Research and innovation as a catalyst for food system transformation

Background: Food systems are associated with severe and persistent problems worldwide. Governance approaches aiming to foster sustainable transformation of food systems face several challenges due to the complex nature of food systems. Scope and approach: In this commentary we argue that addressing these governance challenges requires the development and adoption of novel research and innovation (R&I) approaches that will provide evidence to inform food system transformation and will serve as catalysts for change. We first elaborate on the complexity of food systems (transformation) and stress the need to move beyond traditional linear R&I approaches to be able to respond to persistent problems that affect food systems. Though integrated transdisciplinary approaches are promising, current R&I systems do not sufficiently support such endeavors. As such, we argue, we need strategies that trigger a double transformation - of food systems and of their R&I systems. Key Findings and Conclusions: Seizing the opportunities to transform R&I systems has implications for how research is done - pointing to the need for competence development among researchers, policy makers and society in general - and requires specific governance interventions that stimulate a systemic approach. Such interventions should foster transdisciplinary and transformative research agendas that stimulate portfolios of projects that will reinforce one another, and stimulate innovative experiments to shape conditions for systemic change. In short, a thorough rethinking of the role of R&I as well as how it is funded is a crucial step towards the development of the integrative policies that are necessary to engender systemic change - in the food system and beyond

A research agenda for bipolar disorder developed from a patients’ perspective

Background: Diagnosis and treatment of bipolar disorder is complex. Health care is supported by clinical guidelines, which are highly based on scientific evidence. However, such care does not necessarily correspond to preferred care according to patients. In order to narrow the gap between scientifically based guidelines and the patient's perceptions of the best clinical practice, additional research is needed. The aim of this study was to create a patient based research agenda for bipolar disorder to enhance the alignment between patients’ needs and care system. Methods: A mixed method study design was employed consisting of two phases: consultation and prioritization. In the consultation phase, six focus group discussions with patients (n = 35) were conducted to explore research needs according to patients, resulting in 23 research topics. Subsequently, these topics were prioritized by means of a questionnaire with patients (n = 219). Results: Patients with bipolar disorder mentioned a variety of research topics covered by the following five themes: causes of disorder; pharmacotherapy; non-pharmacological treatment; diagnosis; and recovery & recovery oriented care. ‘Etiology’ was the topic with highest priority. Discussion: The theme ‘causes of disorder’ is prioritized highest. We argue that this can be explained by the added value of an explanatory framework for appropriate treatment and recovery. The theme ‘recovery & recovery oriented care’ is currently underrepresented in actual research. It is argued that in order to bridge the knowledge and implementation gap, social science and health system research is needed in addition to biomedical research

The challenges of living with bipolar disorder: a qualitative study of the implications for health care and research

Background: In mental health care, clinical practice is often based on the best available research evidence. However, research findings are difficult to apply to clinical practice, resulting in an implementation gap. To bridge the gap between research and clinical practice, patients’ perspectives should be used in health care and research. This study aimed to understand the challenges people with bipolar disorder (BD) experience and examine what these challenges imply for health care and research needs. Methods: Two qualitative studies were used, one to formulate research needs and another to formulate healthcare needs. In both studies focus group discussions were conducted with patients to explore their challenges in living with BD and associated needs, focusing on the themes diagnosis, treatment and recovery. Results: Patients’ needs are clustered in ‘disorder-specific’ and ‘generic’ needs. Specific needs concern preventing late or incorrect diagnosis, support in search for individualized treatment and supporting clinical, functional, social and personal recovery. Generic needs concern health professionals, communication and the healthcare system. Conclusion: Patients with BD address disorder-specific and generic healthcare and research needs. This indicates that disorder-specific treatment guidelines address only in part the needs of patients in everyday clinical practice

How to normalize reflexive evaluation? Navigating between legitimacy and integrity

While hybrid evaluation practices are increasingly common, many Western countries continue to favor modernist evaluation logics focused on performance management—hampering the normalization of reflexive logics revolving around system change. We use Normalization Process Theory to analyze the work evaluators from a policy assessment agency undertook to accomplish the alignment between the prevailing and proposed logics guiding evaluation practice, while implementing a reflexive evaluation approach. Ad hoc alignment strategies and insufficient investment in mutual sense-making regarding reflexive evaluation hindered normalization. We conclude that alignment requires developing reflexive evaluation legitimacy in the context of application and guarding reflexive evaluation integrity, while contextual structures and cultures and reflexive evaluation components are being negotiated. Elasticity (of contextual structures and cultures) and plasticity (of reflexive evaluation components) are introduced as helpful concepts to further understand how reflexive evaluation practices can become normalized. We reflect on the use of Normalization Process Theory for studying the normalization of reflexive evaluation

Technologies for inclusive employment:beyond the prosthetic fix–social transformation axis

Technologies are often expected to enhance inclusive employment for people living with a disability. Following conventional dichotomies, policy actors generally consider technologies to either provide a prosthetic fix to ‘able’ people with disabilities, or become instruments for social transformation. In three pilot projects within a national initiative for enhancing inclusive employment through technologies, we empirically explore the potential of such conceptually opposed approaches for realising inclusive employment in practice. Reporting on a transdisciplinary ‘learning evaluation’, we combine semi-structured interviews with participant observation and transformation-oriented methods from Reflexive Monitoring in Action, involving a myriad of stakeholders. We introduce the notion of scripts to explore how we as researchers become part of the de- and re-inscription of technologies for inclusive employment. We find that regardless of an initial prosthetic- or transformative approach, technology can support a transformation toward inclusive employment through the work and effort of the actors involved. Points of interest Whether the initial approach to inclusion through technology is to ‘fix’ disability or ‘transform’ work practices, the concerted effort of the people involved can generate transformative potential For technology to attain this transformative potential it is imperative that the sociocultural environment is shaped accordingly To understand the dynamics that work for transformation, it is critical that technology is seen in practice, in specific situations To understand how disability is made through technology we recommend deconstructing the ‘scripts’, that is the user-assumptions and roles, embedded in the technology To support that technologies contribute to inclusive employment, a method is needed that supports reflexivity and involves people from various backgrounds actively participating

Determinants of an integrated public health approach: The implementation process of Greenland's second public health program 11 Medical and Health Sciences 1117 Public Health and Health Services

Background: Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined. Methods: Qualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II's implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination. Results: Enabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee. Conclusion: Inuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II's integrated approach does not harmonise with the government's inflexible organisational structure resulting in insufficient implementation

Research needs for Bipolar Disorder from clinicians’ perspectives: narrowing the research–practice gap

Research evidence is incompletely translated into clinical practice. This study aimed to explore research needs from clinicians’ perspectives in the field of bipolar disorder and their reflections on patients’ research needs as well as to unravel the potential role of researcher-clinicians, to narrow the research practice gap. Using focus group discussions (FGDs) and interviews, research needs according to psychiatrists, psychologists, and nurses working with bipolar disorder were explored. Subsequently, we interviewed researcher-clinicians to gain insights into their views on patients’ research needs. The clinicians’ research needs were clustered as: causes, diagnosis, pharmacotherapy, nonpharmacological treatment, recovery, and care system, and overlapped with the research needs formulated by patients. Researcher-clinicians were able to translate patients’ needs into feasible research questions. Researcher-clinicians can serve as intermediaries between research and practice and can both integrate their practical experience into research and their research experience into practice

A HTA of what? Reframing through including patient perspectives in health technology assessment processes

OBJECTIVES: Despite increasing emphasis on the inclusion of patient input in health technology assessment (HTA) in Europe in particular, questions remain as to the integration of patient insight alongside other HTA inputs. This paper aims to explore how HTA processes, while ensuring the scientific quality of assessments, "make do" with patient knowledge elicited through patients' involvement mechanisms. METHODS: The qualitative study analyzed institutional HTA and patient involvement in four European country contexts. We combined documentary analysis with interviews with HTA professionals, patient organizations, and health technology industry representatives, complemented with observational findings made during a research stay at an HTA agency. RESULTS: We present three vignettes which showcase how different parameters of assessment become reframed upon the positioning of patient knowledge alongside other forms of evidence and expertise. Each vignette explores patients' involvement during an assessment of a different type of technology and at a different stage of the HTA process. First, cost-effectiveness considerations were reframed during an appraisal of a rare disease medicine based on patient and clinician input regarding its treatment pathway; in the second vignette reframing amounted to what counts as a meaningful outcome measure for a glucose monitoring device; in the third, evaluating pediatric transplantation services involved reframing an option's appropriateness from a question of moral to one of legal acceptability. CONCLUSIONS: Making do with patient knowledge in HTA involves reframing of what is being assessed. Conceptualizing patients' involvement in this way helps us to consider the inclusion of patient knowledge not as complementary to, but as something that can transform the assessment process

The need for capacity building to accelerate food system transformation

Food systems face several persistent environmental, social, health-related and economic-related problems. To stimulate an urgently needed food system transformation, effective reflexive, integrative and participatory research and innovation approaches are essential. These approaches require different sets of competences for a variety of actors. The aim of this paper is to provide an overview of the current state of knowledge regarding competence development among (future) professionals in relation to food system transformation. We propose the development of competences for food system transformation that are not only tailored to profession, but also to envisioned actor role(s) and argue that competence development should be accompanied by broader capacity-building strategies to stimulate the implementation of transformative transdisciplinary research practices

Valuing patient engagement: Reflexive learning in evidence generation practices for health technology assessment

Much attention in health technology assessment (HTA), a health system governance mechanism used for determining the value of health technologies, is being paid to improving the quality and patient-relevance of the evidence used in assessment pratices. Whilst the direct involvement of patient actors throughout HTA processes has become a more routine element of institutional practice, the ‘impacts’ of patient engagement (PE) initiatives have proven difficult to determine and enhance. In reflexive governance theories, reflexive learning is a critical mechanism of multi-stakeholder arrangements that better handles the complexities of technologies and how they are understood through governance practices. This paper explores how reflexive learning can be used to build a richer conceptualisation of PE in HTA, in order to generate suggestions for enhancing PE practices and their impact. We critically apply reflexive learning insights on qualitative data derived from the co-creation process of a PE evaluation framework, organised through an EU project focused on strengthening PE practices across medicines development (2018–2020), including 24 interactive case studies, 3 multi-stakeholder workshops, and our observations throughout the project. The findings characterise two dimensions of reflexive learning in PE: First, reflexive learning refers to the adaptive reorganisation of evidence generating practices, including the revision of medicines' evaluation criteria and the conditions under which evidence ‘relevant’ to HTA is constructed. Second, reflexive learning spotlights the sociopolitics which shape technology evaluation. Four themes affecting meaningful and sustained PE in medicines development were analysed: institutional boundaries due to established evaluation criteria; timing of engagements; network relations between institutional actors; and the politics of patient representation. Extending beyond discrete PE activities and their reported impacts, reflexive forms of learning are crucial to yielding more ‘meaningful’ PE for HTA and medicines development, facilitating a HTA practice that more meaningfully deals with the complexities of medicines evidence generation