BACKGROUND: The use of research evidence in health policy-making is a popular line of inquiry for scholars of public health and policy studies, with qualitative methods constituting the dominant strategy in this area. Research on this subject has been criticized for, among other things, disproportionately focusing on high-income countries; overemphasizing 'barriers and facilitators' related to evidence use to the neglect of other, less descriptive concerns; relying on descriptive, rather than in-depth explanatory designs; and failing to draw on insights from political/policy studies theories and concepts. We aimed to comprehensively map the global, peer-reviewed qualitative literature on the use of research evidence in health policy-making and to provide a descriptive overview of the geographic, temporal, methodological, and theoretical characteristics of this body of literature.
METHODS: We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched nine electronic databases, hand-searched 11 health- and policy-related journals, and systematically scanned the reference lists of included studies and previous reviews. No language, date or geographic limitations were imposed.
RESULTS: The review identified 319 qualitative studies on a diverse array of topics related to the use of evidence in health policy-making, spanning 72 countries and published over a nearly 40 year period. A majority of these studies were conducted in high-income countries, but a growing proportion of the research output in this area is now coming from low- and middle-income countries, especially from sub-Saharan Africa. While over half of all studies did not use an identifiable theory or framework, and only one fifth of studies used a theory or conceptual framework drawn from policy studies or political science, we found some evidence that theory-driven and explanatory (eg, comparative case study) designs are becoming more common in this literature. Investigations of the barriers and facilitators related to evidence use constitute a large proportion but by no means a majority of the work in this area.
CONCLUSION: This review provides a bird's eye mapping of the peer reviewed qualitative research on evidence-to-policy processes, and has identified key features of - and gaps within - this body of literature that will hopefully inform, and improve, research in this area moving forward.
BACKGROUND: The evidence-base for improving health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Facilitating such translation is particularly important in low and middle-income countries that bear a disproportionate share of the global burden of ill-health. OBJECTIVES: The primary objective of this review was to assess the effects of interventions to improve the uptake of research into health policies in low and middle-income countries. A secondary objective was to identify the barriers and facilitators to the uptake of research evidence derived from intervention and non-intervention studies. METHODS: For the main objective of the review, observational or experimental studies were eligible if they assessed any intervention aiming to facilitate the transfer of health research into health policy in low and middle-income countries. Studies had to include policy-makers as a target group, but could also include a variety of other stakeholders. The primary outcome was a change in health policies based on evidence uptake; additional outcomes included other policy-related outcomes, practice-related outcomes and health outcomes (resulting from the policy-change). For the secondary objective of the review, non-intervention studies describing policy processes and barriers and facilitators to evidence uptake into policy were also included. A wide range of electronic databases was searched; additional searching included scanning of a range of websites, reference lists of included studies, and citation searching. Two reviewers independently selected the studies. Data extraction and quality assessment of intervention studies were carried out by one reviewer and a proportion of the data was checked by a second reviewer. Data were summarised narratively, using text and tables. Frequencies of intervention components and reported barriers and facilitators to knowledge translation were computed.
RESULTS: The final analysis included 25 intervention studies and 29 non-intervention studies describing barriers and facilitators to evidence-uptake either from observations of policy-making processes or from stakeholders’ views. Most of the intervention studies were descriptive case-studies with inadequate detail on methodology and intervention design. The interventions were complex and many encompassed the whole cycle of research, policy development and implementation. All interventions had some positive effects in terms of policy-related outcomes. The most frequently cited components of interventions reporting positive effects on policy development included carrying out local research (e.g. for contextualisation), ensuring intensive stakeholder engagement and collaboration, including training and capacity-building activities, and fostering community participation. These elements were also identified in the non-intervention studies as common factors in the analysis of barriers and facilitators to evidence uptake. Few differences were seen between studies from low and middle-income countries in terms of barriers and facilitators. However, one important distinction cited was that low income countries tended to depend more on the support of large multilateral organisations, and that this dependence was also seen as a barrier to focussing on local priorities. CONCLUSIONS: Although the intervention studies from low and middle-income countries included in this review were not of sufficient quality to provide strong recommendations, the findings are broadly consistent with the findings from high-income countries on the need for multi-faceted, tailored interventions and on the importance of contextual influences, particularly organisational. Effective interventions to increase uptake of evidence are likely to be those tailored to the context and include local research, extensive stakeholder engagement, and community participation. High-quality comparative studies reporting on a range of outcomes, with clear and comprehensive descriptions of methodology and of context, are still needed to strengthen understanding on how to improve uptake specifically in low and middle-income countries.
The use of research evidence in health policy-making is a popular line of inquiry for scholars of public health and policy studies, with qualitative methods constituting the dominant strategy in this area. Research on this subject has been criticized for, among other things, disproportionately focusing on high-income countries; overemphasizing 'barriers and facilitators' related to evidence use to the neglect of other, less descriptive concerns; relying on descriptive, rather than in-depth explanatory designs; and failing to draw on insights from political/policy studies theories and concepts. We aimed to comprehensively map the global, peer-reviewed qualitative literature on the use of research evidence in health policy-making and to provide a descriptive overview of the geographic, temporal, methodological, and theoretical characteristics of this body of literature.
METHODS:
We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched nine electronic databases, hand-searched 11 health- and policy-related journals, and systematically scanned the reference lists of included studies and previous reviews. No language, date or geographic limitations were imposed.
RESULTS:
The review identified 319 qualitative studies on a diverse array of topics related to the use of evidence in health policy-making, spanning 72 countries and published over a nearly 40 year period. A majority of these studies were conducted in high-income countries, but a growing proportion of the research output in this area is now coming from low- and middle-income countries, especially from sub-Saharan Africa. While over half of all studies did not use an identifiable theory or framework, and only one fifth of studies used a theory or conceptual framework drawn from policy studies or political science, we found some evidence that theory-driven and explanatory (eg, comparative case study) designs are becoming more common in this literature. Investigations of the barriers and facilitators related to evidence use constitute a large proportion but by no means a majority of the work in this area.
CONCLUSION:
This review provides a bird's eye mapping of the peer reviewed qualitative research on evidence-to-policy processes, and has identified key features of - and gaps within - this body of literature that will hopefully inform, and improve, research in this area moving forward.
