates to reduce risks and highlight the opportunities related to the Achievement Program policy implementation. The use of CLD methods was advantageous to further conceptualise potential leverage points and effective ways to influence obesity prevention policy in future. As such, the findings contribute to the obesity prevention policy evidence base and toward developing a number of recommended actions for policy actors seeking to increase future policy action.

Knowledge translation for public health in low- and middle- income countries: a critical interpretive synthesis

Background

Effective knowledge translation allows the optimisation of access to and utilisation of research knowledge in order to inform and enhance public health policy and practice. In low- and middle- income countries, there are substantial complexities that affect the way in which research can be utilised for public health action. This review attempts to draw out concepts in the literature that contribute to defining some of the complexities and contextual factors that influence knowledge translation for public health in low- and middle- income countries.

Methods

A Critical Interpretive Synthesis was undertaken, a method of analysis which allows a critical review of a wide range of heterogeneous evidence, through incorporating systematic review methods with qualitative enquiry techniques. A search for peer-reviewed articles published between 2000 and 2016 on the topic of knowledge translation for public health in low- and middle – income countries was carried out, and 85 articles were reviewed and analysed using this method.

Results

Four main concepts were identified: 1) tension between ‘global’ and ‘local’ health research, 2) complexities in creating and accessing evidence, 3) contextualising knowledge translation strategies for low- and middle- income countries, and 4) the unique role of non-government organisations in the knowledge translation process.

Conclusion

This method of review has enabled the identification of key concepts that may inform practice or further research in the field of knowledge translation in low- and middle- income countries.

Electronic supplementary material

The online version of this article (10.1186/s41256-018-0084-9) contains supplementary material, which is available to authorized users.

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

Background

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

Methods

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

Results

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

Conclusions

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

What can we learn from interventions that aim to increase policy-makers' capacity to use research? A realist scoping review

BACKGROUND

Health policy-making can benefit from more effective use of research. In many policy settings there is scope to increase capacity for using research individually and organisationally, but little is known about what strategies work best in which circumstances. This review addresses the question: What causal mechanisms can best explain the observed outcomes of interventions that aim to increase policy-makers' capacity to use research in their work?

METHODS

Articles were identified from three available reviews and two databases (PAIS and WoS; 1999-2016). Using a realist approach, articles were reviewed for information about contexts, outcomes (including process effects) and possible causal mechanisms. Strategy + Context + Mechanism = Outcomes (SCMO) configurations were developed, drawing on theory and findings from other studies to develop tentative hypotheses that might be applicable across a range of intervention sites.

RESULTS

We found 22 studies that spanned 18 countries. There were two dominant design strategies (needs-based tailoring and multi-component design) and 18 intervention strategies targeting four domains of capacity, namely access to research, skills improvement, systems improvement and interaction. Many potential mechanisms were identified as well as some enduring contextual characteristics that all interventions should consider. The evidence was variable, but the SCMO analysis suggested that tailored interactive workshops supported by goal-focused mentoring, and genuine collaboration, seem particularly promising. Systems supports and platforms for cross-sector collaboration are likely to play crucial roles. Gaps in the literature are discussed.

CONCLUSION

This exploratory review tentatively posits causal mechanisms that might explain how intervention strategies work in different contexts to build capacity for using research in policy-making.

The dynamic of non-communicable disease control policy in Indonesia

Objective The aim of the present study was to examine non-communicable disease (NCD) policy formation and implementation in Indonesia. Methods Interviews were conducted with 13 Indonesian health policy workers. The processes and issues relating to NCD policy formation were mapped, exploring the interactions between policy makers, technical/implementation bodies, alliances across various levels and the mobilisation of non-policy actors. Results Problems in NCD policy formation include insufficient political interest in NCD control, disconnected policies and difficulty in multisectoral coordination. These problems are well illustrated in relation to tobacco control, but also apply to other control efforts. Nevertheless, participants were optimistic that there are plentiful opportunities for improving NCD control policies given growing global attention to NCD, increases in the national health budget and the growing body of Indonesia-relevant NCD-related research. Conclusion Indonesia's success in the creation and implementation of NCD policy will be dependent on high-level governmental leadership, including support from the President, the Health Minister and coordinating ministries. What is known about the topic? The burden of NCD in Indonesia has increased gradually. Nationally, NCD-related mortality accounted for 65% of deaths in 2010. Indonesia is also a country with the highest burden of tobacco smoking in the world. However, the government has not instituted sufficient policy action to tackle NCDs, including tobacco control. What does this paper add? This paper deepens our understanding of current NCD control policy formation in Indonesia, including the possible underlying reason why Indonesia has weak tobacco control policies. It describes the gaps in the current policies, the actors involved in policy formation, the challenges in policy formation and implementation and potential opportunities for improving NCD control. What are the implications for practitioners? An effective NCD control program requires strong collaboration, including between government and health professionals. Health professionals can actively engage in policy formation, for example through knowledge production.

The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: a systematic review

BACKGROUND

It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors.

METHODS

An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data.

RESULTS

After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1) establishing an imperative for practice change, (2) building trust between implementation stakeholders and (3) developing a shared vision, to (4) actioning change mechanisms. This was underpinned by the (5) employment of effective communication strategies and (6) provision of resources to support change.

CONCLUSIONS

Evidence is developing to support the use of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The design of future implementation strategies should be based on the inter-relating factors perceived to be associated with effective strategies.

TRIAL REGISTRATION

This systematic review was registered with Prospero (record number: 42016032947).

Exploring the dynamics of food-related policymaking processes and evidence use in Fiji using systems thinking

BACKGROUND

Obesity and non-communicable diseases are significant public health issues globally and particularly in the Pacific. Poor diet is a major contributor to this issue and policy change is a powerful lever to improve food security and diet quality. This study aims to apply systems thinking to identify the causes and consequences of poor evidence use in food-related policymaking in selected government ministries in Fiji and to illicit strategies to strengthen the use of evidence in policymaking.

METHODS

The Ministry of Health and Medical Services and the Ministry of Agriculture in Fiji were invited through their respective Permanent Secretaries to participate in the study. Three 180-minute group model building (GMB) workshops were conducted separately in each ministry over three consecutive days with selected policymakers who were instrumental in developing food-related policies designed to prevent non-communicable diseases. The GMB workshops mapped the process of food-related policymaking and the contribution of scientific and local evidence to the process, and identified actions to enhance the use of evidence in policymaking.

RESULTS

An average of 10 policymakers participated from each ministry. The causal loop diagrams produced by each ministry illustrated the causes and consequences of insufficient evidence use in developing food policies or precursors of the specific actions. These included (1) consultation, (2) engagement with stakeholders, (3) access and use of evidence, and (4) delays in policy processes. Participants agreed to potential leverage points on the themes above, addressing pertinent policymaker challenges in precursor control, including political influence, understanding of trade policies, competing government priorities and level of awareness on the problem. Specific actions for strengthening evidence use included training in policy development and research skills, and strengthening of coordination between ministries.

CONCLUSIONS

The GMB workshops improved participants' understanding of how different parts of the policy system interact. The causal loop diagrams and subsequent action plans enabled the identification of systems-level interventions in both ministries to improve evidence-informed policy development. A guide for integrating multi-sectoral consultation and stakeholder engagement in developing cross-cutting policies is currently being developed.

Knowledge-exchange in the Pacific: outcomes of the TROPIC (translational research for obesity prevention in communities) project

Background

The Pacific TROPIC (Translational Research for Obesity Prevention in Communities) project aimed to design, implement and evaluate a knowledge-broking approach to evidence-informed policy making to address obesity in Fiji. This paper reports on the quantitative evaluation of the knowledge-broking intervention through assessment of participants’ perceptions of evidence use and development of policy/advocacy briefs.

Methods

Selected staff from six organizations - four government Ministries and two nongovernment organizations (NGOs) - participated in the project. The intervention comprised workshops and supported development of policy/advocacy briefs. Workshops addressed obesity and policy cycles and developing participants’ skills in accessing, assessing, adapting and applying relevant evidence. A knowledge-broking team supported participants individually and/or in small groups to develop evidence-informed policy/advocacy briefs. A questionnaire survey that included workplace and demographic items and the self-assessment tool “Is Research Working for You?” (IRWFY) was administered pre- and post-intervention.

Results

Forty nine individuals (55% female, 69% 21–40 years, 69% middle-senior managers) participated in the study. The duration and level of participant engagement with the intervention activities varied – just over half participated for 10+ months, just under half attended most workshops and approximately one third produced one or more policy briefs. There were few reliable changes on the IRWFY scales following the intervention; while positive changes were found on several scales, these effects were small (d < .2) and only one individual scale (assess) was statistically significant (p < .05). Follow up (N = 1) analyses of individual-level change indicated that while 63% of participants reported increased research utilization post-intervention, this proportion was not different to chance levels. Similar analysis using scores aggregated by organization also revealed no organizational-level change post-intervention.

Conclusions

This study empirically evaluated a knowledge-broking program that aimed to extend evidence-informed policy making skills and development of a suite of national policy briefs designed to increase the enactment of obesity-related policies. The findings failed to indicate reliable improvements in research utilization at either the individual or organizational level. Factors associated with fidelity and intervention dose as well as challenges related to organizational support and the measurement of research utilization, are discussed and recommendations for future research presented.

Factors affecting evidence-use in food policy-making processes in health and agriculture in Fiji

BACKGROUND

There is limited research on the use of evidence to inform policy-making in the Pacific. This study aims to identify and describe factors that facilitate or limit the use of evidence in food-related policy-making in the Health and Agriculture Ministries in Fiji.

METHODS

Semi-structured face-to-face interviews were conducted with selected policy-makers in two government ministries that were instrumental in the development of food-related policies in Fiji designed to prevent Non-Communicable Diseases (NCDs). Snowball sampling was used to recruit, as key informants, senior policy-makers in management positions such as national advisors and directors who were based at either the national headquarters or equivalent. Interviewees were asked about their experiences in developing food-related or other policies, barriers or facilitators encountered in the policy development and implementation process and the use of evidence. Each interview lasted approximately 45-60 minutes, and was conducted in English. Audio-recorded interviews were transcribed, thematically coded and analyzed using N-Vivo 8.0 software.

RESULTS

Thirty-one policy-makers from the Ministry of Health and Medical Services (MoHMS n = 18) and the Ministry of Agriculture (MoA n = 13) in Fiji participated in the study. Whilst evidence is sometimes used in food-related policy-making in both the Health and Agriculture Ministries (including formal evidence such as published research and informal evidence such as personal experiences and opinions), it is not yet embedded as an essential part of the process. Participants indicated that a lack of resources, poor technical support in terms of training, the absence of clear strategies for improving competent use of evidence, procedures regarding engagement with other stakeholders across sectors, varying support from senior managers and limited consultation across sectors were barriers to evidence use. The willingness of organizations to create a culture of using evidence was reported as a facilitator.

CONCLUSION

The use of evidence in policy-making will only become a reality in Fiji if it is a formalized part of the government's policy-making systems. A systems approach to food-related policy-making and implementation may achieve this by helping Ministries manage the complex and dynamic nature of food-related policy-making in Fiji.

The application of theories of the policy process to obesity prevention: a systematic review and meta-synthesis

BACKGROUND

Theories of the policy process are recommended as tools to help explain both policy stasis and change.

METHODS

A systematic review of the application of such theoretical frameworks within the field of obesity prevention policy was conducted. A meta-synthesis was also undertaken to identify the key influences on policy decision-making.

RESULTS

The review identified 17 studies of obesity prevention policy underpinned by political science theories. The majority of included studies were conducted in the United States (US), with significant heterogeneity in terms of policy level (e.g., national, state) studied, areas of focus, and methodologies used. Many of the included studies were methodologically limited, in regard to rigour and trustworthiness. Prominent themes identified included the role of groups and networks, political institutions, and political system characteristics, issue framing, the use of evidence, personal values and beliefs, prevailing political ideology, and timing.

CONCLUSIONS

The limited application of political science theories indicates a need for future theoretically based research into the complexity of policy-making and multiple influences on obesity prevention policy processes.

Use of a knowledge broker to establish healthy public policies in a city district: a developmental evaluation

Background

Public health is to a large extent determined by non-health-sector policies. One approach to address this apparent paradox is to establish healthy public policies. This requires policy makers in non-health sectors to become more aware of the health impacts of their policies, and more willing to adopt evidence-informed policy measures to improve health. We employed a knowledge broker to set the agenda for health and to specify health-promoting policy alternatives. This study aimed at gaining in-depth understanding of how this knowledge broker approach works.

Methods

In the context of a long-term partnership between the two universities in Amsterdam and the municipal public health service, we employed a knowledge broker who worked part-time at a university and part-time for an Amsterdam city district. When setting an agenda and specifying evidence-informed policy alternatives, we considered three individual policy portfolios as well as the policy organization of the city district. We evaluated and developed the knowledge broker approach through action research using participant observation.

Results

Our knowledge brokering strategy led to the adoption of several policy alternatives in individual policy portfolios, and was especially successful in agenda-setting for health. More specifically, health became an issue on the formal policy agenda as evidenced by its uptake in the city district’s mid-term review and the appointment of a policy analyst for health. Our study corroborated the importance of process factors such as building trust, clearly distinguishing the knowledge broker role, and adequate management support. We also saw the benefits of multilevel agenda-setting and specifying policy alternatives at appropriate policy levels. Sector-specific responsibilities hampered the adoption of cross-sectoral policy alternatives, while thematically designed policy documents offered opportunities for including them. Further interpretation revealed three additional themes in knowledge brokering: boundary spanning, a ripple effect, and participant observation.

Conclusions

The employment of a knowledge broker who works simultaneously on both agenda-setting for health as well as the specification of health-promoting policy alternatives seems to be a promising first step in establishing local healthy public policies. Future studies are needed to explore the usefulness of our approach in further policy development and policy implementation.

Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health-related settings: a systematic review and thematic analysis

Background

Knowledge brokers (KBs) work collaboratively with key stakeholders to facilitate the transfer and exchange of information in a given context. Currently, there is a perceived lack of evidence about the effectiveness of knowledge brokering and the factors that influence its success as a knowledge translation (KT) mechanism. Thus, the goal of this review was to systematically gather evidence regarding the nature of knowledge brokering in health-related settings and determine if KBs effectively contributed to KT in these settings.

Methods

A systematic review was conducted using a search strategy designed by a health research librarian. Eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, ERIC, Scopus, SocINDEX, and Health Business Elite) and relevant grey literature sources were searched using English language restrictions. Two reviewers independently screened the abstracts, reviewed full-text articles, extracted data, and performed quality assessments. Analysis included a confirmatory thematic approach. To be included, studies must have occurred in a health-related setting, reported on an actual application of knowledge brokering, and be available in English.

Results

In total, 7935 records were located. Following removal of duplicates, 6936 abstracts were screened and 240 full-text articles were reviewed. Ultimately, 29 articles, representing 22 unique studies, were included in the thematic analysis. Qualitative (n = 18), quantitative (n = 1), and mixed methods (n = 6) designs were represented in addition to grey literature sources (n = 4). Findings indicated that KBs performed a diverse range of tasks across multiple health-related settings; results supported the KB role as a ‘knowledge manager’, ‘linkage agent’, and ‘capacity builder’. Our systematic review explored outcome data from a subset of studies (n = 8) for evidence of changes in knowledge, skills, and policies or practices related to knowledge brokering. Two studies met standards for acceptable methodological rigour; thus, findings were inconclusive regarding KB effectiveness.

Conclusions

As knowledge managers, linkage agents, and capacity builders, KBs performed many and varied tasks to transfer and exchange information across health-related stakeholders, settings, and sectors. How effectively they fulfilled their role in facilitating KT processes is unclear; further rigourous research is required to answer this question and discern the potential impact of KBs on education, practice, and policy.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-015-0351-9) contains supplementary material, which is available to authorized users.

Building operational research capacity in the Pacific

Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.

Beyond bridging the know-do gap: a qualitative study of systemic interaction to foster knowledge exchange in the public health sector in The Netherlands

Background

Despite considerable attention currently being given to facilitating the use of research results in public health practice, several concerns remain, resulting in the so-called know-do gap. This article aims to identify the key tensions causing the know-do gap from a broad perspective by using a systemic approach and considering the public health sector as an innovation system.

Methods

An exploratory qualitative design including in-depth semi-structured interviews was used, with 33 interviewees from different actor categories in the Dutch public health innovation system. The analyses employed an innovation system matrix to highlight the principal tensions causing the know-do gap.

Results

Seven key tensions were identified, including: research priorities determined by powerful players; no consensus about criteria for knowledge quality; different perceptions about the knowledge broker role; competition engendering fragmentation; thematic funding engendering fragmentation; predominance of passive knowledge sharing; and lack of capacity among users to use and influence research.

Conclusions

The identified tensions indicate that bridging the know-do gap requires much more than linking research to practice or translating knowledge. An innovation system perspective is crucial in providing information on the total picture of knowledge exchange within the Dutch public health sector. Such a system includes broader stakeholder involvement as well as the creation of social, economic, and contextual conditions (achieving shared visions, building networks, institutional change, removing financial and infrastructural barriers), as these create conducive factors at several system levels and induce knowledge co-creation and innovation.

Mobilisation of public support for policy actions to prevent obesity

Public mobilisation is needed to enact obesity-prevention policies and to mitigate reaction against their implementation. However, approaches in public health focus mainly on dialogue between public health professionals and political leaders. Strategies to increase popular demand for obesity-prevention policies include refinement and streamlining of public information, identification of effective obesity frames for each population, strengthening of media advocacy, building of citizen protest and engagement, and development of a receptive political environment with change agents embedded across organisations and sectors. Long-term support and investment in collaboration between diverse stakeholders to create shared value is also important. Each actor in an expanded coalition for obesity prevention can make specific contributions to engaging, mobilising, and coalescing the public. The shift from a top-down to a combined and integrated bottom-up and top-down approach would need an overhaul of current strategies and reprioritisation of resources.

Collaborative development and implementation of a knowledge brokering program to promote research use in Burkina Faso, West Africa

Despite efforts expended over recent decades, there is a persistent gap between the production of scientific evidence and its use. This is mainly due to the difficulty of bringing such knowledge to health workers and decision-makers so that it can inform practices and decisions on a timely basis. One strategy for transferring knowledge to potential users, that is, gaining increasing legitimacy, is knowledge brokering (KB), effectiveness of which in certain conditions has been demonstrated through empirical research. However, little is known about how to implement such a strategy, especially in the African context. The KB program presented here is aimed specifically at narrowing the gap by making scientific knowledge available to users with the potential to improve health-related practices and decision making in Burkina Faso. The program involves Canadian and African researchers, a knowledge broker, health practitioners, and policy-makers. This article presents the collaborative development of the KB strategy and the evaluation of its implementation at year 1. The KB strategy was developed in stages, beginning with a scoping study to ensure the most recent studies were considered. Two one-day workshops were then conducted to explore the problem of low research use and to adapt the strategy to the Burkinabè context. Based on these workshops, the KB program was developed and brokers were recruited and trained. Evaluation of the program's implementation after the first year showed that: 1) the preparatory activities were greatly appreciated by participants, and most considered the content useful for their work; 2) the broker had carried out his role in accordance with the logic model; and 3) this role was seen as important by the participants targeted by the activities and outputs. Participants made suggestions for program improvements in subsequent years, stressing particularly the need to involve decision-makers at the central level.

The role of behavior change in antimicrobial stewardship

Emerging evidence suggests that antimicrobial prescribing behaviors are influenced by local culture and a prescribing etiquette that is abided by all health care professionals. Local cultural unspoken rules often play a more pivotal role than the recommendations of guidelines and policies drawn up by experts in influencing antimicrobial prescribing. It is important to recognize the key drivers of prescribing behaviors and the incentives to alter behaviors and to incorporate these into stewardship programs. This review summarizes key concepts in behavior change in antimicrobial prescribing and the gaps that exist in addressing behavior change in this field.

Knowledge brokering in public health: a tale of two studies

OBJECTIVES

A Knowledge Broker is one approach for facilitating the integration of evidence-informed decision making in public health practice. In this paper, the findings from two studies investigating a Knowledge Broker intervention as a means of enhancing capacity for evidence-informed decision making are presented. Contextual factors that facilitate this strategy are also identified.

STUDY DESIGN

This paper describes work done through a single mixed-methods study (randomized controlled trial with a qualitative component) and a case study.

METHODS

The Health Evidence team conducted two studies examining Knowledge Broker impact in Canadian public health departments. The effectiveness of knowledge translation strategies of varying intensities for promoting the use of research evidence in decisions related to child obesity prevention were explored via a randomized controlled trial with a fundamental descriptive component (2003-2007). In a case study (2010-2013), the authors partnered with three health departments to develop and implement tailored strategies targeted at the organization. Knowledge Brokers worked with designated staff in these studies via one-on-one consultations, small group meetings, and/or workshops and presentations. The Knowledge Broker role was assessed by analysing data from close-ended surveys, interviews, organizational documents, and reflective journals.

RESULTS

In this paper, the authors focus on findings from the qualitative analysis of implementing the Knowledge Broker role in both studies and explore several contextual factors that impacted study outcomes. Knowledge Brokers were shown to enhance individual capacity by improving knowledge and skill in searching for, critically appraising, and applying research evidence to practice-based issues. Organizational capacity was also enhanced with strong management support and policies. Effective Knowledge Broker attributes included both expertise in research methodology and public health, as well as intangible traits such as approachability and patience. Finally, optimal positioning and ways of working were identified, including the importance of in-person meetings and neutrality of the Knowledge Broker.

CONCLUSIONS

Knowledge brokering is a potentially promising knowledge translation strategy for public health, though additional feasibility and cost-effectiveness data are still needed. The research presented here further highlights the importance of context and adopting a tailored approach to implement a Knowledge Broker strategy.