Authors: Nino Paichadze, Emma K. Cook, Heather E. Rosen, Sara Kurtovic and Adnan A. Hyder
Abstract:
Objectives Given the rapid growth of the field of health policy and systems research (HPSR), it is important to monitor the research environment, especially the.....
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Authors: Nino Paichadze, Emma K. Cook, Heather E. Rosen, Sara Kurtovic and Adnan A. Hyder
Objectives Given the rapid growth of the field of health policy and systems research (HPSR), it is important to monitor the research environment, especially the evolution of HPSR research outputs in low- and middle-income countries
(LMICs). The objective of this study was to generate quantitative metrics to assess the production of HPSR publications and the role of the Alliance for Health Policy and Systems Research (the Alliance) grant-funded projects in 11
LMICs over the past 20 years.
Methods We conducted a systematic literature search for HPSR literature from 1999 to 2020 pertaining to 11 target LMIC
countries, including grey literature. We analysed the frequency of publications over time, by country and by thematic area.
We then used a database of the Alliance’s previous grantees to analyse authorship by Alliance-funded investigators.
Results HPSR publications across all 11 target countries increased steadily over the past two decades and the rate
of publication increased by an average of 34% per year. The majority of HPSR publications during the study period
were in health systems (23%) and health workforce (19%) thematic areas. Nineteen per cent of HPSR publications during this time were authored by Alliance-funded investigators. There was extensive heterogeneity between countries
both in number of publications and in proportion of publications authored by Alliance-funded investigators.
Conclusions Growth in the HPSR research environment reflects the expanding prominence of the HPSR field
and increased HPSR research capacity in the 11 target countries. Alliance-funded investigators made an important
contribution to the growth in HPSR output in these countries.
Keywords Bibliometrics, Health policy, Public health systems research, Developing countries
Authors: Debra Winberg, Elizabeth Nauman, Lizheng Shi, Brice L. Mohundro, Kelly Louis, Eboni G. Price-Haywood, Tiange Tang and Alessandra N. Bazzano
Abstract:
Background Type 2 diabetes mellitus (T2D) remains a pressing public health concern. Despite advancements
in antidiabetic medications, suboptimal medication adherence persists among many individuals with T2D,.....
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Authors: Debra Winberg, Elizabeth Nauman, Lizheng Shi, Brice L. Mohundro, Kelly Louis, Eboni G. Price-Haywood, Tiange Tang and Alessandra N. Bazzano
Background Type 2 diabetes mellitus (T2D) remains a pressing public health concern. Despite advancements
in antidiabetic medications, suboptimal medication adherence persists among many individuals with T2D, often due
to the high cost of medications. To combat this issue, Blue Cross and Blue Shield of Louisiana (Blue Cross) introduced the $0 Drug Copay (ZDC) program, providing $0 copays for select drugs. This study sought to explore barriers
and facilitators to the successful implementation of Blue Cross’s ZDC program (updated version).
Methods Focus group discussions and interviews were conducted with health plan leadership, health coaches
and providers who participate in the health plan organization’s healthcare quality improvement program. Focus
group discussions and semi-structured interviews were conducted between October 2022 and July 2023. Discussion
guides were developed collaboratively and tailored to each participant group. Interviews were recorded, transcribed
and analysed using NVivo® qualitative analysis software. A descriptive, qualitative analysis was conducted, resulting
in the identification of seven codes and subsequent candidate themes.
Results In total, 15 participants were interviewed: 6 were Blue Cross administrators, 5 were health coaches and 4
were Quality Blue providers. Overall, participants had positive feedback on the ZDC program and perceived that it
has significant benefits for patients and the health system but could be improved, and four themes related to implementation barriers and facilitators, effectiveness and potential areas of improvement were identified: (1) the ZDC
program reduces friction for patients, prescribers and the health system; (2) the program is aligned with the values
of health systems, insurers and providers, facilitating implementation success; (3) expanding coverage (drug classes
and conditions) and education (for providers and patients) could maximize program benefits; and (4) coronavirus
disease 2019 (COVID-19) did not negatively impact program administration because the $0 copay was programmed
at the benefit level.
Conclusions The ZDC program aligns goals and can benefit patients, providers and patients. The program can have
the largest potential if it is expanded to include new medications and new conditions, and if there is more education
for patients and providers. Regardless of challenges, reduced-copay programs have the potential to improve medication adherence, improve HbA1C control and improve overall health outcomes.
Trial Registration This study was approved by the Tulane University Institutional Review Board, IRB #2020-1986.
Authors: Marc A. Albert, Manoj M. Lalu and Agnes Grudniewicz
Abstract:
Evidence-based policymaking has increased policymakers’ capacity to make scientifically informed health policy decisions. However, reaping the benefits of this approach requires avoiding untrustworthy research – potential sources
of.....
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Authors: Marc A. Albert, Manoj M. Lalu and Agnes Grudniewicz
Evidence-based policymaking has increased policymakers’ capacity to make scientifically informed health policy decisions. However, reaping the benefits of this approach requires avoiding untrustworthy research – potential sources
of which are predatory journals. In this study, we sought to understand how research cited in policy documents
is sourced and evaluated, and identify factors that may be contributing to the citation of predatory journals or other
less trustworthy evidence. To this end, we conducted semi-structured interviews with individuals who have prepared
public health policy documents. These interviews were thematically analysed, and five key overarching themes were
generated regarding the process of deciding how to develop policy documents (e.g. which individuals to involve)
and how this may impact which information is included; obstacles such as limited evidence that may hinder policy
document development; and concerns around transparency throughout the development process. Our findings
highlight that in many cases, information cited in policy documents is sourced and evaluated with variable rigour.
This may contribute to the citation of untrustworthy research in policy documents. Certain steps can be taken to help
minimize any potential negative impact of relying on such sources (e.g. improving transparency), but a better understanding of policymakers’ perspectives regarding how taking these steps would impact their decision-making process
may be required to ensure successful implementation.
Keywords Health policy, Evidence-based policy, Trustworthiness of research, Predatory journals, Knowledge
translation
Authors: Yuqi Zhang, Jonathan Stokes, Laura Anselmi, Peter Bower and Jin Xu
Abstract:
Background An increasing number of people live with chronic disease or multi-morbidity. Current consensus
is that their care requires an integrated model bringing different professionals together.....
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Authors: Yuqi Zhang, Jonathan Stokes, Laura Anselmi, Peter Bower and Jin Xu
Background An increasing number of people live with chronic disease or multi-morbidity. Current consensus
is that their care requires an integrated model bringing different professionals together to provide person-centred
care. Although primary care has a central role in managing chronic disease, and integration may be important
in strengthening this role, previous research has shown insufficient attention to the relationships between primary
care and integration. This review summarizes primary care involvement in integrated care interventions and assesses
the effect of those interventions on a range of measures of primary care functions and wider outcomes.
Methods We searched Medline and Embase using terms for “integrated care”, “chronic disease” and “multimorbidity”.
We included integrated care interventions involving different levels of care organizations or different care sectors. Risk
of bias was appraised, and the contents of integrated care interventions assessed using the Sustainable intEgrated
care modeLs for multi-morbidity: delivery, FInancing and performancE (SELFIE) conceptual framework. Effectiveness
of integrated care interventions was assessed using meta-analysis of primary care functions (access, continuity, comprehensiveness and coordination) and wider outcomes (patient health and mortality, hospital admissions and costs).
Sub-group analyses were conducted for different types of primary care involvement.
Results From 17,752 studies screened, 119 studies on integrated care were identified, of which 69 interventions
(58%) involved primary care. Meta-analyses showed significant beneficial effects on two measures of primary care
function: access (effect size: 0.17, 95% CI 0.05–0.29) and continuity (effect size: 0.32, 95% CI 0.14–0.50). For wider outcomes, the only statistically significant effect was found on costs (effect size: 0.02, 95% CI 0.02–0.03).
Conclusions Integrated care interventions involving primary care can have positive effects on strengthening primary
care functions, but these benefits do not necessarily translate consistently to wider outcomes.
Keywords Integrated care, Primary care, Chronic disease, Multi-morbidity
Authors: D. Rajit, A. Johnson, E. Callander, H. Teede and J. Enticott
Abstract:
Despite forming the cornerstone of modern clinical practice for decades, implementation of evidence-based medicine at scale remains a crucial challenge for health.....
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Authors: D. Rajit, A. Johnson, E. Callander, H. Teede and J. Enticott
Despite forming the cornerstone of modern clinical practice for decades, implementation of evidence-based medicine at scale remains a crucial challenge for health systems. As a result, there has been a growing need for conceptual models to better contextualise and pragmatize the use of evidence-based medicine, particularly in tandem
with patient-centred care. In this commentary, we highlight the emergence of the learning health system as one
such model and analyse its potential role in pragmatizing both evidence-based medicine and patient-centred care.
We apply the learning health system lens to contextualise the key activity of evidence-based guideline development
and implementation, and highlight how current inefficiencies and bottlenecks in the evidence synthesis phase of evidence-based guideline development threaten downstream adherence. Lastly, we introduce the evidence ecosystem
as a complementary model to learning health systems, and propose how innovative developments from the evidence ecosystem may be integrated with learning health systems to better enable health impact at speed and scale.
Keywords Learning health systems, Evidence ecosystems, Evidence-based medicine, Person-centred care, Evidencebased guidelines
Authors: Niamh Smith, Michail Georgiou, Mohammad S. Jalali and Sebastien Chastin
Abstract:
Background Increasingly, public health faces challenges requiring complex, multifaceted and multi-sectoral
responses. This calls for systems-based approaches that facilitate the kind.....
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Authors: Niamh Smith, Michail Georgiou, Mohammad S. Jalali and Sebastien Chastin
Background Increasingly, public health faces challenges requiring complex, multifaceted and multi-sectoral
responses. This calls for systems-based approaches that facilitate the kind of collective and collaborative thinking
and working required to address complexity. While the literature on systems thinking, system dynamics and the associated methodologies is extensive, there remains little clear guidance on how to plan, govern and implement participatory systems approaches within a co-creation process.
Methods We used a three-step process to develop DISCOVER, a framework for implementing, and governing
systems-based co-creation:
Stage 1: We conducted a literature analysis of key texts to identify well-documented methods and phases for cocreation using a systems approach, as well as areas where gaps existed.
Stage 2: We looked for the most appropriate methods and approaches to fill the gaps in the knowledge production chain.
Stage 3: We developed the framework, identifying how the different tools and approaches fit together end-to-end,
from sampling and recruiting participants all the way through to responding with an action plan.
Results We devised DISCOVER to help guide researchers and stakeholders to collectively respond to complex social,
health and wider problems. DISCOVER is a strategic research planning and governance framework that provides
an actionable, systematic way to conceptualise complex problems and move from evidence to action, using systems
approaches and co-creation. In this article, we introduce the eight-step framework and provide an illustrative case
study showcasing its potential. The framework integrates complementary approaches and methods from social network analysis, systems thinking and co-creation literature. The eight steps are followed sequentially but can overlap.
Conclusions DISCOVER increases rigour and transparency in system approaches to tackling complex issues going
from planning to action. It is being piloted in environmental health research but may be suitable to address other
complex challenges and could be incorporated into research proposals and protocols for future projects.
Keywords Systems mapping, Systems thinking, Methods, Public health, Group model building, Health, Policy
formulation, Co-creation
Authors: Sudhakar Morankar, Gelila Abraham, Zubin Shroff4 and Zewdie Birhanu
Abstract:
Background Decision-making about the design and implementation of health care policies should be supported
by research evidence. This article reports on.....
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Authors: Sudhakar Morankar, Gelila Abraham, Zubin Shroff4 and Zewdie Birhanu
Background Decision-making about the design and implementation of health care policies should be supported
by research evidence. This article reports on a qualitative study on the experiences of both research institutes and policymakers in Ethiopia in generating and using research evidence to inform health policy decision-making.
Methods Semi-structured interviews were conducted from January through March 2020, with representatives
of research institutes and with policymakers in Ethiopia. The data collected during the interviews were analyzed
thematically.
Results Half of the institutions represented had engaged in health policy and systems research (HPSR). These
institutes’ capacities were limited by multiple factors, including unsupportive research environments; the limited
number of researchers with extensive experience; high turnover among senior researchers; lack of staff motivation
mechanisms; underdeveloped research culture; limited technical and analytical capacity among researchers; lack
of core funding for HPSR; ineffective financial management; and, lack of connections with health policy platforms.
Research institutes also lacked the capacity in strategic packaging of findings to influence policy decision-making,
although some programs have recently improved in this area. Meanwhile, there lacked a culture of using evidence
in policymaking settings. In general, we found that policymakers had poor attitudes towards the quality or value
of the evidence, and had little capacity to interpret evidence and apply findings to policy options. As a result, much
of the research produced by the institutes have only been relevant academically, with little impact on policy. However, respondents reported that the environment is slowly changing, and the recent creation of a Research Advisory
Council at the Ministry of Health offers a promising model.
Conclusions Despite some recent changes, in Ethiopia researchers and policymakers alike often tend to consider
health policy and systems research (HPSR) to be not very valuable since the findings generated are rarely used
for evidence-informed policy development. Research institutes and researchers need to strengthen their technical,
analytical, and administrative capacities (through, among other efforts, seeking more funding for research, and better
incentives to attract, retain and build skills among qualified researchers); they also need to improve their understanding of the evidence-to-policy cycle and how to engage effectively with policymakers.
Keywords Health system, Health system and policy research, Health research, Evidence-based decision making,
Ethiopia
Authors: Kathleen P. Conte, Alison Laycock, Jodie Bailie, Emma Walke, Leigh‑ann Onnis, Lynette Feeney, Erika Langham, Frances Cunningham, Veronica Matthews and Ross Bailie
Abstract:
Background Despite that stakeholder participation in evidence synthesis could result in more useful outcomes,
there are few examples of processes that.....
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Authors: Kathleen P. Conte, Alison Laycock, Jodie Bailie, Emma Walke, Leigh‑ann Onnis, Lynette Feeney, Erika Langham, Frances Cunningham, Veronica Matthews and Ross Bailie
Background Despite that stakeholder participation in evidence synthesis could result in more useful outcomes,
there are few examples of processes that actively involve them in synthesis work. Techniques are needed that engage
diverse stakeholders as equal partners in knowledge co‑production. The aims of this paper are to describe an inno‑
vative participatory process of synthesising a large body of academic research products and compare the findings
of the participatory process against two traditional approaches to synthesis: a rapid review and a structured review.
Methods First, a rapid synthesis of all research outputs (n = 86) was conducted by researchers with in‑depth knowl‑
edge of the collaboration’s research. Second, a team of researchers and service providers conducted a structured syn‑
thesis of seventy‑eight peer‑reviewed articles and reports generated by the collaboration. Fifty‑five publications were
brought forward for further synthesis in part three, a facilitated participatory synthesis. Finally, we explored the value
added by the participatory method by comparing findings generated across the three synthesis approaches.
Results Twelve researchers and 11 service providers/policy partners—8 self‑identified as Aboriginal and/or Torres
Strait Islander—participated in two facilitated workshops (totalling 4 h). Workshop activities engaged participants
in reviewing publication summaries, identifying key findings, and evoked review, discussion and refinement. The pro‑
cess explicitly linked experiential knowledge to citations of academic research, clearly connecting the two knowledge
types. In comparing the findings generated across all three methods we found mostly consistencies; the few discrep‑
ancies did not contradict but gave deeper insights into statements created by the other methods. The participatory
synthesis generated the most, detailed, and unique findings, and contextual insights about the relevance of the key
messages for practice.
Conclusion The participatory synthesis engaged stakeholders with diverse backgrounds and skillsets in synthesising
a large body of evidence in a relatively short time. The participatory approach produced findings comparable to tradi‑
tional synthesis methods while extending knowledge and identifying lessons most relevant for the participants who,
ultimately, are the end users of the research. This process will interest other large‑scale research collaborations seeking
to engage stakeholders in evidence synthesis.
Authors: Emanuel Orozco‑Núñez, Enai Ojeda‑Arroyo, Nadia Cerecer‑Ortiz, Carlos M. Guerrero‑López, Beatriz M. Ramírez‑Pérez, Ileana Heredia‑Pi, Betania Allen‑Leigh, Emma Feeny and Edson Serván‑Mori
Abstract:
Background Mexico and other low‑ and middle‑income countries (LMICs) present a growing burden of non‑com‑
municable diseases (NCDs), with gender‑differentiated risk.....
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Authors: Emanuel Orozco‑Núñez, Enai Ojeda‑Arroyo, Nadia Cerecer‑Ortiz, Carlos M. Guerrero‑López, Beatriz M. Ramírez‑Pérez, Ileana Heredia‑Pi, Betania Allen‑Leigh, Emma Feeny and Edson Serván‑Mori
Background Mexico and other low‑ and middle‑income countries (LMICs) present a growing burden of non‑com‑
municable diseases (NCDs), with gender‑differentiated risk factors and access to prevention, diagnosis and care. How‑
ever, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive
health rights and preventing violence against women. This research article analyses public policies related to gender
and NCDs, identifying political challenges in the current response to women’s health needs, and opportunities to pro‑
mote interventions that recognize the role of gender in NCDs and NCD care in Mexico.
Methods We carried out a political mapping and stakeholder analysis during July–October of 2022, based on struc‑
tured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico.
We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize
the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed.
Results We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender per‑
spective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered
social and economic aspects of the NCD burden are not widely understood, and the multi‑sectoral approach needed
to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are
a significant obstacle to social protection mechanisms to support those caring for people living with NCDs.
Conclusions Moving towards an effective, equity‑promoting health and social protection system requires the gov‑
ernment to adopt an intersectoral, gender‑based approach to the prevention and control of NCDs and the bur‑
den of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness
among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed
to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes.
Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.
Keywords Gender, Non‑communicable diseases, Stakeholder analysis, Political mapping, Health policy, Social
protection
Authors: Emanuel Orozco‑Núñez, Enai Ojeda‑Arroyo, Nadia Cerecer‑Ortiz, Carlos M. Guerrero‑López, Beatriz M. Ramírez‑Pérez, Ileana Heredia‑Pi, Betania Allen‑Leigh, Emma Feeny and Edson Serván‑Mori
Account Details mentioned below: For Electronic Fund Transfer: (NEFT/RTGS)
Authors: Melissa Taylor, Paul Garner, Sandy Oliver and Nicola Desmond
Abstract:
Background Guidelines depend on effect estimates, usually derived from randomised controlled trials, to inform
their decisions. Qualitative research evidence may improve.....
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Authors: Melissa Taylor, Paul Garner, Sandy Oliver and Nicola Desmond
Background Guidelines depend on effect estimates, usually derived from randomised controlled trials, to inform
their decisions. Qualitative research evidence may improve decisions made but where in the process and the methods to do this have not been so clearly established. We sought to describe and appraise how qualitative research
has been used to inform World Heath Organization guidance since 2020.
Methods We conducted a document analysis of WHO guidelines from 2020 to 2022. We purposely sampled guidelines on the topics of maternal and newborn health (MANH) and infectious diseases, as most of the qualitative
synthesis to date has been conducted on these topics, likely representing the ‘best case’ scenario. We searched the inbuilt repository feature of the WHO website and used standardised search terms to identify qualitative reporting.
Using deductive frameworks, we described how qualitative evidence was used to inform guidelines and appraised
the standards of this use.
Results Of the 29 guidelines, over half used qualitative research to help guide decisions (18/29). A total of 8 of these
used qualitative research to inform the guideline scope, all 18 to inform recommendations, and 1 to inform implementation considerations. All guidelines drew on qualitative evidence syntheses (QES), and five further supplemented
this with primary qualitative research. Qualitative findings reported in guidelines were typically descriptive, identifying people’s perception of the benefits and harms of interventions or logistical barriers and facilitators to programme
success. No guideline provided transparent reporting of how qualitative research was interpreted and weighed used
alongside other evidence when informing decisions, and only one guideline reported the inclusion of qualitative
methods experts on the panel. Only a few guidelines contextualised their recommendations by indicating which
populations and settings qualitative findings could be applied.
Conclusions Qualitative research frequently informed WHO guideline decisions particularly in the field of MANH.
However, the process often lacked transparency. We identified unmet potential in informing implementation considerations and contextualisation of the recommendations. Use in these areas needs further methods development.
Keywords Qualitative evidence synthesis, Qualitative research, Guideline development
Authors: Helen Baxter, Lindsay Bearne, Tracey Stone, Clare Thomas, Rachel Denholm, Sabi Redwood, Sarah Purdy and Alyson Louise Huntley
Abstract:
Background The National Institute of Health and Care Research (NIHR), funds, enables and delivers world-leading
health and social care research to.....
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Authors: Helen Baxter, Lindsay Bearne, Tracey Stone, Clare Thomas, Rachel Denholm, Sabi Redwood, Sarah Purdy and Alyson Louise Huntley
Background The National Institute of Health and Care Research (NIHR), funds, enables and delivers world-leading
health and social care research to improve people’s health and wellbeing. To achieve this aim, effective knowledge sharing (two-way knowledge sharing between researchers and stakeholders to create new knowledge
and enable change in policy and practice) is needed. To date, it is not known which knowledge sharing techniques
and approaches are used or how effective these are in creating new knowledge that can lead to changes in policy
and practice in NIHR funded studies.
Methods In this restricted systematic review, electronic databases [MEDLINE, The Health Management Information Consortium (including the Department of Health’s Library and Information Services and King’s Fund Information and Library Services)] were searched for published NIHR funded studies that described knowledge sharing
between researchers and other stakeholders. One researcher performed title and abstract, full paper screening
and quality assessment (Critical Appraisal Skills Programme qualitative checklist) with a 20% sample independently
screened by a second reviewer. A narrative synthesis was adopted.
Results In total 9897 records were identified. After screening, 17 studies were included. Five explicit forms
of knowledge sharing studies were identified: embedded models, knowledge brokering, stakeholder engagement
and involvement of non-researchers in the research or service design process and organisational collaborative partnerships between universities and healthcare organisations. Collectively, the techniques and approaches included
five types of stakeholders and worked with them at all stages of the research cycle, except the stage of formation
of the research design and preparation of funding application. Seven studies (using four of the approaches) gave
examples of new knowledge creation, but only one study (using an embedded model approach) gave an example
of a resulting change in practice. The use of a theory, model or framework to explain the knowledge sharing process
was identified in six studies.
Conclusions Five knowledge sharing techniques and approaches were reported in the included NIHR funded studies, and seven studies identified the creation of new knowledge. However, there was little investigation of the effectiveness of these approaches in influencing change in practice or policy.
Authors: Gillian Mulvale, Jenn Green, Glenn Robert, Michael Larkin, Nicoline Vackerberg, Sofia Kjellström, Puspita Hossain, Sandra Moll, Esther Lim and Shioma‑Lei Craythorne
Abstract:
Abstract
Background Innovations in coproduction are shaping public service reform in diverse contexts around the world.
Although many innovations are local, others.....
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Authors: Gillian Mulvale, Jenn Green, Glenn Robert, Michael Larkin, Nicoline Vackerberg, Sofia Kjellström, Puspita Hossain, Sandra Moll, Esther Lim and Shioma‑Lei Craythorne
Abstract
Background Innovations in coproduction are shaping public service reform in diverse contexts around the world.
Although many innovations are local, others have expanded and evolved over time. We know very little, however,
about the process of implementation and evolution of coproduction. The purpose of this study was to explore
the adoption, implementation and assimilation of three approaches to the coproduction of public services with struc‑
turally vulnerable groups.
Methods We conducted a 4 year longitudinal multiple case study (2019–2023) of three coproduced public service
innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple
complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness
(Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data
sources included 14 interviews with strategic decision‑makers and a document analysis to understand the history
and contextual factors relating to each case. Three frameworks informed the case study protocol, semi‑structured
interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation
Research, the Diffusion of Innovation model and Lozeau’s Compatibility Gaps to understand assimilation.
Results The adoption of coproduction involving structurally vulnerable populations was a notable evolution of exist‑
ing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts
among community organizations, and the opportunity to inform a new municipal mental health policy sparked
adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experi‑
ence on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered
flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined
programming. According to the informants, efforts to avoid co‑optation risks were successful, resulting in the assimila‑
tion of new mindsets and coproduction processes, with examples of how this had led to transformative change.
Authors: Cristián Mansilla, Arthur Sweetman, Gordon Guyatt and John N. Lavis
Abstract:
Background Globally, a growing number of calls to formalize and strengthen evidence-support systems have
been released, all of which emphasize.....
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Authors: Cristián Mansilla, Arthur Sweetman, Gordon Guyatt and John N. Lavis
Background Globally, a growing number of calls to formalize and strengthen evidence-support systems have
been released, all of which emphasize the importance of evidence-informed decision making. To achieve this, it
is critical that evidence producers and decision-makers interact, and that decision-makers’ evidence needs can be
efficiently translated into questions to which evidence producers can respond. This paper aims to create a taxonomy
of demand-driven questions for use by evidence producers, intermediaries (i.e., people working in between researchers and decision-makers) and decision-makers.
Methods We conducted a global cross-sectional survey of units providing some type of evidence support
at the explicit request of decision-makers. Unit representatives were invited to answer an online questionnaire
where they were asked to provide a list of the questions that they have addressed through their evidence-support
mechanism. Descriptive analyses were used to analyze the survey responses, while the questions collected from each
unit were iteratively analyzed to create a mutually exclusive and collectively exhaustive list of types of questions
that can be answered with some form of evidence.
Results Twenty-nine individuals completed the questionnaire, and more than 250 submitted questions were analysed to create a taxonomy of 41 different types of demand-driven questions. These 41 questions were organized
by the goal to be achieved, and the goals were grouped in the four decision-making stages (i) clarifying a societal
problem, its causes and potential impacts; (ii) finding and selecting options to address a problem; (iii) implementing
or scaling-up an option; and (iv) monitoring implementation and evaluating impacts.
Conclusion The mutually exclusive and collectively exhaustive list of demand-driven questions will help decisionmakers (to ask and prioritize questions), evidence producers (to organize and present their work), and evidence-intermediaries (to connect evidence needs with evidence supply).
Keywords Evidence-informed decision making, Evidence-informed policy, Evidence-based practice, Methodology
Authors: Silvia Helena De Bortoli Cassiani, Bruna Moreno Dias, Jairo Rivera, Andre Noel Roth Deubel, Taycia Ramírez Pérez, Dinora Rebolledo Malpica and Sonja Caffe
Abstract:
Background In Latin America, interventions aimed at adolescents’ health suffer from a shortfall of investment
and lack of sustainability. Nurses, as.....
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Authors: Silvia Helena De Bortoli Cassiani, Bruna Moreno Dias, Jairo Rivera, Andre Noel Roth Deubel, Taycia Ramírez Pérez, Dinora Rebolledo Malpica and Sonja Caffe
Background In Latin America, interventions aimed at adolescents’ health suffer from a shortfall of investment
and lack of sustainability. Nurses, as an integral part of health services and systems, can lead the implementation
and development of public health policies to improve adolescent health.
Objective To identify and analyze the role of nurses in the development and implementation of public policies
and in the provision of health care to adolescents in Colombia, Ecuador, and Peru.
Methods The research was carried out in three phases: a documentary analysis, an online survey, and semi-structured focus groups. A total of 48 documents were analyzed, 288 nurses participated in the survey, and 29 nurses
participated in the focus groups.
Results State policies aim to guarantee rights, with special protection for children and adolescents. It is an incremental process, with greater involvement of civil society and governments. Participants reported a lack of synergy
between law and practice, as well as differences in regulatory compliance in rural areas and in populations of different ethnicities and cultures. Their perception was that the protection of adolescents is not specifically enshrined
in the legal bases and regulatory structures of the countries, meaning that there are both protective factors and tensions in the regulatory framework. While nurses are highly committed to different actions aimed at adolescents, their
participation in policy development and implementation is low, with barriers related to a lack of specialized training
and working conditions.
Conclusions Given nurses’ involvement in different actions aimed at adolescents, they could play a fundamental
role in the development of policies for adolescents and ensure their effective implementation. Policymakers should
consider revising the budget to make compliance viable, incorporating and using monitoring indicators, and increasing the involvement of educational institutions and the community.
Keywords Health policy, Adolescent, Adolescent health, Adolescent development, Nursing, Comprehensive health
care, Adolescent health services
Authors: Candan Kendir, Michael van den Berg, Janika Bloemeke‑Cammin, Oliver Groene, Frederico Guanais, Andree Rochfort, Jose M. Valderas and Niek Klazinga
Abstract:
Healthcare professionals have first‑hand experience with patients in clinical practice and the dynamics in the health‑
care system, which can be of great.....
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Authors: Candan Kendir, Michael van den Berg, Janika Bloemeke‑Cammin, Oliver Groene, Frederico Guanais, Andree Rochfort, Jose M. Valderas and Niek Klazinga
Healthcare professionals have first‑hand experience with patients in clinical practice and the dynamics in the health‑
care system, which can be of great value in the design, implementation, data analysis and dissemination of research
study results. Primary care professionals are particularly important as they provide first contact, accessible, coor‑
dinated, comprehensive and continuous people‑focused care. However, in‑depth examination of the engage‑
ment of health professionals in health system research and planning activities—how professionals are engaged
and how this varies across national contexts‑ is limited, particularly in international initiatives. There is a need
to identify gaps in the planning of engagement activities to inform the design and successful implementation
of future international efforts to improve the responsiveness of health systems to the changing needs of patients
and professionals. The aim of this study was to explore how primary care professionals were engaged in the design
and implementation plans of an international health policy study led by the Organisation for Economic Co‑operation
and Development (OECD). The OECD’s international PaRIS survey measures and disseminates information on patient‑
reported outcome and experience measures (PROMs and PREMs) of people living with chronic conditions who are
managed in primary care. A documentary analysis of 17 written national implementation plans (country roadmaps)
was conducted between January and June 2023. Two reviewers independently performed the screening and data
abstraction and resolved disagreements by discussion. We reported the intended target primary care profession‑
als, phase of the study, channel of engagement, level of engagement, and purpose of engagement. All 17 countries
aimed to engage primary care professionals in the execution plans for the international PaRIS survey. While organisa‑
tions of primary care professionals, particularly of family doctors, were the most commonly targeted group, variation
was found in the timing of engagement activities during the different phases of the study and in the level of engage‑
ment, ranging from co‑development (half of the countries co‑developed the survey together with primary care
professionals) to one‑off consultations with whom. International guidance facilitated the participation of primary care
professionals. Continuous collaborative efforts at the international and national levels can foster a culture of engage‑
ment with primary care organisations and individual professionals and enhance meaningful engagement of primary
care professionals.
Authors: Candan Kendir, Michael van den Berg, Janika Bloemeke‑Cammin, Oliver Groene, Frederico Guanais, Andree Rochfort, Jose M. Valderas and Niek Klazinga
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Authors: Kennedy A. Alatinga, Vivian Hsu, Gilbert Abotisem Abiiro, Edmund Wedam Kanmiki, Emmanuel Kofi Gyan and Chery A. Moyer
Abstract:
Background Ghana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS)
in 2008 to remove financial barriers.....
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Authors: Kennedy A. Alatinga, Vivian Hsu, Gilbert Abotisem Abiiro, Edmund Wedam Kanmiki, Emmanuel Kofi Gyan and Chery A. Moyer
Background Ghana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS)
in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests
that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana’s free maternal healthcare
policy.
Methods Cross-sectional qualitative data were collected through interviews with a purposive sample of 14 mothers
and 8 healthcare providers/administrators in two regions of Ghana between May and September 2022. All interviews
were audio-recorded, transcribed and imported into the NVivo 14.0 software for analysis. An iteratively developed
codebook guided the coding process. Our thematic data analysis followed the Attride-Sterling framework for network
analysis, identifying basic, organising themes and global themes.
Results We found that health systems and demand-side factors are responsible for the persistence of OOP payments despite the existence of the free maternal healthcare policy in Ghana. Reasons for these payments arose
from health systems factors, particularly, NHIS structural issues – delayed and insufficient reimbursements, inadequate
NHIS benefit coverage, stockouts and supply chain challenges and demand-side factors – mothers’ lack of education
about the NHIS benefit package, and passing of cost onto patients. Due to structural and system level challenges,
healthcare providers, exercising their street-level bureaucratic power, have partly repackaged the policy, enabling
the persistence of out-of-pocket payments for maternal healthcare.
Conclusions Urgent measures are required to address the structural and administrative issues confronting Ghana’s
free maternal health policy; otherwise, Ghana may not achieve the sustainable development goals targets on maternal and child health.
Keywords Out-of-pocket payments, Maternal healthcare, National Health Insurance Scheme, Street-level
bureaucrats, Ghana
Authors: Laura Nixon, Laura Sheard, Jessica Sheringham, Amy Creaser, Halima Iqbal, Patience Gansallo, Liina Mansukoski, Maria Bryant and Bridget Lockyer
Abstract:
Background Addressing the upstream social determinants of health (e.g. built environment, education) can reduce
the burden of non-communicable diseases. To do.....
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Authors: Laura Nixon, Laura Sheard, Jessica Sheringham, Amy Creaser, Halima Iqbal, Patience Gansallo, Liina Mansukoski, Maria Bryant and Bridget Lockyer
Background Addressing the upstream social determinants of health (e.g. built environment, education) can reduce
the burden of non-communicable diseases. To do so effectively often requires system-wide collaboration. However,
collaborating across multiple sectors, organizations and disciplines within a complex system can be challenging.
ActEarly was a public health research consortium that aimed to improve child health by building an interdisciplinary,
cross-city partnership to develop and/or evaluate upstream interventions, increase research capacity and improve
collaboration between researchers, local authorities and communities. This paper explores ActEarly’s experiences
of navigating complexity to identify mechanisms that supported its implementation and proposes recommendations
for future intersectoral and interdisciplinary population health research collaborations.
Methods We conducted a longitudinal qualitative study of ActEarly, integrating findings from inductive documentary analysis of internal documents (mainly meetings minutes and reports) (n= 114) and interviews (n= 70) with 45
consortium members at three different timepoints (2018, 2021, 2023). Participants worked across different organizations, cities, roles and levels of seniority in the consortium.
Findings Clarity, Unity, Flexibility and Feasibility were seen as the key mechanisms required to support ActEarly’s
implementation. Clear aims, governance structures and communication were necessary to manage the uncertainty
of the complex system. A unified approach, characterized by strong relationships, having a shared vision and communal access to resources supported effective collaboration. Flexibility was required to adjust to different ways
of working, respond to wider system events and manage the consortium. Establishing feasible aims that responded
to the limitations of the system, the available resources and research infrastructure was required for teams to deliver
the work.
Conclusions Implementing multi-faceted programmes in a complex system can be challenging. We recommend
that future whole-systems consortia seeking to improve population health build Clarity, Unity, Flexibility and Feasibility into their programmes, noting the complex interrelationships between these factors. Iterative reflections
from all parties should support delivery amidst the uncertainty that comes with running a population health research
Authors: Laura Nixon, Laura Sheard, Jessica Sheringham, Amy Creaser, Halima Iqbal, Patience Gansallo, Liina Mansukoski, Maria Bryant and Bridget Lockyer
Account Details mentioned below: For Electronic Fund Transfer: (NEFT/RTGS)
Authors: Georgina Zawolo, Gertrude Nsorma Nyaaba, Gartee Nallo, Karsor Kollie, Rachael Thomson, Joanna Raven, Sally Theobald and Laura Dean
Abstract:
Background Globally, community health worker (CHW) programmes are critical to addressing health worker shortages and have been recognised as critical.....
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Authors: Georgina Zawolo, Gertrude Nsorma Nyaaba, Gartee Nallo, Karsor Kollie, Rachael Thomson, Joanna Raven, Sally Theobald and Laura Dean
Background Globally, community health worker (CHW) programmes are critical to addressing health worker shortages and have been recognised as critical pillars within the drive towards universal health coverage (UHC). In 2016,
the Liberian Ministry of Health launched the National Community Health Services Policy 2016–2021, which included
significant CHW programme reform to address ongoing health workforce capacity gaps in the country. However, little
consideration was given to the impact of such reforms on ongoing health interventions that rely heavily on the use
of CHW cadres. Our study explores how CHW programme reform in Liberia influenced performance of CHWs involved
in the delivery of Neglected Tropical Disease (NTD) programmes to elucidate how health systems reform can impact
the delivery of routine health interventions and vice versa.
Methods We used a qualitative case study approach conducted between March 2017 and August 2018. Our instrumental case study approach uses qualitative methods, including document review of five CHW and NTD programrelated policy documents; 25 key informant interviews with facility, county, and national level decision-makers; and 42
life and job histories with CHWs in Liberia. Data were analysed using a thematic framework approach, guided by Kok
et al. framework of CHW performance. Data were coded in QRS NVIVO 11 Pro.
Results Our findings show that CHW programme reform provides opportunities and challenges for supporting
enhanced CHW performance. In relation to health system hardware, we found that CHW programme reform provides better opportunities for: formal recognition of CHWs; strengthening capacity for effective healthcare delivery
at the community level through improved and formalised training; a more formal supervision structure; and provision of monthly incentives of 70 US dollars. Efficiency gaps in routine intervention delivery can be mitigated
through the strengthening of these hardware components. Conversely, supervision deficits in routine CHW functioning can be supported through health interventions. In relation to systems software, we emphasise the ongoing importance of community engagement in CHW selection that is responsive to gendered power hierarchies
and accompanied by gendered transformative approaches to improving literacy
Authors: Vivi Antonopoulou, Carly Meyer, Paul Chadwick, Beckie Gibson, Falko F. Sniehotta, Ivo Vlaev, Anna Vassova, Louis Goffe, Fabiana Lorencatto, Alison McKinlay and Ange
Abstract:
Background The path of a complaint and patient satisfaction with complaint resolution is often dependent
on the responses of healthcare professionals.....
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Authors: Vivi Antonopoulou, Carly Meyer, Paul Chadwick, Beckie Gibson, Falko F. Sniehotta, Ivo Vlaev, Anna Vassova, Louis Goffe, Fabiana Lorencatto, Alison McKinlay and Ange
Background The path of a complaint and patient satisfaction with complaint resolution is often dependent
on the responses of healthcare professionals (HCPs). It is therefore important to understand the influences shaping
HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs’
responses to complaints, and (2) apply behavioural science frameworks to classify these influences and provide recommendations for more effective complaints handling behaviours.
Methods A systematic literature review of UK published and unpublished (so-called grey literature) studies was conducted (PROSPERO registration: CRD42022301980). Five electronic databases [Scopus, MEDLINE/Ovid, Embase,
Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Health Management Information Consortium
(HMIC)] were searched up to September 2021. Eligibility criteria included studies reporting primary data, conducted
in secondary and tertiary care, written in English and published between 2001 and 2021 (studies from primary care,
mental health, forensic, paediatric or dental care services were excluded). Extracted data included study characteristics, participant quotations from qualitative studies, results from questionnaire and survey studies, case studies
reported in commentaries and descriptions, and summaries of results from reports. Data were synthesized narratively
using inductive thematic analysis, followed by deductive mapping to the Theoretical Domains Framework (TDF).
Results In all, 22 articles and three reports met the inclusion criteria. A total of 8 actors, 22 behaviours and 24
influences on behaviour were found. Key factors influencing effective handling of complaints included HCPs’
knowledge of procedures, communication skills and training, available time and resources, inherent contradictions within the role, role authority, HCPs’ beliefs about their ability to handle complaints, beliefs about the value
of complaints, managerial and peer support and organizational culture and emotions. Themes mapped onto nine
TDF domains: knowledge, skills, environmental context and resources, social/professional role and identity, social influences, beliefs about capability, intentions and beliefs about consequences and emotions. Recommendations
were generated using the Behaviour Change Wheel approach.
Conclusions Through the application of behavioural science, we identified a wide range of individual, social/organizational and environmental influences on complaints handling. Our behavioural analysis informed recommendations
for future intervention strategies, with particular emphasis on reframing and building on the positive aspects of complaints as an underutilized source of feedback at an individual and organizational level.
Keywords Patient safety, Complaints, Quality of healthcare, Behavioural response, Systematic review
Authors: Vivi Antonopoulou, Carly Meyer, Paul Chadwick, Beckie Gibson, Falko F. Sniehotta, Ivo Vlaev, Anna Vassova, Louis Goffe, Fabiana Lorencatto, Alison McKinlay and Ange
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