The utilisation of health research in policy-making: Concepts, examples, and methods of assessment

Chapter 1: Introduction and Background • The importance of utilising health research in policy-making, and therefore the need to understand the mechanisms involved, is increasingly recognised. Recent reports calling for more resources to improve health in developing countries, and global pressures for accountability, draw greater attention to research-informed policy-making. • For at least twenty years there has been recognition of the multiple meanings or models of research utilisation in policy-making. It has similarly been long recognised that a range of factors is involved in the interactions between health research and policy-makers. • The emerging focus on Health Research Systems (HRS) has identified additional mechanisms through which greater utilisation of research could be achieved. Assessment of the role of health research in policy-making is best undertaken as part of a wider study that also includes the utilisation of health research by industry, medical practitioners, and the public. Chapter 2: The Nature of Policy-Making, Types of Research and Utilisation Models • Policy-making broadly interpreted includes national health policies made by government ministers and officials, policies made by local health service managers, and clinical guidelines from professional bodies. In this report, however, the main focus is on public policy-making rather than that conducted by professional bodies. The utilisation of health research in policy-making should eventually lead to desired outcomes, including health gains. Research can make a contribution in at least three phases of the policy-making process: agenda setting; policy formulation; and implementation. Descriptions of these processes, however, can over-estimate the degree of rationality in policy-making. Therefore, the analysis is informed by a review of the full range of policy-making models. These include rational and incrementalist models. • Various categories of research are likely to be used differently in health policy-making. Applied research might be more readily useable by a policy system than basic research, but health policy-makers tend to relate more willingly to natural sciences than social sciences. When research is based on the priorities of potential users, and/or is research of proven quality, this increases the possibility that it will be translated into policies. There also appears to be a greater chance of research being used in clinical policies about delivering care to patients, than in national policies on the structures of the health service. • Models of research utilisation in policy-making start with a link to rational or instrumental views of policy-making, and include descriptions of how commissioned research can help to find solutions to problems. Other models relate to an incrementalist view in which policy-making involves a series of small steps over a long period; research findings might gradually cause a shift in perceptions about an issue in a process of ‘enlightenment’. Interactive models of research utilisation stress the way in which policy-makers and researchers might develop links over a long period. Research can also be used symbolically to support decisions already taken. Chapter 3: Examples from Previous Studies • A study of health policy-making in two southern African countries illustrates how policy-making processes can be analysed. It addresses agenda setting, policy formulation and implementation. The methods used included documentary analysis and key informant interviews. • Many previous studies of research utilisation can provide lessons for future assessments. Two broad approaches can be identified. Some studies start with pieces, or programmes, of research and examine their impact. Others consider policy on a particular topic and assess the role of research in the policy-making. There are advantages and drawbacks in each approach, and overlaps between them. • To facilitate comparison, studies of research utilisation are best organised around a conceptual framework. Despite that, the influence of contextual factors in different settings makes it difficult to generalise. • The two methods used most frequently, and usually together, come from the qualitative tradition: documentary analysis and in-depth interviews. Questionnaires, bibliometric analysis, insider knowledge and historical approaches have all been applied. A few recent studies have attempted to score or scale the level of utilisation. • The examples suggest there is a greater level of utilisation and final outcomes in terms of health, health equity, and social and economic gain than is often assumed, whilst still showing much underutilisation. There is considerable variation in the degree of utilisation, both within and between studies. Chapter 4: Key Issues in the Analysis of Research Utilisation in Policy-Making • Increasing attention is focusing on the concept of interfaces between researchers and the users of research. This incorporates the idea that there are likely to be different values and interests between the two communities. • In relation to utilisation, the prioritisation debate revolves around two key aspects: whether priorities are being set that will produce research that policy-makers and others will want to use, and whether priorities are being set that will engage the interests and commitment of the research community. • Interactions across the interface between policy-makers and researchers are important in transferring research to policy-makers. This fits especially well with the interactive model of utilisation. Actions by individual researchers can be useful in generating interaction, but it is desirable to consider the role of the HRS in encouraging or facilitating interactions, networks and mechanisms at a system-wide level. The HRS could provide funding and organisational support for various items including: long-term research centres; research brokerage/translator mechanisms; the creation of official committees of policy-makers and researchers; and mechanisms for review and synthesis of research findings. • There is increased recognition of the significance of policy-makers in their role as the receptors of research. In relation to the perspective of policy-makers there is a spectrum of key questions. These range from whether relevant research is available and effectively being brought to their attention, to whether they are able to absorb it and willing to use it. The HRS has a responsibility, especially in the early parts of the spectrum, but the wider health system also has a responsibility to create appropriate institutional mechanisms and ensure there are staff willing and able to incorporate relevant research. • More attention should be given to the role of incentives, both for researchers to produce utilisable research, and for policy-makers, at the system or individual level, to use it. The assessment of utilisation becomes a key issue if rewards are to focus on relevance as well as research excellence. • An appropriate model for assessing research utilisation in policy-making combines analysis of two issues: the role of receptors and the importance of actions at the interfaces. An emphasis on the role of the receptor is necessary because ultimately it is up to the policy-maker to make the decisions. Any assessment of the success of the HRS in relation to utilisation must accept that the wider political context is beyond the control of the HRS, but consider the activities of the HRS, within its given context, to enhance the utilisation of research by increasing the permeability of the interfaces. Chapter 5: Assessment of Research Utilisation in Health Policy-Making • The reasons for assessing the utilisation of research in policy-making include: advocacy, accountability, and increased understanding. For the World Health Organization there could be a role in conducting such assessments with the aim of providing evidence of the effective use of research resources. This could support advocacy for greater resources to be made available for health research. It is important that the purposes of any assessment are taken into account in planning the methods to be used. • Previous studies demonstrated the difficulties of making generalisations about specific factors associated with high levels of utilisation. To address this in any cross-national WHO initiative involving a series of studies in a range of countries, it would be desirable to structure all the studies around a conceptual framework (such as the interfaces and receptor framework considered here) and base the studies in each country on common themes. These could include policies for the adoption of multi-drug therapy for treating leprosy, and for the equitable access to health services. • Analysis of documents and semi-structured interviews would be appropriate methods in each study assessing the role of research in policy-making on a specific policy theme. Questionnaires could also have a role. These approaches would provide triangulation of methods and data-sources and should also provide material to help identify the relative importance, in relation to the level of utilisation recorded, of the HRS mechanisms described in the previous analysis. The types and sources of research used, and reasons for their use, should also be recorded and attempts made to correlate them with the previous priority setting approaches. It is expected that each study will produce its own narrative or story of what caused utilisation in the particular context, but the data gathered could also be applied to descriptive scales of the level research utilisation. The four scales could cover the consistency of policy with research findings, and the degree of influence of research on agenda setting, policy formulation, and implementation. • The findings from the assessments in each participating country should be collated. For each policy theme or topic the analysis would compare two sets of data: the scales for level of research utilisation in each country, and the contextualised lists of the HRS activities and other mechanisms and networks thought to be important. Although the account here has focused on research impact on policy-making, the evaluations would be stronger as part of a wider analysis covering research utilisation and interactions with practitioners, industry and the public. • Given appropriate and targeted topic and country selection, this approach is likely to meet the purpose of using structured methods to provide examples of effective research utilisation. The approach should contribute towards enhanced understanding of the issues and could provide the basis of an assessment tool which, if used widely in countries, could lead to greater utilisation of health research.Research Policy and Co-operation (RPC) Department of the World Health Organization, Geneva; UK Department of Health’s Policy Research Programme; Alliance for Health Policy and Systems Research from the governments of Norway and Sweden; World Bank and International Development Research Council of Canad

Chemotaxis When Bacteria Remember: Drift versus Diffusion

{\sl Escherichia coli} ({\sl E. coli}) bacteria govern their trajectories by switching between running and tumbling modes as a function of the nutrient concentration they experienced in the past. At short time one observes a drift of the bacterial population, while at long time one observes accumulation in high-nutrient regions. Recent work has viewed chemotaxis as a compromise between drift toward favorable regions and accumulation in favorable regions. A number of earlier studies assume that a bacterium resets its memory at tumbles -- a fact not borne out by experiment -- and make use of approximate coarse-grained descriptions. Here, we revisit the problem of chemotaxis without resorting to any memory resets. We find that when bacteria respond to the environment in a non-adaptive manner, chemotaxis is generally dominated by diffusion, whereas when bacteria respond in an adaptive manner, chemotaxis is dominated by a bias in the motion. In the adaptive case, favorable drift occurs together with favorable accumulation. We derive our results from detailed simulations and a variety of analytical arguments. In particular, we introduce a new coarse-grained description of chemotaxis as biased diffusion, and we discuss the way it departs from older coarse-grained descriptions.Comment: Revised version, journal reference adde

Analysing detection gaps in acoustic telemetry data to infer differential movement patterns in fish

A wide array of technologies are available for gaining insight into the movement of wild aquatic animals. Although acoustic telemetry can lack the fine‐scale spatial resolution of some satellite tracking technologies, the substantially longer battery life can yield important long‐term data on individual behavior and movement for low per‐unit cost. Typically, however, receiver arrays are designed to maximize spatial coverage at the cost of positional accuracy leading to potentially longer detection gaps as individuals move out of range between monitored locations. This is particularly true when these technologies are deployed to monitor species in hard‐to‐access locations. Here, we develop a novel approach to analyzing acoustic telemetry data, using the timing and duration of gaps between animal detections to infer different behaviors. Using the durations between detections at the same and different receiver locations (i.e., detection gaps), we classify behaviors into “restricted” or potential wider “out‐of‐range” movements synonymous with longer distance dispersal. We apply this method to investigate spatial and temporal segregation of inferred movement patterns in two sympatric species of reef shark within a large, remote, marine protected area (MPA). Response variables were generated using network analysis, and drivers of these movements were identified using generalized linear mixed models and multimodel inference. Species, diel period, and season were significant predictors of “out‐of‐range” movements. Silvertip sharks were overall more likely to undertake “out‐of‐range” movements, compared with gray reef sharks, indicating spatial segregation, and corroborating previous stable isotope work between these two species. High individual variability in “out‐of‐range” movements in both species was also identified. We present a novel gap analysis of telemetry data to help infer differential movement and space use patterns where acoustic coverage is imperfect and other tracking methods are impractical at scale. In remote locations, inference may be the best available tool and this approach shows that acoustic telemetry gap analysis can be used for comparative studies in fish ecology, or combined with other research techniques to better understand functional mechanisms driving behavior

Mapping of health system functions to strengthen priority programs. The case of maternal health in Mexico

<p>Abstract</p> <p>Background</p> <p>Health system strengthening is critical to ensure the integration and scaling-up of priority health promotion, disease prevention and control programs. Normative guidelines are available to address health system function imbalances while strategic and analytical frameworks address critical functions in complex systems. Tacit knowledge-based health system constructs can help identify actors' perspectives, contributing to improve strengthening strategies. Using maternal health as an example, this paper maps and analyses the health system functions that critical actors charged with formulating and delivering priority health programs consider important for their success.</p> <p>Methods</p> <p>Using concept mapping qualitative and statistical methods, health system functions were mapped for different categories of actors in high maternal mortality states of Mexico and at the federal level. Functions within and across maps were analyzed for degree of classification, importance, feasibility and coding.</p> <p>Results</p> <p>Hospital infrastructure and human resource training are the most prominent functions in the maternal health system, associated to federal efforts to support emergency obstetric care. Health policy is a highly diffuse function while program development, intercultural and community participation and social networks are clearly stated although less focused and with lower perceived importance. The importance of functions is less correlated between federal and state decision makers, between federal decision makers and reproductive health/local health area program officers and between state decision makers and system-wide support officers. Two sets of oppositions can be observed in coding across functions: health sector vs. social context; and given structures vs. manageable processes.</p> <p>Conclusions</p> <p>Concept mapping enabled the identification of critical functions constituting adaptive maternal health systems, including aspects of actor perspectives that are seldom included in normative and analytical frameworks. Important areas of divergence across actors' perceptions were identified to target capacity strengthening efforts towards better integrated, performing health systems.</p

Maximising the value of transmitted data from PSATs tracking marine fish: a case study on Atlantic bluefin tuna

This is the final version. Available from BMC via the DOI in this record. Availability of data and materials: The data sets generated and analysed during the current study are not publicly available due to funder restrictions but may be available from the corresponding author on reasonable request.Background: The use of biologging tags to answer questions in animal movement ecology has increased in recent decades. Pop-up satellite archival tags (PSATs) are often used for migratory studies on large fish taxa. For PSATs, movements are normally reconstructed from variable amounts of transmitted data (unless tags are recovered, and full data archives accessed) by coupling geolocation methods with a state-space modelling (SSM) approach. Between 2018 and 2019, we deployed Wildlife Computers PSATs (MiniPATs) from which data recovery varied considerably. This led us to examine the effect of PSAT data volume on SSM performance (i.e., variation in reconstructed locations and their uncertainty). We did this by comparing movements reconstructed using partial ( 1000 km); (ii) for fish that travelled long distances, mean distance of locations from corresponding complete data set locations were inversely correlated with the volume of data received; (iii) if only 5% of data was used for geolocation, reconstructed locations for long-distance fish differed by 2213 ± 647 km from the locations derived from complete data sets; and, (iv) track reconstructions omitted migrations into the Mediterranean Sea if less than 30% of data was used for geolocation. Conclusions: For Wildlife Computers MiniPATs in our specific application, movements reconstructed with as little as 30% of the total geolocation data results in plausible outputs from the GPE3. Below this data volume, however, significant differences of more than 2000 km can occur. Whilst for a single species and manufacturer, this highlights the importance of careful study planning and the value of conducting study-specific sensitivity analysis prior to inclusion of modelled locations in research outputs. Based on our findings, we suggest general steps and refinements to maximise the value of light geolocation data from PSATs deployed on aquatic animals and highlight the importance of conducting data sensitivity analyses.European Maritime and Fisheries FundDepartment for Environment, Food and Rural Affairs (UK

Rapid Growth Reduces Cold Resistance: Evidence from Latitudinal Variation in Growth Rate, Cold Resistance and Stress Proteins

Background: Physiological costs of rapid growth may contribute to the observation that organisms typically grow at submaximal rates. Although, it has been hypothesized that faster growing individuals would do worse in dealing with suboptimal temperatures, this type of cost has never been explored empirically. Furthermore, the mechanistic basis of the physiological costs of rapid growth is largely unexplored. Methodology/Principal Finding: Larvae of the damselfly Ischnura elegans from two univoltine northern and two multivoltine southern populations were reared at three temperatures and after emergence given a cold shock. Cold resistance, measured by chill coma recovery times in the adult stage, was lower in the southern populations. The faster larval growth rates in the southern populations contributed to this latitudinal pattern in cold resistance. In accordance with their assumed role in cold resistance, Hsp70 levels were lower in the southern populations, and faster growing larvae had lower Hsp70 levels. Yet, individual variation in Hsp70 levels did not explain variation in cold resistance. Conclusions/Significance: We provide evidence for a novel cost of rapid growth: reduced cold resistance. Our results indicate that the reduced cold resistance in southern populations of animals that change voltinism along the latitudinal gradient may not entirely be explained by thermal selection per se but also by the costs of time constraint-induced higher growth rates. This also illustrates that stressors imposed in the larval stage may carry over and shape fitness in the adul

Hafnium Resonance Parameter Analysis Using Neutron Capture and Transmission Experiments

The focus of this work is to determine resonance parameters for stable hafnium isotopes in the 0.005-200 eV region, with special emphasis on the overlapping {sup 176}Hf and {sup 178}Hf resonances near 8 eV. The large neutron cross section of hafnium, combined with its corrosion resistance and excellent mechanical properties, make it a useful material for controlling nuclear reactions. Experiments measuring neutron capture and transmission were performed at the Rensselaer Polytechnic Institute (RPI) electron linear accelerator (LINAC) using the time of flight method. {sup 6}Li glass scintillation detectors were used for transmission experiments at flight path lengths of 15 and 25 m. Capture experiments were done using a sixteen section NaI(Tl) multiplicity detector at a flight path length of 25 m. These experiments utilized various thicknesses of metallic and isotopically-enriched liquid samples. The liquid samples were designed to provide information on the {sup 176}Hf and {sup 178}Hf contributions to the 8 eV doublet without saturation. Data analysis was done using the R-matrix Bayesian code SAMMY version M6 beta. SAMMY is able to account for experimental resolution effects for each of the experimental setups at the RPI LINAC, and also can correct for multiple scattering effects in neutron capture yield data. The combined capture and transmission data analysis yielded resonance parameters for all hafnium isotopes from 0.005-200 eV. Resonance integrals were calculated along with errors for each hafnium isotope using the NJOY [1] and INTER [2] codes. The isotopic resonance integrals calculated were significantly different than previously published values; however the calculated elemental hafnium resonance integral changed very little

Tracking Atlantic bluefin tuna from foraging grounds off the west coast of Ireland

This is the author accepted manuscript. The final version is available from Oxford University Press via the DOI in this recordPop-up archival tags (n=16) were deployed on Atlantic bluefin tuna off the west coast of Ireland in October and November 2016 (199 to 246cm Curved Fork Length, CFL), yielding 2799 days of location data and 990 and 989 days of depth and temperature time-series data respectively, including downloaded archives from three recovered tags. Most daily locations (96%, n=2,651) occurred east of 45°W, the current stock management boundary for Atlantic bluefin tuna. Key open ocean habitats occupied were the Bay of Biscay and the Central North Atlantic, with two migratory patterns evident: an east-west group and an eastern resident group. Five out of six tags that remained attached until July 2017 returned to the northeast Atlantic after having migrated as far as the Canary Islands, the Mediterranean Sea and the Central North Atlantic. Tracked bluefin tuna exhibited a diel depth-use pattern occupying shallower depths at night and deeper depths during the day. Four bluefin tuna visited known spawning grounds in the central and western Mediterranean Sea, and one may have spawned, based on recovered data showing oscillatory dives transecting the thermocline on 15 nights. These findings demonstrate the complexity of the aggregation of Atlantic bluefin tuna off Ireland and, more broadly in the northeast Atlantic, highlighting the need for dedicated future research to conserve this important aggregation.European Maritime and Fisheries FundU.K. Department for Farming Fisheries and Rural Affair