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Wilkinson-Stokes M, Yap C, Crellin D, Bange R, Braitberg G, Gerdtz M. How should non-emergency EMS presentations be managed? A thematic analysis of politicians', policymakers', clinicians' and consumers' viewpoints. BMJ Open 2024; 14:e083866. [PMID: 39059805 DOI: 10.1136/bmjopen-2024-083866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE In 2023, Australian government emergency medical services (EMS) responded to over 4 million consumers, of which over 56% were not classified as an 'emergency', at the cost of AU$5.5 billion. We explored the viewpoints of politicians, policymakers, clinicians and consumers on how these non-emergency requests should be managed. DESIGN A realist framework was adopted; a multidisciplinary team (including paramedicine, medicine and nursing) was formed; data were collected via semistructured focus groups or interviews, and thematic analysis was performed. SETTING AND PARTICIPANTS 56 participants were selected purposefully and via open advertisement: national and state parliamentarians (n=3); government heads of healthcare disciplines (n=3); government policymakers (n=5); industry policymakers in emergency medicine, general practice and paramedicine (n=6); EMS chief executive officers, medical directors and managers (n=7); academics (n=8), frontline clinicians in medicine, nursing and paramedicine (n=8); and consumers (n=16). RESULTS Three themes emerged: first, the reality of the EMS workload (theme titled 'facing reality'); second, perceptions of what direction policy should take to manage this ('no silver bullet') and finally, what the future role of EMS in society should be ('finding the right space'). Participants provided 16 policy suggestions, of which 10 were widely supported: increasing public health literacy, removing the Medical Priority Dispatch System, supporting multidisciplinary teams, increasing 24-hour virtual emergency departments, revising undergraduate paramedic university education to reflect the reality of the contemporary role, increasing use of management plans for frequent consumers, better paramedic integration with the healthcare system, empowering callers by providing estimated wait times, reducing ineffective media campaigns to 'save EMS for emergencies' and EMS moving away from hospital referrals and towards community care. CONCLUSIONS There is a need to establish consensus on the role of EMS within society and, particularly, on whether the scope should continue expanding beyond emergency care. This research reports 16 possible ideas, each of which may warrant consideration, and maps them onto the standard patient journey.
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Affiliation(s)
- Matt Wilkinson-Stokes
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Celene Yap
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Di Crellin
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ray Bange
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - George Braitberg
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Marie Gerdtz
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Ashtari N, Abbasi J, Barnert E. Perspectives of California Legislators on Institutional Barriers and Facilitators to Non-Partisan Research Evidence Use in State Health Policymaking. J Gen Intern Med 2024; 39:1704-1712. [PMID: 38102408 PMCID: PMC11255140 DOI: 10.1007/s11606-023-08547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Bridging the translational gap between research evidence and health policy in state legislatures requires understanding the institutional barriers and facilitators to non-partisan research evidence use. Previous studies have identified individual-level barriers and facilitators to research evidence use, but limited perspectives exist on institutional factors within legislatures that influence non-partisan research evidence use in health policymaking. OBJECTIVE We describe the perspectives of California state legislators and legislative staff on institutional barriers and facilitators of non-partisan research evidence use in health policymaking and explore potential solutions for enhancing use. DESIGN Case study design involving qualitative interviews. PARTICIPANTS We interviewed 24 California state legislators, legislative office staff, and legislative research staff. APPROACH Semi-structured recorded interviews were conducted in person or by phone to identify opportunities for enhancing non-partisan research evidence use within state legislatures. We conducted thematic analyses of interview transcripts to identify (1) when research evidence is used during the policymaking process, (2) barriers and facilitators operating at the institutional level, and (3) potential solutions for enhancing evidence use. RESULTS Institutional barriers to non-partisan research evidence use in health policymaking were grouped into three themes: institutional policies, practices, and priorities. Interviews also revealed institutional-level facilitators of research evidence use, including (1) access and capacity to engage with research evidence, and (2) perceived credibility of research evidence. The most widely supported institutional-level solution for enhancing evidence-based health policymaking in state legislatures involved establishing independent, impartial research entities to provide legislators with trusted evidence to inform decision-making. CONCLUSIONS Potential institutional-level changes within state legislatures may enhance evidence use in health policymaking, leading to improved health outcomes and lower healthcare costs for states.
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Affiliation(s)
- Neda Ashtari
- UCLA David Geffen School of Medicine, Los Angeles, CA, 90024, USA.
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
| | - Justin Abbasi
- UCLA David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Elizabeth Barnert
- UCLA David Geffen School of Medicine, Los Angeles, CA, 90024, USA
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, 90024, USA
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Sturmberg JP, Martin JH, Tramonti F, Kühlein T. The need for a change in medical research thinking. Eco-systemic research frames are better suited to explore patterned disease behaviors. Front Med (Lausanne) 2024; 11:1377356. [PMID: 38887671 PMCID: PMC11180740 DOI: 10.3389/fmed.2024.1377356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
Many practicing physicians struggle to properly evaluate clinical research studies - they either simply do not know them, regard the reported findings as 'truth' since they were reported in a 'reputable' journal and blindly implement these interventions, or they disregard them as having little pragmatic impact or relevance to their daily clinical work. Three aspects for the latter are highlighted: study populations rarely reflect their practice population, the absolute average benefits on specific outcomes in most controlled studies, while statistically significant, are so small that they are pragmatically irrelevant, and overall mortality between the intervention and control groups are unaffected. These observations underscore the need to rethink our research approaches in the clinical context - moving from the predominant reductionist to an eco-systemic research approach will lead to knowledge better suited to clinical decision-making for an individual patient as it takes into account the complex interplay of multi-level variables that impact health outcomes in the real-world setting.
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Affiliation(s)
- Joachim P. Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- International Society for Systems and Complexity Sciences for Health, Waitsfield, VT, United States
| | - Jennifer H. Martin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Francesco Tramonti
- Department of Mental Health, Azienda USL Toscana Nordovest & Istituto di Psicoterapia Relazionale, Pisa, Italy
| | - Thomas Kühlein
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
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Acharya S, Shrestha M, Thang ND, Wini L, Habib MN, Neukom J, Lhazeen K, Lynch CA, Thriemer K. Optimizing test and treat options for vivax malaria: An options assessment toolkit (OAT) for Asia Pacific national malaria control programs. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002970. [PMID: 38776349 PMCID: PMC11111040 DOI: 10.1371/journal.pgph.0002970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024]
Abstract
Designing policy in public health is a complex process requiring decision making that incorporates available evidence and is suitable to a country's epidemiological and health system context. The main objective of this study was to develop an options assessment toolkit (OAT) to provide a pragmatic and evidence-based approach to the development of policies for the radical cure (prevention of relapse) of vivax malaria for national malaria control programs in the Asia-Pacific region. The OAT was developed using participatory research methods and a Delphi process using a sequential multi-phase design, adapted with a pre-development phase, a development phase, and a final development phase. In the pre-development phase, a literature review was conducted to inform the toolkit development. Data collection in the development phase consisted of core research team discussions, multiple rounds of consultation with participants from National Malaria Control Programs (NMP) (online and in person), and two separate modified e-Delphi processes with experts. The final development phase was the piloting of the toolkit during the annual meeting of the Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group. We developed a tool kit containing the following elements: i) Baseline Assessment Tool (BAT) to assess the readiness of NMPs for new or improved coverage of radical cure, ii) eight scenarios representative of Asia Pacific region, iii) matching test and treat options based on available options for G6PD testing and radical cure for the given scenarios, iv) an approaches tool to allow NMPs to visualize considerations for policy change process and different implementation strategies/approaches for each test and treat option. The OAT can support vivax radical cure policy formulation among NMPs and stakeholders tailoring for their unique country context. Future studies are needed to assess the utility and practicality of using the OAT for specific country context.
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Affiliation(s)
- Sanjaya Acharya
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Manash Shrestha
- Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group, Singapore, Singapore
- MMV Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Ngo Duc Thang
- National Institute of Malariology, Parasitology and Entomology (NIMPE), Ministry of Health, Hanoi, Viet Nam
| | - Lyndes Wini
- National Vector Borne Disease Control Programme, Ministry of Health and Medical Services, Honiara, The Solomon Islands
| | - M. Naeem Habib
- National Malaria Control Program, Ministry of Public Health, Kabul, Afghanistan
| | | | - Karma Lhazeen
- Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group, Singapore, Singapore
| | - Caroline A. Lynch
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group, Singapore, Singapore
- MMV Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Schmitt T, Czabanowska K, Schröder-Bäck P. What is context in knowledge translation? Results of a systematic scoping review. Health Res Policy Syst 2024; 22:52. [PMID: 38685073 PMCID: PMC11057149 DOI: 10.1186/s12961-024-01143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Knowledge Translation (KT) aims to convey novel ideas to relevant stakeholders, motivating their response or action to improve people's health. Initially, the KT literature focused on evidence-based medicine, applying findings from laboratory and clinical research to disease diagnosis and treatment. Since the early 2000s, the scope of KT has expanded to include decision-making with health policy implications.This systematic scoping review aims to assess the evolving knowledge-to-policy concepts, that is, macro-level KT theories, models and frameworks (KT TMFs). While significant attention has been devoted to transferring knowledge to healthcare settings (i.e. implementing health policies, programmes or measures at the meso-level), the definition of 'context' in the realm of health policymaking at the macro-level remains underexplored in the KT literature. This study aims to close the gap.A total of 32 macro-level KT TMFs were identified, with only a limited subset of them offering detailed insights into contextual factors that matter in health policymaking. Notably, the majority of these studies prompt policy changes in low- and middle-income countries and received support from international organisations, the European Union, development agencies or philanthropic entities.
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Affiliation(s)
- Tugce Schmitt
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Peter Schröder-Bäck
- Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Shikako K, Lai J, Yoo PY, Teachman G, Majnemer A. Evidence-informed stakeholder consultations to promote rights-based approaches for children with disabilities. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1322191. [PMID: 38742042 PMCID: PMC11089101 DOI: 10.3389/fresc.2024.1322191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
Purpose To strengthen the translation of evidence to actionable policy, stakeholder engagement is necessary to synthesize, prioritize and contextualize the academic research content into accessible language. In this manuscript we describe a multi-level evidence-based stakeholder consultation process and related outcomes proposed to promote awareness of and foster cross-sectorial collaborations towards human rights-based approaches for children with disabilities. Methods Mixed-methods participatory action research done in three steps: (1) A literature review of peer-reviewed evidence on rights-based approaches in childhood disabilities; (2) Consultation with researchers in diverse fields, grassroot organizations, caregivers, and youth with disabilities; (3) A constructive dialogue with decision makers at federal and provincial levels in Canada to discuss consultations results. Results Stakeholders value human rights approaches that can have a direct impact on practical aspects of their daily living. Organizations give high importance to adopting rights-based approaches to measure policy outcomes, while parents value service provision and youth emphasize accessibility. Conclusion The implementation of rights-based approaches in childhood disabilities can support policy, services, and daily lives of children with disabilities and the ecosystems around them. It can also guide research priorities, and create a common language to foster collaborations across sectors and interested parties.
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Affiliation(s)
- Keiko Shikako
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jonathan Lai
- Autism Alliance of Canada and Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul Y. Yoo
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Gail Teachman
- School of Occupational Therapy, Western University, London, ON, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Su HI, Kaiser BN, Crable EL, Ortega RF, Yoeun SW, Economou MA, Fernandez E, Romero SAD, Aarons GA, McMenamin SB. Implementation of state health insurance benefit mandates for cancer-related fertility preservation: following policy through a complex system. Implement Sci 2024; 19:14. [PMID: 38365808 PMCID: PMC10870606 DOI: 10.1186/s13012-024-01343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/20/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND A myriad of federal, state, and organizational policies are designed to improve access to evidence-based healthcare, but the impact of these policies likely varies due to contextual determinants of, reinterpretations of, and poor compliance with policy requirements throughout implementation. Strategies enhancing implementation and compliance with policy intent can improve population health. Critically assessing the multi-level environments where health policies and their related health services are implemented is essential to designing effective policy-level implementation strategies. California passed a 2019 health insurance benefit mandate requiring coverage of fertility preservation services for individuals at risk of infertility due to medical treatments, in order to improve access to services that are otherwise cost prohibitive. Our objective was to document and understand the multi-level environment, relationships, and activities involved in using state benefit mandates to facilitate patient access to fertility preservation services. METHODS We conducted a mixed-methods study and used the policy-optimized exploration, preparation, implementation, and sustainment (EPIS) framework to analyze the implementation of California's fertility preservation benefit mandate (SB 600) at and between the state insurance regulator, insurer, and clinic levels. RESULTS Seventeen publicly available fertility preservation benefit mandate-relevant documents were reviewed. Interviews were conducted with four insurers; 25 financial, administrative, and provider participants from 16 oncology and fertility clinics; three fertility pharmaceutical representatives; and two patient advocates. The mandate and insurance regulator guidance represented two "Big P" (system level) policies that gave rise to a host of "little p" (organizational) policies by and between the regulator, insurers, clinics, and patients. Many little p policies were bridging factors to support implementation across levels and fertility preservation service access. Characterizing the mandate's functions (i.e., policy goals) and forms (i.e., ways that policies were enacted) led to identification of (1) intended and unintended implementation, service, and patient outcomes, (2) implementation processes by level and EPIS phase, (3) actor-delineated key processes and heterogeneity among them, and (4) inner and outer context determinants that drove adaptations. CONCLUSIONS Following the midstream and downstream implementation of a state health insurance benefit mandate, data generated will enable development of policy-level implementation strategies, evaluation of determinants and important outcomes of effective implementation, and design of future mandates to improve fit and fidelity.
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Affiliation(s)
- H Irene Su
- Moores Cancer Center and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, San Diego, CA, 92093, USA.
| | - Bonnie N Kaiser
- Department of Anthropology and Global Health Program, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Erika L Crable
- Department of Psychiatry, Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, Los Angeles, CA, 92093, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Ricardo Flores Ortega
- Moores Cancer Center and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Sara W Yoeun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, Loss Angeles, CA, 92093, USA
| | - Melina A Economou
- Department of Anthropology and Global Health Program, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Estefania Fernandez
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Sally A D Romero
- Department of Obstetrics, Gynecology and Reproductive Sciences and Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, San Diego, CA, 92093, USA
| | - Sara B McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, Loss Angeles, CA, 92093, USA.
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Edwards RC, Kneale D, Stansfield C, Lester S. What are the mechanisms driving the early stages of embedded researcher interventions? A qualitative process evaluation in English local government. Soc Sci Med 2024; 340:116407. [PMID: 38016307 DOI: 10.1016/j.socscimed.2023.116407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/23/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
Improved collaboration and communication between public health practitioners and academia could enhance the flow of research evidence into policy and practice. Embedded researchers present one type of intervention with the potential to bridge the research-implementation gap through their dual affiliations with decision makers and academia. Although embedded researcher posts are garnering increasing attention in public health, there remains a need to understand the mechanisms through which they may promote the translation of evidence into practice. To address this gap, we conducted a processes evaluation incorporating data from seventeen semi-structured interviews with embedded researchers in local government public health teams across England. We aimed to expand theoretical understandings of embedded researchers in public health through providing a detailed conceptualisation of the mechanisms shaping the early stages of their roles. Interviews with embedded researchers were conducted from late 2021 to spring 2022. Our results suggest that the initial months of embedded researcher roles are defined by a lengthy embedding phase centred on building trust and gathering contextual knowledge. This phase forms the foundation on which these interventions are built. We identified seven categories of outputs delivered by embedded researchers which primarily revolved around building research capacity and addressed many of the primary barriers limiting research activity in public health. Improvements in research awareness, interest, and involvement reflected early changes in local research cultures. However, our results align with previous work suggesting that changing an organisational research culture is a long-term process. Expectations for embedded researchers should thus be proportionate to the seniority and scale of the post and we add our voice to calls for sustained investment in these valuable interventions. Further examination of how embedded researcher roles evolve over time in public health is necessary to broaden understandings of the concept of embeddedness in these settings.
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Affiliation(s)
- Rachael C Edwards
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Dylan Kneale
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Claire Stansfield
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Sarah Lester
- Evidence for Policy and Practice Information Centre, UCL Social Research Institute, Institute of Education, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
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Wabnitz K, Rueb M, Rehfuess EA, Strahwald B, Pfadenhauer LM. Assessing the impact of an evidence- and consensus-based guideline for controlling SARS-CoV-2 transmission in German schools on decision-making processes: a multi-component qualitative analysis. Health Res Policy Syst 2023; 21:138. [PMID: 38115061 PMCID: PMC10729453 DOI: 10.1186/s12961-023-01072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, decision-making on measures to reduce or prevent transmission of SARS-CoV-2 in schools was rendered difficult by a rapidly evolving and uncertain evidence base regarding their effectiveness and unintended consequences. To support decision-makers, an interdisciplinary panel of scientific experts, public health and school authorities as well as those directly affected by school measures, was convened in an unprecedented effort to develop an evidence- and consensus-based public health guideline for German schools. This study sought to assess whether and how this guideline impacted decision-making processes. METHODS This study comprised three components: (1) we sent inquiries according to the Freedom of Information Acts of each Federal State to ministries of education, family, and health. (2) We conducted semi-structured interviews with individuals involved in decision-making regarding school measures in two Federal States, and (3) we undertook semi-structured interviews with members of the guideline panel. The content of response letters in component 1 was analysed descriptively; data for components 2 and 3 were analysed using deductive-inductive thematic qualitative content analysis according to Kuckartz. RESULTS Responses to the Freedom of Information Act inquiries showed that the guideline was recognised as a relevant source of information by ministries of education in nine out of 16 Federal States and used as a reference to check existing directives for school measures in five Federal States. All participants (20 interviews) emphasised the value of the guideline given its evidence- and consensus-based development process but also noted limitations in its usability and usefulness, e.g., lack of context-specificity. It was consulted by participants who advised policy-makers (5 interviews) alongside other sources of evidence. Overall, perceptions regarding the guideline's impact were mixed. CONCLUSIONS Our findings suggest that the guideline was relatively well-known in Federal States' decision-making bodies and that it was considered alongside other forms of evidence in some of these. We suggest that further research to evaluate the impact of public health guidelines on (political) decision-making is warranted. Guideline development processes may need to be adapted to account for the realities of decision-making during public health emergencies and beyond.
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Affiliation(s)
- Katharina Wabnitz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | - Mike Rueb
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Khan AA, Khan R, Khawaja Z, Ibrahim M, Shaheen Z, Khan A. Exploring the typology of decision-makers, institutions, and incentives that shape health decisions in Pakistan and insulate decision makers from citizens feedback. Front Public Health 2023; 11:1253798. [PMID: 38145073 PMCID: PMC10748403 DOI: 10.3389/fpubh.2023.1253798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/15/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction In developing countries such as Pakistan, program and policies underperform in providing public good as weak institutions lead to decisions that are unresponsive to citizens and are driven by personal motivations of the incumbents. We describe the decision-making processes in the health sector through the framework of "Public Choice" theory which posits how individual motives shape institutional performance and direction. Methods We conducted 84 qualitative interviews with five types of stakeholders: politicians, senior and mid-level bureaucrats, donors, public health experts and media personnel spanning 2 periods over a decade. The initial interviews were conducted during 2013-2015 period and a case study on decision-making during the COVID-19 response was added in 2020-2022 period. Findings Most new ideas originate from top political leadership, guided by personal agendas or political expediency. Senior bureaucrats implement politicians' agenda and mid-level officials maintain the status quo and follow established "authority." Since officials' performance, promotions, transfers, and the rare dismissals are based on tenure deviations rather than work performance, individuals and institutions are reluctant to take initiative without "consensus" among their colleagues often leading to inaction or delays that obviate initiative and reform. The public sector lacks institutional memory, formal information gathering, and citizen engagement, impacting public goods, health services, and policies. Media and donor personnel are important influencers. However, media mostly report only "hot issues" in health, with short publication and reader attention cycles. Donor personnel are the most likely to follow evidence for decision making, albeit while following their institutional priorities determined centrally. The COVID-19 response is presented as a contrast from usual practices, where evidence was used to guide decisions, as the pandemic was perceived as a national threat by the highest leadership. Conclusion Absence of citizen feedback and formal systems for evidence gathering and processing leads to decisions that neglect the needs of those they serve, prioritizing personal or political gains and perpetuating the status quo. However, the COVID-19 pandemic emphasized the importance of evidence-based decision-making and offers valuable lessons for reforming decision-making processes.
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Affiliation(s)
- Adnan A. Khan
- Research and Development Solutions, Islamabad, Pakistan
- Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Romesa Khan
- Research and Development Solutions, Islamabad, Pakistan
| | | | | | | | - Ayesha Khan
- Akhter Hameed Khan Foundation, Islamabad, Pakistan
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Semahegn A, Manyazewal T, Hanlon C, Getachew E, Fekadu B, Assefa E, Kassa M, Hopkins M, Woldehanna T, Davey G, Fekadu A. Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review. Health Res Policy Syst 2023; 21:131. [PMID: 38057873 PMCID: PMC10699029 DOI: 10.1186/s12961-023-01084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND An estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review. METHODS The scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question. RESULTS A total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms. CONCLUSION Important barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.
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Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | | | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
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Vargas Riaño EM, Becerril-Montekio V, Agudelo Botero M. [Analysis of the internal coherence of the Mental Health and Addictions Program of Mexico 2020-2024]. GACETA SANITARIA 2023; 37:102327. [PMID: 37913590 DOI: 10.1016/j.gaceta.2023.102327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To analyse the internal coherence of the Specific Mental Health and Addictions Program 2020-2024 (PAE-SM20-24) of the Health Secretary of Mexico. METHOD Qualitative descriptive analysis of the logic connection and causal articulation between the objectives, the strategies, and the specific actions of the PAE-SM20-24. RESULTS PAE-SM20-24 formulates 3 priority objectives, 9 priority strategies, and 49 specific actions. The formulation of the objectives, strategies and actions lacks the necessary structure to define the who, how, where, and when. Neither does it establish financing sources, the mechanisms for resource administration, nor the strategies and actions that are needed to restructure the functions of the participating institutions. It does not define the mechanisms for social participation nor any clear actions for intersectoral work. The actions that are presented are limited to rhetoric proposals to promote, encourage, support, strengthen, and foster, which do not allow us to determine tangible effects due to their implementation. In general terms, the formulation of the program is ambiguous. CONCLUSIONS PAE-SM20-24 lacks internal coherence, which means that there is only a medium connection between its objectives, strategies, and specific actions. This jeopardizes its implementation and, therefore, its potential to contribute to the improvement of public policy related to mental health and addictions in the country.
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Affiliation(s)
- Emily María Vargas Riaño
- Unidad de Posgrado e Investigación, Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatán, México
| | - Víctor Becerril-Montekio
- Centro de Investigación en Sistemas de Salud del Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
| | - Marcela Agudelo Botero
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México.
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Windle A, Javanparast S, Freeman T, Baum F. Factors that influence evidence-informed meso-level regional primary health care planning: a qualitative examination and conceptual framework. Health Res Policy Syst 2023; 21:99. [PMID: 37749644 PMCID: PMC10521552 DOI: 10.1186/s12961-023-01049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/04/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Evidence-informed primary health care (PHC) planning in decentralised, meso-level regional organisations has received little research attention. In this paper we examine the factors that influence planning within this environment, and present a conceptual framework. METHODS We employed mixed methods: case studies of five Australian Primary Health Networks (PHNs), involving 29 primary interviews and secondary analysis of 38 prior interviews; and analysis of planning documents from all 31 PHNs. The analysis was informed by a WHO framework of evidence-informed policy-making, and institutional theory. RESULTS Influential actors included federal and state/territory governments, Local Health Networks, Aboriginal Community Controlled Health Organisations, local councils, public hospitals, community health services, and providers of allied health, mental health and aged care services. The federal government was most influential, constraining PHNs' planning scope, time and funding. Other external factors included: the health service landscape; local socio-demographic and geographic characteristics; (neoliberal) ideology; interests and politics; national policy settings and reforms; and system reorganisation. Internal factors included: organisational structure; culture, values and ideology; various capacity factors; planning processes; transition history; and experience. The additional regional layer of context adds to the complexity of planning. CONCLUSIONS Like national health policy-making, meso-level PHC planning occurs in a complex environment, but with additional regional factors and influences. We have developed a conceptual framework of the meso-level PHC planning environment, which can be employed by similar regional organisations to elucidate influential factors, and develop strategies and tools to promote transparent, evidence-informed PHC planning for better health outcomes.
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Affiliation(s)
- Alice Windle
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Sara Javanparast
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Toby Freeman
- Stretton Health Equity, Stretton Institute, The University of Adelaide, Adelaide, SA Australia
| | - Fran Baum
- Stretton Health Equity, Stretton Institute, The University of Adelaide, Adelaide, SA Australia
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Lauber K, Brooks E. Why meta-regulation matters for public health: the case of the EU better regulation agenda. Global Health 2023; 19:70. [PMID: 37710336 PMCID: PMC10500858 DOI: 10.1186/s12992-023-00971-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
Meta-regulation - the rules that govern how individual policies are developed and reviewed - has not received much attention in the study of health policy. We argue that these rules, far from value-free and objective, have significant potential to shape policy outputs and, as such, health outcomes. Channelling and operationalising wider paradigms like neoliberalism, they determine, for instance, what is considered 'good' policy, how decisions are made, based on which evidence, and whose voices matter. Exploring an archetypal example of meta-regulation, the European Union's Better Regulation agenda, we illustrate why meta-regulatory tools such as impact assessment, stakeholder consultation, and evaluation - and the norms that underlie their application - matter for health. In so doing, we concentrate especially on the ways in which Better Regulation may affect interest groups' ability to exert influence and, conversely, how actors have sought to shape Better Regulation. We argue that attention to meta-regulation contributes to counter-balancing the focus on agency within debates at the intersection of globalisation and health, and notably those on regulatory practices and coordination. Whilst research has noted, for instance, the origins of frameworks like Better Regulation and the increasing inclusion of 'good regulatory practice' provisions within trade and investment agreements, less attention is directed to the role that these frameworks play once institutionalised. Yet, as we illustrate, there is considerable scope for meta-regulation to enhance our understanding of the forces shaping health policy via, for instance, conceptualisations of the (social, economic, political, commercial) determinants of health. As such, we call for increased attention to the role of meta-regulation in research and practice aimed at improving human and planetary health.
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Affiliation(s)
- Kathrin Lauber
- Global Health Policy Unit, School of Social and Political Science, Chrystal Macmillan Building, 15a George Square, University of Edinburgh, Edinburgh, EH8 9LD, UK.
| | - Eleanor Brooks
- Global Health Policy Unit, School of Social and Political Science, Chrystal Macmillan Building, 15a George Square, University of Edinburgh, Edinburgh, EH8 9LD, UK
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Dam JL, Nagorka-Smith P, Waddell A, Wright A, Bos JJ, Bragge P. Research evidence use in local government-led public health interventions: a systematic review. Health Res Policy Syst 2023; 21:67. [PMID: 37400905 DOI: 10.1186/s12961-023-01009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/13/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Local governments play an important role in improving public health outcomes globally, critical to this work is applying the best-available research evidence. Despite considerable exploration of research use in knowledge translation literature, how research is practically applied by local governments remains poorly understood. This systematic review examined research evidence use in local government-led public health interventions. It focused on how research was used and the type of intervention being actioned. METHODS Quantitative and qualitative literature published between 2000 and 2020 was searched for studies that described research evidence use by local governments in public health interventions. Studies reporting interventions developed outside of local government, including knowledge translation interventions, were excluded. Studies were categorised by intervention type and their level of description of research evidence use (where 'level 1' was the highest and 'level 3' was the lowest level of detail). FINDINGS The search identified 5922 articles for screening. A final 34 studies across ten countries were included. Experiences of research use varied across different types of interventions. However, common themes emerged including the demand for localised research evidence, the legitimising role of research in framing public health issues, and the need for integration of different evidence sources. CONCLUSIONS Differences in how research was used were observed across different local government public health interventions. Knowledge translation interventions aiming to increase research use in local government settings should consider known barriers and facilitators and consider contextual factors associated with different localities and interventions.
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Affiliation(s)
- Jennifer L Dam
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia.
| | - Phoebe Nagorka-Smith
- School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Alex Waddell
- Action Lab, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Annemarie Wright
- Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, VIC, 3053, Carlton, Australia
| | - Joannette J Bos
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
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Freudenberg N, Israel B. Integrating Public Health Research and Teaching With Social Justice Activism: Lessons From 80 Years of Practice. HEALTH EDUCATION & BEHAVIOR 2023; 50:301-309. [PMID: 36847337 DOI: 10.1177/10901981231158403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
In this commentary, we reflect on the lessons we have learned from our successes and failures in aligning the roles of scholars and activists. Our hope is to provide insights that can guide public health students, faculty, practitioners, and activists seeking to chart their professional, political, and personal futures in today's polarized and catastrophe-burdened world. Several experiences motivate us to write this commentary now. In the last few years, inspired in part by the new activism against systemic racism sparked by the murder of George Floyd and others, growing climate emergencies, the COVID pandemic, anti-immigrant politics, increasing anti-Asian acts of violence, gun bloodshed, attacks on the right to reproductive and sexual health, resurgence of interest in worker organizing, and the ongoing quest for lesbian, gay, bisexual, transgender, and intersex (LGBTQI+) rights, we are impressed by the number of young people engaged in activism to defend and expand their rights and show that another world is possible.
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Affiliation(s)
- Nicholas Freudenberg
- City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
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Crable EL, Grogan CM, Purtle J, Roesch SC, Aarons GA. Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol. Implement Sci Commun 2023; 4:16. [PMID: 36797794 PMCID: PMC9936679 DOI: 10.1186/s43058-023-00396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Policy is a powerful tool for systematically altering healthcare access and quality, but the research to policy gap impedes translating evidence-based practices into public policy and limits widespread improvements in service and population health outcomes. The US opioid epidemic disproportionately impacts Medicaid members who rely on publicly funded benefits to access evidence-based treatment including medications for opioid use disorder (MOUD). A myriad of misaligned policies and evidence-use behaviors by policymakers across federal agencies, state Medicaid agencies, and managed care organizations limit coverage of and access to MOUD for Medicaid members. Dissemination strategies that improve policymakers' use of current evidence are critical to improving MOUD benefits and reducing health disparities. However, no research describes key determinants of Medicaid policymakers' evidence use behaviors or preferences, and few studies have examined data-driven approaches to developing dissemination strategies to enhance evidence-informed policymaking. This study aims to identify determinants and intermediaries that influence policymakers' evidence use behaviors, then develop and test data-driven tailored dissemination strategies that promote MOUD coverage in benefit arrays. METHODS Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will conduct a national survey of state Medicaid agency and managed care organization policymakers to identify determinants and intermediaries that influence how they seek, receive, and use research in their decision-making processes. We will use latent class methods to empirically identify subgroups of agencies with distinct evidence use behaviors. A 10-step dissemination strategy development and specification process will be used to tailor strategies to significant predictors identified for each latent class. Tailored dissemination strategies will be deployed to each class of policymakers and assessed for their acceptability, appropriateness, and feasibility for delivering evidence about MOUD benefit design. DISCUSSION This study will illuminate key determinants and intermediaries that influence policymakers' evidence use behaviors when designing benefits for MOUD. This study will produce a critically needed set of data-driven, tailored policy dissemination strategies. Study results will inform a subsequent multi-site trial measuring the effectiveness of tailored dissemination strategies on MOUD benefit design and implementation. Lessons from dissemination strategy development will inform future research about policymakers' evidence use preferences and offer a replicable process for tailoring dissemination strategies.
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Affiliation(s)
- Erika L Crable
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
- University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA.
| | - Colleen M Grogan
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, IL, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York City, NY, USA
- Global Center for Implementation Science, New York University School of Global Public Health, New York City, NY, USA
| | - Scott C Roesch
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
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Boatwright M, Lawrence M, Russell C, Russ K, McCoy D, Baker P. The Politics of Regulating Foods for Infants and Young Children: A Case Study on the Framing and Contestation of Codex Standard-Setting Processes on Breast-Milk Substitutes. Int J Health Policy Manag 2022; 11:2422-2439. [PMID: 34973054 PMCID: PMC9818087 DOI: 10.34172/ijhpm.2021.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Breastfeeding is important for the health and development of the child, and for maternal health, in all country contexts. However, global sales of breast-milk substitutes (BMS), including infant, follow-up and toddler formulas, have 'boomed' in recent decades. This raises the importance of international food standards established by the Codex Alimentarius Commission (Codex) on the safety, composition and labelling of BMS. Such standards appear to be strongly contested by governments, industry and civil society groups, yet few studies have investigated the politics of Codex standard-setting processes. The aim of this paper is to understand who participates in decision-making, and how actors frame and contest proposals to revise the Codex Standard on Follow-up Formula (FUF). METHODS We adopted a case study design involving two steps. First, we enumerated government, industry, civil society, and international organization stakeholders participating in standard-setting processes of the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU). Second, we conducted a framing analysis of stakeholder inputs during the FUF standard revision in CCNFSDU meetings. Publicly available online meeting reports (2015-2019) were retrieved, analyzed using a theoretical framework, and organized thematically. RESULTS High-income country (HIC) delegates greatly outnumbered those from other country income categories. Industry representation was higher compared with other observer categories. Member state delegations included more industry representation than civil society representation, and were occasionally the only member state delegates. Industry stakeholders framed arguments in terms of trade implications, science, and flexible standards. Civil society groups used public health, science, and pro-breastfeeding frames. CONCLUSION Codex BMS standard-setting procedures are dominated by HICs and industry groups. Limited representation of civil society, and of low- and middle-income countries (LMICs), suggest actions are needed to substantially increase support for their involvement at Codex. Such representation may help to counteract power asymmetries and commercial influences on food standards for infants and young children.
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Affiliation(s)
- Monique Boatwright
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | | | - David McCoy
- Centre for Primary Care and Public Health, Queen Mary University, London, UK
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition, Deakin University, Geelong, VIC, Australia
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Describing the Value of Physical Therapy in a Complex System Using the Socio-Ecological Model. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mahdavi M, Sajjadi Khasraghi J, Sajadi HS, Yazdizadeh B, Nikooee S, Ehsani-Chimeh E, Dargahi H, Doshmangir L, Ghaffari S, Toyserkanmanesh R, Majdzadeh R. Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project. Int J Health Policy Manag 2022; 11:2236-2247. [PMID: 34814672 PMCID: PMC9808291 DOI: 10.34172/ijhpm.2021.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/10/2021] [Indexed: 01/12/2023] Open
Abstract
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.
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Affiliation(s)
- Mahdi Mahdavi
- The Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Nikooee
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ehsani-Chimeh
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Dargahi
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Tabriz Health Services Management Research Center, Department of Health Policy & Management, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Reza Majdzadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Preventive health resource allocation decision-making processes and the use of economic evidence in an Australian state government—A mixed methods study. PLoS One 2022; 17:e0274869. [PMID: 36121814 PMCID: PMC9484643 DOI: 10.1371/journal.pone.0274869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Context Recommended best practice for resource allocation decisions by governments include a stepwise process guided by economic evidence. However, the use of economic evidence in preventive health decision-making, which often impacts on multiple sectors of government, is under-researched. This study aimed to explore the resource allocation decision-making processes for preventive health interventions in the New South Wales (NSW) Government in Australia, and specifically examined the barriers and facilitators to the use of economic evidence from the perspective of multiple government departments. Methods This mixed methods study was conducted using semi-structured interviews with NSW Treasury representatives (n = 4), a focus group of NSW Ministry of Health representatives (n = 9), and a quantitative questionnaire of all participants. The schedule for the interviews and focus group was based on resource allocation guidance documents from Australian government agencies. Deductive content analysis was undertaken, guided by the Multiple Streams Framework. Findings NSW Treasury participants believed that decision-making processes where economic efficiency was the key guiding principle was the ideal approach. However, the NSW Ministry of Health participants identified that for preventive health decision-making, economic evidence was not used to inform their own choices but was typically only used to convince other agencies of the merits of proposed initiatives when seeking approval. The key barriers to the use of economic evidence were the lack of capacity within the NSW Ministry of Health to understand and undertake economic evaluations; a lack of collaboration between NSW Treasury and preventive health decision-makers within the NSW Ministry of Health; and deficient processes and governance mechanisms that do not facilitate or incentivise effective inter-sectoral decision-making. Conclusions Institutional structures for resource allocation decision-making regarding preventive health result in processes that contrast with best practice recommendations. The multiple challenges to collaborative decision-making across agencies require organisational change to promote a whole-of-government approach.
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Al Sabahi S, Wilson MG, Lavis JN, El-Jardali F, Moat K. Examining and Contextualizing Approaches to Establish Policy Support Organizations - A Mixed Method Study. Int J Health Policy Manag 2022; 11:1788-1800. [PMID: 34380206 PMCID: PMC9808249 DOI: 10.34172/ijhpm.2021.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There has been an increase in the number of policy support organizations (PSOs) that have been created to foster the systematic use of evidence in health system policymaking. Our aim was to identify approaches for establishing a PSO or similar entities by soliciting insights from those with practical experience with developing and operationalizing PSOs in real-world contexts. METHODS We used a sequential mixed method approached. We first conducted a survey to identify the views and experiences of those who were directly involved in the establishment of PSOs that have been developed and implemented across a variety of political-, health- and research-system contexts. The survey findings were then used to develop a purposive sample of PSO leaders and refine an interview guide for interviews with them. RESULTS We received 19 completed surveys from leaders of PSOs in countries across the WHO regions and that operate in different settings (eg, as independent organization or within a university or government department) and conducted interviews with 15 senior managers from nine PSOs. Our findings provide in-depth insights about approaches and strategies across four stages for establishing a PSO, which include: (i) building awareness for the PSO; (ii) developing the PSO; (iii) assessing the PSO to identify potential areas for enhancement; and (iv) supporting maturation to build sustainability in the long-term. Our findings provide rich insights about the process of establishing a PSO from leaders who have undertaken the process. CONCLUSION While all PSOs share the same objective in supporting evidence-informed policy-making (EIPM), there is no single approach that can be considered to be the most successful in establishing a PSO, and each country should identify the approach based on its context.
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Affiliation(s)
| | - Michael G. Wilson
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - John N. Lavis
- Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
- Department of Political Science, McMaster University, Hamilton, ON, Canada
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Fadi El-Jardali
- Knowledge to Policy Center, American University of Beirut, Beirut, Lebanon
| | - Kaelan Moat
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
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Doarn CR. What Is the True Value of Peer-Reviewed Literature in Telemedicine? Telemed J E Health 2022; 28:1075-1076. [PMID: 35877813 DOI: 10.1089/tmj.2022.29079.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Verboom B, Baumann A. Mapping the Qualitative Evidence Base on the Use of Research Evidence in Health Policy-Making: A Systematic Review. Int J Health Policy Manag 2022; 11:883-898. [PMID: 33160295 PMCID: PMC9808178 DOI: 10.34172/ijhpm.2020.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/06/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The use of research evidence in health policy-making is a popular line of inquiry for scholars of public health and policy studies, with qualitative methods constituting the dominant strategy in this area. Research on this subject has been criticized for, among other things, disproportionately focusing on high-income countries; overemphasizing 'barriers and facilitators' related to evidence use to the neglect of other, less descriptive concerns; relying on descriptive, rather than in-depth explanatory designs; and failing to draw on insights from political/policy studies theories and concepts. We aimed to comprehensively map the global, peer-reviewed qualitative literature on the use of research evidence in health policy-making and to provide a descriptive overview of the geographic, temporal, methodological, and theoretical characteristics of this body of literature. METHODS We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched nine electronic databases, hand-searched 11 health- and policy-related journals, and systematically scanned the reference lists of included studies and previous reviews. No language, date or geographic limitations were imposed. RESULTS The review identified 319 qualitative studies on a diverse array of topics related to the use of evidence in health policy-making, spanning 72 countries and published over a nearly 40 year period. A majority of these studies were conducted in high-income countries, but a growing proportion of the research output in this area is now coming from low- and middle-income countries, especially from sub-Saharan Africa. While over half of all studies did not use an identifiable theory or framework, and only one fifth of studies used a theory or conceptual framework drawn from policy studies or political science, we found some evidence that theory-driven and explanatory (eg, comparative case study) designs are becoming more common in this literature. Investigations of the barriers and facilitators related to evidence use constitute a large proportion but by no means a majority of the work in this area. CONCLUSION This review provides a bird's eye mapping of the peer reviewed qualitative research on evidence-to-policy processes, and has identified key features of - and gaps within - this body of literature that will hopefully inform, and improve, research in this area moving forward.
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Affiliation(s)
- Ben Verboom
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK
| | - Aron Baumann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Reichmann S, Wieser B. Open science at the science-policy interface: bringing in the evidence? Health Res Policy Syst 2022; 20:70. [PMID: 35725491 PMCID: PMC9208144 DOI: 10.1186/s12961-022-00867-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/16/2022] [Indexed: 12/04/2022] Open
Abstract
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.
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Trapero-Bertran M, Pokhrel S, Hanney S. Research can be integrated into public health policy-making: global lessons for and from Spanish economic evaluations. Health Res Policy Syst 2022; 20:67. [PMID: 35717247 PMCID: PMC9206096 DOI: 10.1186/s12961-022-00875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
WHO promotes the use of research in policy-making to drive improvements in health, including in achieving Sustainable Development Goals such as tobacco control. The European Union’s new €95 billion Horizon Europe research framework programme parallels these aims, and also includes commitments to fund economic evaluations. However, researchers often express frustration at the perceived lack of attention to scientific evidence during policy-making. For example, some researchers claim that evidence regarding the return on investment from optimal implementation of evidence-based policies is frequently overlooked. An increasingly large body of literature acknowledges inevitable barriers to research use, but also analyses facilitators encouraging such use. This opinion piece describes how some research is integrated into policy-making. It highlights two recent reviews. One examines impact assessments of 36 multi-project research programmes and identifies three characteristics of projects more likely to influence policy-making. These include a focus on healthcare system needs, engagement of stakeholders, and research conducted for organizations supported by structures to receive and use evidence. The second review suggests that such characteristics are likely to occur as part of a comprehensive national health research system strategy, especially one integrated into the healthcare system. We also describe two policy-informing economic evaluations conducted in Spain. These examined the most cost-effective package of evidence-based tobacco control interventions and the cost-effectiveness of different strategies to increase screening coverage for cervical cancer. Both projects focused on issues of healthcare concern and involved considerable stakeholder engagement. The Spanish examples reinforce some lessons from the global literature and, therefore, could help demonstrate to authorities in Spain the value of developing comprehensive health research systems, possibly following the interfaces and receptor model. The aim of this would be to integrate needs assessment and stakeholder engagement with structures spanning the research and health systems. In such structures, economic evaluation evidence could be collated, analysed by experts in relation to healthcare needs, and fed into both policy-making as appropriate, and future research calls. The increasingly large local and global evidence base on research utilization could inform detailed implementation of this approach once accepted as politically desirable. Given the COVID-19 pandemic, increasing the cost-effectiveness of healthcare systems and return on investment of public health interventions becomes even more important.
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Affiliation(s)
- Marta Trapero-Bertran
- Basic Sciences Department, Patients Institute, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Subhash Pokhrel
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, UK.
| | - Stephen Hanney
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, UK
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Choi KE(A, Lindert L, Schlomann L, Pfaff H. "I'll leave that to the case managers." Healthcare Service Providers' Perceptions of Organizational Readiness for Change in a Randomized Controlled Trial-A Qualitative Analysis Exploring Implementation Success. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095782. [PMID: 35565177 PMCID: PMC9104361 DOI: 10.3390/ijerph19095782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/24/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022]
Abstract
Up to 50% of unsuccessful implementations of organizational change are due to a lack of organizational readiness for change (ORC). This qualitative study aims to investigate the experiences of occupational physicians (OPs) and staff of test and training centers (ETTCs) with team effectiveness in the context of ORC. The change setting is the implementation of a new occupational health program in a multicentric randomized controlled trial for musculoskeletal disorders (MSD) in Germany. Two rounds of expert interviews with OPs (1st round: n = 10, 2nd round: n = 13) and one round of expert interviews with ETTCs (n = 9) were conducted and analyzed with a deductive-inductive procedure. The focus of the analysis was the assessment of change commitment and change efficacy, as well as their influence on general ORC on a collective level according to Weiner's model (2009). Differential critical assessment of change by the care providers led to a missing collective change commitment and consequently to a missing organizational change commitment. Main inhibiting factors include lacking feedback about (e.g., recruitment) success, limited time resources of and narrow communication between responsible study staff, along with a low rate of utilization and limited adherence of the study population. Main facilitators include standardized procedures and documentation along with easy-access digital tools. Researchers may use the findings to improve the development of new intervention studies, especially in a randomized setting.
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Affiliation(s)
- Kyung-Eun (Anna) Choi
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
- Health Services Research, MIAAI group, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstr. 124, 3500 Krems an der Donau, Austria
- Correspondence: ; Tel.: +49-(0)33638-83987
| | - Lara Lindert
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
| | - Lara Schlomann
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Medicine, University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany; (L.S.); (H.P.)
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Meijers K, van der Kwaak A, Aqel I, Borst R, Jenniskens F, Radyowijati A, Chakrabarty A, Nzeyimana E, Sawitri E, Tromp N. Using a Rapid Knowledge Translation Approach for Better Sexual and Reproductive Health and Rights in Bangladesh, Burundi, Indonesia, and Jordan. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00461. [PMID: 35487555 PMCID: PMC9053141 DOI: 10.9745/ghsp-d-21-00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022]
Abstract
There is a growing need for approaches to support rapid knowledge translation processes that can create changes in policy and practice and that can apply to different country contexts. The collaborative rapid improvement model for knowledge translation in sexual and reproductive health and rights (SRHR) implemented in 4 countries improved SRHR practice and policies. Introduction: Translation of knowledge into policy and practice is important to prevent sexual reproductive health and rights (SRHR)-related morbidity and mortality and ensure access to rights. Existing approaches to knowledge translation are often relatively rigid and implicitly assume linear processes, leading to time-consuming processes that are not tailored to countries' needs. Approach: SRHR knowledge platforms designed and implemented a collaborative rapid improvement model for knowledge translation (CRIM-KT) in Burundi, Bangladesh, Indonesia, and Jordan. The approach consisted of learning sessions and action periods aimed at improving policies and practices addressing the prevention of child marriage and teenage pregnancies. To evaluate the approach, a participatory action learning process took place throughout the implementation (September 2017 and January 2019). An end evaluation was conducted using a desk review of project documentation, in-depth interviews, and a focus group discussion to document the process, outcomes, and lessons learned. Achievements: In Indonesia, a local government policy was changed that aims to prevent child marriage by avoiding misinterpretation of a local cultural practice. In Jordan, the cabinet endorsed a national action plan to prevent child marriage and changes in practice took place. In Burundi, no tangible changes in policy and practice in SRHR were observed. In Bangladesh, practice changed by strengthening coordination for collaboration and exchange among stakeholders to prevent child marriage. In all countries, the approach considerably strengthened participants' knowledge translation capacities. Conclusion: The CRIM-KT led to improvements in policy and practice in a relatively short time frame and different contexts. This can be explained by the systematic, structured, and participatory approach, allowing for contextual adaptation and involvement of stakeholders, as well as the cross-learning on 2 levels (international and country collaboration teams). The principles of the CRIM-KT may be further developed and applied in other fields in global health to strengthen knowledge translation processes.
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Affiliation(s)
| | | | - Ibrahim Aqel
- Institute for Family Health, King Hussein Foundation, Amman, Jordan
| | - Robert Borst
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Françoise Jenniskens
- Independent senior sexual and reproductive health and rights expert, Wittem, Netherlands
| | | | | | | | | | - Noor Tromp
- KIT Royal Tropical Institute, Amsterdam, Netherlands
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Esdaile EK, Rissel C, Baur LA, Wen LM, Gillespie J. Intergovernmental policy opportunities for childhood obesity prevention in Australia: Perspectives from senior officials. PLoS One 2022; 17:e0267701. [PMID: 35482812 PMCID: PMC9049527 DOI: 10.1371/journal.pone.0267701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early childhood (from conception to five years) is a key life stage for interventions to prevent obesity. In the Australian Federation, policy responsibility for obesity prevention sits across all levels of government and several intergovernmental institutions, rendering a complicated policy space. There is a gap in our understanding of the role of intergovernmentalism in developing obesity prevention policy in Australia. Given the complexity of intergovernmental structures and initiatives influencing childhood obesity prevention policy, it is important to understand the perspectives of senior health officials within the bureaucracy of government who through their roles may be able to influence processes or new strategies. METHODS Document analysis relating to obesity prevention in the intergovernmental context provided material support to the study. This analysis informed the interview guides for nine interviews with ten senior health department officials (one interview per jurisdiction). FINDINGS Several opportunities exist to support nutrition and obesity prevention in early childhood including marketing regulation (discretionary choices, breastmilk substitutes, commercial complementary foods and 'toddler milks') and supporting the early childhood education and care sector. This study found a widening structural gap to support national obesity policy in Australia. New public management strategies limit the ability of intergovernmental institutions to support coordination within and between governments to address complex issues such as obesity. Subnational informants perceived a gap in national leadership for obesity prevention, while a Commonwealth informant noted the commitment of the national government to partner with industry under a self-regulation model. In this gap, subnational leaders have pursued nationally consistent action to address obesity, including the development of a national obesity strategy as a bipartisan endeavour across jurisdictions. Public officials calculate the strategic possibilities of pursuing opportunities within state agendas but note the limited chances of structural change in the absence of national leadership and funding.
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Affiliation(s)
- Emma K. Esdaile
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence for the Early Prevention of Obesity in Childhood, Canberra, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence for the Early Prevention of Obesity in Childhood, Canberra, Australia
| | - Louise A. Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence for the Early Prevention of Obesity in Childhood, Canberra, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence for the Early Prevention of Obesity in Childhood, Canberra, Australia
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - James Gillespie
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
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Schwarzman J, Bauman A, Gabbe BJ, Rissel C, Shilton T, Smith BJ. How practitioner, organisational and system-level factors act to influence health promotion evaluation capacity: Validation of a conceptual framework. EVALUATION AND PROGRAM PLANNING 2022; 91:102019. [PMID: 34756707 DOI: 10.1016/j.evalprogplan.2021.102019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 06/13/2023]
Abstract
The need to improve the practice and quality of evaluation in the health promotion and disease prevention field is widely recognised. In order to plan, implement and evaluate health promotion evaluation capacity building efforts, there is a need to better understand the practitioner, organisational and system-level determinants of evaluation capacity and practice. This study aimed to assess the validity Evaluation Practice Analysis Survey (EPAS) constructs using confirmatory factor analysis and validate a conceptual framework of health promotion evaluation capacity using path analysis. Experienced Australian health promotion practitioners completed the survey (n = 219). Twenty-one of the original 23 EPAS scales were assessed as reliable and valid. The final model was found to have good fit (χ214 = 18.72, p = 0.18, root mean square error of approximation = 0.04, 90% CI 0.00-0.82, Comparative Fit Index = 1.00, standardised root mean square residual = 0.04). This model supports the role of the organisation in facilitating evaluation practice through leadership, culture, systems, support and resources. It builds on existing frameworks from other fields to incorporate political, funding and administrative factors. This study provides an evidence-based model of evaluation capacity that organisations, funders and policy makers can use to plan and implement more effective evaluation capacity building strategies within organisations and the wider prevention field.
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Affiliation(s)
- Joanna Schwarzman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
| | - Adrian Bauman
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea SA2 8PP, Wales, UK
| | - Chris Rissel
- Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Trevor Shilton
- School of Public Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; National Heart Foundation of Australia, 334 Rokeby Road, Subiaco, WA 6008, Australia
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
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Vickery J, Atkinson P, Lin L, Rubin O, Upshur R, Yeoh EK, Boyer C, Errett NA. Challenges to evidence-informed decision-making in the context of pandemics: qualitative study of COVID-19 policy advisor perspectives. BMJ Glob Health 2022; 7:e008268. [PMID: 35450862 PMCID: PMC9023846 DOI: 10.1136/bmjgh-2021-008268] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/04/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The exceptional production of research evidence during the COVID-19 pandemic required deployment of scientists to act in advisory roles to aid policy-makers in making evidence-informed decisions. The unprecedented breadth, scale and duration of the pandemic provides an opportunity to understand how science advisors experience and mitigate challenges associated with insufficient, evolving and/or conflicting evidence to inform public health decision-making. OBJECTIVES To explore critically the challenges for advising evidence-informed decision-making (EIDM) in pandemic contexts, particularly around non-pharmaceutical control measures, from the perspective of experts advising policy-makers during COVID-19 globally. METHODS We conducted in-depth qualitative interviews with 27 scientific experts and advisors who are/were engaged in COVID-19 EIDM representing four WHO regions and 11 countries (Australia, Canada, Colombia, Denmark, Ghana, Hong Kong, Nigeria, Sweden, Uganda, UK, USA) from December 2020 to May 2021. Participants informed decision-making at various and multiple levels of governance, including local/city (n=3), state/provincial (n=8), federal or national (n=20), regional or international (n=3) and university-level advising (n=3). Following each interview, we conducted member checks with participants and thematically analysed interview data using NVivo for Mac software. RESULTS Findings from this study indicate multiple overarching challenges to pandemic EIDM specific to interpretation and translation of evidence, including the speed and influx of new, evolving, and conflicting evidence; concerns about scientific integrity and misinterpretation of evidence; the limited capacity to assess and produce evidence, and adapting evidence from other contexts; multiple forms of evidence and perspectives needed for EIDM; the need to make decisions quickly and under conditions of uncertainty; and a lack of transparency in how decisions are made and applied. CONCLUSIONS Findings suggest the urgent need for global EIDM guidance that countries can adapt for in-country decisions as well as coordinated global response to future pandemics.
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Affiliation(s)
- Jamie Vickery
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Paul Atkinson
- Department of Public Health Policy and Systems/Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Olivier Rubin
- Department of Social Sciences and Business, Roskilde University, Roskilde, Denmark
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, China
| | - Chris Boyer
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Nicole A Errett
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
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Kuchenmüller T, Boeira L, Oliver S, Moat K, El-Jardali F, Barreto J, Lavis J. Domains and processes for institutionalizing evidence-informed health policy-making: a critical interpretive synthesis. Health Res Policy Syst 2022; 20:27. [PMID: 35246139 PMCID: PMC8894559 DOI: 10.1186/s12961-022-00820-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND While calls for institutionalization of evidence-informed policy-making (EIP) have become stronger in recent years, there is a paucity of methods that governments and organizational knowledge brokers can use to sustain and integrate EIP as part of mainstream health policy-making. The objective of this paper was to conduct a knowledge synthesis of the published and grey literatures to develop a theoretical framework with the key features of EIP institutionalization. METHODS We applied a critical interpretive synthesis (CIS) that allowed for a systematic, yet iterative and dynamic analysis of heterogeneous bodies of literature to develop an explanatory framework for EIP institutionalization. We used a "compass" question to create a detailed search strategy and conducted electronic searches to identify papers based on their potential relevance to EIP institutionalization. Papers were screened and extracted independently and in duplicate. A constant comparative method was applied to develop a framework on EIP institutionalization. The CIS was triangulated with the findings of stakeholder dialogues that involved civil servants, policy-makers and researchers. RESULTS We identified 3001 references, of which 88 papers met our eligibility criteria. This CIS resulted in a definition of EIP institutionalization as the "process and outcome of (re-)creating, maintaining and reinforcing norms, regulations, and standard practices that, based on collective meaning and values, actions as well as endowment of resources, allow evidence to become-over time-a legitimate and taken-for-granted part of health policy-making". The resulting theoretical framework comprised six key domains of EIP institutionalization that capture both structure and agency: (1) governance; (2) standards and routinized processes; (3) partnership, collective action and support; (4) leadership and commitment; (5) resources; and (6) culture. Furthermore, EIP institutionalization is being achieved through five overlapping stages: (i) precipitating events; (ii) de-institutionalization; (iii) semi-institutionalization (comprising theorization and diffusion); (iv) (re)-institutionalization; and (v) renewed de-institutionalization processes. CONCLUSIONS This CIS advances the theoretical and conceptual discussions on EIP institutionalization, and provides new insights into an evidence-informed framework for initiating, strengthening and/or assessing efforts to institutionalize EIP.
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Affiliation(s)
- Tanja Kuchenmüller
- Research for Health, Science Division, World Health Organization, Geneva, Switzerland
| | | | - Sandy Oliver
- Social Research Institute, University College London, London, United Kingdom
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Kaelan Moat
- McMaster Health Forum/WHO Collaborating Centre for Evidence-Informed Policy, McMaster University, Hamilton, ON Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Fadi El-Jardali
- Knowledge to Policy (K2P) Center/WHO Collaborating Centre for Evidence-Informed Policy and Practice, American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | | | - John Lavis
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- McMaster Health Forum/WHO Collaborating Centre for Evidence-Informed Policy, McMaster University, Hamilton, ON Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON Canada
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Weldon I, Parkhurst J. Governing evidence use in the nutrition policy process: evidence and lessons from the 2020 Canada food guide. Nutr Rev 2022; 80:467-478. [PMID: 35043195 PMCID: PMC8829674 DOI: 10.1093/nutrit/nuab105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Nutrition guideline development is traditionally seen as a mechanism by which evidence is used to inform policy decisions. However, applying evidence in policy is a decidedly complex and politically embedded process, with no single universally agreed-upon body of evidence on which to base decisions, and multiple social concerns to address. Rather than simply calling for “evidence-based policy,” an alternative is to look at the governing features of the evidence use system and reflect on what constitutes improved evidence use from a range of explicitly identified normative concerns. This study evaluated the use of evidence within the Canada Food Guide policy process by applying concepts of the “good governance of evidence” – an approach that incorporates multiple normative principles of scientific and democratic best practice to consider the structure and functioning of evidence advisory systems. The findings indicated that institutionalizing a process for evidence use grounded in democratic and scientific principles can improve evidence use in nutrition policy making.
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Affiliation(s)
- Isaac Weldon
- I. Weldon is with the Department of Politics and with the Global Strategy Lab, Dahdaleh Institute for Global Health Research, School of Global Health and Osgoode Hall Law School, York University, Toronto, Canada. J. Parkhurst is with the Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Justin Parkhurst
- I. Weldon is with the Department of Politics and with the Global Strategy Lab, Dahdaleh Institute for Global Health Research, School of Global Health and Osgoode Hall Law School, York University, Toronto, Canada. J. Parkhurst is with the Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Uneke C, Sombie I, Johnson E, Uneke B, Okolo S. Promoting the use of evidence in health policy-making in the economic commission of the West African States Region: Exploring the perception of policy-makers on the necessity of an evidence-based policy-making guidance. Ann Afr Med 2022; 21:223-230. [DOI: 10.4103/aam.aam_90_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Doshmangir L, Yazdizadeh B, Sajadi HS, Mohtasham F, Majdzadeh R. What is going on in the future for evidence-informed health policymaking in Iran? J Evid Based Med 2021; 14:285-290. [PMID: 34904390 DOI: 10.1111/jebm.12458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/08/2021] [Accepted: 09/22/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management & Medical Informatics, and Social Determinants of Health Services Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bahareh Yazdizadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research & Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community-Based Participatory Research Center, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Mohammadpour M, Zarifinezhad E, Ghanbarzadegan A, Naderimanesh K, Shaarbafchizadeh N, Bastani P. Main Factors Affecting the Readiness and Responsiveness of Healthcare Systems during Epidemic Crises: A Scoping Review on Cases of SARS, MERS, and COVID-19. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:81-92. [PMID: 33753952 PMCID: PMC7966936 DOI: 10.30476/ijms.2020.87608.1801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Given the significance of the preparedness and responsiveness of healthcare systems in relation to epidemics, this study aimed to determine their influencing factors during epidemic crises with a view to utilizing the findings in the battle against the coronavirus disease 2019 (COVID-19) outbreak. Methods: This scoping study was conducted in 2020 via the Arksey and O’Malley approach. A systematic search was conducted on five online databases from January 2000 to June 15, 2020. Initially, 1926 English articles were retrieved based on their abstracts. After the screening process, 60 articles were considered for the final analysis. Data were charted by applying Microsoft Office Excel 2013 and were synthesized via thematic analysis. Results: Five main factors have affected the responsiveness and preparedness of countries during the epidemics of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19: community-related interventions, managerial interventions, socioeconomic factors, the readiness of hospitals and health centers, and environmental factors. These themes are associated with 38 related sub-themes. The thematic framework shows that interactions between these five determinantes can affect the preparedness and responsiveness of healthcare systems during pandemics/epidemics. Conclusion: According to the results, healthcare systems need to pay attention to their internal capacities, managerial interventions, and health centers to overcome the current pandemic. They should also consider such external factors as socioeconomic and environmental determinants that can affect their potential preparedness against pandemic/epidemic crises. Community-related interventions such as improvement of the community health literacy, teamwork, and social responsibility can enhance the readiness of healthcare systems against the COVID-19 outbreak.
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Affiliation(s)
- Mohammadtaghi Mohammadpour
- Department of Health Care Management and Health Economics, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Effat Zarifinezhad
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Ghanbarzadegan
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Khodadad Naderimanesh
- Social Determinant of Health Research Centre, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Nasrin Shaarbafchizadeh
- Health Management and Economics Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peivand Bastani
- Health Human Resources Research Centre, School of Health Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
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Shen X, Li CJ, Dong T, Cao H, Feng J, Lei Z, Wang Z, Han X, Lv C, Gan Y. Public Opinion and Expectations: Development of Public Health Education in China After COVID-19 Pandemic. Front Public Health 2021; 9:702146. [PMID: 34447736 PMCID: PMC8383066 DOI: 10.3389/fpubh.2021.702146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Policymakers must promote the development of public health education and human resources. As a feature of the political environment, public opinion is essential for policy-making, but virtually the attitudes of Chinese citizens toward human resources development in public health is unknown. Methods: This study conducted a crosssectional survey from February 4, 2021 to February 26, 2021 in China. We adopted a convenient sampling strategy to recruit participators. Participants filled out the questions, which assess the attitudes of the expanding public health professionals. A logistic regression analysis was given to identify the predictors associated with the attitudes of the subjects. Results: There were 2,361 residents who have finished our questionnaire. Chinese residents who lived in urban (OR = 1.293, 95% CI = 1.051-1.591), "themselves or relatives and friends have participated in relevant epidemic prevention work" (OR = 1.553, 95% CI = 1.160-2.079), "themselves or family members engaged in medical-related work" (OR = 1.468, 95% CI = 1.048-2.056), and those who "were aware of public health before the outbreak of COVID-19" (OR = 1.428, 95% CI = 1.125-1.812) were more likely to support the promotion of public health education and training. Conclusions: The present study found that 74.50% of Chinese citizens supported the promotion of public health education and training in China, in which economic status, personal perception, and comprehension are the crucial factors that influence public opinion. COVID-19 has aroused the attention of Chinese residents to public health education, with only 22.11% of residents being aware of public health before the outbreak of COVID-19. The COVID-19 pandemic has profound implications for human society. Literally, this impact will feed back into future public health policies based on public opinion. This innovative perspective will also help us better understand the potential social impact of COVID-19 on human resources and development for health in the modern world.
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Affiliation(s)
- Xin Shen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Crystal Jingru Li
- Department of Psychology, School of Education and Human Development, Hong Kong Education University, Hong Kong, China
| | - Tianyi Dong
- Department of Labor and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Cao
- Department of Labor Economics and Management, Beijing Vocational College of Labour and Social Security, Beijing, China
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zihui Lei
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zijian Wang
- School of Arts and Communication, Guangxi University of Science and Technology, Liuzhou, China
| | - Xiaotong Han
- Department of Emergency Medicine, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabolomics, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China
| | - Chuanzhu Lv
- Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Whyle EB, Olivier J. Towards an Explanation of the Social Value of Health Systems: An Interpretive Synthesis. Int J Health Policy Manag 2021; 10:414-429. [PMID: 32861236 PMCID: PMC9056134 DOI: 10.34172/ijhpm.2020.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/15/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Health systems are complex social systems, and values constitute a central dimension of their complexity. Values are commonly understood as key drivers of health system change, operating across all health systems components and functions. Moreover, health systems are understood to influence and generate social values, presenting an opportunity to harness health systems to build stronger, more cohesive societies. However, there is little investigation (theoretical, conceptual, or empirical) on social values in health policy and systems research (HPSR), particularly regarding the capacity of health systems to influence and generate social values. This study develops an explanatory theory for the 'social value of health systems.' METHODS We present the results of an interpretive synthesis of HPSR literature on social values, drawing on a qualitative systematic review, focusing on claims about the relationship between 'health systems' and 'social values.' We combined relational claims extracted from the literature under a common framework in order to generate new explanatory theory. RESULTS We identify four mechanisms by which health systems are considered to contribute social value to society: Health systems can: (1) offer a unifying national ideal and build social cohesion, (2) influence and legitimise popular attitudes about rights and entitlements with regard to healthcare and inform citizen's understanding of state responsibilities, (3) strengthen trust in the state and legitimise state authority, and (4) communicate the extent to which the state values various population groups. CONCLUSION We conclude that, using a systems-thinking and complex adaptive systems perspective, the above mechanisms can be explained as emergent properties of the dynamic network of values-based connections operating within health systems. We also demonstrate that this theory accounts for how HPSR authors write about the relationship between health systems and social values. Finally, we offer lessons for researchers and policy-makers seeking to bring about values-based change in health systems.
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Affiliation(s)
- Eleanor Beth Whyle
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ilin C, Annan-Phan S, Tai XH, Mehra S, Hsiang S, Blumenstock JE. Public mobility data enables COVID-19 forecasting and management at local and global scales. Sci Rep 2021; 11:13531. [PMID: 34188119 PMCID: PMC8241991 DOI: 10.1038/s41598-021-92892-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/17/2021] [Indexed: 01/07/2023] Open
Abstract
Policymakers everywhere are working to determine the set of restrictions that will effectively contain the spread of COVID-19 without excessively stifling economic activity. We show that publicly available data on human mobility-collected by Google, Facebook, and other providers-can be used to evaluate the effectiveness of non-pharmaceutical interventions (NPIs) and forecast the spread of COVID-19. This approach uses simple and transparent statistical models to estimate the effect of NPIs on mobility, and basic machine learning methods to generate 10-day forecasts of COVID-19 cases. An advantage of the approach is that it involves minimal assumptions about disease dynamics, and requires only publicly-available data. We evaluate this approach using local and regional data from China, France, Italy, South Korea, and the United States, as well as national data from 80 countries around the world. We find that NPIs are associated with significant reductions in human mobility, and that changes in mobility can be used to forecast COVID-19 infections.
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Affiliation(s)
| | - Sébastien Annan-Phan
- Goldman School of Public Policy, U.C. Berkeley, Berkeley, USA
- Agricultural and Resource Economics, U.C. Berkeley, Berkeley, USA
| | - Xiao Hui Tai
- School of Information, U.C. Berkeley, Berkeley, USA
| | | | - Solomon Hsiang
- Goldman School of Public Policy, U.C. Berkeley, Berkeley, USA.
- National Bureau of Economic Research and Centre for Economic Policy Research, Cambridge, USA.
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Cyr PR, Jain V, Chalkidou K, Ottersen T, Gopinathan U. Evaluations of public health interventions produced by health technology assessment agencies: A mapping review and analysis by type and evidence content. Health Policy 2021; 125:1054-1064. [PMID: 34112508 DOI: 10.1016/j.healthpol.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/30/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Health technology assessments (HTAs) have been suggested as a strategy to bridge the evidence-to-policy gap in public health. It is unclear to what extent HTAs have been prepared to assist decisions to implement public health interventions (PHIs). We aimed to describe the experience of HTA agencies by mapping, classifying, and analyzing the evidence content of HTAs of PHIs. METHODS We systematically searched databases of 35 HTA agencies from 18 countries for evaluations of PHIs between 2008-2018. Interventions were classified using the International Classification of Health Interventions and the evidence content analysed with the INAHTA Product-Type-mark checklist. RESULTS Only 1010 (9%) of HTAs were on PHIs. 500 (50%) publications targeted Body Systems and Functions, 302 (30%) Health-related Behaviours, 137 (14%) the Environment and 44 (4%) Activities and Participation Domains. Out of 734 publications perused, few met the criteria of full-HTAs (71;10%) or mini-HTAs (110;15%). Most were rapid reviews (420;57%). 72% of all reports came from only 6 countries. CONCLUSION HTAs on PHIs were uncommon relative to clinical interventions. HTAs on population-based PHIs were less comprehensive in quality and rigor of the evidence. Countries with more resources and mature HTA-systems had done the most evaluations. Exploring the experiences of forerunners could help overcome barriers to evaluations of PHIs and exploit the full potential of HTAs to promote evidence-based public health.
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Affiliation(s)
- Pascale Renée Cyr
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway.
| | - Vageesh Jain
- Public Health England, London, United Kingdom; Institute for Global Health, University College London (UCL), London, United Kingdom
| | - Kalipso Chalkidou
- Department of Infectious Disease Epidemiology School of Public Health, Imperial College London, London, United Kingdom; Center for Global Development, London, United Kingdom
| | - Trygve Ottersen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway; Division for Health Services, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
| | - Unni Gopinathan
- Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
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Yazdizadeh B, Sajadi HS, Mohtasham F, Mohseni M, Majdzadeh R. Systematic review and policy dialogue to determine challenges in evidence-informed health policy-making: findings of the SASHA study. Health Res Policy Syst 2021; 19:73. [PMID: 33947402 PMCID: PMC8097912 DOI: 10.1186/s12961-021-00717-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 04/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Various interventions have been undertaken in Iran to promote evidence-informed health policy-making (EIHP). Identifying the challenges in EIHP is the first step toward strengthening EIHP in each country through the design of tailored interventions. Therefore, the current study was conducted to synthesize the results of earlier studies and to finalize the list of barriers to EIHP in Iran. Methods To identify the barriers to EIHP in Iran, two steps were taken: a systematic review and policy dialogue. To conduct the systematic review, three Iranian databases and PubMed, Health Systems Evidence (HSE), Embase, and Scopus were searched. The reference lists of included papers and documentation from some local organizations were hand-searched. Upon conducting the systematic review, given the significance of stakeholders in clarifying the problem of EIHP, policy dialogue was used to complete the list previously extracted and to do advocacy. Selection criteria for the stakeholders included influential and informed individuals from knowledge-producing, knowledge-utilizing, and knowledge-brokering organizations. Semi-structured interviews were held with three important absent stakeholders. Results Challenges specific to Iran that were identified included the lack of integration of the health ministry and the medical universities, lack of ties between health knowledge utilization organizations, failure to establish long-term research plans, neglect of national research needs at the time of recruiting human resources in knowledge-producing organizations, and duplication and lack of coordination in routine data obtained from surveillance systems, disease registration systems, and censuses. It seems that some challenges are common across countries, including neglecting the importance of inter- and intra-disciplinary studies, the capacity of policy-makers and managers to utilize evidence, the criteria for evaluating the performance of policy-makers, managers, and academic members, the absence of long-term programmes in knowledge-utilizing organizations, the rapid replacement of policy-makers and managers, and lack of use of evaluation studies. Conclusions In this study, we tried to identify the challenges regarding EIHP in Iran using a systematic review and policy dialogue approach. This is the first step toward determining the best interventions to improve evidence-informed policy-making in each country, because these challenges are contextual and need to be investigated contextually. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00717-x.
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Affiliation(s)
- Bahareh Yazdizadeh
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Mohtasham
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Mohseni
- Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Community Based Participatory Research Center, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Fisayo T. Science in action? A critical view of UK blood donation deferral policy and men who have sex with men. Int J Health Plann Manage 2021; 36:1207-1222. [PMID: 33834528 DOI: 10.1002/hpm.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/30/2021] [Accepted: 03/21/2021] [Indexed: 11/06/2022] Open
Abstract
The rules that govern blood donation vary globally. Some potential blood donors are ineligible for immediate blood donation, and as such are deferred until such time that they become eligible. This practice, the blood donation deferral period, is intended to reduce the risk of blood-borne infections being transfused into a blood product-recipient. As blood screening technologies improve, the risk of an infected blood product remaining undetected decreases-and so too have the deferral periods for certain donors. Much has been made of the importance of an evidence-based, scientific approach to protecting blood product-recipients. However, these deferrals are controversial. What exactly determines the blood donation deferral period? This article argues that blood donation deferral periods are not merely the result of enacting empirical data. Instead, the deferral periods represent a negotiation between scientific evidence, experts, politically expedient narratives, institutionalised risk aversion, as well as more mundane concerns such as operational feasibility. As a case study, I examine how the UK Advisory Committee on the Safety of Blood, Tissues and Organs changed the 12-month deferral period for blood donation from men who have sex with men to a 3-month deferral period.
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Affiliation(s)
- Temitope Fisayo
- King's College London School of Medicine, Guy's Campus, London, UK
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43
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Rubin O, Errett NA, Upshur R, Baekkeskov E. The challenges facing evidence-based decision making in the initial response to COVID-19. Scand J Public Health 2021; 49:790-796. [PMID: 33685289 DOI: 10.1177/1403494821997227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Olivier Rubin
- Department of Social Sciences and Businesses, Roskilde University, Denmark
| | - Nicole A Errett
- Department of Environmental and Occupational Health Sciences, University of Washington, USA
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Erik Baekkeskov
- School of Social and Political Sciences, University of Melbourne, Australia
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Gilson L, Barasa E, Brady L, Kagwanja N, Nxumalo N, Nzinga J, Molyneux S, Tsofa B. Collective sensemaking for action: researchers and decision makers working collaboratively to strengthen health systems. BMJ 2021; 372:m4650. [PMID: 33593963 PMCID: PMC7879277 DOI: 10.1136/bmj.m4650] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Lucy Gilson and colleagues draw on experiences from Kenya and South Africa to consider the practice, benefits, and challenges of research co-production for strengthening health systems
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Affiliation(s)
- Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - Leanne Brady
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Emergency Medical Services, Department of Health, Western Cape Government, South Africa
| | - Nancy Kagwanja
- Health Systems Research Group, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Nonhlanhla Nxumalo
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
- Health Systems Research Group, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Benjamin Tsofa
- Health Systems Research Group, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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Pivodic L, Smets T, Gott M, Sleeman KE, Arrue B, Cardenas Turanzas M, Pechova K, Kodba Čeh H, Lo TJ, Nakanishi M, Rhee Y, Ten Koppel M, Wilson DM, Van den Block L. Inclusion of palliative care in health care policy for older people: A directed documentary analysis in 13 of the most rapidly ageing countries worldwide. Palliat Med 2021; 35:369-388. [PMID: 33295232 DOI: 10.1177/0269216320972036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care is insufficiently integrated in the continuum of care for older people. It is unclear to what extent healthcare policy for older people includes elements of palliative care and thus supports its integration. AIM (1) To develop a reference framework for identifying palliative care contents in policy documents; (2) to determine inclusion of palliative care in public policy documents on healthcare for older people in 13 rapidly ageing countries. DESIGN Directed documentary analysis of public policy documents (legislation, policies/strategies, guidelines, white papers) on healthcare for older people. Using existing literature, we developed a reference framework and data extraction form assessing 10 criteria of palliative care inclusion. Country experts identified documents and extracted data. SETTING Austria, Belgium, Canada, Czech Republic, England, Japan, Mexico, Netherlands, New Zealand, Singapore, Slovenia, South Korea, Spain. RESULTS Of 139 identified documents, 50 met inclusion criteria. The most frequently addressed palliative care elements were coordination and continuity of care (12 countries), communication and care planning, care for family, and ethical and legal aspects (11 countries). Documents in 10 countries explicitly mentioned palliative care, nine addressed symptom management, eight mentioned end-of-life care, and five referred to existing palliative care strategies (out of nine that had them). CONCLUSIONS Health care policies for older people need revising to include reference to end-of-life care and dying and ensure linkage to existing national or regional palliative care strategies. The strong policy focus on care coordination and continuity in policies for older people is an opportunity window for palliative care advocacy.
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Affiliation(s)
- Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Merryn Gott
- Te Arai Palliative Care and End of Life Research Group, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | | | - Karolina Pechova
- Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Hana Kodba Čeh
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Tong Jen Lo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Miharu Nakanishi
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - YongJoo Rhee
- Department of Health Sciences, College of Natural Science, Dongduk Women's University, Seoul, Republic of Korea
| | - Maud Ten Koppel
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
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Uneke CJ, Sombie I, Johnson E, Uneke BI. Lessons Learned from Strategies for Promotion of Evidence-to-Policy Process in Health Interventions in the ECOWAS Region: A Rapid Review. Niger Med J 2021; 61:227-236. [PMID: 33487844 PMCID: PMC7808283 DOI: 10.4103/nmj.nmj_188_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/04/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Context: The West African Health Organization (WAHO) is vigorously supporting evidence-informed policymaking (EIPM) in the countries of West Africa. EIPM is increasingly recognized as one of the key strategies that can contribute to health systems strengthening and the improvement of health outcomes. The purpose of this rapid review is to examine two key examples of evidence-based strategies used to successfully implement health interventions in each of the West African countries and to highlight the lessons learned. Methods: A rapid review technique, defined as a type of knowledge synthesis in which systematic review processes are accelerated and methods are streamlined to complete the review more quickly, was used. A PubMed search was conducted using the combination of the following keywords: Health, policy making, evidence, plus name of each of the 15 countries to identify studies that described the process of use of evidence in policymaking in health interventions. Two examples of the publications that fulfilled the study inclusion criteria were selected. Results: Among the key processes used by the countries to promote EIPM in health interventions include policy cycle mechanism and political prioritization, rapid response services, technical advisory group and steering committees (SCs), policy dialog, capacity-strengthening mechanisms, local context evidence and operational guidelines, multisectoral action and consultative process. Conclusion: Various degrees of success have been achieved in by West African countries in the promotion of EIPM. As the science of EIPM continues to evolve and better understanding of the process is gained among policymakers, more studies on effective strategies to improve the evidence-to-policy process are advocated.
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Affiliation(s)
- Chigozie Jesse Uneke
- Department of Health Policy/Systems, African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, Nigeria
| | - Issiaka Sombie
- Department of Public Health and Research, West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01 01 BP 153, Burkina Faso
| | - Ermel Johnson
- Department of Public Health and Research, West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01 01 BP 153, Burkina Faso
| | - Bilikis Iyabo Uneke
- Department of Health Policy/Systems, African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, Nigeria
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Purtle J. Public opinion about evidence-informed health policy development in U.S. Congress. Transl Behav Med 2020; 10:1549-1553. [PMID: 31209499 DOI: 10.1093/tbm/ibz083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Promoting evidence-informed health policymaking is a priority of the Society of Behavioral Medicine and other professional societies. However, politics often impede the translation of research into policy. Public opinion is an important feature of political context that influences policymakers' behaviors, but prior research has not examined public opinion about evidence-informed health policy development. This exploratory study sought to characterize public opinion about the influence that evidence should, and does, have on health policy development in U.S. Congress relative to other factors and examine differences by political party affiliation. A public opinion survey was conducted in 2018 using the SSRS Probability Panel (N = 532). Respondents separately rated the extent to which six factors (e.g., evidence, budget impact, industry interests) "should have" and "currently have" influence on U.S. congresspersons' health policy decisions. Evidence (59%) was the most frequently identified factor that should have "a lot of influence" on health policy development, but only 11% of respondents thought that evidence currently has "a lot of influence" (p < .001). Opinions about evidence did not vary significantly by political party. The interests of insurance and pharmaceutical companies were identified as factors that should have the least influence on policy development, but were perceived as having the most influence (p < .001). There is strong bipartisan public support for evidence to have much more influence on health policy development in U.S. Congress. Efforts that aim to improve evidence-informed health policymaking should consider harnessing the power of public opinion to change elected policymakers' behaviors.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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48
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Stratil JM, Voss M, Arnold L. WICID framework version 1.0: criteria and considerations to guide evidence-informed decision-making on non-pharmacological interventions targeting COVID-19. BMJ Glob Health 2020; 5:bmjgh-2020-003699. [PMID: 33234529 PMCID: PMC7688443 DOI: 10.1136/bmjgh-2020-003699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Public health decision-making requires the balancing of numerous, often conflicting factors. However, participatory, evidence-informed decision-making processes to identify and weigh these factors are often not possible- especially, in the context of the SARS-CoV-2 pandemic. While evidence-to-decision frameworks are not able or intended to replace stakeholder participation, they can serve as a tool to approach relevancy and comprehensiveness of the criteria considered. Objective To develop a decision-making framework adapted to the challenges of decision-making on non-pharmacological interventions to contain the global SARS-CoV-2 pandemic. Methods We employed the ‘best fit’ framework synthesis technique and used the WHO-INTEGRATE framework as a starting point. First, we adapted the framework through brainstorming exercises and application to case studies. Next, we conducted a content analysis of comprehensive strategy documents intended to guide policymakers on the phasing out of applied lockdown measures in Germany. Based on factors and criteria identified in this process, we developed the WICID (WHO-INTEGRATE COVID-19) framework version 1.0. Results Twelve comprehensive strategy documents were analysed. The revised framework consists of 11+1 criteria, supported by 48 aspects, and embraces a complex systems perspective. The criteria cover implications for the health of individuals and populations due to and beyond COVID-19, infringement on liberties and fundamental human rights, acceptability and equity considerations, societal, environmental and economic implications, as well as implementation, resource and feasibility considerations. Discussion The proposed framework will be expanded through a comprehensive document analysis focusing on key stakeholder groups across the society. The WICID framework can be a tool to support comprehensive evidence-informed decision-making processes.
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Affiliation(s)
- Jan M Stratil
- Institute for Medical Informatics, Biometry and Epidemiology - IBE and Pettenkofer School of Public Health, LMU Munich, Munich, Bavaria, Germany
| | - Maike Voss
- Global Issues Division, German Institute for International and Security Affairs, Berlin, Germany
| | - Laura Arnold
- Epidemiology and Health Reporting, Academy of Public Health Services, Duesseldorf, North Rhine-Westphalia, Germany
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Haynes A, Rychetnik L, Finegood D, Irving M, Freebairn L, Hawe P. Applying systems thinking to knowledge mobilisation in public health. Health Res Policy Syst 2020; 18:134. [PMID: 33203438 PMCID: PMC7670767 DOI: 10.1186/s12961-020-00600-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Knowledge mobilisation (KM) is a vital strategy in efforts to improve public health policy and practice. Linear models describing knowledge transfer and translation have moved towards multi-directional and complexity-attuned approaches where knowledge is produced and becomes meaningful through social processes. There are calls for systems approaches to KM but little guidance on how this can be operationalised. This paper describes the contribution that systems thinking can make to KM and provides guidance about how to put it into action. METHODS We apply a model of systems thinking (which focuses on leveraging change in complex systems) to eight KM practices empirically identified by others. We describe how these models interact and draw out some key learnings for applying systems thinking practically to KM in public health policy and practice. Examples of empirical studies, tools and targeted strategies are provided. FINDINGS Systems thinking can enhance and fundamentally transform KM. It upholds a pluralistic view of knowledge as informed by multiple parts of the system and reconstituted through use. Mobilisation is conceived as a situated, non-prescriptive and potentially destabilising practice, no longer conceptualised as a discrete piece of work within wider efforts to strengthen public health but as integral to and in continual dialogue with those efforts. A systems approach to KM relies on contextual understanding, collaborative practices, addressing power imbalances and adaptive learning that responds to changing interactions between mobilisation activities and context. CONCLUSION Systems thinking offers valuable perspectives, tools and strategies to better understand complex problems in their settings and for strengthening KM practice. We make four suggestions for further developing empirical evidence and debate about how systems thinking can enhance our capacity to mobilise knowledge for solving complex problems - (1) be specific about what is meant by 'systems thinking', (2) describe counterfactual KM scenarios so the added value of systems thinking is clearer, (3) widen conceptualisations of impact when evaluating KM, and (4) use methods that can track how and where knowledge is mobilised in complex systems.
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Affiliation(s)
- Abby Haynes
- The Australian Prevention Partnership Centre, Sydney, Australia.
- University of Sydney, Menzies Centre for Health Policy, Sydney, Australia.
- University of Sydney, School of Public Health, Institute for Musculoskeletal Health, PO Box M179, Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sydney, Australia
- University of Sydney, School of Public Health, Sydney, Australia
- University of Notre Dame Australia, School of Medicine, Sydney, Australia
| | - Diane Finegood
- Morris J. Wosk Centre for Dialogue and Department of Biomedical Physiology & Kinesiology, Simon Fraser University, Vancouver, Canada
| | - Michelle Irving
- The Australian Prevention Partnership Centre, Sydney, Australia
- University of Sydney, Menzies Centre for Health Policy, Sydney, Australia
| | - Louise Freebairn
- The Australian Prevention Partnership Centre, Sydney, Australia
- ACT Health Directorate, ACT Government, Canberra, Australia
| | - Penelope Hawe
- The Australian Prevention Partnership Centre, Sydney, Australia
- University of Sydney, Menzies Centre for Health Policy, Sydney, Australia
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada
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50
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Partridge ACR, Mansilla C, Randhawa H, Lavis JN, El-Jardali F, Sewankambo NK. Lessons learned from descriptions and evaluations of knowledge translation platforms supporting evidence-informed policy-making in low- and middle-income countries: a systematic review. Health Res Policy Syst 2020; 18:127. [PMID: 33129335 PMCID: PMC7603785 DOI: 10.1186/s12961-020-00626-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) platforms are organisations, initiatives and networks that focus on supporting evidence-informed policy-making at least in part about the health-system arrangements that determine whether the right programmes, services and products get to those who need them. Many descriptions and evaluations of KT platforms in low- and middle-income countries have been produced but, to date, they have not been systematically reviewed. METHODS We identified potentially relevant studies through a search of five electronic databases and a variety of approaches to identify grey literature. We used four criteria to select eligible empirical studies. We extracted data about seven characteristics of included studies and about key findings. We used explicit criteria to assess study quality. In synthesising the findings, we gave greater attention to themes that emerged from multiple studies, higher-quality studies and different contexts. RESULTS Country was the most common jurisdictional focus of KT platforms, EVIPNet the most common name and high turnover among staff a common infrastructural feature. Evidence briefs and deliberative dialogues were the activities/outputs that were the most extensively studied and viewed as helpful, while rapid evidence services were the next most studied but only in a single jurisdiction. None of the summative evaluations used a pre-post design or a control group and, with the exception of the evaluations of the influence of briefs and dialogues on intentions to act, none of the evaluations achieved a high quality score. CONCLUSIONS A large and growing volume of research evidence suggests that KT platforms offer promise in supporting evidence-informed policy-making in low- and middle-income countries. KT platforms should consider as next steps expanding their current, relatively limited portfolio of activities and outputs, building bridges to complementary groups, and planning for evaluations that examine 'what works' for 'what types of issues' in 'what types of contexts'.
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Affiliation(s)
- Arun C R Partridge
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Cristián Mansilla
- McMaster Health Forum and Health Policy PhD Program, McMaster University, Hamilton, Canada
| | - Harkanwal Randhawa
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - John N Lavis
- McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Fadi El-Jardali
- Knowledge to Policy Center and Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Nelson K Sewankambo
- Clinical Epidemiology and Biostatistics Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
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