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

Building bridges: evaluating policymakers' research capacities, engagement, and utilization in health policymaking within the Kuwaiti context: a cross-sectional study

BACKGROUND

Health policymaking is a critical aspect of governmental decision-making that shapes the well-being of populations. In the Middle East and North Africa, particularly in Kuwait, limited attention has been given to exploring the research capacities, engagement, and utilization among health policymakers. This study aims to bridge this gap by investigating how Kuwaiti health policymakers incorporate evidence-based research into the formulation of health-related policies.

METHODS

This cross-sectional study targeted health policymakers in leadership positions within the Kuwait Ministry of Health (MOH). Using the Seeking, Engaging with and Evaluating Research (SEER) questionnaire, participants' capacities, engagement, and use of research were assessed. The targeted sample was all health policymakers in leadership positions, starting from the head of departments and above. The questionnaire comprises four domains, 14 sections, and 50 questions and utilizes Likert and binary scales, with aggregate scores predicting engagement actions and research use. The data were collected between March and July 2023. All the statistical analyses were performed using SPSS v27, and the numerical and categorical variables were analyzed using appropriate statistical tests, including t-tests, ANOVA, and Pearson's correlation.

RESULTS

Out of 205 policymakers, 88 participated (42.9% response rate): predominantly male (51.1%) and married (78.4%). The mean age was 49.84 ± 7.28 years, with a mean MOH tenure of 24.39 ± 6.80 years. Participants demonstrated high value for research (mean score 4.29 ± 0.55) and expressed confidence in the research utilization. Organizational emphasis on research use exhibited nuanced perceptions, identifying areas where MOH support may be lacking. Access to research resources and processes for policy development guidance were highlighted as challenges.

CONCLUSIONS

This study provides crucial insights into the research capacities and engagement of Kuwaiti health policymakers. It emphasizes the need for targeted interventions to align individual perceptions with organizational expectations, address confidence disparities, and enhance collaborative efforts. Organizational investments are crucial for fostering a dynamic research ecosystem to improve evidence-based policy development in Kuwait's healthcare landscape.

Health research evidence: its current usage in health planning, determinants and readiness to use knowledge translation tools among health planning teams in Tanzania-an exploratory mixed-methods study protocol

INTRODUCTION

Achieving universal health coverage requires using research evidence to inform decision-making. However, little information is available on the use of research evidence in planning in lower middle-income countries, including Tanzania. This paper presents a protocol that aims to investigate the usage of research evidence in health planning, determinants and readiness of the planning team members to use knowledge translation tools in Tanzania.

METHODS AND ANALYSIS

This study will employ a sequential exploratory mixed-methods design, with participants selected from national, regional and council levels. Qualitative data will be collected through a maximum of 52 in-depth interviews and 12 focused group discussions until saturation. To collect quantitative data, a structured questionnaire will be used to survey 422 participants, and a document review will be conducted from health facilities. Qualitative data will be analysed using thematic analysis, while descriptive and inferential analyses will be employed for quantitative data.

ETHICS AND DISSEMINATION

The study participants will provide written informed consent, and all recorded data will be stored on a secured research server accessible only to the investigators. Ethical approval has been obtained from the University of Dodoma Research Ethics Committee (ref. MA.84/261/02/'A'/64/91). The findings of this study will inform policymakers, researchers and implementers in the country on the use of research evidence in decision-making. We will disseminate our findings through publications, conferences, workshops and interactive communication with national, regional, council and health facility planning teams.

[Orientations de facilitation pour soutenir l'application de l'Algo dans les services de soutien à domicile des personnes aînées]

Comment soutenir le déploiement de connaissances coconstruites par des personnes cliniciennes, gestionnaires ou chercheures? Ce thème est abordé à partir de l'étude de l'application de l'Algo, un algorithme clinique décisionnel conçu pour la sélection des aides techniques visant à faciliter l'hygiène corporelle des personnes aînées vivant à domicile. L'objectif de cette note sur les politiques et les pratiques est de présenter les orientations de facilitation dégagées à la suite d'un devis mixte multiphases (2015-2019) mis en œuvre dans les services de soutien à domicile au Québec (Canada). Les orientations de facilitation centrée sur la tâche et holistique sont présentées en fonction des stades d'utilisation de l'Algo, afin de soutenir les personnes cliniciennes, gestionnaires et chercheures dans la poursuite de son application auprès des personnes aînées. De plus, cette note illustre l'apport des devis mixtes à la conduite et à la compréhension de l'application des connaissances coconstruites.

[Application of scientific knowledge: knowledge translation in an institute of science and technology in public health]

Knowledge translation (KT) aims at the practical use of scientific research results and at the monitoring of the benefits caused to the population's health. In health, the government and especially society expect that investments in research will produce results that go beyond the production and publication of knowledge, provoking outcomes such as public policies, systems, products, and technologies to benefit the health of the population. However, closing the gaps between research and application requires overcoming a number of challenges. This study aimed to propose strategies to foster the process of transforming the scientific knowledge generated in research into actions and products that contribute to improving the population's health based on the identification of barriers and facilitating factors of a health science and technology institute. The reports of interviews conducted with 16 researchers showed 10 categories of barriers, especially: "limited funding to the science and technology institute" and "insufficient technical support for knowledge translation". "Infrastructure and institutional support" was the facilitating factor category participants mentioned the most. Finally, we developed the artifact "strategies and approaches for overcoming barriers to implement research results". Among the strategies, we suggest the inclusion of a knowledge translation discipline in stricto sensu graduate programs and the creation of an instance in the organizational structure of the science and technology institute to technically and managerially support the application of research results.

Factors influencing the utilization of doctoral research findings at a university in KwaZulu-Natal, South Africa: Views of academic leaders

BACKGROUND

Translation of health research findings into policy remains a challenge in sub-Saharan Africa. Factors influencing health research utilization are poorly described in literature. Therefore, identifying factors that influence the utilization of research findings for policy formulation is essential to facilitate implementation of evidence-based interventions. The purpose of this study was to explore the views of academic leaders as to why doctoral research is not adequately used in policymaking.

METHODS

In-depth interviews were held with purposively selected key informants from the College of Health Sciences. An open-ended interview guide aimed at exploring college leadership views on factors influencing utilization of PhD generated knowledge into policy was used. Data was analysed thematically using NVivo 12 software. Thematic analysis was used to generate themes around the factors influencing utilization of doctoral research into policy.

RESULTS

Factors such as inaccessibility of research results, lack of funding, poor quality of research, lack of continuity in translating research into policy, lack of timeliness of research results and lack of collaboration between researchers and policymakers hindered the utilization of PhD generated knowledge. Participants recommended engagement with the Department of Health/policymakers, collaboration with Department of Health/policymakers, increasing enrolment of South African citizens into PhD program, making final research products available to Department of Health/policymakers, and provision of funding for dissemination of research results.

CONCLUSION

The study demonstrated that final doctoral research results are mainly disseminated through journal articles and theses. Participants cited inaccessibility of research findings, lack of funding and poor-quality research as the most common factors hindering utilization of doctoral research findings. The study also recommended availing adequate funding for dissemination of research results, collaboration between researchers and policymakers, facilitation of policymaker-researcher engagement to find best ways of using research findings to influence policy and making final research products accessible to policymakers. Further research to gain the perspective of policymakers as to why doctoral research is not adequately used in policy formulation is recommended.

Advancing health through evidence assisted decisions with health policy and systems research program: a qualitative evaluation of a national health research grant management process in the Philippines

BACKGROUND

Health policy and systems research (HPSR) has influenced Philippine policies, including tobacco control, mental health, and COVID-19. The Department of Health (DOH) Philippines and Philippine Council for Health Research and Development (PCHRD) launched the Advancing Health through Evidence-Assisted Decisions (AHEAD) with HPSR program in 2017, aiming to build a community of researchers and decision-makers committed to evidence production and utilization. Research systems employ grant management processes for transparency and accountability in research funding, preventing waste, fraud, and misuse of funds.

METHODS

This study evaluated AHEAD-HPSR's grant management using surveys, interviews, and focus groups to document (1) grant administration processes implemented by DOH and PCHRD, and (2) experiences of grantees, program managers, staff, and policymakers. Data were initially analyzed through the USA Grant Accountability Office's Federal Grant Life Cycle, with new themes created as they emerged. The study identified processes and gaps in the research grant life cycle stages: design/redesign, pre-award, award, implementation, closeout, and research dissemination and utilization.

RESULTS

Identification of research areas for the grant are identified using national and departmental research priorities. While Calls for Proposals are posted publicly, researchers that have previously worked with policymakers are contacted directly to submit proposals. The evaluation found that research is delayed by bureaucracies in grant administration, particularly in financial reporting and ethics review processes. Complying with the terminal financial report was identified as the most challenging part of the grant process due to immense auditing requirements. Grantees recommend the simplification of bureaucracy for fund release to enable them to focus on research work.

CONCLUSION

This study contributes to the limited literature on health research grant management in developing countries. Valuable information and recommendations were contributed by stakeholders in this evaluation. These are manifestations of a continuing interest and desire to make health policy and systems research in the Philippines more robust and relevant. It is imperative for the program to continually evolve and build systems most applicable to its multidisciplinary context.

Open science at the science-policy interface: bringing in the evidence?

Part of the current enthusiasm about open science stems from its promises to reform scientific practice in service of the common good, to ensure that scientific outputs will be found and reused more easily, and to enhance scientific impact on policy and society. With this article, we question this optimism by analysing the potential for open science practices to enhance research uptake at the science–policy interface. Science advice is critical to help policy-makers make informed decisions. Likewise, some interpretations of open science hold that making research processes and outputs more transparent and accessible will also enhance the uptake of results by policy and society at large. However, we argue that this hope is based on an unjustifiably simplistic understanding of the science–policy interface that leaves key terms (“impact”, “uptake”) undefined. We show that this understanding—based upon linear models of research uptake—likewise grounds the influential “evidence–policy gap” diagnosis which holds that to improve research uptake, communication and interaction between researchers and policy-makers need to be improved. The overall normative stance of both discussions has sidelined empirical description of the science–policy interface, ignoring questions about the underlying differences between the policy domain and academia. Importantly, both open science and literature on closing the evidence–policy gap recommend improving communication (in terms of either the content or the means) as a viable strategy. To correct some of these views, we combine insights from policy theory with a narrative review of the literature on the evidence–policy gap in the health domain and find that removing barriers to access by itself will not be enough to foster research uptake.

Theory-based capacity building intervention for intersectoral action for health at local governments: An exploratory pilot study

Aim

To design, implement and evaluate a nurse‐led capacity building intervention (PromoGOB) for intersectoral action for health at local governments.

Design

The programme was based on theories of the policy process and organizational change and facilitated by a nurse developing a health broker role. A complex intervention perspective was adopted in carrying out the study. The intervention was evaluated using a mixed method embedded design.

Methods

Quantitative component relied on a specific questionnaire. This tool, designed and piloted ad hoc, measured the capacity in terms of knowledge, awareness, resources, skills, and commitment, both at sectoral and government levels. For the qualitative component, semi‐structured interviews were conducted. These explored the perceived capacity and feasibility and acceptability issues. The programme was initiated at the end of October 2019, and it lasted a total of 5 weeks. Nineteen individuals representing various sectors at a local government in northern Spain participated in the study. The data analysis was concluded by the end of March 2020.

Findings

PromoGOB positively influenced participants' capacity for addressing health promotion. Awareness component, intersectoral work and the nurse as health broker were essential in the programme. The necessity of political participation was identified as an issue to be prioritized in future studies.

Conclusion

This study highlights the relevance of capacity building at local governments and the role that nurses can play in it. Further work should be undertaken to continue developing Health in All Policies approach at local level.

Impact

This study offers a starting point for nurses to get involved in the policy process of health promotion, performing a specific role as health brokers, building capacity at local governments for addressing social determinants of health, and delving into theories and concepts of the Health in All Policies field.

Supporting researchers in knowledge translation and dissemination of their research to increase usability and impact

PURPOSE

One of the key areas of delivery of the 'Action Plan for Health Research 2019-2029', for the Health Service Executive (HSE) in Ireland, is adding value and using data and knowledge, including health-related quality of life (HRQoL), for improved health care, service delivery and better population health and wellbeing. The development of governance, management and support framework and mechanisms will provide a structure for ensuring research is relevant to the organisation's service plan, well designed, has a clear plan for dissemination and translation of knowledge, and minimises research waste. Developing a process for the translation, dissemination and impact of research is part of the approach to improving translation of research into practice and aligning it with knowledge gaps. A project was undertaken to develop a clear, unified, universally applicable approach for the translation, dissemination, and impact of research undertaken by HSE staff and commissioned, sponsored, or hosted by the organisation. This included the development of guidance, training, and information for researchers.

METHODS

Through an iterative process, an interdisciplinary working group of experts in knowledge translation (KT), implementation science, quality improvement and research management, identified KT frameworks and tools to form a KT, dissemination, and impact process for the HSE. This involved a literature review, screening of 247 KT theories, models, and frameworks (TMFs), review of 18 TMFs selected as usable and applicable to the HSE, selection of 11 for further review, and final review of 6 TMFs in a consensus workshop. An anonymous online survey of HSE researchers, consisting of a mixture of multiple choice and free text questions, was undertaken to inform the development of the guidance and training.

RESULTS

A pilot of the KT process and guidance, involving HSE researchers testing its use at various stages of their research, demonstrated the need to guide researchers through planning, stakeholder engagement, and disseminating research knowledge, and provide information that could easily be understood by novice as well as more experienced researchers. A survey of all active researchers across the organisation identified their support and knowledge requirements and led to the development of accompanying guidance to support researchers in the use of the process. Researchers of all levels reported that they struggled to engage with stakeholders, including evidence users and policy makers, to optimise the impact of their research. They wanted tools that would support better engagement and maximise the value of KT. As a result of the project a range of information, guidance, and training resources have been developed.

CONCLUSION

KT is a complex area and researchers need support to ensure they maximise the value of their research. The KT process outlined enables the distilling of a clear message, provides a process to engage with stakeholders, create a plan to incorporate local and political context, and can show a means to evaluate how much the findings are applied in practice. This is a beneficial application of KT in the field of patient reported outcomes. In implementing this work, we have reinforced the message that stakeholder engagement is crucial from the start of the research study and increases engagement in, and ownership of, the research knowledge.

What informs oral health and chronic disease policy development in Australia: a citation analysis

Improvement of health services and patient outcomes depends on the translation of health research into health policy. Oral health research can inform policies to manage chronic diseases and improve quality of life of affected individuals. To determine if translation of this research into policy is occurring, we identify where policymakers obtain evidence to inform the development of Australian health policy. We conducted a citation analysis of oral health, cardiovascular disease, diabetes and cognitive impairment National policies to determine if current oral health research has informed oral health and chronic disease policy. We analysed five National policies with 268 individual references to policy or organizational documents (n = 179), peer-reviewed research (n = 74), grey literature (n = 12), or unidentifiable (n = 3). Although we found oral health references listed in the National policies (92), we did not find this information to have been translated into the oral health and chronic disease policies we analysed.

Policymakers' Research Capacities, Engagement, and Use of Research in Public Health Policymaking

The use of research in public health policymaking is one of the prerequisites for successfully implemented health policies which have better population health as an outcome. This policy process is influenced by the actors involved under the policy umbrella, with inter-related contextual factors and specific structural and institutional circumstances. Our study investigates how policymakers’ research capacities influence the use of research in the health policy process and identify areas where capacity-building interventions give the most meaning and impact. Furthermore, we investigate policymakers’ research engagement and use this to inform public health policy in the public sector in Denmark. We collect and report data using Seeking, Engaging with, and Evaluation Research (SEER) methodology. Policymakers are reported to have research capacity, but it is questionable how those competences have actually been used in policymaking. Decision-makers were often not aware or did not know about the existing organizational tools and systems for research engagement and use and two third of respondents had not been part of any research activities or had any collaboration with researchers. Overall, research use in public health policymaking and evaluation was limited. As a conclusion, we propose that capacity-building interventions for increasing research use and collaboration in EIPM should be context-oriented, measurable, and sustainable in developing individual and organizational competences.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

NA.

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

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.

Limited knowledge and distrust are important social factors of out-patient' s 'inappropriate diagnosed seeking behaviour': a qualitative research in Shanghai

AIMS

This study is designed to present out-patient's 'inappropriate diagnosed seeking behaviour' in tertiary hospitals and interpret its association with some potential social factors.

METHODS

A qualitative study based on grounded theory was designed in this paper. The participates were recruited by a two-stage process. The field observation and in-depth interview were adopted for data collection. Multi-round (five rounds) sampling and continuing data analysis were adopted as well.

RESULTS

Totally 26 out-patients from three tertiary hospitals in Shanghai were involved. Four focused codes, including 'limited policy-related knowledge', 'limited health-related knowledge', 'distrust on related policy' and 'distrust on medical networks', were identified. Then, a theoretical model about the association of out-patient's 'limited knowledge' with 'distrust' and its relationship with 'inappropriate first-diagnosed seeking behaviour' in tertiary hospitals was developed.

CONCLUSION

'Inappropriate first-diagnosed seeking behaviour' of the out-patients in tertiary hospitals is closely associated with their limited knowledge and related distrust. Great effort on improving publics' knowledge and rebuilding a benign trust relationship with out-patients and the medical networks is found to be essential for guiding publics' appropriate first-diagnosed health behaviour in various levels of medical institutions.

A Data-informed Public Health Policy-Makers Platform

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.

Knowledge implementation in health care management: a qualitative study

Background

The gap between knowledge and practice is a global issue, which increases wasteful spending in healthcare. There are several models and frameworks to address this gap and try to solve the challenge. Promoting Action on Research Implementation in Health Services (PARIHS) framework highlights the interaction of three main elements: evidence, context and facilitation, to implement research into practice, successfully. This framework can use as a tool to evaluate the situation and guide the changing. This study conducted to explain the status of knowledge implementation in Iran’s healthcare management system.

Methods

This qualitative study was done by using a directive content analysis approach through conducting in-depth, structured interviews with 15 health managers based on the PARIHS framework. Guiding questions were based on the three main elements of the framework: evidence, context and facilitation. The content of the interviews entered into the Qualitative Data Analysis software (MAXQDA version 10) and, then, analyzed.

Results

The most common source of evidence used by managers for decision-making was local information and previous experience. Evaluation more emphasized compared to other sub-elements of context, i.e. culture and leadership. In terms of facilitation, performing tasks by others was the dominant opinion.

Conclusion

Our results showed that managers in the healthcare system of Iran use their own and other manager’s experience and the local information for decision-making and have no ideas about facilitation.

Knowledge mobilisation in practice: an evaluation of the Australian Prevention Partnership Centre

Background

Cross-sector collaborative partnerships are a vital strategy in efforts to strengthen research-informed policy and practice and may be particularly effective at addressing the complex problems associated with chronic disease prevention. However, there is still a limited understanding of how such partnerships are implemented in practice and how their implementation contributes to outcomes. This paper explores the operationalisation and outcomes of knowledge mobilisation strategies within the Australian Prevention Partnership Centre — a research collaboration between policy-makers, practitioners and researchers.

Methods

The Centre’s programme model identifies six knowledge mobilisation strategies that are hypothesised to be essential for achieving its objectives. Using a mixed methods approach combining stakeholder interviews, surveys, participant feedback forms and routine process data over a 5-year period, we describe the structures, resources and activities used to operationalise these strategies and explore if and how they have contributed to proximal outcomes.

Results

Results showed that Centre-produced research, resources, tools and methods were impacting policy formation and funding. Policy-makers reported using new practical methodologies that were helping them to design, implement, evaluate and obtain funding for scaled-up policies and programmes, and co-creating compelling prevention narratives. Some strategies were better implemented and more impactful than others in supporting these outcomes, with variation in who they worked for. The activities used to effect engagement, capacity-building and partnership formation were mostly generating positive results, but co-production could be enhanced by greater shared decision-making. Considerably more work is needed to successfully operationalise knowledge integration and adaptive learning.

Conclusions

Describing how collaborative cross-sector research partnerships are operationalised in practice, and with what effects, can provide important insights into practical strategies for establishing and growing such partnerships and for maximising their contributions to policy. Findings suggest that the Centre has many strengths but could benefit from more inclusive and transparent governance and internal processes that facilitate dialogue about roles, expectations and co-production practices.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Erlang could have told you so-A case study of health policy without maths

Little consideration is given to the operational reality of implementing national policy at local scale. Using a case study from Norway, we examine how simple mathematical models may offer powerful insights to policy makers when planning policies. Our case study refers to a national initiative requiring Norwegian municipalities to establish acute community beds (municipal acute units or MAUs) to avoid hospital admissions. We use Erlang loss queueing models to estimate the total number of MAU beds required nationally to achieve the original policy aim. We demonstrate the effect of unit size and patient demand on anticipated utilisation. The results of our model imply that both the average demand for beds and the current number of MAU beds would have to be increased by 34% to achieve the original policy goal of transferring 240 000 patient days to MAUs. Increasing average demand or bed capacity alone would be insufficient to reach the policy goal. Day-to-day variation and uncertainty in the numbers of patients arriving or leaving the system can profoundly affect health service delivery at the local level. Health policy makers need to account for these effects when estimating capacity implications of policy. We demonstrate how a simple, easily reproducible, mathematical model could assist policy makers in understanding the impact of national policy implemented at the local level.

Health researchers and policy makers involvement in knowledge translation activities in Malawi

PURPOSE

The purpose of this paper is to explore health researchers' involvement of policy or decision makers in knowledge translation activities in Malawi.

DESIGN/METHODOLOGY/APPROACH

The case study collected quantitative through questionnaire from health researchers from the University of Malawi. The study used inferential statistics for the analysis of the quantitative data. Pearson χ² test was used to establish the relationship between categorical data and determine whether any observed difference between the data sets arose by chance. The Kruskal-Wallis H test was used to determine if there were statistically significant differences between independent variable and dependent variables. Data has been presented in a form of tables showing means, standard deviation and p-values.

FINDINGS

Health researchers sometimes involve policy or decision makers in government-sponsored meetings (M=2.5, SD=1.17). They rarely involve policy or decision makers in expert committee or group meetings (M=2.4, SD=1.20). Researchers rarely involve policy or decision makers in conferences and workshops (M=2.4, SD=1.31). Rarely do researchers involve policy or decision makers in formal private or public networks (M=2.4, SD=1.17). In events organised by the colleges researchers rarely involve policy or decision makers (M=2.3, SD=1.11); and rarely share weblinks with policy or decision makers (M=2.0, SD=1,17). On average, health researchers occasionally conduct deliberate dialogues with key health policy makers and other stakeholders (M=2.5, SD=1.12). The researchers rarely established and maintained long-term partnerships policy or decision makers (M=2.2, SD=1.20). They rarely involve policy or decision makers in the overall direction of the health research conducted by themselves or the Colleges (M=2.1, SD=1.24).

RESEARCH LIMITATIONS/IMPLICATIONS

The study recommends that there should be deliberate efforts by health researchers and policy makers to formally engage each other. Individuals need technical skills, knowledge of the processes and structures for engaging with health research evidence to inform policy and decision making. At the institutional level, the use of research evidence should be embedded within support research engagement structures and linked persons.

PRACTICAL IMPLICATIONS

Formal interactions in a form of expert meetings and technical working groups between researchers and policy makers can facilitate the use of health research evidence in policy formulation.

SOCIAL IMPLICATIONS

In terms of framework there is need to put in place formal interaction frameworks between health researchers and policy makers within the knowledge translation and exchange.

ORIGINALITY/VALUE

There is dearth of literature on the levels of involvement and interaction between health researchers and health policy or decision makers in health policy, systems and services research in Malawi. This study seeks to bridge the gap with empirical evidence.

The perspectives of politicians on tobacco control in Turkey

Background

Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations.

Aim

This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT).

Methods

This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT-which is the Turkish parliament and unicameral Turkish legislature-1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption.

Results and recommendations

Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians.