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

Research influence on antimalarial drug policy change in Tanzania: case study of replacing chloroquine with sulfadoxine-pyrimethamine as the first-line drug

INTRODUCTION: Research is an essential tool in facing the challenges of scaling up interventions and improving access to services. As in many other countries, the translation of research evidence into drug policy action in Tanzania is often constrained by poor communication between researchers and policy decision-makers, individual perceptions or attitudes towards the drug and hesitation by some policy decision-makers to approve change when they anticipate possible undesirable repercussions should the policy change as proposed. Internationally, literature on the role of researchers on national antimalarial drug policy change is limited. OBJECTIVES: To describe the (a) role of researchers in producing evidence that influenced the Tanzanian government replace chloroquine (CQ) with sulfadoxine-pyrimethamine (SP) as the first-line drug and the challenges faced in convincing policy-makers, general practitioners, pharmaceutical industry and the general public on the need for change (b) challenges ahead before a new drug combination treatment policy is introduced in Tanzania. METHODS: In-depth interviews were held with national-level policy-makers, malaria control programme managers, pharmaceutical officers, general medical practitioners, medical research library and publications officers, university academicians, heads of medical research institutions and district and regional medical officers. Additional data were obtained through a review of malaria drug policy documents and participant observations were also done. RESULTS: In year 2001, the Tanzanian Government officially changed its malaria treatment policy guidelines whereby CQ – the first-line drug for a long time was replaced with SP. This policy decision was supported by research evidence indicating parasite resistance to CQ and clinical CQ treatment failure rates to have reached intolerable levels as compared to SP and amodiaquine (AQ). Research also indicated that since SP was also facing rising resistance trend, the need for a more effective drug was indispensable but for an interim 5–10 year period it was justifiable to recommend SP that was relatively more cost-effective than CQ and AQ. The government launched the policy change considering that studies (ethically approved by the Ministry of Health) on therapeutic efficacy and cost-effectiveness of artemisinin drug combination therapies were underway. Nevertheless, the process of communicating research results and recommendations to policy-making authorities involved critical debates between policy makers and researchers, among the researchers themselves and between the researchers and general practitioners, the speculative media reports on SP side-effects and reservations by the general public concerning the rationale for policy change, when to change, and to which drug of choice. CONCLUSION: Changing national drug policy will remain a sensitive issue that cannot be done overnight. However, to ensure that research findings are recognised and the recommendations emanating from such findings are effectively utilized, a systematic involvement of all the key stakeholders (including policy-makers, drug manufacturers, media, practitioners and the general public) at all stages of research is crucial. It also matters how and when research information is communicated to the stakeholders. Professional organizations such as the East African Network on Malaria Treatment have potential to bring together malaria researchers, policy-makers and other stakeholders in the research-to-drug policy change interface

Cool and warm dust emission from M33 (HerM33es)

We study the far-infrared emission from the nearby spiral galaxy M33 in order to investigate the dust physical properties such as the temperature and the luminosity density across the galaxy. Taking advantage of the unique wavelength coverage (100, 160, 250, 350 and 500 micron) of the Herschel Space Observatory and complementing our dataset with Spitzer-IRAC 5.8 and 8 micron and Spitzer-MIPS 24 and 70 micron data, we construct temperature and luminosity density maps by fitting two modified blackbodies of a fixed emissivity index of 1.5. We find that the 'cool' dust grains are heated at temperatures between 11 and 28 K with the lowest temperatures found in the outskirts of the galaxy and the highest ones in the center and in the bright HII regions. The infrared/submillimeter total luminosity (5 - 1000 micron) is estimated to be 1.9x10^9 Lsun. 59% of the total luminosity of the galaxy is produced by the 'cool' dust grains (~15 K) while the rest 41% is produced by 'warm' dust grains (~55 K). The ratio of the cool-to-warm dust luminosity is close to unity (within the computed uncertainties), throughout the galaxy, with the luminosity of the cool dust being slightly enhanced in the center of the galaxy. Decomposing the emission of the dust into two components (one emitted by the diffuse disk of the galaxy and one emitted by the spiral arms) we find that the fraction of the emission in the disk in the mid-infrared (24 micron) is 21%, while it gradually rises up to 57% in the submillimeter (500 micron). We find that the bulk of the luminosity comes from the spiral arm network that produces 70% of the total luminosity of the galaxy with the rest coming from the diffuse dust disk. The 'cool' dust inside the disk is heated at a narrow range of temperatures between 18 and 15 K (going from the center to the outer parts of the galaxy).Comment: 12 pages, 14 figures, accepted for publication in A&

The Opacity of Nearby Galaxies from Colors and Counts of Background Galaxies: I. The Synthetic Field Method and its Application to NGC 4536 and NGC 3664

We describe a new, direct method for determining the opacity of foreground galaxies which does not require any a priori assumptions about the spatial distribution or the reddening law of the obscuring material. The method is to measure the colors and counts of background galaxies which can be identified through the foreground system. The method is calibrated, and the effects of confusion and obscuration are decoupled by adding various versions of a suitable deep reference frame containing only field galaxies with known properties into the image of the foreground galaxy, and analyzing these ``synthetic field'' images in the same way as the real images. We test the method on HST WFPC2 archived images of two galaxies which are quite different: NGC 4536 is a large Sc spiral, and NGC 3664 is a small Magellanic irregular. The reference frames are taken from the Hubble Deep Field. From the background galaxy counts, NGC 4536 shows an extinction A_I ~ 1 mag in the northwestern arm region, and lower than 0.5 mag in the corresponding interarm region (no correction for inclination has been attempted). However, from the galaxy colors, the same reddening of E(V - I) ~ 0.2 is observed in both the arm and the interarm regions. In the interarm region, the combination of extinction and reddening can be explained by a diffuse component with a Galactic reddening law (R_V ~ 3). In the spiral arm, however, the same diffuse, low opacity component seems to coexist with regions of much higher opacity. Since the exposures are shorter the results for NGC 3664 are less clear, but also appear to be consistent with a two component distribution.Comment: 42 pages, 18 figures; accepted for publication in The Astrophysical Journal, Vol. 506, October 10, 199

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

The importance of health research utilisation in policy-making, and of understanding 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. Key utilisation issues have been described for at least twenty years, but the growing focus on health research systems creates additional dimensions. The utilisation of health research in policy-making should contribute to policies that may eventually lead to desired outcomes, including health gains. In this article, exploration of these issues is combined with a review of various forms of policy-making. When this is linked to analysis of different types of health research, it assists in building a comprehensive account of the diverse meanings of research utilisation. Previous studies report methods and conceptual frameworks that have been applied, if with varying degrees of success, to record utilisation in policy-making. These studies reveal various examples of research impact within a general picture of underutilisation. Factors potentially enhancing utilisation can be identified by exploration of: priority setting; activities of the health research system at the interface between research and policy-making; and the role of the recipients, or 'receptors', of health research. An interfaces and receptors model provides a framework for analysis. Recommendations about possible methods for assessing health research utilisation follow identification of the purposes of such assessments. Our conclusion is that research utilisation can be better understood, and enhanced, by developing assessment methods informed by conceptual analysis and review of previous studies

Spitzer Sage Survey of the Large Magellanic Cloud. III. Star Formation and ~1000 New Candidate Young Stellar Objects

We present ~1000 new candidate Young Stellar Objects (YSOs) in the Large Magellanic Cloud selected from Spitzer Space Telescope data, as part of the Surveying the Agents of a Galaxy's Evolution (SAGE) Legacy program. The YSOs, detected by their excess infrared (IR) emission, represent early stages of evolution, still surrounded by disks and/or infalling envelopes. Previously, fewer than 20 such YSOs were known. The candidate YSOs were selected from the SAGE Point Source Catalog from regions of color-magnitude space least confused with other IR-bright populations. The YSOs are biased toward intermediate- to high-mass and young evolutionary stages, because these overlap less with galaxies and evolved stars in color-magnitude space. The YSOs are highly correlated spatially with atomic and molecular gas, and are preferentially located in the shells and bubbles created by massive stars inside. They are more clustered than generic point sources, as expected if star formation occurs in filamentary clouds or shells. We applied a more stringent color-magnitude selection to produce a subset of "high-probability" YSO candidates. We fitted the spectral-energy distributions (SEDs) of this subset and derived physical properties for those that were well fitted. The total mass of these well-fitted YSOs is ~2900 M_☉ and the total luminosity is ~2.1 × 10^6 L_☉ . By extrapolating the mass function with a standard initial mass function and integrating, we calculate a current star-formation rate of ~0.06 M_☉ yr^(–1), which is at the low end of estimates based on total ultraviolet and IR flux from the galaxy (~0.05 – 0.25 M_☉ yr^(–1)), consistent with the expectation that our current YSO list is incomplete. Follow-up spectroscopy and further data mining will better separate the different IR-bright populations and likely increase the estimated number of YSOs. The full YSO list is available as electronic tables, and the SEDs are available as an electronic figure for further use by the scientific community

Building health research systems to achieve better health

Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS) provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics related to the above priorities on which we hope to feature further articles in HARPS and thus contribute to an informed debate on how best to achieve such progress

Health systems research in Lao PDR: capacity development for getting research into policy and practice

<p>Abstract</p> <p>Background</p> <p>Lao PDR is a low-income country with an urgent need for evidence-informed policymaking in the healthcare sector. During the last decade a number of Health Systems Research (HSR) projects have been conducted in order to meet this need. However, although knowledge about research is increasing among policymakers, the use of research in policymaking is still limited.</p> <p>Methods</p> <p>This article investigates the relationship between research and policymaking from the perspective of those participating in HSR projects. The study is based on 28 interviews, two group discussions and the responses from 56 questionnaires.</p> <p>Results</p> <p>The interviewees and questionnaire respondents were aware of the barriers to getting research into policy and practice. But while some were optimistic, claiming that there had been a change of attitudes among policymakers in the last two years, others were more pessimistic and did not expect any real changes until years from now. The major barriers to feeding research results into policy and practice included an inability to influence the policy process and to get policymakers and practitioners interested in research results. Another barrier was the lack of continuous capacity development and high-quality research, both of which are related to funding and international support. Many of the interviewees and questionnaire respondents also pointed out that communication between those conducting research and policymakers must be improved.</p> <p>Conclusion</p> <p>The results show that in the case of Lao PDR, research capacity development is at a crucial stage for implementing research into policy and practice. If research is going to make a consistent impact on policymaking in the Lao health care sector, the attitude towards research will need to be changed in order to get research prioritised, both among those conducting research, and among policymakers and practitioners. Our findings indicate that there is awareness about the barriers in this process.</p

The Calibration of Monochromatic Far-Infrared Star Formation Rate Indicators

(Abridged) Spitzer data at 24, 70, and 160 micron and ground-based H-alpha images are analyzed for a sample of 189 nearby star-forming and starburst galaxies to investigate whether reliable star formation rate (SFR) indicators can be defined using the monochromatic infrared dust emission centered at 70 and 160 micron. We compare recently published recipes for SFR measures using combinations of the 24 micron and observed H-alpha luminosities with those using 24 micron luminosity alone. From these comparisons, we derive a reference SFR indicator for use in our analysis. Linear correlations between SFR and the 70 and 160 micron luminosity are found for L(70)>=1.4x10^{42} erg/s and L(160)>=2x10^{42} erg/s, corresponding to SFR>=0.1-0.3 M_sun/yr. Below those two luminosity limits, the relation between SFR and 70 micron (160 micron) luminosity is non-linear and SFR calibrations become problematic. The dispersion of the data around the mean trend increases for increasing wavelength, becoming about 25% (factor ~2) larger at 70 (160) micron than at 24 micron. The increasing dispersion is likely an effect of the increasing contribution to the infrared emission of dust heated by stellar populations not associated with the current star formation. The non-linear relation between SFR and the 70 and 160 micron emission at faint galaxy luminosities suggests that the increasing transparency of the interstellar medium, decreasing effective dust temperature, and decreasing filling factor of star forming regions across the galaxy become important factors for decreasing luminosity. The SFR calibrations are provided for galaxies with oxygen abundance 12+Log(O/H)>8.1. At lower metallicity the infrared luminosity no longer reliably traces the SFR because galaxies are less dusty and more transparent.Comment: 69 pages, 19 figures, 2 tables; accepted for publication on Ap