Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project

Document Type : Original Article

Authors

1 The Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA

2 National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran

3 School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

4 Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran

5 Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran

6 Tabriz Health Services Management Research Center, Department of Health Policy & Management, Tabriz University of Medical Sciences, Tabriz, Iran

7 Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran

8 Iranian Social Security Organization, Tehran, Iran

9 Social Security Research Institute, Tehran, Iran

Abstract

Background 
SASHA, which stands for “evidence-informed health policy-making (EIHP)” in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidencebased and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran.

Methods 
This was a qualitative study, which was informed by a literature review of pull efforts’ capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method.

Results 
We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context.
 
Conclusion 
To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.

Keywords

References

  1. Bowen S, Zwi AB. Pathways to "evidence-informed" policy and practice: a framework for action. PLoS Med. 2005;2(7):e166. doi:1371/journal.pmed.0020166
  2. Champagne F, Lemieux-Charles L, Duranceau MF, MacKean G, Reay T. Organizational impact of evidence-informed decision making training initiatives: a case study comparison of two approaches. Implement Sci. 2014;9:53. doi:1186/1748-5908-9-53
  3. Haynes A, Rowbotham SJ, Redman S, Brennan S, Williamson A, Moore G. What can we learn from interventions that aim to increase policy-makers' capacity to use research? a realist scoping review. Health Res Policy Syst. 2018;16(1):31. doi:1186/s12961-018-0277-1
  4. Oxman AD, Lavis JN, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 1: what is evidence-informed policymaking? Health Res Policy Syst. 2009;7 Suppl 1:S1. doi:1186/1478-4505-7-s1-s1
  5. Evans D. Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. J Clin Nurs. 2003;12(1):77-84. doi:1046/j.1365-2702.2003.00662.x
  6. Davies HT, Nutley SM. What Works?: Evidence-Based Policy and Practice in Public Services. Policy Press; 2000.
  7. Hawkins B, Parkhurst J. The 'good governance' of evidence in health policy. Evid Policy. 2016;12(4):575-92. doi:1332/174426415x14430058455412
  8. Oxman AD, Lavis JN, Fretheim A, Lewin S. SUPPORT Tools for evidence-informed health Policymaking (STP) 17: dealing with insufficient research evidence. Health Res Policy Syst. 2009;7 Suppl 1:S17. doi:1186/1478-4505-7-s1-s17
  9. World Health Organization (WHO). Everybody's Business--Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action. WHO; 2007.
  10. Goodman RM, Speers MA, McLeroy K, et al. Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Educ Behav. 1998;25(3):258-278. doi:1177/109019819802500303
  11. Brown L, LaFond A, Macintyre K. Measuring Capacity Building. Chapel Hill: Carolina Population Center, University of North Carolina at Chapel Hill; 2001.
  12. Lavis JN. Research, public policymaking, and knowledge-translation processes: Canadian efforts to build bridges. J Contin Educ Health Prof. 2006;26(1):37-45. doi:1002/chp.49
  13. Tate K, Hewko S, McLane P, et al. Learning to lead: a review and synthesis of literature examining health care managers' use of knowledge. J Health Serv Res Policy. 2019;24(1):57-70. doi:1177/1355819618786764
  14. Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence-informed health Policymaking (STP) 7: finding systematic reviews. Health Res Policy Syst. 2009;7 Suppl 1:S7. doi:1186/1478-4505-7-s1-s7
  15. Lavis JN, Permanand G, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 13: preparing and using policy briefs to support evidence-informed policymaking. Health Res Policy Syst. 2009;7 Suppl 1:S13. doi:1186/1478-4505-7-s1-s13
  16. Lavis JN, Boyko JA, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 14: organising and using policy dialogues to support evidence-informed policymaking. Health Res Policy Syst. 2009;7 Suppl 1:S14. doi:1186/1478-4505-7-s1-s14
  17. Lavis JN, Wilson MG, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 4: using research evidence to clarify a problem. Health Res Policy Syst. 2009;7 Suppl 1:S4. doi:1186/1478-4505-7-s1-s4
  18. Ellen ME, Léon G, Bouchard G, Ouimet M, Grimshaw JM, Lavis JN. Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study. Implement Sci. 2014;9:179. doi:1186/s13012-014-0179-8
  19. Crisp BR, Swerissen H, Duckett SJ. Four approaches to capacity building in health: consequences for measurement and accountability. Health Promot Int. 2000;15(2):99-107. doi:1093/heapro/15.2.99
  20. Ettelt S, Hawkins B, Alvarez-Roset A. Analysing Evidence Use in National Health Policy-Making-An Institutional Approach. London, UK: London School of Hygiene & Tropical Medicine (LSHTM); 2013.
  21. Liverani M, Hawkins B, Parkhurst JO. Political and institutional influences on the use of evidence in public health policy. A systematic review. PLoS One. 2013;8(10):e77404. doi:1371/journal.pone.0077404
  22. Schleiff MJ, Kuan A, Ghaffar A. Comparative analysis of country-level enablers, barriers and recommendations to strengthen institutional capacity for evidence uptake in decision-making. Health Res Policy Syst. 2020;18(1):78. doi:1186/s12961-020-00546-4
  23. Sajadi HS, Majdzadeh R, Yazdizadeh B, et al. A roadmap for strengthening evidence-informed health policy-making in Iran: protocol for a research programme. Health Res Policy Syst. 2019;17(1):50. doi:1186/s12961-019-0455-9
  24. Snilstveit B, Oliver S, Vojtkova M. Narrative approaches to systematic review and synthesis of evidence for international development policy and practice. J Dev Effect. 2012;4(3):409-429. doi:1080/19439342.2012.710641
  25. O'Cathain A, Murphy E, Nicholl J. Three techniques for integrating data in mixed methods studies. BMJ. 2010;341:c4587. doi:1136/bmj.c4587
  26. D'Aquila R, Fine DJ, Kovner AR. Evidence-Based Management in Healthcare. Health Administration Press; 2009.
  27. Imani-Nasab MH, Seyedin H, Majdzadeh R, Yazdizadeh B, Salehi M. Development of evidence-based health policy documents in developing countries: a case of Iran. Glob J Health Sci. 2014;6(3):27-36. doi:5539/gjhs.v6n3p27
  28. Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open. 2016;2:8-14. doi:1016/j.npls.2016.01.001
  29. Gibbert WS, Keating SM, Jacobs JA, et al. Training the workforce in evidence-based public health: an evaluation of impact among US and international practitioners. Prev Chronic Dis. 2013;10:E148. doi:5888/pcd10.130120
  30. Yost J, Dobbins M, Traynor R, DeCorby K, Workentine S, Greco L. Tools to support evidence-informed public health decision making. BMC Public Health. 2014;14:728. doi:1186/1471-2458-14-728
  31. Uneke CJ, Ezeoha AE, Uro-Chukwu H, et al. Improving Nigerian health policymakers' capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop. Pan Afr Med J. 2015;21:212. doi:11604/pamj.2015.21.212.6375
  32. Uneke CJ, Ezeoha A, Ndukwe C, Oyibo P, Onwe F, Bhupinder A. Enhancing policy makers' capacity for evidence-informed policy making through mentorship: a reflection on the Nigeria experience. Evid Policy. 2014;10(1):137-159. doi:1332/174426414x13902186944415
  33. Berman J, Mitambo C, Matanje-Mwagomba B, et al. Building a knowledge translation platform in Malawi to support evidence-informed health policy. Health Res Policy Syst. 2015;13:73. doi:1186/s12961-015-0061-4
  34. Denis JL, Lomas J, Stipich N. Creating receptor capacity for research in the health system: the Executive Training for Research Application (EXTRA) program in Canada. J Health Serv Res Policy. 2008;13 Suppl 1:1-7. doi:1258/jhsrp.2007.007123
  35. Bullock A, Morris ZS, Atwell C. Collaboration between health services managers and researchers: making a difference? J Health Serv Res Policy. 2012;17 Suppl 2:2-10. doi:1258/jhsrp.2011.011099
  36. Jacobs JA, Duggan K, Erwin P, et al. Capacity building for evidence-based decision making in local health departments: scaling up an effective training approach. Implement Sci. 2014;9:124. doi:1186/s13012-014-0124-x
  37. Langlois EV, Becerril Montekio V, Young T, Song K, Alcalde-Rabanal J, Tran N. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches. Health Res Policy Syst. 2016;14:20. doi:1186/s12961-016-0089-0
  38. Waqa G, Mavoa H, Snowdon W, et al. Knowledge brokering between researchers and policymakers in Fiji to develop policies to reduce obesity: a process evaluation. Implement Sci. 2013;8:74. doi:1186/1748-5908-8-74
  39. Bullock A, Morris ZS, Atwell C. A Formative Evaluation of the Service Delivery and Organisation (SDO) Management Fellowships. National Institute for Health Research (NIHR); 2012.
  40. Chaney P. Critical mass, deliberation and the substantive representation of women: evidence from the UK's devolution programme. Polit Stud. 2006;54(4):691-714. doi:1111/j.1467-9248.2006.00633.x
  41. Shroff Z, Aulakh B, Gilson L, Agyepong IA, El-Jardali F, Ghaffar A. Incorporating research evidence into decision-making processes: researcher and decision-maker perceptions from five low- and middle-income countries. Health Res Policy Syst. 2015;13:70. doi:1186/s12961-015-0059-y
  42. Bazyar M, Rashidian A, Kane S, Vaez Mahdavi MR, Akbari Sari A, Doshmangir L. Policy options to reduce fragmentation in the pooling of health insurance funds in Iran. Int J Health Policy Manag. 2016;5(4):253-258. doi:15171/ijhpm.2016.12
  43. Mostafavi H, Rashidian A. The role of lobbying and conflict of interests on the Iranian health system decision-making. Hakim Res J. 2017;20(1):27-34. [Persian].
International Journal of Health Policy and Management
Volume 11, Issue 10
October 2022
Pages 2236-2247

Files

History

  • Receive Date: 04 August 2020
  • Revise Date: 19 September 2021
  • Accept Date: 10 October 2021
  • First Publish Date: 11 October 2021

Share

How to cite

Statistics