TY - JOUR
T1 - Strategies to promote evidence use for health programme improvement
T2 - learning from the experiences of embedded implementation research teams in Latin America and the Caribbean
AU - Varallyay, N. Ilona
AU - Kennedy, Caitlin
AU - Bennett, Sara C.
AU - Peters, David H.
N1 - Funding Information:
The EIR initiative of interest in this paper, Improving Program Implementation through Embedded Research (iPIER) [, ], was supported in Latin America and the Caribbean (LAC) by the WHO Alliance for Health Policy and Systems Research (the Alliance) and the Pan American Health Organization (PAHO). A previous retrospective analysis of barriers and facilitators to EIR suggests this approach has the potential to enhance use of research evidence by decision-makers for programme/policy improvement []. However, there is limited understanding of how this engagement of decision-makers and their “interaction” with researchers influences research utilization in the context of EIR approaches. If decision-maker-led IR approaches are effective, then it is important to understand the specific pathways through which EIR teams contribute to “research use” in its various forms—i.e. direct application in decisions about implementation (instrumental) or indirect processes that shift stakeholder understanding and attitudes toward the issue (conceptual) [, ]. Advancing EIR practice requires a deeper understanding of the how and why of the embedded approach—particularly in linking key processes and outcomes.
Funding Information:
This case study evaluation was supported by the Alliance for Health Policy and Systems Research, an international partnership hosted by WHO Headquarters in Geneva, Switzerland. In particular, we would like to thank Abdul Ghaffar (Executive Director) for spearheading the iPIER initiative studied in this manuscript and for ensuring that such an evaluation of iPIER could take place. The Pan American Health Organization (PAHO) Evidence and Intelligence for Action in Health Unit also contributed support to the iPIER initiative. We would like to thank Ludovic Reveiz and other PAHO colleagues who supported the initial phase of the iPIER evaluation work and helped liaise with PAHO country offices to conduct this study. Finally, but not least, we would like to thank the iPIER grant participants from Bolivia, Colombia and Dominican Republic who formed part of the teams studied in these cases and dedicated a significant amount of time not only to participate in multiple interviews but also to help organize the data collection field visits in their respective countries.
Funding Information:
Between 2014 and 2017, iPIER disbursed grants to 10 countries (totalling 19 projects); this is the first initiative in the LAC region to implement this model of EIR. The 2016–2017 cohort funded seven projects (approximately US$ 30 000–35 000 each), supported by technical assistance (TA) from researchers at the National Institute for Public Health of Mexico for the duration of the research phase. No support was provided in the post-research phase, which in part motivated our focus on this phase. These IR studies aimed to understand the root causes of an implementation problem to devise solutions.
Funding Information:
This case study evaluation was supported by the Alliance for Health Policy and Systems Research, an international partnership hosted by WHO Headquarters in Geneva, Switzerland. In particular, we would like to thank Abdul Ghaffar (Executive Director) for spearheading the iPIER initiative studied in this manuscript and for ensuring that such an evaluation of iPIER could take place. The Pan American Health Organization (PAHO) Evidence and Intelligence for Action in Health Unit also contributed support to the iPIER initiative. We would like to thank Ludovic Reveiz and other PAHO colleagues who supported the initial phase of the iPIER evaluation work and helped liaise with PAHO country offices to conduct this study. Finally, but not least, we would like to thank the iPIER grant participants from Bolivia, Colombia and Dominican Republic who formed part of the teams studied in these cases and dedicated a significant amount of time not only to participate in multiple interviews but also to help organize the data collection field visits in their respective countries.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: To achieve global health targets, innovative approaches are needed to strengthen the implementation of efficacious interventions. New approaches in implementation research that bring together health system decision-makers alongside researchers to collaboratively design, produce and apply research evidence are gaining traction. Embedded implementation research (EIR) approaches led by decision-maker principal investigators (DM PIs) appear promising in this regard. Our aim is to describe the strategies study teams employ in the post-research phase of EIR to promote evidence-informed programme or policy improvement. Methods: We conducted a prospective, comparative case study of an EIR initiative in Bolivia, Colombia and Dominican Republic. Guided by a conceptual framework on EIR, we used semi-structured key informant interviews (n = 51) and document reviews (n = 20) to examine three decision-maker-led study teams (“cases”). Focusing on three processes (communication/dissemination, stakeholder engagement with evidence, integrating evidence in decision-making) and the main outcome (enacting improvements), we used thematic analysis to identify associated strategies and enabling or hindering factors. Results: Across cases, we observed diverse strategies, shaped substantially by whether the DM PI was positioned to lead the response to study findings within their sphere of work. We found two primary change pathways: (1) DM PIs implement remedial measures directly, and (2) DM PIs seek to influence other stakeholders to respond to study findings. Throughout the post-research phase, EIR teams adapted research use strategies based on the evolving context. Conclusions: EIR led by well-positioned DM PIs can facilitate impactful research translation efforts. We draw lessons around the importance of (1) understanding DM PI positionality, (2) ongoing assessment of the evolving context and stakeholders and (3) iterative adaptation to dynamic, uncertain circumstances. Findings may guide EIR practitioners in planning and conducting fit-for-purpose and context-sensitive strategies to advance the use of evidence for programme improvement.
AB - Background: To achieve global health targets, innovative approaches are needed to strengthen the implementation of efficacious interventions. New approaches in implementation research that bring together health system decision-makers alongside researchers to collaboratively design, produce and apply research evidence are gaining traction. Embedded implementation research (EIR) approaches led by decision-maker principal investigators (DM PIs) appear promising in this regard. Our aim is to describe the strategies study teams employ in the post-research phase of EIR to promote evidence-informed programme or policy improvement. Methods: We conducted a prospective, comparative case study of an EIR initiative in Bolivia, Colombia and Dominican Republic. Guided by a conceptual framework on EIR, we used semi-structured key informant interviews (n = 51) and document reviews (n = 20) to examine three decision-maker-led study teams (“cases”). Focusing on three processes (communication/dissemination, stakeholder engagement with evidence, integrating evidence in decision-making) and the main outcome (enacting improvements), we used thematic analysis to identify associated strategies and enabling or hindering factors. Results: Across cases, we observed diverse strategies, shaped substantially by whether the DM PI was positioned to lead the response to study findings within their sphere of work. We found two primary change pathways: (1) DM PIs implement remedial measures directly, and (2) DM PIs seek to influence other stakeholders to respond to study findings. Throughout the post-research phase, EIR teams adapted research use strategies based on the evolving context. Conclusions: EIR led by well-positioned DM PIs can facilitate impactful research translation efforts. We draw lessons around the importance of (1) understanding DM PI positionality, (2) ongoing assessment of the evolving context and stakeholders and (3) iterative adaptation to dynamic, uncertain circumstances. Findings may guide EIR practitioners in planning and conducting fit-for-purpose and context-sensitive strategies to advance the use of evidence for programme improvement.
KW - Embedded research
KW - Evidence coproduction
KW - Evidence-informed decision-making
KW - Health policy and systems research
KW - Implementation research
KW - Knowledge translation
KW - Latin America and the Caribbean
KW - Low- and middle-income countries
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U2 - 10.1186/s12961-022-00834-1
DO - 10.1186/s12961-022-00834-1
M3 - Article
C2 - 35392931
AN - SCOPUS:85127975660
SN - 1478-4505
VL - 20
JO - Health Research Policy and Systems
JF - Health Research Policy and Systems
IS - 1
M1 - 38
ER -