About STP
Scenario
Background
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Interaction between researchers and policymakers increases the likelihood of research being used by policymakers
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Good timing and timely research increase (and poor timing or lack of timeliness decrease) the likelihood of research being used by policymakers
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When policymakers have negative attitudes towards research evidence, the likelihood of research being used by them decreases
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When policymakers lack relevant skills and expertise, the likelihood of research being used by them decreases
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Policy networks and trust in researchers increase the likelihood of research being used by policymakers, and
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A lack of perceived relevance, the use of jargon, and the production of publications aimed at a scholarly audience are all factors that decrease the likelihood of research being used by policymakers
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Establish strong links between policymakers and researchers, and involve stakeholders in the work undertaken
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Be independent and manage conflicts of interest among those involved in the work
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Use appropriate methods and be transparent in the work
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Collaborate with other organisations
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Start small, have a clear audience and scope, and address important questions
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Build capacity among those working in the organisation
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Be attentive to implementation considerations even if implementation is not a remit
Questions to consider
1. What is the capacity of your organisation to use research evidence to inform decision making?
2. What strategies should be used to ensure collaboration between policymakers, researchers and stakeholders?
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Locating those who support the use of research by policymakers (by accessing, appraising and summarising evidence) within or close to those organisations responsible for policymaking
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Involving policymakers on an advisory board or steering committee in instances when organisations are located outside government or policymaking organisations
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Formal agreements linking academic organisations to policymaking organisations
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Using trusted individuals as ‘knowledge brokers’ to build relationships among researchers and policymakers [34]
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Involving policymakers in research processes such as the preparation of policy briefs [35]
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Involving researchers in policy-informing processes such as policy dialogues [36]
Since the early 1990s, policymakers in the provincial government of the Free State in South Africa have worked closely with researchers on health and health policy-related topics, including the monitoring and evaluation of antiretroviral (ARV) therapy rollouts [21]. The evidence from these studies has exposed major deficiencies in the ARV rollout, and concerns have been raised that if the research findings become too critical, the privileged data access offered to researchers, and the collaboration offered on evaluations, may simply end. This has led to tensions in the relationship between the researchers and the provincial Health Department with both sides being very direct about these concerns. While acknowledging that it is challenging to manage the tensions, both the policymakers and the researchers are committed to learning how to manage this kind of conflict. From the Health Department’s perspective, this is essential in order to evaluate and improve the services delivered by the provincial government. From the researchers’ perspective, this is motivated by “a feeling that you are doing research that is actually relevant and addressing actual needs as opposed to just driving publications” [21]. |
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The degree of involvement (consultation or collaboration)
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Different forums for communication (e.g. committee membership, permanent panels, town meetings, interviews, written consultation)
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Different methods for recruiting stakeholders (e.g. targeted personal invitations, advertisements, or the use of mass media)
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Different ways of training and supporting consumers or other stakeholders to ensure effective involvement
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Different degrees of financial support to facilitate the involvement of consumers or other stakeholders
Few organisations have sought to integrate stakeholders (especially patients and their caregivers) more thoroughly than the National Institute for Health and Clinical Excellence (NICE) in England and Wales [50]. NICE has created effective strategies to involve stakeholder groups including [50‐52]: • A programme within the Institute with dedicated staff responsible for patient and public involvement • The identification and recruitment of stakeholders, including lay people, to NICE’s independent advisory committees • The provision of training and support to lay people on NICE’s committees • The registration of stakeholder groups, which are then routinely consulted electronically and through meetings • The involvement of stakeholders throughout the development of guidance and decisions from topic selection to reviews of draft guidance, through to consultation and active participation on committees • Systematic and transparent responses to stakeholders’ comments on drafts • The development and dissemination of lay versions of NICE’s guidance, versions for key stakeholder groups, and mass media briefings, as well as versions for clinicians and managers, and • The involvement of stakeholders in guidance implementation |
NICE’s experience suggests that the involvement of stakeholders in healthcare decision making is possible and can work well, but requires strong commitment and specific arrangements. It can also be costly. Although NICE’s investment in stakeholder involvement is widely valued, it is uncertain whether the right stakeholders are involved, both in terms of which stakeholder groups engage in the process and in terms of the extent to which the individuals who become involved appropriately represent various stakeholders. It is also uncertain whether the strategies they use are as efficient as they could be – in other words, whether the resources invested in those processes represent good value for money [51]. There are also concerns about the growing burden of managing stakeholder input. Although the number of submissions from stakeholders has been increasing, involvement at the individual level within stakeholder organisations may be less than desired. |
3. What strategies should be used to ensure independence as well as the effective management of conflicts of interest?
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Specific, detailed, structured disclosure forms that solicit as much information as possible about the nature and extent of competing interests. Minimal or open-ended formats for disclosure forms are likely to be uninformative
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Explicit criteria to make decisions easier about whether a disclosed interest constitutes a conflict of interest
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A range of management strategies to address disclosed conflicts of interest, ranging from the public disclosure of conflicts associated with each meeting as a minimum prerequisite, through to the recusal of conflicted individuals as the most extreme measure
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A standard policy requiring all financial ties to be made public (e.g. that they be recorded in meeting minutes), may reduce the number of problematic cases
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A standing committee to review all financial disclosure statements prior to the commencement of committee meetings or hearings, to make management recommendations when necessary, and which can help to ensure that conflict of interest policies are enforced
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Financial arrangements that minimise the risk of inappropriate influence on what evidence is summarised, or how it is summarised
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Management arrangements, including the involvement of independent stakeholders in advisory boards or steering groups
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Mechanisms for managing disputes such as independent arbitrators or appeal processes, particularly for governmental agencies that fund the work and for industry
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Ensuring that decision making is transparent in terms of how evidence is accessed, appraised, summarised and publicly reported
4. What strategies should be used to ensure the use of systematic and transparent methods for accessing, appraising and using research evidence?
The World Health Organization (WHO) has had guidelines for guidelines since 2003, emphasising the use of systematic reviews for the evidence of effects, processes that allow for the explicit incorporation of other types of information (including values), and evidence-informed dissemination and implementation strategies. However, until 2007 systematic reviews were rarely used for developing recommendations [53]. Instead, processes usually relied heavily on experts in a particular specialty, rather than representatives of those who have to live with the consequences of those recommendations, or experts in particular methodological areas. To address these problems and to ensure the use of systematic and transparent methods, WHO has taken a number of actions, based on a review of its own work and the methods used by others [21, 26, 40, 53‐55]. These actions include: • Revising and updating a manual describing the methods that are to be used, which is updated and revised based on both WHO’s experience and new developments • Establishing a committee with a mandate to review and approve plans for developing recommendations prior to initiating the work, and recommendations prior to their publication • Developing checklists for assessing recommendations and plans for developing recommendations based on the manual • Establishing a secretariat and a network to provide training and support to implement the methods described in the manual, and • Monitoring and evaluating the impacts of these arrangements to ensure the use of systematic and transparent methods |
5. What strategies should be used to ensure adequate capacity to employ these methods?
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Collaborate with other organisations, both informally and formally, to learn from their experience in order to avoid the unnecessary duplication of efforts, to draw on their capacity, and to help build capacity (see Table 4 for examples of international collaboration)
The following are examples of international collaborations that help to build capacity and support for the use of research evidence in health policymaking: |
EVIPNet (the Evidence Informed Policy Network) – initiated by the World Health Organization and the Ministries of Health in 25 countries, its aim is to promote the use of research evidence in health policy formulation in order to strengthen health systems [22, 56]. At the country level, EVIPNet takes the form of partnerships between policymakers, researchers and civil society and focuses on facilitating the use of research evidence. Launched in 2005, EVIPNet now supports activities in Africa, Asia and the Americas. |
Region of East Africa Community Health (REACH) policy initiative – established within the East African Community (EAC) (Kenya, Tanzania and Uganda, with the recent addition of Rwanda and Burundi) to bridge the gap between evidence and health policy and practice [57]. Its mission is to access, synthesise, package and communicate evidence required for policy and practice and to influence policy-relevant research agendas for improved population health and health equity in each of the member countries. |
Reforming States Group (RSG) – since 1991, leaders in health policy from the legislative and executive branches of state government, with the financial support and staff collaboration of the Milbank Memorial Fund, have shared their experiences and have worked on practical solutions to shared healthcare problems. They have focused increasingly on the use of research evidence to inform health policy decisions [38, 39, 58]. The RSG now also includes members outside the United States of America. The Center for Evidence-based Policy, which works with RSG members, was established in 2003 by former Oregon Governor, John Kitzhaber, to address public policy challenges by identifying and applying the best available evidence through self-governing communities of interest [59]. |
Cochrane Collaboration – a global network whose aim is to improve healthcare decision making through the preparation and updating of systematic reviews of the effects of healthcare interventions. The Cochrane Collaboration ensures that these reviews are made accessible. See http://cochrane.org/ |
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Build capacity among those working in the organisation through training, making the best use of available staff (numbers are often limited), and actions aimed at retaining skilled staff, and
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Start small, have a clear scope, and address important questions in order to ensure that available resources are focused on areas where they are needed most
Conclusion
Resources
Useful documents and further reading
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Moynihan R, Oxman AD, Lavis JN, Paulsen E. Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier. Rapport Nr 1-2008. Oslo: Nasjonalt kunnskapssenter for helsetjenesten, 2008. http://www.nokc.no/Publikasjoner/469.cms
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Alliance for Health Policy and Systems Research. Strengthening health systems: the role and promise of policy and systems research. Geneva: Alliance for Health Policy and Systems Research, 2004. http://www.who.int/alliance-hpsr/resources/Strengthening_complet.pdf
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Lavis JN, Lomas J, Hamid M, Sewankambo NK. Assessing country-level efforts to link research to action. Bull World Health Organ 2007; 84:620-8. http://www.scielosp.org/scielo.php?pid=S0042-96862006000800013%26script=sci_arttext%26tlng=en
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EUnetHTA Work Package 8. EUnetHTA Handbook on Health Technology Assessment Capacity Building. Barcelona: Catalan Agency for Health Technology Assessment and Research. Catalan Health Service. Department of Health Autonomous Government of Catalonia; 2008. http://www.gencat.cat/salut/depsan/units/aatrm/pdf/eunethta_wp8_hb_hta_capacity_building.pdf
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Thornhill J, Judd M, Clements D. CHSRF Knowledge Transfer: (Re)introducing the self-assessment tool that is helping decision-makers assess their organization’s capacity to use research. Healthc Q 2008; 12:22-4. http://www.longwoods.com/product.php?productid=20410
Links to websites
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Evidence-Informed Policy Network (EVIPNet): http://www.evipnet.org/php/index.php – EVIPNet promotes the systematic use of health research evidence in policymaking. Focusing on low- and middle-income countries, EVIPNet promotes partnerships at the country level between policymakers, researchers and civil society in order to facilitate both policy development and policy implementation through the use of the best scientific evidence available. EVIPNet comprises networks that bring together country-level teams, which are coordinated at both regional and global levels.
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Alliance for Health Systems Policy and Research: http://www.who.int/alliance-hpsr/en/ –The Alliance for Health Policy and Systems Research is an international collaboration based in the WHO, Geneva. It has its origins in the recommendations of the 1996 report of WHO’s Ad Hoc Committee on Health Research which identified a lack of health policy and systems research as a key problem impeding the improvement of health outcomes in low- and middle-income countries. It aims to promote the generation and use of health policy and systems research as a means to improve the health systems of developing countries.
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Canadian Health Services Research Foundation: http://www.chsrf.ca – The Foundation brings researchers and decision makers together to create and apply knowledge to improve health services for Canadians. It is an independent, not-for-profit corporation, established with endowed funds from the federal government and its agencies.