Using research to inform health policy: barriers and strategies in developing countries

This article examines the dissemination and uptake of health research into policy and program delivery in four developing countries. In-depth interviews were conducted with health researchers, policymakers, and practitioners at both the local and national level. The study highlights the similarities across the study countries in the barriers to effective dissemination and uptake of research results. A fundamental barrier to the uptake of research by decisionmakers is the lack of appreciation of the important contribution that research can make to policy and program development. A further barrier is researchers' lack of appropriate "packaging" of research findings that consider the needs of different policy audiences. Dissemination within academic circles also restricts access by decisionmakers nd practitioners. Overcoming the barriers requires effort on behalf of researchers, decisionmakers, and donor agencies. The strong presence of donor agencies in developing countries places them in a position both to enable and encourage dissemination activities and communication between researchers and policymakers or practitioners. Increased collaboration between all three parties is one of the key strategies toward increasing the uptake of research into health policy and program development.     

Innovation spaces: six strategies to inform health care

Innovation remains an understudied resource within health care. Furthermore, the goals of US health care reform make innovation vitally important, while the time and resource limitations characteristic of health care make new strategies for innovation both necessary and potentially highly meaningful. The purpose of this study was to examine strategies for innovation in various industries and draw lessons for improving innovation in health care. This qualitative study began with literature research that provided a framework for discussion and identified a recurrent challenge in innovation: balancing the freedom to be creative with the need for structured management of ideas. Researchers then identified leading innovative companies and conducted phone interviews with innovation officers and other experts about their strategies for addressing the major innovation challenge. This article breaks out innovation strategies into 6 categories (dedicated times, formal teams, outside ideas, idea-sharing platforms, company/job goals, and incentives) and evaluates them for levels of control, yield, and pervasiveness. Based on this analysis, recommendations are offered for improving innovation in health care, calling for employee time allocated to innovation, dedicated innovation teams, and the incorporation of outside ideas.     

Disclosing clinical adverse events to patients: can practice inform policy?

Objectives To understand patients’ and health professionals’ experience of Open Disclosure and how practice can inform policy. Background Open Disclosure procedures are being implemented in health services worldwide yet empirical evidence on which to base models of patient–clinician communication and policy development is scant. Design, setting and participants A qualitative method was employed using semi‐structured open‐ended interviews with 154 respondents (20 nursing, 49 medical, 59 clinical/administrative managerial, 3 policy coordinators, 15 patients and 8 family members) in 21 hospitals and health services in four Australian states. Results Both patients and health professionals were positive about Open Disclosure, although each differed in their assessments of practice effectiveness. We found that five major elements influenced patients’ and professionals’ experience of openly disclosing adverse events namely: initiating the disclosure, apologizing for the adverse event, taking the patient’s perspective, communicating the adverse event and being culturally aware. Conclusions Evaluating the impact of Open Disclosure refines policy implementation because it provides an evidence base to inform policy. Health services can use specific properties relating to each of the five Open Disclosure elements identified in this study as training standards and to assess the progress of policy implementation. However, health services must surmount their sensitivity to revealing the extent of error so that research into patient experiences can inform practice and policy development.     

Support services for carers of people with mental health problems: building an evidence base to inform policy decisions

In Great Britain, over 1.5 million people look after someone with a mental disability. The UK government has shown an increasing awareness of the value of carers' contribution to society and of carers' need for support, information and care. As part of a recent scoping study, the current evidence for support services for mental health carers was reviewed and key stakeholders were consulted. This paper elucidates issues arising from the study and explores ways towards a more evidence-based future.     

Integrating health law and health policy: a European perspective

Health law is intended to create an environment in which the promotion of health goes hand in hand with the protection of individual rights and the general principles of equality and justice. Over the years, the importance of health law has grown, both at national and international level. As health and human rights are closely interlinked, it is important to integrate health law and health policy. It is to be expected that, especially in Europe, the impact of health law on health policy-making will increase as a result of several developments, e.g. the internationalization of health care and health policy, the issue of consumer protection and the legalization of society. This requires a strategy to stimulate the fruitful relationship between health policy and health law. The most important components of this strategy are discussed.     

Integrating evidence-based clinical and community strategies to improve health

Multiple and diverse preventive strategies in clinical and community settings are necessary to improve health. This paper (1) introduces evidence-based recommendations from the U.S. Preventive Services Task Force sponsored by the Agency for Healthcare Research and Quality and the Community Task Force sponsored by the Centers for Disease Control and Prevention, (2) examines, using a social-ecologic model, the evidence-based strategies for use in clinical and community settings to address preventable health-related problems such as tobacco use and obesity, and (3) advocates for prioritization and integration of clinical and community preventive strategies in the planning of programs and policy development, calling for additional research to develop the strategies and systems needed to integrate them.     

Human trafficking and health: a conceptual model to inform policy, intervention and research

Human trafficking is an international crime renowned for extreme forms of violence against women, men and children. Although trafficking-related violence has been well-documented, the health of trafficked persons has been a largely neglected topic. For people who are trafficked, health risks and consequences may begin before they are recruited into the trafficking process, continue throughout the period of exploitation and persist even after individuals are released. Policy-making, service provision and research often focus narrowly on criminal violations that occur during the period of exploitation, regularly overlooking the health implications of trafficking. Similarly, the public health sector has not yet incorporated human trafficking as a health concern. We present a conceptual model that highlights the migratory and exploitative nature of a multi-staged trafficking process, which includes: 'recruitment', travel-transit', 'exploitation' and 'integration' or 'reintegration', and for some trafficked persons, 'detention' and 're-trafficking' stages. Trafficked persons may suffer from physical, sexual and psychological harm, occupational hazards, legal restrictions and difficulties associated with being marginalised or stigmatised. Researchers and decision-makers will benefit from a theoretical approach that conceptualizes trafficking and health as a multi-staged process of cumulative harm. To address a health risk such as trafficking, which spans geographical boundaries and involves multiple sectors, including immigration and law enforcement, labour, social and health services, interventions must be coordinated between nations and across sectors to promote the protection and recovery of people who are trafficked.     

Nutrition and health literacy: a systematic review to inform nutrition research and practice

Health literacy is defined as the degree to which individuals obtain, process, and understand basic health information and services to make informed health decisions. Health literacy is a stronger predictor of health than age, income, employment, education, and race. Although the field has grown during the past decade, most health literacy research does not explicitly focus on food or nutrition, and dietetics practitioners often remain unaware of patients' health literacy level. The purpose of this systematic review was to summarize the literature on nutrition and health literacy to enhance dietetics practitioners' awareness of the importance of health literacy in practice and research. Of the 33 studies reviewed, four focused on measurement development, 16 on readability assessments, and 13 on individual literacy skills assessments. Collective evaluation revealed four noteworthy gaps, including the need to use more comprehensive assessment approaches that move beyond readability and numeracy to address the full spectrum of health literacy factors; the need to apply more robust experimental studies to examine the effectiveness of health literacy interventions among individuals, communities, health care providers, and health care systems; the need to explore the moderating and mediating roles of an individual's health literacy status on nutrition outcomes; and the need to examine long-term effects of health literacy interventions on nutrition outcomes. This article defines health literacy gaps and opportunities in nutrition research and practice, and calls for continued action to elevate the role of dietetics practitioners in addressing health literacy.     

Managing research evidence to inform action: Influencing HIV policy to protect marginalised populations in Pakistan

Abstract

Our aim was to demonstrate that an understanding of the process of how research may (or may not) influence policy and practice is crucial to leverage research findings and bring about evidence-informed policy and its implementation. We describe a process of research design and execution, based on theories of the relationship between evidence and public policy-making, which sought to improve the uptake of evidence into the HIV policy-making process in Pakistan. We designed and implemented specific strategies in research methods, management and dissemination to increase the policy influence by recommendations from a multi-disciplinary research project. Research to policy is complex, rarely linear and causal attribution is problematic. Nonetheless, we believe that, in part, some of the current changes in HIV policy and practice in Pakistan may be due to the managed process of research influence. We offer four key recommendations for those concerned with improving the chances of seeing their research incorporated into policy and practice – these are (1) involve stakeholders in research management; (2) set realistic expectations of research impact; (3) invest in long-term research–policy-maker relationships; and (4) build capacity of end users to use research to demand policy change.     

Managing research evidence to inform action: influencing HIV policy to protect marginalised populations in Pakistan

Abstract Our aim was to demonstrate that an understanding of the process of how research may (or may not) influence policy and practice is crucial to leverage research findings and bring about evidence-informed policy and its implementation. We describe a process of research design and execution, based on theories of the relationship between evidence and public policy-making, which sought to improve the uptake of evidence into the HIV policy-making process in Pakistan. We designed and implemented specific strategies in research methods, management and dissemination to increase the policy influence by recommendations from a multi-disciplinary research project. Research to policy is complex, rarely linear and causal attribution is problematic. Nonetheless, we believe that, in part, some of the current changes in HIV policy and practice in Pakistan may be due to the managed process of research influence. We offer four key recommendations for those concerned with improving the chances of seeing their research incorporated into policy and practice - these are (1) involve stakeholders in research management; (2) set realistic expectations of research impact; (3) invest in long-term research-policy-maker relationships; and (4) build capacity of end users to use research to demand policy change.     

The public health enterprise: examining our twenty-first-century policy challenges

This paper examines the public health enterprise and its policy challenges in the twenty-first century. Among the many challenges public health faces, we include here collaboration across a broad range of stakeholders, the public health infrastructure, agreement on public health's essential services, preparedness, accountability and measurement, workforce, and a research agenda. Two Institute of Medicine reports on the future of public health have set the context for a more in-depth review of the public health workforce and infrastructure. Policy advocates must ask, however, why, if the way and the means are so clear, the public health system is still in disarray.     

Integrating public health policy, practice, evaluation, surveillance, and research: the school health action planning and evaluation system

The Canadian Cancer Society and the National Cancer Institute of Canada have charged their Centre for Behavioral Research and Program Evaluation with contributing to the development of the country's systemic capacity to link research, policy, and practice related to population-level interventions. Local data collection and feedback systems are integral to this capacity. Canada's School Health Action Planning and Evaluation System (SHAPES) allows data to be collected from all of a school's students, and these data are used to produce computer-generated school "health profiles." SHAPES is being used for intervention planning, evaluation, surveillance, and research across Canada. Strong demand and multipartner investment suggest that SHAPES is adding value in all of these domains. Such systems can contribute substantially to evidence-informed public health practice, public engagement, participatory action research, and relevant, timely population intervention research.     

Best practices in use of research evidence to inform health decisions

The WHO Advisory Committee on Health Research (ACHR) is committed to the notion that WHO should exemplify best practice in use of research evidence to inform decisions about health. A major ongoing initiative of the ACHR is the Sub-committee on the Use of Research Evidence (SURE). This group is examining WHOs roles and responsibilities in the use of health research to inform decisions about health. WHOs leadership has expressed strong support for this initiative. The series of articles being published in Health Research Policy and Systems, which examine the methods used by WHO and other organisations to formulate recommendations about health, is part of the background documentation SURE has produced to inform ACHRs advice to WHO.     

Bridging evidence,policy, and practice to strengthen health systems for improved maternal and newborn health in Pakistan

Policy and decision making should be based on evidence, but translating evidence into policy and practice is often sporadic and slow. It is recognised that the relationship between research and policy uptake is complex and that dissemination of research findings is necessary, but insufficient, for policy uptake. Political, social, and economic context, use of (credible) data and dialogues between and across networks of researchers and policymakers play important roles in evidence uptake. Advocacy is the process of mobilising political and public opinions to achieve specific aims and its role is crucial in mobilising key actors to push for policy uptake. Advocacy and research groups (i.e. those who would like to see research evidence used by policymakers) may use different approaches and tools to stimulate the diffusion of research findings. The use of mass- and social media, communication with study participants, and the involvement of stakeholders at the early stages of research development are examples of the approaches that can be employed to stimulate diffusion of evidence and increase evidence uptake. The Research and Advocacy Fund (RAF) for Maternal and Newborn Health (MNH) worked within the health system context in Pakistan with the aim of espousing the principles of evidence, advocacy, and dissemination to improve MNH outcomes. The articles included in this special issue are outputs of RAF and highlight where RAF’s approaches contributed to MNH policy reforms. The papers discuss critical health system issues facing Pakistan, including service delivery components, demand creation, equitable access, transportation interventions for improved referrals, availability of medicines and equipment, and health workforce needs. In addition to these tangible elements, the health system ‘software’, i.e. the power and the political and social contexts, is also represented in the collection. These articles highlight three considerations for the future: the growing importance of implementation research, the crucial need for participation and ownership, and the recognition that policymaking can be ‘informed’ by rather than ‘based-on’ evidence. The future challenge will be to continue the momentum RAF has created and to welcome a new era of health, wealth, and growth for Pakistan.