Opportunities for linking research to policy: lessons learned from implementation research in sexual and reproductive health within the ANSER network

The impact of research on policy development is complex [1]. Policy formulation and implementation processes do not necessarily incorporate knowledge and research evidence, while research findings do not necessarily result in policy changes [1, 2]. Research plays a vital role in providing evidence for individual and social interventions that have the potential to impact on healthcare delivery and utilisation in different health systems. It could also provide feasible cost-effective solutions by synthesising evidence of ‘what works best’, ‘for whom’ and ‘in which contexts’ [3]. Weiss discussed the different models of research utilisation and grouped them into ‘the knowledge-driven model’, ‘the problem solving model’, ‘the interactive model’, ‘the political model’, ‘the tactical model’ and ‘the enlightenment model’ and defined ‘research as part of the intellectual enterprise of the society’ [4]. These different models explain the spectrum of research utilisation by policy-makers, going from a linear process (knowledge-driven model) that assumes uptake of evidence is based on the existence of information and relevant technology only, to more dynamic interactive models that take into account context, political priorities, stakeholder involvement and multiple sources of information used in the policy development process [4].

The uptake of research findings in policy development remains challenging, as this process is influenced by a myriad of societal factors, including the availability of resources, values of the policy-makers and the socio-political context [5]. These difficulties are not taken into account in the development and implementation of research. Researchers often believe that, if their research is rigorous enough and the findings are published, uptake by politicians and service providers would be inevitable [6]. However, in reality, this is rarely the case. The existence of published, relevant evidence-based research is not sufficient to ensure uptake [7]. Translating research evidence into policy involves an emotive component, of manipulation and persuasion, that most researchers are either ignorant of or unwilling to do; however, this is essential to framing the policy dialogue [8].

There are several challenges to translating research into policy in the health policy environment, including the ‘dynamic nature of the health policy environment’, and the fact that health policy is interwoven with other domains. These challenges make documenting evidence and navigating the different interests of policy-makers and other stakeholders difficult [9]. In this article, by ‘stakeholders’ we refer to the different actors involved in sexual and reproductive health and rights (SRHR) policy formulation, namely policy-makers and civil society. A systematic review of barriers and facilitators to uptake of research evidence by policy-makers identified “unavailability or lack of access to research evidence, level of clarity/relevance/reliability of research eveidence, lack of time or opportunity to utilise research evidence, costs and lack of knowledge of research methods” as commonly cited barriers to research uptake [10]. Facilitators commonly cited as important were “timely access to good quality and relevant research evidence, and collaborations between researchers and policy-makers, as the most important factors that influence the uptake of evidence by policy-makers” [10]. These findings address some of the inherent assumptions made in existing health policy research about policy-makers and what ‘evidence-based policy-making’ means. Policy-makers will prioritise the perceived relevance of the research evidence to their policy strategy over the values attached to research methodology and quality by researchers. A critique of assumptions that portray policy-makers as “interest-oriented and indifferent to evidence” calls to attention the need for nuance in interpreting research on uptake of evidence by policy-makers [8]. Oliver et al. [8, 10] encourage a shift in focus from “evidence of research uptake” to understanding the value placed on specific sources and types of information by policy-makers, for example, locally sourced data might be more valued than randomised controlled trials that are published and recognised internationally.

In the field of sexual and reproductive health (SRH) research, as some interventions are targeted at vulnerable groups and at topics that are often culturally sensitive, difficulties emerge in navigating conflicts between research evidence and cultural and political norms or debates. Policy-makers have competing priorities that are value laden and influenced by context, requiring the added effort of advocacy for “SRH supportive policies” as a way to encourage prioritisation of SRH policies [11].

The Academic Network for Sexual and Reproductive Health and Rights Policy (ANSER) was developed to address the gap between research and policy in SRHR. It is a global platform for SRHR policy research, education and healthcare delivery. The network does so by initiating collaborative research on SRHR policy-related topics, by developing a portfolio of education and training programmes on SRHR policy, and by fostering interaction between SRHR researchers and policy-makers. The network is currently composed of 28 institutions in 16 countries, across 5 continents. A workshop was organised to pool the knowledge of ANSER member experts on best practices for translating SRH research into policies. The workshop took place on the November 29, 2017, at Ghent University, Belgium. Selected case studies were presented and interactive group discussions held to develop recommendations for promoting translation of SRH research into policy. This article presents some of the main conclusions from the workshop and strategies to ensure research uptake.

A facilitated interactive workshop within the ANSER was organised, incorporating an experiential learning cycle developed by Kolb et al. [12] to ensure that discussions were reflective and based on key learning points from the experiences of the researchers present. Three case studies, which were based on successful methods that promoted the ‘uptake of research evidence’ into policy development and implementation, were presented by experts. The 22 workshop participants included SRH researchers from different leading academic institutions based in South Africa, Germany, China, Kenya, Nigeria, Portugal, Belgium and the United Kingdom, as well as SRHR experts with experience in developing international health policies drawn from different continents, including the European Union, Africa and Asia.

The presenters for the workshop included Gunta Lazdane (former Programme Manager, Sexual and Reproductive Health, WHO Regional Office for Europe) who introduced key issues around translating SRHR research into policy based on her experience working at the WHO Regional Office in Europe. Case studies were then presented by Marleen Temmerman (Gynaecologist, Professor, former Director of the Department of Reproductive Health and Research, at WHO and former Senator), Ines Keygnaert (Senior Researcher at Ghent University responsible for implementing the first National Programme for Sexual Assault Care Centres in Belgium) and Wilson de los Reyes (Senior Legal Advisor and Representative to the UN for The Swedish Association for Sexuality Education – The Swedish Association for Sexuality Education). The case studies covered experiences of implementing policies influenced by SRHR research in the European Union, Africa and Asia.

These experts’ presentations outlined the best practices and key learning points from their experiences; these were discussed in three groups, using facilitated interactive methods. Participants were randomly assigned to the groups to ensure a diverse representation of interests and experiences. The reflexive discussions were guided by questions focused on identifying the significant changes that resulted from the programme, and implications of their research for policy implementation. More details about these research questions are included in the Appendix. The workshop participants proposed concrete ‘real world’ applications of the lessons learned.

The results of the interactive sessions were documented and key recommendations outlined. Key themes and discourses were identified and linked with recommendations focused on how researchers can engage with stakeholders and work together more efficiently. The findings were interpreted using the framework proposed by Hanney et al. [1], which outlines the “place of policy-making in the stages of assessment of research utilisation and final outcomes” (Fig. 1, [1]). Key stages relevant to the case studies were identified within the framework and used for this purpose.

The key stages relevant to the case studies are outlined below:

The key themes that emerged from the facilitated group discussions are discussed herein. These recommendations were focused on two levels, namely researcher-stakeholder focused, where recommendations focused on ways to engage policy-makers and other stakeholders, and researcher-researcher focused, where recommendations focused on more efficient ways for collaborative research to promote the policy uptake of research.

These different types of recommendations were applied across the different stages identified that were relevant to the case studies. It is important to note that policy uptake of research findings is not a linear process and there are often time loops between stages. Nevertheless, to communicate the key findings of the workshop, we have described our findings using the stages described by Hanney et al. [1], specifically Stages 0, 1, 4 and 5, as these are opportunities within the policy formulation and implementation process for researchers to engage with stakeholders. An overview of the case studies and entry points are presented in Table 1.

The findings from the participatory workshop and the literature review elucidate the importance of co-production and collaboration between researchers, policy-makers and other stakeholders to improve research utilisation in policy-making [18, 19]. This echoes similar findings in other research focused on uptake of SRHR research in policy-making [11]. The importance of identifying opportunities and strategic phases in the research and policy cycle where uptake of evidence could be maximised through dialogue with stakeholders is supported by evidence from the case studies discussed in our research in Ghana, Belgium and Kenya [14, 15, 17, 16], as well as by other research done in the Netherlands among stakeholders working in international development and SRHR [20]. Joint agenda-setting has been mentioned as an important approach for advocating the prioritisation of specific SRHR issues and an opportunity for policy framing, especially in low- and middle-income contexts [21]. Policy-makers often interpret their priorities through a context and value-laden lens. Understanding their decision-making process and the information sources that are valued the most by them, would strengthen researchers’ efforts to engage and advocate for specific SRHR priorities [10]. Developing strong communication pathways, skills and practices with policy-makers sustained over time, was found to be essential for the effective translation and dissemination of SRH research evidence by programme partners involved in developing a comprehensive care model for responding to sexual and gender-based violence in Kenya, as discussed in one of the case studies [17] and also among a health policy group in Nigeria [22]. An active engagement process, which involves sustained stakeholder engagement, dialogue with policy-makers, media engagement and pre-emptively synthesising relevant SRHR evidence, has been proposed by different research papers on SRHR policy [11, 23‐26]. These papers echo our findings that the policy cycle is not linear, and sustained engagement is the best way to identify strategic entry points for policy uptake.

Translating SRH research findings into feasible policy and practice is possible but needs to occur in conjunction with effective stakeholder engagement at different stages of the research cycle. This can only occur taking into account existing and changing political contexts and priorities. The ANSER is an opportunity to help close the gap between SRH research and policy.