Project description:BackgroundRapid reviews are increasingly used by policy agencies to access relevant research in short timeframes. Despite the growing number of programmes, little is known about how rapid reviews are used by health policy agencies. This study examined whether and how rapid reviews commissioned using a knowledge brokering programme were used by Australian policy-makers.MethodsThis study used interview data to examine the use of 139 rapid reviews by health policy agencies that were commissioned between 2006 and 2015. Transcripts were coded to identify how rapid reviews were used, the type of policy processes in which they were used, what evidence of use was provided and what reasons were given when rapid reviews were not used. Fisher's exact test was used to assess variation between types of agencies.ResultsOverall, 89% of commissioned rapid reviews were used by the commissioning agencies and 338 separate instances of use were identified, namely, on average, three uses per review. Policy-makers used reviews primarily to determine the details of a policy or programme, identify priorities for future action or investment, negotiate interjurisdictional decisions, evaluate alternative solutions for a policy problem, and communicate information to stakeholders. Some variation in use was observed across agencies. Reasons for non-use were related to changes in organisational structures, resources or key personnel in the commissioning agencies, or changes in the broader political environment.ConclusionsThis study found that almost all rapid reviews had been used by the agencies who commissioned them, primarily in policy and programme development, agenda-setting, and to communicate information to stakeholders. Reviews were used mostly in instrumental and conceptual ways and there was little evidence of symbolic use. Variations in use were identified across agencies. The findings suggest that commissioned rapid reviews are an effective means of providing timely relevant research for use in policy processes and that review findings may be applied in a variety of ways.

Project description:BackgroundPharmaceuticals are an integral component of health care systems worldwide, thus, regulatory weaknesses in governance of the pharmaceutical system negatively impact health outcomes especially in developing countries 1. Nigeria is one of a number of countries whose pharmaceutical system has been impacted by corruption and has struggled to curtail the production and trafficking of substandard drugs. In 2001, the National Agency for Food and Drug Administration and Control (NAFDAC) underwent an organizational restructuring resulting in reforms to reduce counterfeit drugs and better regulate pharmaceuticals 2. Despite these changes, there is still room for improvement. This study assessed the perceived level of transparency and potential vulnerability to corruption that exists in four essential areas of Nigeria's pharmaceutical sector: registration, procurement, inspection (divided into inspection of ports and of establishments), and distribution.MethodsStandardized questionnaires were adapted from the World Health Organization assessment tool and used in semi-structured interviews with key stakeholders in the public and private pharmaceutical system. The responses to the questions were tallied and converted to scores on a numerical scale where lower scores suggested greater vulnerability to corruption and higher scores suggested lower vulnerability.ResultsThe overall score for Nigeria's pharmaceutical system was 7.4 out of 10, indicating a system that is marginally vulnerable to corruption. The weakest links were the areas of drug registration and inspection of ports. Analysis of the qualitative results revealed that the perceived level of corruption did not always match the qualitative evidence.ConclusionDespite the many reported reforms instituted by NAFDAC, the study findings suggest that facets of the pharmaceutical system in Nigeria remain fairly vulnerable to corruption. The most glaring deficiency seems to be the absence of conflict of interest guidelines which, if present and consistently administered, limit the promulgation of corrupt practices. Other major contributing factors are the inconsistency in documentation of procedures, lack of public availability of such documentation, and inadequacies in monitoring and evaluation. What is most critical from this study is the identification of areas that still remain permeable to corruption and, perhaps, where more appropriate checks and balances are needed from the Nigerian government and the international community.

Project description:BACKGROUND:Providing healthcare professionals with health surveillance data aims to support professional and organisational behaviour change. The UK Five Year Antimicrobial Resistance (AMR) Strategy 2013 to 2018 identified better access to and use of surveillance data as a key component. Our aim was to determine the extent to which data on antimicrobial use and resistance met the perceived needs of health care professionals and policy-makers at national, regional and local levels, and how provision could be improved. METHODS:We conducted 41 semi-structured interviews with national policy makers in the four Devolved Administrations and 71 interviews with health care professionals in six locations across the United Kingdom selected to achieve maximum variation in terms of population and health system characteristics. Transcripts were analysed thematically using a mix of a priori reasoning guided by the main topics in the interview guide together with themes emerging inductively from the data. Views were considered at three levels - primary care, secondary care and national - and in terms of availability of data, current uses, benefits, gaps and potential improvements. RESULTS:Respondents described a range of uses for prescribing and resistance data. The principal gaps identified were prescribing in private practice, internet prescribing and secondary care (where some hospitals did not have electronic prescribing systems). Some respondents under-estimated the range of data available. There was a perception that the responsibility for collecting and analysing data often rests with a few individuals who may lack sufficient time and appropriate skills. CONCLUSIONS:There is a need to raise awareness of data availability and the potential value of these data, and to ensure that data systems are more accessible. Any skills gap at local level in how to process and use data needs to be addressed. This requires an identification of the best methods to improve support and education relating to AMR data systems.

Project description:BackgroundKnowledge Translation (KT) and data visualization play a vital role in the dissemination of data and information to improve healthcare systems. A better understanding of KT and its utility requires examining its processes, and how these interact with available data tools and platforms and various users. In this context, the aim of this paper is to understand how relevant users interact with data visualization tools, in particular Global Burden of Disease (GBD) visualizations, while also examining KT processes related to data visualization.MethodsA qualitative case-study consisting of semi-structured interviews with eight policy officers. Interviewees were selected by the Institute for Health Metrics and Evaluation (IHME) from three countries: Canada, Kenya and New Zealand. Data were analyzed through framework coding, using qualitative analysis software.ResultsPolicy officers' responses indicated that data can prompt action by engaging users, and effective delivery and translation of data was enhanced by data visualization tools. GBD was considered valuable for use in policy (e.g., planning and prioritizing health policy; facilitating accountability; and tracking and monitoring progress and trends over time and between countries). Using GBD and data visualization tools, participants quickly and easily accessed key information and turned it into actionable messages; engaging visuals captured decision-makers' attention while providing information in a digestible, time-saving manner. However, participants emphasized an overall disconnect between research and public health. Functionality and technical issues, e.g., absence of tool guides and tool complexity, as well as lacking buy-in and awareness of certain tools from those less familiar with GBD, were named as major barriers. In order to address this "know-do" gap, user-friendly knowledge translation tools were stated as crucial, as was the importance of collaboration and leveraging different insights from data generators and users to inform health policy.ConclusionsPolicy officers aware of KT are willing to utilize data visualization tools as they value them as an engaging and important mechanism to foster the use of GBD data in policy-making. To further facilitate policy officers' efforts to effectively use GBD data in policy and practice, further research is required into how users perceive and interact with data visualization and other KT tools.

Project description:BACKGROUND:It is unclear how to engage a wide range of knowledge users in research. We aimed to map the evidence on engaging knowledge users with an emphasis on policy-makers, health system managers, and policy analysts in the knowledge synthesis process through a scoping review. METHODS:We used the Joanna Briggs Institute guidance for scoping reviews. Nine electronic databases (e.g., MEDLINE), two grey literature sources (e.g., OpenSIGLE), and reference lists of relevant systematic reviews were searched from 1996 to August 2016. We included any type of study describing strategies, barriers and facilitators, or assessing the impact of engaging policy-makers, health system managers, and policy analysts in the knowledge synthesis process. Screening and data abstraction were conducted by two reviewers independently with a third reviewer resolving discrepancies. Frequency and thematic analyses were conducted. RESULTS:After screening 8395 titles and abstracts followed by 394 full-texts, 84 unique documents and 7 companion reports fulfilled our eligibility criteria. All 84 documents were published in the last 10 years, and half were prepared in North America. The most common type of knowledge synthesis with knowledge user engagement was a systematic review (36%). The knowledge synthesis most commonly addressed an issue at the level of national healthcare system (48%) and focused on health services delivery (17%) in high-income countries (86%). Policy-makers were the most common (64%) knowledge users, followed by healthcare professionals (49%) and government agencies as well as patients and caregivers (34%). Knowledge users were engaged in conceptualization and design (49%), literature search and data collection (52%), data synthesis and interpretation (71%), and knowledge dissemination and application (44%). Knowledge users were most commonly engaged as key informants through meetings and workshops as well as surveys, focus groups, and interviews either in-person or by telephone and emails. Knowledge user content expertise/awareness was a common facilitator (18%), while lack of time or opportunity to participate was a common barrier (12%). CONCLUSIONS:Knowledge users were most commonly engaged during the data synthesis and interpretation phases of the knowledge synthesis conduct. Researchers should document and evaluate knowledge user engagement in knowledge synthesis. REGISTRATION DETAILS:Open Science Framework ( https://osf.io/4dy53/ ).

Project description:BackgroundOpportunities exist to disseminate evidence-based cancer control strategies to state-level policy makers in both the legislative and executive branches. We explored factors that influence the likelihood that state-level policy makers will find a policy brief understandable, credible, and useful.MethodsA systematic approach was used to develop four types of policy briefs on the topic of mammography screening to reduce breast cancer mortality: data-focused brief with state-level data, data-focused brief with local-level data, story-focused brief with state-level data, and story-focused brief with local-level data. Participants were recruited from three groups of state-level policy makers-legislative staff, legislators, and executive branch administrators- in six states that were randomly chosen after stratifying all 50 states by population size and dominant political party in state legislature. Participants from each of the three policy groups were randomly assigned to receive one of the four types of policy briefs and completed a questionnaire that included a series of Likert scale items. Primary outcomes-whether the brief was understandable, credible, likely to be used, and likely to be shared-were measured by a 5-point Likert scale according to the degree of agreement (1 = strongly disagree, 5 = strongly agree). Data were analyzed with analysis of variance and with classification trees. All statistical tests were two-sided.ResultsData on response to the policy briefs (n = 291) were collected from February through December 2009 (overall response rate = 35%). All three policy groups found the briefs to be understandable and credible, with mean ratings that ranged from 4.3 to 4.5. The likelihood of using the brief (the dependent variable) differed statistically significantly by study condition for staffers (P = .041) and for legislators (P = .018). Staffers found the story-focused brief containing state-level data most useful, whereas legislators found the data-focused brief containing state-level data most useful. Exploratory classification trees showed distinctive patterns for brief usefulness across the three policy groups.ConclusionOur results suggest that taking a "one-size-fits-all" approach when delivering information to policy makers may be less effective than communicating information based on the type of policy maker.

Project description:The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU's European Semester.This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits.The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs.The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC, given the demographic- and fiscal circumstances, and the complexities of LTC systems. It also shows the usefulness to learn from policy design and implementation of LTC policy in other countries, within and outside the EU. Researchers can contribute by studying conditions, under which the strategies explored might deliver solutions for policy-makers.

Project description:BackgroundUnderstanding why research is conducted may help address the under-utilisation of research. This study examined the reasons for childhood obesity prevention knowledge production in New South Wales (NSW), Australia, and the factors influencing research choices from the perspective of the researchers and health policy agencies contributing to the research.MethodsA literature search of SCOPUS and ISI Web of Knowledge (affiliation and key word searches) was conducted to compile a database of NSW childhood obesity research outputs, published between 2000 and 2015 (n = 543). Descriptive statistics were used to quantify outputs by research type, differentiating measurement, descriptive, and intervention research, systematic reviews and other publications. Interviews were conducted with a sample of researchers drawn from the database (n = 13) and decision makers from health policy agencies who funded and contributed to childhood obesity research in NSW (n = 15). Researcher interviews examined views about societal impacts, why and under what circumstances the research was conducted. Decision-maker interviews examined policy agency research investment and how research was used in decision making. Content analysis and a thematic approach was used to analyse the interview transcripts.ResultsThe research in this case was conducted for mix of reasons including those traditionally associated with academic inquiry, as well as intentions to influence policy and practice. Differences in funding mechanisms, administrative and employment arrangements, and 'who' initiated the research, created differing incentives and perspectives for knowledge production. Factors associated with the characteristics and experience of the individuals involved also influenced goals, as did the type of research conducted. Policy agencies played a role in directing research to address policy needs.ConclusionsThe findings of this study confirm that researchers are strongly influenced by their working environment. Funding schemes and other incentives to support policy relevant knowledge production are important. Contextual factors such as policy priorities, policy-driven research funding and the embedded nature or strong connections between some researchers and the policy agencies involved, are likely to have influenced the extent to which policy goals were reported in this study.

Project description:BackgroundCurrently, little is known about the types of evidence used by policy makers. This study aimed to investigate how policy makers in the health domain use and evaluate evidence and how this differs from academic epidemiologists. By having a better understanding of how policy makers select, evaluate, and use evidence, academics can tailor the way in which that evidence is produced, potentially leading to more effective knowledge translation.MethodsAn exploratory mixed-methods study design was used. Quantitative measures were collected via an anonymous online survey (n?=?28), with sampling from three health-related government and non-government organizations. Semi-structured interviews with policy makers (n?=?20) and epidemiologists (n?=?6) were conducted to gather qualitative data.ResultsPolicy makers indicated systematic reviews were the preferred research resource (19%), followed closely by qualitative research (16%). Neither policy makers nor epidemiologists used grading instruments to evaluate evidence. In the web survey, policy makers reported that consistency and strength of evidence (93%), the quality of data (93%), bias in the evidence (79%), and recency of evidence (79%) were the most important factors taken into consideration when evaluating the available evidence. The same results were found in the qualitative interviews. Epidemiologists focused on the methodology used in the study. The most cited barriers to using robust evidence, according to policy makers, were political considerations (60%), time limitations (55%), funding (50%), and research not being applicable to current policies (50%).ConclusionThe policy maker's investigation did not report a systematic approach to evaluating evidence. Although there was some overlap between what policy makers and epidemiologists identified as high-quality evidence, there was also some important differences. This suggests that the best scientific evidence may not routinely be used in the development of policy. In essence, the policy-making process relied on other jurisdictions' policies and the opinions of internal staff members as primary evidence sources to inform policy decisions. Findings of this study suggest that efforts should be directed toward making scientific information more systematically available to policy makers.

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