Stakeholders’ experiences of the public health research process: time to change the system?Health Research Policy and Systems - Tập 18 Số 1 - 2020
Yvonne Laird, Jillian Manner, Louise Baldwin, Ruth F. Hunter, John McAteer, Sarah Rodgers, Chloë Williamson, Ruth Jepson
Abstract
Background
The importance of engaging stakeholders in the research process is well recognised. Whilst engagement is important, guidelines and practices vary for how stakeholders should be involved in research and how to facilitate effective collaborative relationships.
Methods
This study aimed to explore the perspectives and experiences of stakeholders involved in the policy and practice area of outdoor space and non-communicable disease prevention. Stakeholders interviewed included academics, practitioners, policy-makers, knowledge brokers and a funder.
Results
The findings suggest that stakeholders had positive experiences when engaged meaningfully in the research process, where research projects were carefully planned and managed with attention to context and culture, and where the research team was effective, respectful and communicative. These factors help to facilitate the translation of research into policy and practice. However, multiple challenges of collaborative research were identified which related to structural and systemic challenges, building and maintaining relationships, use and collection of data and information, cultural perceptions of research and research generation, and getting evidence into action. Participants felt that changing the funding system, exploring more collaborative research methodologies, improved research translation, and more effective collaborative relationships at all stages of the research process could address some of these challenges.
Conclusions
The findings highlight that, whilst stakeholder engagement in research was considered important, structural, cultural and individual practices impacted how this worked in practice. Identifying and testing solutions to address these challenges could improve synergies between research, policy, and practice and lead to the production of impactful research that reduces wastage of public funding, improves implementation of findings and ultimately improves public health outcomes.
Resurrecting social infrastructure as a determinant of urban tuberculosis control in Delhi, IndiaHealth Research Policy and Systems - Tập 12 - Trang 1-13 - 2014
Shivani Chandra, Nandini Sharma, Kulanand Joshi, Nishi Aggarwal, Anjur Tupil Kannan
The key to universal coverage in tuberculosis (TB) management lies in community participation and empowerment of the population. Social infrastructure development generates social capital and addresses the crucial social determinants of TB, thereby improving program performance. Recently, there has been renewed interest in the concept of social infrastructure development for TB control in developing countries. This study aims to revive this concept and highlight the fact that documentation on ways to operationalize urban TB control is required from a holistic development perspective. Further, it explains how development of social infrastructure impacts health and development outcomes, especially with respect to TB in urban settings. A wide range of published Government records pertaining to social development parameters and TB program surveillance, between 2001 and 2011 in Delhi, were studied. Social infrastructure development parameters like human development index along with other indicators reflecting patient profile and habitation in urban settings were selected as social determinants of TB. These include adult literacy rates, per capita income, net migration rates, percentage growth in slum population, and percentage of urban population living in one-room dwelling units. The impact of the Revised National Tuberculosis Control Program on TB incidence was assessed as an annual decline in new TB cases notified under the program. Univariate linear regression was employed to examine the interrelationship between social development parameters and TB program outcomes. The decade saw a significant growth in most of the social development parameters in the State. TB program performance showed 46% increment in lives saved among all types of TB cases per 100,000 population. The 7% reduction in new TB case notifications from the year 2001 to 2011, translates to a logarithmic decline of 5.4 new TB cases per 100,000 population. Except per capita income, literacy, and net migration rates, other social determinants showed significant correlation with decline in new TB cases per 100,000 population. Social infrastructure development leads to social capital generation which engenders positive growth in TB program outcomes. Strategies which promote social infrastructure development should find adequate weightage in the overall policy framework for urban TB control in developing countries.
Output-orientated policy engagement: a model for advancing the use of epidemiological evidence in health policyHealth Research Policy and Systems - Tập 21 - Trang 1-11 - 2023
Emily Banks, Abby Haynes, Ray Lovett, Uday Narayan Yadav, Jason Agostino
Use of epidemiological research in policy and practice is suboptimal, contributing to significant preventable morbidity and mortality. Barriers to the use of research evidence in policy include lack of research–policy engagement, lack of policy-relevant research, differences in policymaker and researcher practice norms, time constraints, difficulties in coordination, and divergent languages and reward systems. In order to increase policy-relevant research and research uptake, we developed the output-orientated policy engagement (OOPE) model, in Australia. It integrates a foundational approach to engagement with cycles of specific activity focused around selected research outputs. Foundational elements include measures to increase recognition and valuing of policymaker expertise, emphasis on policy uptake, policy awareness of the research group’s work, regular policy engagement and policy-relevant capacity-building. Specific activities include (i) identification of an “output”—usually at draft stage—and program of work which are likely to be of interest to policymakers; (ii) initial engagement focusing on sharing “preview” evidence from this output, with an invitation to provide input into this and to advise on the broader program of work; and (iii) if there is sufficient interest, formation of a researcher–policy-maker partnership to shape and release the output, as well as inform the program of work. This cycle is repeated as the relationship continues and is deepened. As well as supporting policy-informed evidence generation and research-aware policymakers, the output-orientated model has been found to be beneficial in fostering the following: a pragmatic starting place for researchers, in often large and complex policy environments; purposeful and specific engagement, encouraging shared expectations; non-transactional engagement around common evidence needs, whereby researchers are not meeting with policymakers with the expectation of receiving funding; built-in translation; time and resource efficiency; relationship-building; mutual learning; policy-invested researchers and research-invested policy-makers; and tangible policy impacts. A case study outlines how the output-orientated approach supported researcher–policymaker collaboration to generate new evidence regarding Aboriginal and Torres Strait Islander cardiovascular disease risk and to apply this to national guidelines. Output-orientated policy engagement provides a potentially useful pragmatic model to catalyse and support partnerships between researchers and policymakers, to increase the policy-relevance and application of epidemiological evidence.
Should policy makers trust composite indices? A commentary on the pitfalls of inappropriate indices for policy formationHealth Research Policy and Systems - Tập 19 - Trang 1-11 - 2021
Matthias Kaiser, Andrew Tzer-Yeu Chen, Peter Gluckman
This paper critically discusses the use and merits of global indices, in particular, the Global Health Security Index (GHSI; Cameron et al.
https://www.ghsindex.org/#l-section--map
) in times of an imminent crisis, such as the current pandemic. This index ranked 195 countries according to their expected preparedness in the case of a pandemic or other biological threat. The coronavirus disease 2019 (Covid-19) pandemic provides the background to compare each country's predicted performance from the GHSI with the actual performance. In general, there is an inverted relation between predicted versus actual performance, i.e. the predicted top performers are among those that are the worst hit. Obviously, this reflects poorly on the potential policy uses of this index in imminent crisis management. The paper analyses the GHSI and identifies why it may have struggled to predict actual pandemic preparedness as evidenced by the Covid-19 pandemic. The paper also uses two different data sets, one from the Worldmeter on the spread of the Covid-19 pandemics, and the other from the International Network for Government Science Advice (INGSA) Evidence-to-Policy Tracker, to draw comparisons between the actual introduction of pandemic response policies and the corresponding death rate in 29 selected countries. This paper analyses the reasons for the poor match between prediction and reality in the index, and mentions six general observations applying to global indices in this respect. These observations are based on methodological and conceptual analyses. The level of abstraction in these global indices builds uncertainties upon uncertainties and hides implicit value assumptions, which potentially removes them from the policy needs on the ground. From the analysis, the question is raised if the policy community might have better tools for decision-making in a pandemic. On the basis of data from the INGSA Evidence-to-Policy Tracker, and with backing in studies from social psychology and philosophy of science, some simple heuristics are suggested, which may be more useful than a global index.
Assessment of data demand for informed-decisions among health facility and department heads in public health facilities of Amhara Region, northwest EthiopiaHealth Research Policy and Systems - - 2023
Moges Asressie Chanyalew, Mezgebu Yitayal, Asmamaw Atnafu, Binyam Tilahun
Evidence-based decision-making is a foundation of health information systems; however, routine health information is not mostly utilized by decision makers in the Amhara region. Therefore, this study aimed to explore the facility and department heads' perceptions towards the demand for and use of routine health information for decision making. A phenomenological qualitative study was done in eight districts of the Amhara region from June 10/2019 to July 30/2019. We obtained written informed consent and recruited 22 key informants purposively. The research team prepared a codebook, assigned codes to ideas, identified salient patterns, grouped similar ideas, and developed themes from the data. Thus, data were analyzed thematically using OpenCode software. The study revealed that health workers collected many data, but little was demanded and utilized to inform decisions. The majority of respondents perceived that data were collected merely for reporting. Lack of skills in data management, analysis, interpretation, and use were the technical attributes. Individual attributes included low staff motivation, carelessness, and lack of value for data. Poor access to data, low support for Health Information System, limited space for archiving, and inadequate finance were related to organizational attributes. The contextual (social-political) factors also influenced the use of eHealth applications for improved data demand and use among health care providers. In this study, health workers collect routine health data merely for reporting, and they did not demand and use it mostly to inform decisions and solve problems. Technical, individual, organizational, and contextual attributes were contributors to low demand and use of routine health data. Thus, we recommend building the technical capacity of health workers, introducing motivation mechanisms and ensuring accountability systems for better data use.
Quality improvements of healthcare trajectories by learning from aggregated patient-reported outcomes: a mixed-methods systematic literature reviewHealth Research Policy and Systems - Tập 20 Số 1
Maarten C. Dorr, K. S. van Hof, J. G. M. Jelsma, Emilie A. C. Dronkers, Rob J. Baatenburg de Jong, Marinella P. J. Offerman, M.C. de Bruijne
Abstract
Background
In healthcare, analysing patient-reported outcome measures (PROMs) on an aggregated level can improve and regulate healthcare for specific patient populations (meso level). This mixed-methods systematic review aimed to summarize and describe the effectiveness of quality improvement methods based on aggregated PROMs. Additionally, it aimed to describe barriers, facilitators and lessons learned when using these quality improvement methods.
Methods
A mixed-methods systematic review was conducted. Embase, MEDLINE, CINAHL and the Cochrane Library were searched for studies that described, implemented or evaluated a quality improvement method based on aggregated PROMs in the curative hospital setting. Quality assessment was conducted via the Mixed Methods Appraisal Tool. Quantitative data were synthesized into a narrative summary of the characteristics and findings. For the qualitative analysis, a thematic synthesis was conducted.
Results
From 2360 unique search records, 13 quantitative and three qualitative studies were included. Four quality improvement methods were identified: benchmarking, plan-do-study-act cycle, dashboards and internal statistical analysis. Five studies reported on the effectiveness of the use of aggregated PROMs, of which four identified no effect and one a positive effect. The qualitative analysis identified the following themes for facilitators and barriers: (1) conceptual (i.e. stakeholders, subjectivity of PROMs, aligning PROMs with clinical data, PROMs versus patient-reported experience measures [PREMs]); (2a) methodological—data collection (i.e. choice, timing, response rate and focus); (2b) methodological—data processing (i.e. representativeness, responsibility, case-mix control, interpretation); (3) practical (i.e. resources).
Conclusion
The results showed little to no effect of quality improvement methods based on aggregated PROMs, but more empirical research is needed to investigate different quality improvement methods. A shared stakeholder vision, selection of PROMs, timing of measurement and feedback, information on interpretation of data, reduction of missing data, and resources for data collection and feedback infrastructure are important to consider when implementing and evaluating quality improvement methods in future research.
Getting evidence to travel inside public systems: what organisational brokering capacities exist for evidence-based policy?Health Research Policy and Systems - Tập 16 - Trang 1-6 - 2018
Pernelle Smits, Jean-Louis Denis, Johanne Préval, Evert Lindquist, Miguel Aguirre
Implementing research findings into healthcare policy is an enduring challenge made even more difficult when policies must be developed and implemented with the help and support of multiple ideas, agendas and actors taking part in determinants of health. Only looking at mechanisms to feed policy-makers with evidence or to interest researchers in the policy process will simply bring partial clues; implementing evidence-based policy also requires organisations to lead and to partner in the production and intake of scientific evidence from academics and practical evidence from one another. This Commentary argues for the need to better understand the capacities required by organisations to foster evidence-based policy in a dispersed environment. It proposes a framework of 11 brokering capacities for organisations involved in evidence-based policy. Eight of these capacities are informed by streams of research related to the roles of knowledge broker, innovation broker and policy broker. Three complementary brokering capacities are informed by our experience studying real-life evidence-based policies; these are capturing boundary knowledge, trending know-how on scientific and practical evidence-based policy, and conveying evidence outward. Previous guidelines on brokering capacities focused on the individual level more than on the organisational level. Beyond the individual capacities of managers, designers and implementers of new policies, there is a need to identify and assess the brokering capacities of organisations involved in evidence-based policy. The three specific organisational brokering capacities for evidence-based policy that we present offer a means for policy-makers and policy designers to reflect upon favourable environments for evidence-based policy. These capacities could also help administrators and implementation scholars to think about and develop measurements to assess the quality and readiness of organisations involved in evidence-based policy design.
Embedded health service development and research: why and how to do it (a ten-stage guide)Health Research Policy and Systems - Tập 16 - Trang 1-8 - 2018
John Walley, Mohammad Amir Khan, Sophie Witter, Rumana Haque, James Newell, Xiaolin Wei
In a world of changing disease burdens, poor quality care and constrained health budgets, finding effective approaches to developing and implementing evidence-based health services is crucial. Much has been published on developing service tools and protocols, operational research and getting policy into practice but these are often undertaken in isolation from one another. This paper, based on 25 years of experience in a range of low and middle income contexts as well as wider literature, presents a systematic approach to connecting these activities in an embedded development and research approach. This approach can circumvent common problems such as lack of local ownership of new programmes, unrealistic resource requirements and poor implementation. We lay out a ten-step process, which is based on long-term partnerships and working within local systems and constraints and may be tailored to the context and needs. Service development and operational research is best prioritised, designed, conducted and replicated when it is embedded within ministry of health and national programmes. Care packages should from the outset be designed for scale-up, which is why the piloting stage is so crucial. In this way, the resulting package of care will be feasible within the context and will address local priorities. Researchers must be entrepreneurial and responsive to windows of funding for scale-up, working in real-world contexts where funding and decisions do not wait for evidence, so evidence generation has to be pragmatic to meet and ensure best use of the policy and financing cycles. The research should generate tested and easily usable tools, training materials and processes for use in scale-up. Development of the package should work within and strengthen the health system and other service delivery strategies to ensure that unintended negative consequences are minimised and that the strengthened systems support quality care and effective scale up of the package. While embedded development and research is promoted in theory, it is not yet practiced at scale by many initiatives, leading to wasted resources and un-sustained programmes. This guide presents a systematic and practical guide to support more effective engagements in future, both in developing interventions and supporting evidence-based scale-up.
Successes and challenges of health systems governance towards universal health coverage and global health security: a narrative review and synthesis of the literatureHealth Research Policy and Systems - Tập 20 Số 1
Ayal Debie, Resham Bahadur Khatri, Yibeltal Assefa
Abstract
Background
The shift in the global burden of disease from communicable to noncommunicable was a factor in mobilizing support for a broader post-Millennium Development Goals (MDGs) health agenda. To curb these and other global health problems, 193 Member States of the United Nations (UN) became signatories of the Sustainable Development Goals (SDGs) and committed to achieving universal health coverage (UHC) by 2030. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the importance of health systems governance (HSG) is felt now more than ever for addressing the pandemic and continuing to provide essential health services. However, little is known about the successes and challenges of HSG with respect to UHC and health security. This study, therefore, aims to synthesize the evidence and identify successes and challenges of HSG towards UHC and health security.
Methods
We conducted a structured narrative review of studies published through 28 July 2021. We searched the existing literature using three databases: PubMed, Scopus and Web of Science. Search terms included three themes: HSG, UHC and health security. We synthesized the findings using the five core functions of HSG: policy formulation and strategic plans; intelligence; regulation; collaboration and coalition; and accountability.
Results
A total of 58 articles were included in the final review. We identified that context-specific health policy and health financing modalities helped to speed up the progress towards UHC and health security. Robust health intelligence, intersectoral collaboration and coalition were also essential to combat the pandemic and ensure the delivery of essential health services. On the contrary, execution of a one-size-fits-all HSG approach, lack of healthcare funding, corruption, inadequate health workforce, and weak regulatory and health government policies were major challenges to achieving UHC and health security.
Conclusions
Countries, individually and collectively, need strong HSG to speed up the progress towards UHC and health security. Decentralization of health services to grass root levels, support of stakeholders, fair contribution and distribution of resources are essential to support the implementation of programmes towards UHC and health security. It is also vital to ensure independent regulatory accreditation of organizations in the health system and to integrate quality- and equity-related health service indicators into the national social protection monitoring and evaluation system; these will speed up the progress towards UHC and health security.
