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

Brave Forms of Mentoring Supported by Technology in Teacher Education

Indexación: Web of ScienceQuality education is undoubtedly a global concern, tied closely to preoccupations with economic and social development. Increasingly, the adoption and effective use of current technology tools are being recognized as visible signs of that quality. Scholars are providing increasing evidence of the kinds of empowered teacher identities that will adopt the effective use of technology tools in teaching. Less is being discussed about how technology can support the processes needed to mediate such identities. The context of Teacher Education is a strategic place to begin to initiate such processes. Our aim in this article is twofold: 1) to describe two recent examples of innovative, technology - supported mentoring processes that were conducted in the context of an EFL Teacher Education program in Chile; 2) to revisit the findings of these studies in light of new evidence from participants who have moved on in their careers. This evidence is viewed in the framework of recent scholarship on the responsibilities that Teacher Education plays in their development. The first 16-month study examined the influences of a guided reading program involving e-readers on the identities and literacy skills of pre-service teachers. The second was a student-conceived study. That inquiry sought to determine the influence of upper year students' peer mentoring, made available partly through a social media site (SMS), on the identities and investment in learning of 12 firs-year students in the pedagogy program. The initial evidence from ethnographic tools used in both studies indicated that the participants were struggling with confidence and doubting themselves as knowledgeable, effective future teachers - not predictive of a potential for quality teaching. Positive signs at the end of both studies and more recent reports from participants suggest that the mentoring had longitudinal benefits for some, although not uniformly. The potential of apprenticeship and mentoring in a technology-supported environment requires rethinking Teacher Education mandates if we are to empower emerging teachers to be quality teachers.http://www.ejel.org/issue/download.html?idArticle=48

Examining the Link Between Funding and Intellectual Interventions Across Universities and Think Tanks: a Theoretical Framework

Policy-oriented expert knowledge is increasingly applied, collaborative and socially accountable, created in a variety of organisations and institutions that display a diversity of funding patterns with a wide range of requirements and expectations. Given the complexities of knowledge production and recent changes in its funding environment (e.g. mode and availability of research funding and evaluation), few existing theoretical elaborations consider tensions between structural funding conditions and intellectual production in policy research contexts. This paper examines the role of funding in shaping the policy issues, format and content of intellectual output across two research contexts (universities, think tanks). It sets out a theoretical and methodological approach to understand the link between funding modalities and the type of knowledge and intellectual interventions they facilitate or thwart

Vacuolating cytotoxin (vacA) alleles of Helicobacter pylori comprise two geographically widespread types, m1 and m2, and have evolved through limited recombination

Vacuolating cytotoxin (vacA) alleles of Helicobacter pylori vary, particularly in their mid region (which may be type m1 or m2) and their signal peptide coding region (type s1 or s2). We investigated nucleotide diversity among vacA alleles in strains from several locales in Asia, South America, and the USA. Phylogenetic analysis of vacA mid region sequences from 18 strains validated the division into two main groups (m1 and m2) and showed further significant divisions within these groups. Informative site analysis demonstrated one example of recombination between m1 and m2 alleles, and several examples of recombination among alleles within these groups. Recombination was not sufficiently extensive to destroy phylogenetic structure entirely. Synonymous nucleotide substitution rates were markedly different between regions of vacA, suggesting different evolutionary divergence times and implying horizontal transfer of genetic elements within vacA. Non-synonymous/synonymous rate ratios were greater between m1 and m2 sequences than among m1 sequences, consistent with m1 and m2 alleles encoding functions fitting strains for slightly different ecological niches

Understanding the hydrogeology and surface flow in the Cuatrocienegas Basin (NE Mexico) using stable isotopes

In this paper we present surface water oxygen (δ18O), hydrogen (δD) and inorganic carbon (δ13CDIC) isotope data to gain a better understanding of the modern day hydrogeology of Cuatrociénegas Basin, a semi-arid region in northeastern Mexico. Our study focuses on 26 water samples collected in March 2008 to investigate: 1) current provenance and flow pathways of surface waters, 2) the use of stable isotopes in identifying water loss and environmental degradation, and 3) human influence on hydrogeology. δ18O for Cuatrociénegas water samples ranged from −7.99 to +4.97‰ (mean −5.23 ± 3.13‰), δD from −54.8 to +0.3‰ (mean −42.4 ± 14.4‰), and δ13CTDICfrom −21.6 to −9.2‰ (mean −14.3 ± 3.4‰). Samples collected progressively away from their respective spring lines display increasing δ18O and δD values. Isotope data suggest that where the residence time of the groundwater is long and/or the system is hydrologically open, δ18O may not be a reliable indicator of water loss and environmental degradation. Our data suggest the central ciénega (area W(b)) is the most viable area for palaeoenvironmental study and long term monitoring is an essential tool in the identification of ecosystem damage and response, allowing for better future management of the complex and fragile CCB ecosystem

Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme

BACKGROUND: Diabetes self-management involves adherence to healthy daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. OBJECTIVE: The objective of our study was to identify and classify barriers to adoption of remote health for management of type 2 diabetes. METHODS: The following 6 electronic databases were searched for articles published from 2010 to 2015: MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier). The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of 2 to review and extract data from identified papers. Information collected included study characteristics, outcomes, dropout rates, technologies used, and barriers identified. RESULTS: A total of 53 publications on 41 studies met the specified criteria. Lack of data accuracy due to input bias (32%, 13/41), limitations on scalability (24%, 10/41), and technology illiteracy (24%, 10/41) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations, whereas limitations on scalability were more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. In total, 40.5% (60/148) of identified barrier instances impeded patient engagement, which is manifest in the large dropout rates cited (up to 57%). CONCLUSIONS: The barriers identified represent major challenges in the design of remote health interventions for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high dropout rates, and new interventions are needed to identify and assist those at the greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financial sustainability

Trends in alcohol-related injury admissions in adolescents in Western Australia and England: population-based cohort study

BACKGROUND: Alcohol-related harm in young people is now a global health priority. We examined trends in hospital admissions for alcohol-related injuries for adolescents in Western Australia (WA) and in England, identified groups most at risk and determined causes of injuries. METHODS: Annual incidence rates for alcohol-related injury rates were calculated using population-level hospital admissions data for WA and England. We compared trends in different types of alcohol-related injury by age and gender. RESULTS: Despite a decrease in the overall rate of injury admissions for people aged 13-17 years in WA, alcohol-related injuries have increased significantly from 1990 to 2009 (from 8 to 12 per 10 000). Conversely, alcohol-related injury rates have declined in England since 2007. In England, self-harm is the most frequently recorded cause of alcohol-related injury. In WA, unintentional injury is most common; however, violence-related harm is increasing for boys and girls. CONCLUSION: Alcohol-related harm of sufficient severity to require hospital admission is increasing among adolescents in WA. Declining trends in England suggest that this trend is not inevitable or irreversible. More needs to be done to address alcohol-related harm, and on-going monitoring is required to assess the effectiveness of strategies

Direct Torque and Predictive Control Strategies in Nine-phase Electric Drives Using Virtual Voltage Vectors

One of the main distinctive features of multiphase machines is the appearance of new degrees of freedom ( - voltages/currents) that do not exist in their three-phase counterparts. As a direct consequence, control approaches that apply a single switching state during the sampling period cannot achieve zero average - voltage production. In direct torque control (DTC) this implies that - currents are not regulated, whereas in finite-control-set model predictive control (FCS-MPC) an enhanced - current regulation is feasible only at the expense of disturbing the flux/torque production. Aiming to avoid these shortcomings, this work makes use of the concept of synthetic/virtual voltage vectors (VVs) to nullify/limit the - voltage production in order to improve the current regulation in the secondary planes. Two strategies using two and four virtual voltage vectors (2-VV and 4-VV, respectively) are proposed and compared with the standard case that applies a single switching state. Since standard MPC has the capability to indirectly regulate - currents, the improvements with the inclusion of VVs are expected to be more significant in DTC strategies. Experimental results validate the proposed VVs and confirm the expectations through a detailed performance comparison of standard, 2-VV and 4-VV approaches for DTC and MPC strategies

Linewidth Tolerance for THz Communication Systems Using Phase Estimation Algorithm

This paper presents the impact of signal linewidth on photonic THz wireless systems using phase estimation (PE) algorithms at the receiver. The penalty associated with signal linewidth, as well as the optical linewidth requirements for systems using free-running lasers are evaluated using extensive Monte Carlo simulations for different modulation formats. The BER performance and power penalty induced by signal linewidth are also measured experimentally by varying the linewidth of the local oscillator laser. Simulation and experimental results show similar penalty trends. Differences between them are likely to be due to impairments not considered in the simulations and the THz signal linewidth being bigger than the sum of the optical linewidths of the two free-running lasers used in the experiment