A Process Evaluation to Assess Contextual Factors Associated With the Uptake of a Rapid Response Service to Support Health Systems' Decision-Making in Uganda.

Rhona Mijumbi-Deve,Nelson K Sewankambo

doi:10.15171/ijhpm.2017.04

Rhona Mijumbi-Deve, Nelson K Sewankambo

Open Access

https://doi.org/10.15171/ijhpm.2017.04

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Abstract

Background: Although proven feasible, rapid response services (RRSs) to support urgent decision and policymaking are still a fairly new and innovative strategy in several health systems, more especially in low-income countries. There are several information gaps about these RRSs that exist including the factors that make them work in different contexts and in addition what affects their uptake by potential end users. Methods: We used a case study employing process evaluation methods to determine what contextual factors affect the utilization of a RRS in Uganda. We held in-depth interviews with researchers, knowledge translation (KT) specialists and policy-makers from several research and policy-making institutions in Uganda’s health sector. We analyzed the data using thematic analysis to develop categories and themes about activities and structures under given program components that affected uptake of the service. Results: We identified several factors under three themes that have both overlapping relations and also reinforcing loops amplifying each other: Internal factors (those factors that were identified as over which the RRS had full [or almost full] control); external factors (factors over which the service had only partial influence, a second party holds part of this influence); and environmental factors (factors over which the service had no or only remote control if at all). Internal factors were the design of the service and resources available for it, while the external factors were the service’s visibility, integrity and relationships. Environmental factors were political will and health system policy and decision-making infrastructure. Conclusion: For health systems practitioners considering RRSs, knowing what factors will affect uptake and therefore modifying them within their contexts is important to ensure efficient use and successful utilization of the mechanisms.

Highlights

Over the past few years, researchers in low- and middleincome countries have shown the feasibility of rapid response services (RRSs) to meet policy-makers’ urgent needs for research evidence about health systems to aid policymaking in low income countries.[1,2] RRSs are designed to receive policy and decision questions and respond to these with the best available research evidence in summarized and contextualized forms within short periods of time, for example, less than 28 days.[1]
The knowledge on why and how the RRS works are important to inform among other things, what affects its uptake by potential end users. (The concept of ‘Uptake’ as used in this paper refers to the action of making use of something that is available)
Contextual factors affecting the uptake of knowledge translation (KT) strategies have not yet been well articulated – we do not know of any study that has looked at factors affecting the uptake of a RRS in any setting – several factors affecting the uptake of evidence for policy and practice have been documented

Summary

Introduction

Over the past few years, researchers in low- and middleincome countries have shown the feasibility of rapid response services (RRSs) to meet policy-makers’ urgent needs for research evidence about health systems to aid policymaking in low income countries.[1,2] RRSs are designed to receive policy and decision questions and respond to these with the best available research evidence in summarized and contextualized forms within short periods of time, for example, less than 28 days.[1]. Scholars have cited factors in the context of organizations and systems that affect uptake of innovations as including the strength of the relationship between the producers or suppliers and the end users, including the importance of network effects.[9] Other factors include culture referring to the norms and values of the environment in which the KT is placed, and power (perceived and/or actual).[18,19] Innovations will tend to be taken up and achieve higher levels of saturation if they have among other things, high compatibility with current norms and work processes.[20] Other influential factors include internal organizational structure – centralization, complexity, formalization, interconnectedness, organizational slack, and external characteristics of the organization.[15] the customs and behavior of the supply side, affect and sometimes facilitate or act as a barrier to the eventual acceptance and uptake of the innovation.[8] It is important to note that both the user and supplier of the innovation may have no direct control over some contextual factors within the environment or institution that the innovation is being introduced Such factors may include institution rules and culture, government regulations, and country economic situations.[15,18,19] Despite the work done far, scholars still need to understand more on the concepts of context in KT. Such factors are important for, and should be considered during the implementation and scale up of RRSs in similar settings

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