Abstract
BackgroundAlthough increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. The present study explores the role of evidence, barriers, and factors facilitating the uptake of evidence in the change in malaria treatment policy in Uganda, building on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitatory factors for KT. Application of the MRT to a health policy case will contribute to refining it.MethodsUsing a case study approach and mixed methods, perceptions of respondents on whether evidence was available, had been considered and barriers and facilitatory factors to the uptake of evidence were explored. In addition, the respondents’ rating of the degree of consistency between the policy decision and available evidence was assessed. Data collection methods included key informant interviews and document review. Qualitative data were analysed using content thematic analysis, whereas quantitative data were analysed using Excel spreadsheets. The two data sets were eventually triangulated.ResultsEvidence was used to change the malaria treatment policy, though the consistency between evidence and policy decisions varied along the policy development cycle. The availability of high-quality and contextualized evidence, including effective dissemination, Ministry of Health institutional capacity to lead the KT process, intervention of the WHO and a regional professional network, the existence of partnerships for KT with mutual trust and availability of funding, tools, and inputs to implement evidence, were the most important facilitatory factors that enhanced the uptake of evidence. Among the barriers that had to be overcome were resistance from implementers, the health system capacity to implement evidence, and financial sustainability.ConclusionThe results agree with facilitatory factors identified in the earlier developed MRT, though additional factors emerged. These results refine the earlier MRT stating that high-quality and contextualized evidence will be taken up in policies, leading to evidence-informed policies when the MoH leads the KT process, partnerships are in place for KT, the WHO and regional professional bodies play a role, and funding, tools, and required inputs for implementing evidence are available.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-345) contains supplementary material, which is available to authorized users.
Highlights
Increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent
Technical support was provided by East African Network on Monitoring Antimalarial Treatment (EANMAT) and the World Health Organization (WHO) when setting up the sites and for the development of research protocols, data analysis, and interpretation
Different types of evidence were used in changing the malaria treatment policy in Uganda, though the level of consistency between evidence and policy decisions varied along the policy development cycle
Summary
Increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. Evidence is broadly defined to include research study results (both published and unpublished), findings from monitoring and evaluation (M&E) studies and population-based surveys, Ministry of Health (MoH) reports, community complaints, and clinician observations [14,15]. EANMAT was established as a platform to bring together malaria researchers and policy-makers from the Ministries of Health of the three East African countries: Kenya, Uganda, and Tanzania. The sentinel sites represented all geographic, epidemiological, and ecological strata of malaria in Uganda Evidence from these sentinel sites showed that resistance to CQ exceeded the WHO-recommended threshold beyond which a policy change is recommended [21,22]. Several countries, including Uganda, embarked on changing their malaria treatment policies [7,10,19,23,24]. The process occurred over a period of 25 months, from March 2004 to April 2006
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