Implementation research evidence uptake and use for policy-making
Identifieur interne : 002D41 ( Pmc/Corpus ); précédent : 002D40; suivant : 002D42Implementation research evidence uptake and use for policy-making
Auteurs : Ulysses Panisset ; Tracey Pérez Koehlmoos ; Ahmad Hamdi Alkhatib ; Tomás Pantoja ; Prabal Singh ; Jane Kengey-Kayondo ; Ben Mccutchen ; Miguel Ngel González BlockSource :
- Health Research Policy and Systems [ 1478-4505 ] ; 2012.
Abstract
A major obstacle to the progress of the Millennium Development Goals has been the inability of health systems in many low- and middle-income countries to effectively implement evidence-informed interventions. This article discusses the relationships between implementation research and knowledge translation and identifies the role of implementation research in the design and execution of evidence-informed policy. After a discussion of the benefits and synergies needed to translate implementation research into action, the article discusses how implementation research can be used along the entire continuum of the use of evidence to inform policy. It provides specific examples of the use of implementation research in national level programmes by looking at the scale up of zinc for the treatment of childhood diarrhoea in Bangladesh and the scaling up of malaria treatment in Burkina Faso. A number of tested strategies to support the transfer of implementation research results into policy-making are provided to help meet the standards that are increasingly expected from evidence-informed policy-making practices.
Url:
DOI: 10.1186/1478-4505-10-20
PubMed: 22748142
PubMed Central: 3443065
Links to Exploration step
PMC:3443065Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Implementation research evidence uptake and use for policy-making</title><author><name sortKey="Panisset, Ulysses" sort="Panisset, Ulysses" uniqKey="Panisset U" first="Ulysses" last="Panisset">Ulysses Panisset</name><affiliation><nlm:aff id="I1">Coordinator, Evidence Informed Policy Network (EVIPNet), Department of Knowledge Management and Sharing, WHO, Avenue Appia 20, 1211, Geneva 27, Switzerland</nlm:aff></affiliation></author><author><name sortKey="Koehlmoos, Tracey Perez" sort="Koehlmoos, Tracey Perez" uniqKey="Koehlmoos T" first="Tracey Pérez" last="Koehlmoos">Tracey Pérez Koehlmoos</name><affiliation><nlm:aff id="I2">Programme Head, Health & Family Planning Systems Programme, ICDDR,B, 68 ShahedTajuddin Ahmed, Sarani, Mohakhali, Dhaka, 1212, Bangladesh</nlm:aff></affiliation></author><author><name sortKey="Alkhatib, Ahmad Hamdi" sort="Alkhatib, Ahmad Hamdi" uniqKey="Alkhatib A" first="Ahmad Hamdi" last="Alkhatib">Ahmad Hamdi Alkhatib</name><affiliation><nlm:aff id="I3">Faculty of Health Sciences, McMaster University; Forum Fellow, McMaster Health Forum, 1280 Main St. West, Hamilton, ON, L8S 4L6, Canada</nlm:aff></affiliation></author><author><name sortKey="Pantoja, Tomas" sort="Pantoja, Tomas" uniqKey="Pantoja T" first="Tomás" last="Pantoja">Tomás Pantoja</name><affiliation><nlm:aff id="I4">Family Medicine Department, Pontificia Universidad Católica de Chile, Avenue Libertador Bernardo O’Higgins 340, Santiago, Chile</nlm:aff></affiliation></author><author><name sortKey="Singh, Prabal" sort="Singh, Prabal" uniqKey="Singh P" first="Prabal" last="Singh">Prabal Singh</name><affiliation><nlm:aff id="I5">ACCESS Health International Inc., Centre for Emerging Markets Solutions, Indian School of Business, Gachibowli, Hyderabad, 500 032, Andhra Pradesh, India</nlm:aff></affiliation></author><author><name sortKey="Kengey Kayondo, Jane" sort="Kengey Kayondo, Jane" uniqKey="Kengey Kayondo J" first="Jane" last="Kengey-Kayondo">Jane Kengey-Kayondo</name><affiliation><nlm:aff id="I6">Strategic Alliances, Special Programme for Research and Training in Tropical Diseases (TDR), WHO, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland</nlm:aff></affiliation></author><author><name sortKey="Mccutchen, Ben" sort="Mccutchen, Ben" uniqKey="Mccutchen B" first="Ben" last="Mccutchen">Ben Mccutchen</name><affiliation><nlm:aff id="I7">Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L6, Canada</nlm:aff></affiliation></author><author><name sortKey="Gonzalez Block, Miguel Ngel" sort="Gonzalez Block, Miguel Ngel" uniqKey="Gonzalez Block M" first="Miguel Ngel" last="González Block">Miguel Ngel González Block</name><affiliation><nlm:aff id="I8">Centre for Health Systems Research Institute, Av. Universidad 655 Col. Santa María Ahuacatitlán Cuernavaca, (CP 62100), Morelos, México</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22748142</idno><idno type="pmc">3443065</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443065</idno><idno type="RBID">PMC:3443065</idno><idno type="doi">10.1186/1478-4505-10-20</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002D41</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002D41</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Implementation research evidence uptake and use for policy-making</title><author><name sortKey="Panisset, Ulysses" sort="Panisset, Ulysses" uniqKey="Panisset U" first="Ulysses" last="Panisset">Ulysses Panisset</name><affiliation><nlm:aff id="I1">Coordinator, Evidence Informed Policy Network (EVIPNet), Department of Knowledge Management and Sharing, WHO, Avenue Appia 20, 1211, Geneva 27, Switzerland</nlm:aff></affiliation></author><author><name sortKey="Koehlmoos, Tracey Perez" sort="Koehlmoos, Tracey Perez" uniqKey="Koehlmoos T" first="Tracey Pérez" last="Koehlmoos">Tracey Pérez Koehlmoos</name><affiliation><nlm:aff id="I2">Programme Head, Health & Family Planning Systems Programme, ICDDR,B, 68 ShahedTajuddin Ahmed, Sarani, Mohakhali, Dhaka, 1212, Bangladesh</nlm:aff></affiliation></author><author><name sortKey="Alkhatib, Ahmad Hamdi" sort="Alkhatib, Ahmad Hamdi" uniqKey="Alkhatib A" first="Ahmad Hamdi" last="Alkhatib">Ahmad Hamdi Alkhatib</name><affiliation><nlm:aff id="I3">Faculty of Health Sciences, McMaster University; Forum Fellow, McMaster Health Forum, 1280 Main St. West, Hamilton, ON, L8S 4L6, Canada</nlm:aff></affiliation></author><author><name sortKey="Pantoja, Tomas" sort="Pantoja, Tomas" uniqKey="Pantoja T" first="Tomás" last="Pantoja">Tomás Pantoja</name><affiliation><nlm:aff id="I4">Family Medicine Department, Pontificia Universidad Católica de Chile, Avenue Libertador Bernardo O’Higgins 340, Santiago, Chile</nlm:aff></affiliation></author><author><name sortKey="Singh, Prabal" sort="Singh, Prabal" uniqKey="Singh P" first="Prabal" last="Singh">Prabal Singh</name><affiliation><nlm:aff id="I5">ACCESS Health International Inc., Centre for Emerging Markets Solutions, Indian School of Business, Gachibowli, Hyderabad, 500 032, Andhra Pradesh, India</nlm:aff></affiliation></author><author><name sortKey="Kengey Kayondo, Jane" sort="Kengey Kayondo, Jane" uniqKey="Kengey Kayondo J" first="Jane" last="Kengey-Kayondo">Jane Kengey-Kayondo</name><affiliation><nlm:aff id="I6">Strategic Alliances, Special Programme for Research and Training in Tropical Diseases (TDR), WHO, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland</nlm:aff></affiliation></author><author><name sortKey="Mccutchen, Ben" sort="Mccutchen, Ben" uniqKey="Mccutchen B" first="Ben" last="Mccutchen">Ben Mccutchen</name><affiliation><nlm:aff id="I7">Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L6, Canada</nlm:aff></affiliation></author><author><name sortKey="Gonzalez Block, Miguel Ngel" sort="Gonzalez Block, Miguel Ngel" uniqKey="Gonzalez Block M" first="Miguel Ngel" last="González Block">Miguel Ngel González Block</name><affiliation><nlm:aff id="I8">Centre for Health Systems Research Institute, Av. Universidad 655 Col. Santa María Ahuacatitlán Cuernavaca, (CP 62100), Morelos, México</nlm:aff></affiliation></author></analytic><series><title level="j">Health Research Policy and Systems</title><idno type="eISSN">1478-4505</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>A major obstacle to the progress of the Millennium Development Goals has been the
inability of health systems in many low- and middle-income countries to effectively
implement evidence-informed interventions. This article discusses the relationships
between implementation research and knowledge translation and identifies the role of
implementation research in the design and execution of evidence-informed policy.
After a discussion of the benefits and synergies needed to translate implementation
research into action, the article discusses how implementation research can be used
along the entire continuum of the use of evidence to inform policy. It provides
specific examples of the use of implementation research in national level programmes
by looking at the scale up of zinc for the treatment of childhood diarrhoea in
Bangladesh and the scaling up of malaria treatment in Burkina Faso. A number of
tested strategies to support the transfer of implementation research results into
policy-making are provided to help meet the standards that are increasingly expected
from evidence-informed policy-making practices.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lengeler, C" uniqKey="Lengeler C">C Lengeler</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Madon, T" uniqKey="Madon T">T Madon</name></author><author><name sortKey="Hofman, Kj" uniqKey="Hofman K">KJ Hofman</name></author><author><name sortKey="Kupfer, L" uniqKey="Kupfer L">L Kupfer</name></author><author><name sortKey="Glass, Ri" uniqKey="Glass R">RI Glass</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lavis, Jn" uniqKey="Lavis J">JN Lavis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Remme, Jhf" uniqKey="Remme J">JHF Remme</name></author><author><name sortKey="Adam, T" uniqKey="Adam T">T Adam</name></author><author><name sortKey="Becerra Posada, F" uniqKey="Becerra Posada 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Health Res Policy Syst</journal-id><journal-id journal-id-type="iso-abbrev">Health Res Policy Syst</journal-id><journal-title-group><journal-title>Health Research Policy and Systems</journal-title></journal-title-group><issn pub-type="epub">1478-4505</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22748142</article-id><article-id pub-id-type="pmc">3443065</article-id><article-id pub-id-type="publisher-id">1478-4505-10-20</article-id><article-id pub-id-type="doi">10.1186/1478-4505-10-20</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Implementation research evidence uptake and use for policy-making</article-title></title-group><contrib-group><contrib contrib-type="author" id="A1"><name><surname>Panisset</surname><given-names>Ulysses</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>panissetu@who.int</email></contrib><contrib contrib-type="author" corresp="yes" id="A2"><name><surname>Koehlmoos</surname><given-names>Tracey Pérez</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>Tracey@icddrb.org</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Alkhatib</surname><given-names>Ahmad Hamdi</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>ahmad.alkhatib@medportal.ca</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Pantoja</surname><given-names>Tomás</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>tpantoja@med.puc.cl</email></contrib><contrib contrib-type="author" id="A5"><name><surname>Singh</surname><given-names>Prabal</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>prabal.singh@accessh.org</email></contrib><contrib contrib-type="author" id="A6"><name><surname>Kengey-Kayondo</surname><given-names>Jane</given-names></name><xref ref-type="aff" rid="I6">6</xref><email>kengeyakayondo@who.int</email></contrib><contrib contrib-type="author" id="A7"><name><surname>McCutchen</surname><given-names>Ben</given-names></name><xref ref-type="aff" rid="I7">7</xref><email>ben.mccutchen@medportal.ca</email></contrib><contrib contrib-type="author" id="A8"><name><surname>González Block</surname><given-names>Miguel Ángel</given-names></name><xref ref-type="aff" rid="I8">8</xref><email>miguel.gonzalezblock@insp.mx</email></contrib></contrib-group><aff id="I1"><label>1</label>Coordinator, Evidence Informed Policy Network (EVIPNet), Department of Knowledge Management and Sharing, WHO, Avenue Appia 20, 1211, Geneva 27, Switzerland</aff><aff id="I2"><label>2</label>Programme Head, Health & Family Planning Systems Programme, ICDDR,B, 68 ShahedTajuddin Ahmed, Sarani, Mohakhali, Dhaka, 1212, Bangladesh</aff><aff id="I3"><label>3</label>Faculty of Health Sciences, McMaster University; Forum Fellow, McMaster Health Forum, 1280 Main St. West, Hamilton, ON, L8S 4L6, Canada</aff><aff id="I4"><label>4</label>Family Medicine Department, Pontificia Universidad Católica de Chile, Avenue Libertador Bernardo O’Higgins 340, Santiago, Chile</aff><aff id="I5"><label>5</label>ACCESS Health International Inc., Centre for Emerging Markets Solutions, Indian School of Business, Gachibowli, Hyderabad, 500 032, Andhra Pradesh, India</aff><aff id="I6"><label>6</label>Strategic Alliances, Special Programme for Research and Training in Tropical Diseases (TDR), WHO, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland</aff><aff id="I7"><label>7</label>Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L6, Canada</aff><aff id="I8"><label>8</label>Centre for Health Systems Research Institute, Av. Universidad 655 Col. Santa María Ahuacatitlán Cuernavaca, (CP 62100), Morelos, México</aff><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub"><day>2</day><month>7</month><year>2012</year></pub-date><volume>10</volume><fpage>20</fpage><lpage>20</lpage><history><date date-type="received"><day>18</day><month>3</month><year>2012</year></date><date date-type="accepted"><day>10</day><month>6</month><year>2012</year></date></history><permissions><copyright-statement>Copyright ©2012 Panisset et al.; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2012</copyright-year><copyright-holder>Panisset et al.; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which
permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.health-policy-systems.com/content/10/1/20"></self-uri><abstract><p>A major obstacle to the progress of the Millennium Development Goals has been the
inability of health systems in many low- and middle-income countries to effectively
implement evidence-informed interventions. This article discusses the relationships
between implementation research and knowledge translation and identifies the role of
implementation research in the design and execution of evidence-informed policy.
After a discussion of the benefits and synergies needed to translate implementation
research into action, the article discusses how implementation research can be used
along the entire continuum of the use of evidence to inform policy. It provides
specific examples of the use of implementation research in national level programmes
by looking at the scale up of zinc for the treatment of childhood diarrhoea in
Bangladesh and the scaling up of malaria treatment in Burkina Faso. A number of
tested strategies to support the transfer of implementation research results into
policy-making are provided to help meet the standards that are increasingly expected
from evidence-informed policy-making practices.</p></abstract><kwd-group><kwd>Evidence-informed policy</kwd><kwd>Implementation</kwd><kwd>Knowledge translation</kwd><kwd>Policy</kwd><kwd>Policy-making</kwd></kwd-group></article-meta></front><body><sec><title>Introduction</title><p>The 2010 Millennium Development Goals (MDGs) Report reveals that without a major push
forward, many of the MDG targets are likely to be missed in most regions [<xref ref-type="bibr" rid="B1">1</xref>]. A major obstacle to the progress of the MDGs has been
the inability of health systems in many low- and middle-income countries to effectively
implement evidence-informed interventions. Consider MDG 6 (combat HIV/AIDS, malaria and
other diseases), which explicitly outlines that people at risk of malaria (and
especially children less than 5) should be sleeping under insecticide-treated bed nets.
The value of insecticide-treated bed nets is supported by high quality systematic
reviews, which indicate that bed nets are highly effective in reducing childhood
mortality and morbidity from malaria [<xref ref-type="bibr" rid="B2">2</xref>].
However, only 35% of young children were sleeping under bed nets in 2010, still below
the World Health Assembly target of 80% [<xref ref-type="bibr" rid="B3">3</xref>]. In
general, nearly 14,000 people in sub-Saharan Africa and South Asia die daily from
preventable and/or treatable diseases that in some cases have been eliminated in
developed countries, including malaria, HIV and diarrheal diseases [<xref ref-type="bibr" rid="B4">4</xref>].</p><p>This illustrates that the availability of evidence on the effectiveness of an
intervention is necessary, but not sufficient to produce better health outcomes.
Barriers and facilitators of implementation must be identified and strategies must be
designed in order to improve the chances of successfully delivering a proven
intervention. Implementation research can detect barriers and facilitators of delivery
and characterize strategies that can address and utilize, respectively, such factors
[<xref ref-type="bibr" rid="B5">5</xref>,<xref ref-type="bibr" rid="B6">6</xref>]. However,
generating implementation research evidence is not sufficient to improve the chances of
successfully delivering an intervention; it is also important that innovative tools are
used to ensure that implementation research is available for uptake and use by
policy-makers. As international agencies are increasingly recognizing, “research
helps us to identify what works, what does not work and how to understand the local
context when introducing new ways of working [but] there is no point doing research if
the findings do not get into policy and practice” [<xref ref-type="bibr" rid="B7">7</xref>]. Therefore, emphasis must be placed not only on the production of
implementation research, but also on its integration into knowledge translation (KT)
processes to ensure its use by policy-makers and programme managers.</p><p>KT is defined by the Canadian Institutes for Health Research (CIHR) as “…a
dynamic and iterative process that includes synthesis, dissemination, exchange and
ethically-sound application of knowledge, through sustainable partnerships to improve
the health of citizens, provide more effective health services and products and
strengthen the health care system” [<xref ref-type="bibr" rid="B8">8</xref>]. The
main objective of this paper is to explore the different ways in which implementation
research can inform policy-making through KT processes as they are integrated into
knowledge translation platforms [<xref ref-type="bibr" rid="B9">9</xref>]. To this end,
the article discusses the relationships between implementation research and KT and
identifies the role of implementation research in the design and implementation of
evidence-informed policy.</p></sec><sec><title>Benefits of using implementation research in knowledge translation to inform
policy-making</title><p>Many promising health interventions, when implemented, fail to achieve their maximum
potential and/or reach those most in need. In some cases they may even cause economic or
health harms. Health systems interventions are often social experiments; there is the
potential for not only positive, but also null or negative outcomes [<xref ref-type="bibr" rid="B10">10</xref>,<xref ref-type="bibr" rid="B11">11</xref>]. If policy-makers are
unaware of, or ignore evidence on the root causes of problems in the implementation of
interventions, they increase the chances of producing negative outcomes. This includes
wasting precious resources on inadequately designed programmes and policies and, more
importantly, causing harm to human lives. Implementation research “aims to develop
strategies for available or new health interventions in order to improve access to and
use of these interventions by the populations in need” [<xref ref-type="bibr" rid="B6">6</xref>]. By identifying the barriers and facilitators and trying to
address them in the design of strategies, implementation research increases the chances
of producing positive outcomes.</p><p>It is well established that implementation research can be used to improve access to
vaccines, treatments, diagnostics, and interventions. However, implementation research
also can be used to strengthen health systems, improve patient safety, expand community
based interventions and strengthen public-private partnerships [<xref ref-type="bibr" rid="B12">12</xref>]. Political support and interdisciplinary frameworks are still
in need of developing in some of the newer areas that can employ of implementation
research. To that end in 2011 a ‘road map for action’ was developed by World
Health Organization’s Special Programme for Training and Research on Tropical
Diseases [<xref ref-type="bibr" rid="B12">12</xref>].</p><p>Synergies between implementation research and KT improve demand, delivery and access to
interventions. Implementation research can inform at multiple points in the
policy-making process. Research can be used to identify problems, set country priorities
during the design stages of policymaking, monitor and evaluate policies and programmes
and/or ensure the successful implementation of policies once they have been devised. At
each point, implementation research can address the political, historical, cultural,
socioeconomic, health services and/or resource factors that affect policy-making and
policy implementation. To summarize, implementation research can facilitate
policy-making by helping to:</p><p>· Map the political and institutional context in which policies will be
implemented,</p><p>· identify barriers to implementation and the determinants which prevent
effective access to interventions,</p><p>· develop practical solutions and monitor and evaluate new
implementation strategies,</p><p>· introduce evidence-informed implementation strategies in health
systems,</p><p>· facilitate full scale implementation and</p><p>· collaborate in policy evaluation and modification<italic>.</italic></p><p>KT can facilitate the use of implementation research in policy-making, helping
politicians, policy-makers and managers to make better decisions. As discussed later in
the article, KT processes aided policy-makers in Bangladesh in integrating
implementation research in decision-making on the scale-up of zinc use for childhood
diarrhea. The article also discusses the use of implementation research by KT platforms,
such as the WHO’s Evidence Informed Policy Network (EVIPNet). KT platforms
integrate KT processes, which are characterized by the following elements:</p><p>· A governing body comprising of representatives from groups of
producers, purveyors and users of evidence,</p><p>· the political will to act based on the best available evidence,</p><p>· regular priority-setting processes to ensure that efforts to link
research to action are highly relevant to the needs of potential research users,</p><p>· efforts to push evidence into policy-making in areas where actionable
messages have been identified and</p><p>· a range of efforts to facilitate user pull of evidence [<xref ref-type="bibr" rid="B9">9</xref>].</p></sec><sec><title>Challenges and opportunities for translating implementation research evidence</title><p>Implementation research faces technical and political challenges in informing policy
when addressing the delivery of innovative programmes, services and/or tools. At this
stage, substantial investments will have been committed towards the development of the
intervention, putting stakeholders at great political risk. As such, a large number of
stakeholders will favor the implementation of the policy, although they will not
necessarily agree as to the feasibility of the expected benefits. The implementation of
a policy may also face opposition at multiple decision points; the resistance may come
from a programme manager concerned with costs and profit margin, the target population
or healthcare providers. In either case, implementation research can provide evidence to
either back or refute the basis for opposition or support. Stakeholders will therefore
interpret evidence from implementation research through both technical and political
contexts [<xref ref-type="bibr" rid="B13">13</xref>]. Further there are issues such as
opposition from industry and potentially from other sectors as well as high turn-over
among political appointees working in government agencies. For policy-makers in
particular, evidence may be perceived as a way of reducing political and legal risk, as
it allows politicians to acknowledge that evidence to inform decisions about public
programmes is incomplete. In the case that programmes do not work as expected, research
can also provide alternative courses for action [<xref ref-type="bibr" rid="B11">11</xref>].</p><p>The differences between policy-makers and researchers that have been exhaustively
identified and described in the KT literature represent another challenge for the uptake
of implementation research. For instance, in Uganda, there is evidence that
implementation research results are valued differently by researchers and policy-makers.
While researchers place importance on research evidence that is backed by rigorous
methodology, policy-makers are more concerned about evidence that captures feasibility
constraints.</p><p>KT offers opportunities to help overcome the challenges in the uptake and use of
implementation research. KT tools and strategies can help researchers to deliver
evidence that is packaged to address the concerns and needs of decision makers
[<xref ref-type="bibr" rid="B5">5</xref>]. This includes packaging evidence to
address dimensions of feasibility, including social acceptability, cost-effectiveness,
community benefits and health system readiness to deliver the intervention
[<xref ref-type="bibr" rid="B14">14</xref>]. Some of these KT processes
include:</p><p>· Encouraging researchers to develop and translate implementation
research that targets current health systems needs,</p><p>· packaging systematic reviews of relevant, wide-ranging and high
quality implementation research literature focused on specific recommendations,</p><p>· preparing policy briefs and other executive summaries on
implementation research results focused on policy makers and</p><p>· scientific publications with shared authorship between researchers and
policy makers [<xref ref-type="bibr" rid="B5">5</xref>,<xref ref-type="bibr" rid="B15">15</xref>].</p><p>Interactive KT processes offer opportunities to overcome the technical and political
barriers for the uptake of implementation research, as well as helping policy-makers and
researchers to identify mutual interests, to relate to research evidence with greater
trust and interest and to learn how to better work together. Systematic reviews have
shown that “interactions between researchers and health care policy-makers
increased the prospects for research use by policy-makers” [<xref ref-type="bibr" rid="B16">16</xref>]. Some of these interactive KT processes include:</p><p>· Preparing a deliberative policy dialogue (or other
stakeholder-engagement approaches) as a key step to review and start implementing the
policy options, with direct involvement of policy-makers, managers, health care
providers and researchers to elicit tacit knowledge and evaluate feasibility,</p><p>· priority setting exercises whereby policy makers and researchers
develop a shared implementation research and policy agenda,</p><p>· clearinghouses of easy-to-access and clearly relevant case studies,
systematic reviews and other publications relevant for implementation of specific
policies and packaged to facilitate its use in policy-making and</p><p>· learning workshops for decision makers with researchers to encourage
collaboration on finding, appraising (both quality and relevance) and applying
implementation research [<xref ref-type="bibr" rid="B5">5</xref>,<xref ref-type="bibr" rid="B17">17</xref>].</p><p>The deliberative dialogues can be especially designed to elicit policy-makers’
tacit knowledge and negotiating positions as a starting point to identify the research
evidence to confirm or critique their positions [<xref ref-type="bibr" rid="B18">18</xref>]. The research results used to inform such dialogues must be
thoroughly evaluated and graded to decide how much confidence to place in the evidence
presented [<xref ref-type="bibr" rid="B19">19</xref>]. Interactive processes like
deliberative dialogues also help develop a common value framework across researchers and
other stakeholders, promoting team building and distributed leadership for action. Trust
depends on the selection of stakeholders for dialogues. Participants must be carefully
chosen and comply with house-rules on the diffusion of deliberations and on the
confidentiality of participants [<xref ref-type="bibr" rid="B17">17</xref>].</p><p>Accurate reports in the mass media represent another important means of delivering
up-to-date evidence to policy-makers. Researchers can work with journalists to use media
reports as means of disseminating evidence to decision makers in a timely manner, while
also informing the public. Several strategies and tools have been developed in order to
facilitate the accurate reporting of research by journalists, including structured press
releases, fact boxes, press conferences, providing ready-to-use stories, avoiding jargon
in communication, providing access to experts, tip sheets and providing workshops and
other types of training to help journalists gain a greater understanding of
evidence-informed health policymaking [<xref ref-type="bibr" rid="B14">14</xref>,<xref ref-type="bibr" rid="B20">20</xref>]. Some researchers develop media releases for systematic
reviews and profile and place in context locally conducted studies [<xref ref-type="bibr" rid="B9">9</xref>], providing evidence that is both timely and
relevant.</p></sec><sec><title>An example of implementation research supporting KT from Bangladesh</title><p>The scale up of zinc use for childhood diarrhea in Bangladesh, known as the ‘SUZY
Project’ for Scaling Up Zinc for Young Children with Diarrhea, illustrates the use
of KT strategies in encouraging the uptake of implementation research by policy-makers.
Systematic reviews of the research literature and on a joint UNICEF/WHO recommendation
established that zinc provides a very effective treatment for diarrhea among children
under five years of age by reducing the severity and duration of diarrhea as well as the
likelihood of future episodes of diarrhea and the need for hospitalization. It was
estimated that zinc treatment could save the lives of 30,000 to 75,000 children per year
in Bangladesh alone [<xref ref-type="bibr" rid="B21">21</xref>-<xref ref-type="bibr" rid="B25">25</xref>].</p><p>As a first step towards implementing this promising intervention, the Ministry of Health
and Family Welfare (MOHFW) in collaboration with the Scaling Up of Zinc in Early
Childhood (SUZY) team developed two committees: A National Advisory Committee, headed by
the Health Secretary, and a Planning and Implementation Committee, headed by the Joint
Secretary, Public Health and WHO. These committees acted as platforms for collaboration
between policy-makers and researchers, facilitating the sharing of tacit knowledge and
policy positions and the setting of common priorities and goals. For example, the
committee suggested involving the Bangladesh Pediatric Association for their technical
opinion as well as the Directorate General of Health Services (DGHS) to expedite the
scaling up process [<xref ref-type="bibr" rid="B23">23</xref>].</p><p>Based on the evidence, the National Advisory Committee approved the policy on using zinc
in addition to ORS for under-five children suffering from diarrhea and incorporated zinc
into a revised National Diarrhea Treatment Guideline. Research also guided the
development of the product, a dispersible zinc tablet, as well as its pricing. The
following evidence-based policy changes were approved with regard to the national scale
up of zinc in Bangladesh:</p><p>· Tablet formulation by the Bangladesh Drugs Administration,</p><p>· branding the product as “Baby Zinc”,</p><p>· over-the-counter sales waiver and</p><p>· mass media promotion of Baby Zinc.</p><p>An early misstep, trying to scale up with community health workers whose primary focus
was family planning, led to the commissioning of qualitative studies to identify who
should deliver the intervention. These studies discovered a cascade effect for adoption:
Even though the product was available over-the-counter and could be easily administered,
physicians and especially pediatricians were identified as key players in promoting and
prescribing it [<xref ref-type="bibr" rid="B23">23</xref>].</p><p>Based on this evidence, the project embarked on a training blitz of all medical colleges
and public health physicians at the district and sub-district level, as well as 8000
village doctors in their role as trainers for the more than 200,000 informal providers.
Repeat impact surveys were conducted every three months and then annually in order to
monitor for intended and unintended consequences. Rapid increase in zinc awareness
occurred, from near zero prior to the launch to nearly 90% of urban and over 70% of
rural caregivers. However, use of zinc lags far behind awareness in all settings with a
national average of 17%. Within the rural poor and in urban slums coverage rates
stagnated by the end of the first year of the campaign. Implementation research
suggested that it was the lack of a recommendation from the provider that kept
caretakers from using zinc for the first time. In addition to more targeted training at
formal and informal providers and drug vendors, further research was undertaken to
identify barriers to the sale of zinc among drug vendors [<xref ref-type="bibr" rid="B23">23</xref>,<xref ref-type="bibr" rid="B26">26</xref>].</p><p>The experience of scaling-up zinc use in Bangladesh reflects the factors identified by
Ssengooba <italic>et al.</italic> (2011) as facilitating policy uptake and continued use of
implementation research, they include:</p><p>· Shared platforms for learning and decision making,</p><p>· pilots to assess feasibility of interventions,</p><p>· evolution of agencies to undertake operational research and</p><p>· visibility of the benefits of the intervention [<xref ref-type="bibr" rid="B14">14</xref>].</p></sec><sec><title>Strengthening implementation research and KT capacity in low and middle income
countries</title><p>The KT process is often viewed in an oversimplified and linear fashion, built upon a
singular input of research on the effectiveness of a health intervention, and not
addressing the policy process as a whole, nor the capacity that organizations have for
policy [<xref ref-type="bibr" rid="B27">27</xref>]. How can we encourage the use of KT
and implementation research at both the organizational and country level? Although this
article has provided reasoning for the generation of implementation research and its
potential use in KT, preparing the policy environment to reap these benefits can be
difficult. There must be sufficient capacity at the organizational and country levels to
acquire, analyze, adapt and apply implementation research. While still rare
[<xref ref-type="bibr" rid="B16">16</xref>], policy-maker involvement in KT is
now being promoted by global initiatives such as EVIPNet, as well as regional and
country initiatives [<xref ref-type="bibr" rid="B28">28</xref>,<xref ref-type="bibr" rid="B29">29</xref>].</p><p>There are many strategies for strengthening capacity to encourage evidence informed
decision-making [<xref ref-type="bibr" rid="B16">16</xref>,<xref ref-type="bibr" rid="B30">30</xref>].
One systematic review looked at the barriers to and facilitators of evidence-informed
decision-making in public health and, although focused in a high-income country, made
the following recommendations that can be applied elsewhere:</p><p>· Encourage strong relationships between policy-makers and researchers
as interactions increase the likelihood of research use by policy-makers,</p><p>· manage conflicts which arise between policy-makers and
researchers,</p><p>· promote interactions between stakeholders and researchers and
policy-makers so that decisions will be informed in part by stakeholder input,</p><p>· encourage collaboration between healthcare organizations and networks,
particularly between newer organizations and more mature ones and</p><p>· encourage capacity building for research use among policy-makers as an
effective strategy for research use [<xref ref-type="bibr" rid="B31">31</xref>].</p><p>One way to combine these strategies and create a fertile KT environment is to promote
country mechanisms or KT platforms to systematically use evidence in policy-making in
low and middle-income countries. EVIPNet is a successful example, a WHO programme with
characteristics of a global social network that encompasses 26 KT platforms, also known
as country teams. The paramount goal of each country team is to promote evidence
informed decision-making in public health at national and other jurisdictional levels.
In order to build capacity it is vital to continuously engage various participants in
the policy-making process. As such, each country team consists of researchers,
high-level decision-makers and other stakeholders (e.g. patients, healthcare workers and
civil society representatives). The diversity of membership promotes sustainable
partnerships between individuals and organizations and allows for the sharing of best
practices and feedback.</p><p>EVIPNet holds capacity building workshops to enhance the knowledge translation capacity
of policy-makers, researchers and other stakeholders. The diversity of stakeholders at
workshops is intended to enhance the educational experience of attendees; EVIPNet
promotes the philosophy of learning by doing together, so as to better work together.
These capacity strengthening programmes place emphasis on producing tangible objects
such as evidence-informed policy briefs, as well as the preparation of processes such as
deliberative dialogues. This combined approach enables policy-makers to develop skills
related to problem identification, framing a research problem, context mapping and
priority setting, to name a few. The skills and lessons developed by policy-makers and
researchers contribute to sustainable health systems strengthening.</p><p>The EVIPNet team in Burkina Faso’s work on access to artemisinin-based combination
therapies (ACT) for uncomplicated malaria illustrates EVIPNet’s potential to
strengthen knowledge translation capacity towards programme scale-up. The Burkina
Faso’s EVIPNet team, consisting of policy-makers and researchers, prepared a
policy brief that presented three viable policy options for supporting the widespread
use of ACT to treat uncomplicated malaria:</p><p>· Engaging the private sector in adhering to national guidelines about
subsidized drugs in all settings,</p><p>· motivating and retaining community health workers involved in the home
management of malaria and</p><p>· banning monotherapies after ensuring the ACT is fully deployed across
the country and that pharmacies are informed about the policy.</p><p>The policy brief was a key input to a national policy dialogue, involving senior
government officials and key stakeholders, held to discuss how both the public and
private sector can best support the widespread use of ACT. The policy brief also
directly informed Burkina Faso’s successful application to the Global Fund for
HIV-AIDS, TB and Malaria (GFATM) in its 7th Round.</p><p>The EVIPNet team’s work has now led to the implementation of the community health
worker option through a pilot in three districts of the country, with the goal of a
full-scale implementation by the 8th Round of the GFATM. An implementation research
protocol (mostly a rapid ethnographic assessment) has been applied to each participating
district, in order to monitor and evaluate the advantages, disadvantages, costs,
barriers and facilitators in the execution of the policy option at the very specific
district level. The other two options proposed in the policy brief are also being
implemented through additional activities [<xref ref-type="bibr" rid="B32">32</xref>].</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>Implementation research is an integral part of the KT continuum. Emphasis must be placed
not only on its production, but also on its quality, proper use and uptake in
decision-making. In order to more effectively implement evidence informed policy,
policy-makers and researchers should learn together and work in partnership to improve
access and delivery. Steps should be taken to increase the demand for research use and
KT through sustainable partnerships and mechanisms, including KT platforms (at the
district, provincial and national levels) that promote the early involvement of
policy-makers, managers, health care providers and patients and serve as the basis for
capacity-strengthening activities.</p></sec><sec><title>Abbreviations</title><p>ACT, Artemisinin-based Combination Therapy; CIHR, Canadian Institutes for Health
Research; DGHS, Directorate General of Health Services; EVIPNet, Evidence Informed
Policy Network; GFATM, Global Fund for HIV-AIDS, TB and Malaria; KT, Knowledge
Translation; MDG, Millennium Development Goals; MOHFW, Ministry of Health and Family
Welfare; SUZY Project, Scaling Up of Zinc in Early Childhood Project.</p></sec><sec><title>Competing interests</title><p>The authors report no competing interest.</p></sec><sec><title>Authors’ contributions</title><p>UP: Designed the study, developed the outline, and contributed to the analysis, writing
and revision of the report. TPK: Revised the outline, contributed to the analysis,
writing and revision of the report, and wrote a case study. AA: Revised and reorganized
the outline, contributed to the analysis, writing and revision of the report, and
reviewed bibliography. PS: Developed the outline, contributed to the analysis, writing
and revision of the report. TP: Developed the outline, contributed to the analysis,
writing and revision of the report. JKK: Developed the outline, contributed to the
analysis, writing and revision of the report. BM: Helped develop the outline and first
manuscript, contributed to the analysis, writing and revision of the report. All authors
read and approved the final manuscript.</p></sec><sec><title>Authors’ information</title><p>The authors do not wish to disclose any additional professional information.</p></sec></body><back><sec><title>Acknowledgements</title><p>The authors do not wish to make any acknowledgements.</p></sec><ref-list><ref id="B1"><mixed-citation publication-type="book"><collab>United Nations</collab><source>The Millennium Development Goals Report 2010</source><year>2010</year><publisher-name>United Nations, New York</publisher-name></mixed-citation></ref><ref id="B2"><mixed-citation publication-type="journal"><name><surname>Lengeler</surname><given-names>C</given-names></name><article-title>Insecticide-treated bed nets and curtains for preventing malaria (Review)</article-title><source>Cochrane Database Syst Rev</source><year>2004</year><volume>2</volume><fpage>CD000363</fpage><pub-id pub-id-type="pmid">15106149</pub-id></mixed-citation></ref><ref id="B3"><mixed-citation 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