Evidence For Policy Development Research Articles

An assessment of the performance of the national health research system in Mauritius

BackgroundThe goal of universal health coverage (UHC) is that every individual has access to high-quality health services without running the consequences of financial hardship. The World health report 2013 "Research for universal health coverage" states a performant National Health Research Systems (NHRS) can contribute by providing solutions to challenges encountered in advancing towards UHC by 2030. Pang et al. define a NHRS as the people, institutions, and activities whose primary aim is to generate and promote utilization of high-quality knowledge that can be used to promote, restore, and/or maintain the health status of populations. The WHO Regional Committee for Africa (RC) adopted a resolution in 2015 urging member states to strengthen their NHRS to facilitate production and utilization of evidence in policy development, planning, product development, innovation, and decision-making. This study aimed to calculate NHRS barometer scores for Mauritius in 2020, identify the gaps in NHRS performance, and recommend interventions for boosting the Mauritius NHRS in the pursuit of UHC.MethodsThe study used a cross-sectional survey design. A semi-structured NHRS questionnaire was administered and complemented with a review of documents archived in pertinent Mauritius Government Ministries, universities, research-oriented departments, and non-governmental organizations websites. The African NHRS barometer developed in 2016 for countries to monitor the RC resolution implementation was applied. The barometer consists of four NHRS functions (leadership and governance, developing and sustaining resources, producing and utilizing research, financing research for health [R4H]), and 17 sub-functions, e.g., existence of a national policy on research for health (R4H), presence of a Mauritius Research and Innovation Council (MRIC), existence of knowledge translation platform.ResultsIn 2020, Mauritius had an overall average NHRS barometer score of 60.84%. The four NHRS functions average indices were 50.0% for leadership and governance, 77.0% for developing and sustaining resources, 52.0% for producing and utilizing R4H, and 58.2% for financing R4H.ConclusionThe performance of NHRS could be improved through the development of a national R4H policy, strategic plan, prioritized agenda, and national multi-stakeholder health research management forum. Furthermore, increased funding for the NHRS may nurture the human resources for health research capacities, hence the number of pertinent publications and health innovations.

Research use at the Ministry of Health in Burkina Faso: the decision-makers\u2019 perspective

BackgroundDespite the increased emphasis placed on the use of evidence for policy development, relatively few initiatives have been developed to support evidence-informed decision-making, especially in West Africa. Moreover, studies examining the conditions under which policy-makers use research-based evidence are still scarce, but they show that their attitudes and opinions about research are one of the main determinants of such use. In February 2017, Burkina Faso’s Minister of Health planned to create a unit to promote evidence-informed decision-making within the ministry. Before the unit was set up, documenting the attitudes towards research at the highest levels of his Ministry appeared profitable to the unit’s planning.MethodIndividual interviews were conducted by the author with 14 actors positioned to consider evidence during decision-making from the Burkina Faso’s Minister of health cabinet. An interview grid was used to explore several themes such as attitudes towards research, obstacles and facilitators to research use, example of research use in decision-making and finally, ways to increase decision-makers’ participation in knowledge transfer activities. Interviews were partially transcribed and analysed by the author.ResultsThe results show a mixed attitude towards research and relatively little indication of research use reported by respondents. Important obstacles were identified: evidence inaccessibility, lack of implementation guidelines, absence of clear communication strategy and studies’ lack of relevance for decision-making. Many suggestions were proposed such as raising awareness, improving access and research communication and prioritizing interactions with researchers. Respondents agree with the low participation of decision-makers in knowledge transfer activities: more leadership from the senior officials was suggested and greater awareness of the importance of their presence.ConclusionsThe conclusion presents avenues for reflection and action to increase the potential impact of the knowledge transfer unit planned within the Ministry of Health of Burkina Faso. This innovative initiative will be impactful if the obstacles identified in this study and policy-makers’ preferences and needs are taken into account during its development and implementation.

Strategies and practical examples

Abstract Various tools and mechanisms can help to increase the use of scientific evidence in policy development by making policymakers appreciate, understand and incorporate such scientific information into policy decisions. As part of this process, it is crucial that researchers and public health practitioners acquire the ability to translate their knowledge and become skilled on communicating the evidence effectively. The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health-care systems in Europe. It engages directly with policy-makers and experts, and works in partnership with research centers, governments and international organizations to analyze health systems and policy trends. In this presentation, concrete strategies will be given for advocating scientific evidence. The focus will lie particularly on the process of real-life applications of evidence-informed policy-making. By this way, it will help the participants to analyze to whom they are targeting, what are their interests and how to communicate scientific information to a decision-maker effectively based on specific examples from the European Observatory on Health Systems and Policies.

2.N. How to Advocate Scientific Evidence to Decision-makers?

Abstract Public health research aims to change the world, or at least contribute to the development of healthier and more equitable societies. However, the availability of health information does not inherently lead to its increased use in policy and decision-making. Significant gap remains between the knowledge of public health researchers and the actions taken by decision-makers. Various tools and mechanisms can help to increase the use of scientific evidence in policy development by making policymakers appreciate, understand and incorporate such scientific information into policy decisions. As part of this process, it is crucial that researchers and public health practitioners acquire the ability to translate their knowledge and become skilled on communicating the evidence effectively. To this aim, we will present firstly a WHO approach for that on the basis of EVIPNet Europe. Member countries have benefited of EVIPNet Europe’s capacity building efforts, its training workshops, coaching and mentoring schemes, leading to increased knowledge and skills in view of identifying, accessing, appraising, synthesizing and communicating the best available evidence. The presentation will focus on the ways to trigger tangible changes at policy and legislative levels. The second presentation will give more specific information about the process of real-life applications. Main question will be “How to advocate scientific evidence to decision-makers in the frame of evidence-informed policy-making?”. The presentation will help the participants to analyze to whom they are targeting, what their interests are and how to communicate scientific information to a decision-maker effectively. Last but not least, common challenges of evidence-informed policy-making process in health care and ways to tackle them will be presented. By doing so, special attention will be paid to the methodologies for joint fact-finding, responsive evaluation and citizen science. The workshop will engage participants interactively and leave time for answering their questions at the end. Key messages Public health professionals can influence health policies, if they learn strategies in communicating scientific evidence to decision-makers effectively. Providing correct skills to researchers when communicating about and advocating for the scientific evidence with policymakers will enhance the impact of evidence on policy making.

Birth ball for pregnant women in labour research protocol: a multi-centre randomised controlled trial

BackgroundBirth ball is one of the non-pharmacologic pain relief methods to help mothers cope with the labouring process. A randomised controlled trial (RCT) is conducted to evaluate the effectiveness, safety and harm of birth ball use by pregnant women in labour compared to treatment as usual group.MethodsA prospective multi-centre randomised controlled trial (RCT) will be conducted in Obstetrics and Gynaecological units of five public hospitals in Hong Kong, China. Data will be collected from March 2016 onward for 2 years. The target population is Chinese women with an uncomplicated singleton pregnancy at gestational age of 37 to 42 weeks. Participants are randomised based on parity (nulliparous and multiparous) and type of labour onset (spontaneous and induced). Women in the intervention group are actively offered and taught how to use a birth ball; those in the control group receive the usual midwifery care. The target sample size is 512. The primary outcome measures are maternal pain intensity, satisfaction with pain relief, sense of control in labour, assisted delivery and satisfaction with childbirth experience. Labour pain relief is measured by visual analogue scale (VAS). Other outcomes will be measured through four different validated questionnaires. To control for potential cluster effects, a linear mixed model will be used. An intention-to-treat analysis is adopted and performed by researchers unknown to subjects’ group allocation.DiscussionResults will provide rigorous scientific evidence for policy development and practice. We are using stratified randomisation according to potential confounders of parity and type of labour onset to give four possible combinations. If the results are favourable, it will facilitate systematic implementation to promote birth ball use for women in labour.Trial registrationChinese Clinical Trial Register (ChiCTR), Registration number: ChiCTR-IIC-16008275, Date of registration 12 April 2016 (retrospectively registered), Date of enrolment of the first participant to the trial 1 March 2016.

Use of Evidence in Policy Development by Policy Makers and Evidence Generators at the Federal Ministry of Health, Khartoum - Sudan

Background: Evidence informed policy is defined as an approach to decisions that ensure that decision making is informed by the best available research evidence. Evidence has a great impact on policy development and implementation especially in countries with scarce resources. Health systems research- evidence is not always communicated effectively or in a timely manner. Purpose: The Aim of this study is to explore the use of evidence in policy development among directors of the Federal Ministry of Health (FMoH) and the factors affecting evidence-generating bodies in Khartoum, Sudan 2016. Materials and Methods: This is a descriptive qualitative exploratory study involving two groups: Decision makers who were the heads of the directorates involved in policy development and evidence generating bodies: the Public Health Institute, Sudan Health Observatory and the Institute of Endemic Diseases. Using purposive sampling of 17 personnel, in depth interviews were conducted. Data analysis was done through thematic framework analysis combined with the deductive approach. Results: Knowledge, attitude and skills of the policy makers interviewed showed that all the interviewees had good knowledge and positive attitudes towards evidence even though obstacles, such as intervention from higher authorities, faced some decisions. This study identified many sources of evidence, such as research, reports, surveys, key informants, experts and stakeholders’ consensus; but obstacles arise when evidence is not timely available. Most of respondents generated evidence themselves and most departments collaborated with each other and with other entities to get evidence. However, working with others depended on personal relationship, otherwise the decision making process would be a lengthy process. It was noted that local universities had no big role in generating evidence. There is no evidence generated by the Research department in FMoH, and the respondents pointed out that there are many obstacles regarding the implementation of the policy, such as high turnover of the staff, lack of skilled staff and unavailability of funds Conclusions: There is a positive attitude towards the concept of evidence among decision makers. Many factors affect the use of evidence in policy and decision making in general. Joint mechanism should be developed to allow for the flow down of evidence between local researchers and universities and decision makers.

A priority-driven, policy-relevant research program to support a response to blood-borne viruses and sexually transmissible infections in NSW, Australia.

Strong collaboration between researchers, policy makers and practitioners supports the use of research evidence in policy and practice. Strategies for increasing the use of evidence in policy development and implementation include creating more opportunities for closer collaboration between researchers and policy makers, ensuring research syntheses are more accessible to policy makers, and increasing workforce capacity to utilise evidence. Type of program or service: The BBV & STI Research, Intervention and Strategic Evaluation Program, 2014-2019 (BRISE) is a coherent and integrated program that delivers policy-relevant research, strategic advice, capacity building and communications to support the response to blood-borne viruses (BBV) and sexually transmissible infections (STI) in New South Wales (NSW), Australia. BRISE has five key objectives: generate high-quality research; maximise the use of research; build research capacity; communication and marketing; and governance and management. BRISE facilitates the coproduction of research where researchers and policy makers are meaningfully involved in all stages of research priority setting and codesign from development to application, building an understanding of the way evidence is generated to allow for greater integration between research and use of evidence. Bringing multiple research projects together under a single contract and budget provided the NSW Ministry of Health (the Ministry) with cost efficiencies and streamlined contract management and project reporting. A flexible work plan allowed for a mix of longer-term (up to 5-year) projects and shorter projects that were responsive to emerging policy-relevant research priorities. The Ministry became involved in the production of collaborative research as a research partner, rather than solely a research 'funder'. The joint management of research projects involving a policy officer from the Ministry provided opportunities for individuals to build on their research capabilities and literacy. Collaborative priority setting and project work, and increased research literacy, improved the likelihood that research generated would then be used in policy and practice.

Cardiovascular Disease Prevention Policy in Human Immunodeficiency Virus: Recommendations From a Modeling Study.

Cardiovascular disease (CVD) is expected to contribute a large noncommunicable disease burden among human immunodeficiency virus (HIV)-infected people. We quantify the impact of prevention interventions on annual CVD burden and costs among HIV-infected people in the Netherlands. We constructed an individual-based model of CVD in HIV-infected people using national ATHENA (AIDS Therapy Evaluation in The Netherlands) cohort data on 8791 patients on combination antiretroviral therapy (cART). The model follows patients as they age, develop CVD (by incorporating a CVD risk equation), and start cardiovascular medication. Four prevention interventions were evaluated: (1) increasing the rate of earlier HIV diagnosis and treatment; (2) avoiding use of cART with increased CVD risk; (3) smoking cessation; and (4) intensified monitoring and drug treatment of hypertension and dyslipidemia, quantifying annual number of averted CVDs and costs. The model predicts that annual CVD incidence and costs will increase by 55% and 36% between 2015 and 2030. Traditional prevention interventions (ie, smoking cessation and intensified monitoring and treatment of hypertension and dyslipidemia) will avert the largest number of annual CVD cases (13.1% and 20.0%) compared with HIV-related interventions-that is, earlier HIV diagnosis and treatment and avoiding cART with increased CVD risk (0.8% and 3.7%, respectively)-as well as reduce cumulative CVD-related costs. Targeting high-risk patients could avert the majority of events and costs. Traditional CVD prevention interventions can maximize cardiovascular health and defray future costs, particularly if targeting high-risk patients. Quantifying additional public health benefits, beyond CVD, is likely to provide further evidence for policy development.

Reframing the evidence base for policy‐relevance to increase impact: a case study on forest fragmentation in the oil palm sector

Summary It is necessary to improve knowledge exchange between scientists and decision‐makers so that scientific evidence can be readily accessed to inform policy. To maximise impact of scientific evidence in policy development, the scientific community should engage more fully with decision‐makers, building long‐term working relationships in order to identify and respond to ‘policy windows’ with science that is reframed for policy‐relevance. We illustrate the process and challenges using a case study in which we synthesised evidence from studies of habitat fragmentation to provide information for improved biodiversity conservation in the oil palm sector, resulting in the uptake of this research into new industry guidelines. Policy implications. The case study demonstrates how having an in‐depth understanding of the ‘policy arena’ (the state of policy and the actors and influencing factors that affect policy) and responding with relevant and specific information, enabled effective uptake of science to inform the design of conservation set‐asides in the oil palm industry.

Potential Health Outcome and Vulnerability Indicators of Climate Change for Australia: Evidence for Policy Development

There is a growing need to develop health‐related indicators for climate change to assist in policy, planning, and evaluation of preventive measures. To date, no environmental health indicators of climate change have been developed specifically for Australia. We conducted a review of the Australian literature relevant to climate change health impacts to find out which exposure–response relationships could be readily used as indicators. The bulk of the literature relates to direct health‐related outcomes of extreme heat, and indirect outcomes associated with air pollution and infectious disease agents. Based on this information, evidence‐based indicators were chosen using the modified Driving force‐Pressure‐State‐Exposure‐Effect‐Action framework. Three groups of health outcome indicators are proposed: direct heat related, air pollution related, and climate‐sensitive infectious diseases. Indicators of human vulnerability to these outcomes are also included. The potential usefulness of and barriers to their use are discussed in the context of relevance for policy makers.

Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda.

BackgroundSeveral countries in Sub Saharan Africa have abolished user fees for health care but the extent to which such a policy decision is guided by evidence needs further exploration. We explored the barriers and facilitating factors to uptake of evidence in the process of user fee abolition in Uganda and how the context and stakeholders involved shaped the uptake of evidence. This study builds on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitating factors for knowledge translation (KT). Application of the MRT to the case of abolition of user fees contributes to its refining.MethodsEmploying a theory-driven inquiry and case study approach given the need for in-depth investigation, we reviewed documents and conducted interviews with 32 purposefully selected key informants. We assessed whether evidence was available, had or had not been considered in policy development and the reasons why and; assessed how the actors and the context shaped the uptake of evidence.ResultsSymbolic, conceptual and instrumental uses of evidence were manifest. Different actors were influenced by different types of evidence. While technocrats in the ministry of health (MoH) relied on formal research, politicians relied on community complaints. The capacity of the MoH to lead the KT process was weak and the partnerships for KT were informal. The political window and alignment of the evidence with overall government discourse enhanced uptake of evidence. Stakeholders were divided, seemed to be polarized for various reasons and had varying levels of support and influence impacting the uptake of evidence.ConclusionEvidence will be taken up in policy development in instances where the MoH leads the KT process, there are partnerships for KT in place, and the overall government policy and the political situation can be expected to play a role. Different actors will be influenced by different types of evidence and their level of support and influence will impact the uptake of evidence. In addition, the extent to which a policy issue is contested and, whether stakeholders share similar opinions and preferences will impact the uptake of evidence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0639-5) contains supplementary material, which is available to authorized users.

The roles and influence of actors in the uptake of evidence: the case of malaria treatment policy change in Uganda.

BackgroundUganda changed its malaria treatment policy in response to evidence of resistance to commonly used antimalarials. The use of evidence in policy development—also referred to as knowledge translation (KT)—is crucial, especially in resource-limited settings. However, KT processes occur amidst a complex web of stakeholder interactions. Stakeholder involvement in evidence generation and in KT activities is essential. In the present study, we explored how stakeholders impacted the uptake of evidence in the malaria treatment policy change in Uganda.MethodsWe employed a qualitative case study methodology involving interviews with key informants and review of documents. A timeline of events was developed, which guided the purposive sampling of respondents and identification of relevant documents. Data were analysed using inductive content analysis techniques.ResultsStakeholders played multiple roles in evidence uptake in the malaria treatment policy change. Donors, the Ministry of Health (MoH), service providers, and researchers engaged in the role of evidence generation. The MoH, parliamentarians, and opinion leaders at the national and local levels engaged in dissemination of evidence. The donors, MoH, researchers, and service providers engaged in the uptake of evidence in policy development and implementation. Stakeholders exerted varying levels of support and influence for different reasons. It is noteworthy that all of the influential stakeholders were divided regarding the best antimalarial alternative to adopt.ConclusionOur results showed a diverse group of stakeholders who played multiple roles, with varying levels of support and influence on the uptake of evidence in the malaria treatment policy change. For a given KT processes, mapping the relevant stakeholders and devising mechanism for their engagement and for how to resolve conflicts of interest and disagreements a priori will enhance uptake of evidence in policy development.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0150-8) contains supplementary material, which is available to authorized users.

Key influences over actors’ preferences and use of evidence in policy development: insights from the Nigerian IMNCH strategy

Background Evidence based policy-making has been promoted as a means of ensuring better outcomes but what counts as evidence in policy-making lies within a spectrum of expert knowledge through scientifically generated information. Different actors provide varying degrees of support for and use of different types of evidence in policy development. Since not all forms of evidence share an equal validity or weighting for policy-makers, it is important to understand the key factors that influence their choice of evidence.

Understanding the Development of Minimum Unit Pricing of Alcohol in Scotland: A Qualitative Study of the Policy Process

BackgroundMinimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing’s development by taking a ‘multiple-lenses’ approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon’s multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking.MethodsSemi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation.FindingsThe three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy ‘image’ to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions.ConclusionsEvidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy.

Knowledge systems in health in sub-Saharan Africa: results of a questionnaire-based survey

To describe the mechanisms and systems of knowledge acquisition, creation, diffusion, application and improvement of knowledge in two layers of the health system: health policy formulation and the provision of clinical services. A questionnaire-based survey. Health research institutions in 46 countries of the World Health Organization (WHO) African Region. Key informants in ministries of health and health care institutions in 39 countries of the Region. Existence of knowledge management infrastructure or components of infrastructure in the countries of the Region. Central national bodies are always cited as having a major role in policy-setting. Non-national bodies most frequently provide advice and act in monitoring and evaluation, while decentralised entities are strongly involved in dissemination, implementation, and monitoring and evaluation. In general, ministries tend not to have an explicit knowledge management framework and do not map knowledge sources and flows for policy-making. The main sources of evidence are guidelines or recommendations from international or national agencies, although systematic reviews are rarely used. Routine monitoring and evaluation of quality and effectiveness of the process of policy development and its implementation was reported in 19 of the 39 respondent countries. In most respondent countries, electronic medical records were rarely used. As systematic reviews are rarely utilised as a source of evidence in policy development and few mechanisms exist to assess the performance of the policies, there are significant opportunities for improving policy development.

Why is uptake of research evidence in the policy making process such a drag? The Dutch perspective.

Background In The Netherlands the Health Nearby policy (2011) is the main current national health policy. Sports and HEPA are a focus of a separate policy brief attached to the Healthy Nearby policy. The purpose was to analyze Health Nearby policy. Methods A qualitative policy analysis was used for mapping the role and use of research evidence in policy development and six relevant stakeholders of the policy making process was interviewed. Results …

At the crossroads: transforming health systems to address women’s health across the life course

In 2010, the World Health Organization (WHO) published a report titled Women and health: today’s evidence, tomorrow’s agenda. The report summarized the evidence surrounding the health-related issues affecting girls and women throughout their life course1 and signalled the need for innovative strategies and new health service delivery models. Since then, other global initiatives, including the Women Deliver 2013 conference, the United Nations Commission on Information and Accountability for Women’s and Children’s Health, Family Planning 2020 and the call of the Global Fund to Fight AIDS, Tuberculosis and Malaria in support of child and maternal health, have kept the world focused on women’s health issues, particularly maternal mortality and universal access to reproductive health. Yet these initiatives do not address all the health problems that women are facing in the 21st century as a result of the epidemiological and demographic transitions. According to the Global Burden of Disease Study 2010, the years of life lost (YLLs) on account of conditions addressed under the Millenium Development Goals (MDGs) declined by 2.0% per year between 1990 and 2010, but those attributable to conditions not targeted under the MDGs increased by 0.8% per year. If these trends continue, by 2015 more than two thirds of all YLLs will be caused by conditions not included in the MDG framework.2 Noncommunicable diseases (NCDs) already represent 54% of the world’s burden of disability-adjusted life years; injuries represent an additional 11%.3 This is one reason that WHO, together with key global partners, conceived this theme issue on women’s health beyond reproduction. Our intention is to underscore the changing nature of the health problems confronting women and to highlight policies and strategies that low- and middle-income countries can implement.4 A life course approach to women’s health makes sense because many of the health problems faced by adult women have their roots in early life. Interventions that promote good nutrition during pregnancy, optimize early child development and facilitate access to health information, especially during adolescence, can lay the foundations for a healthy life in later years. Changing exposures across the life course, particularly in terms of harmful tobacco and alcohol use, unhealthy dietary habits and poor physical activity, pay important health dividends in the long term. This continuum can best be promoted by building on existing reproductive and maternal health services “diagonally” – i.e. by expanding the role of health workers, strengthening their skills and reorienting services towards the prevention and early detection and management of NCDs and their risk factors.5 For example, women with gestational diabetes have a significantly elevated risk of developing type 2 diabetes in later life, and antenatal care provides an opportunity to intervene early to try to prevent the subsequent onset of diabetes in this group. The life-course approach to women’s health involves several health system challenges. We need to better understand the epidemiological characteristics of diseases affecting adult women and the overlapping effects of gender inequalities and advancing age on women’s health. Data are still not regularly disaggregated by sex when collected or reported and age disaggregation is seldom done beyond 50 years of age. Particular attention should be paid to the consequences of harmful gender norms and roles and to the effects of stigma and social isolation among older people on patterns of disease, illness and mortality. The development of an evidence-based policy framework on the health of women across the life course is a formidable task for which WHO and its partners are seeking to bring together policy-makers and public health experts from around the world. The life-course approach to women’s health has three innovative aspects. First, it marks the convergence of three complementary domains: maternal and reproductive health, ageing and noncommunicable diseases. Second, it involves the development, piloting and testing of new health-care delivery systems featuring diagonal approaches and private–public partnerships. Third, it is driven by policy-makers engaged in applying knowledge translation methods that encourage the use of research and evidence in policy development and planning. This theme issue of the Bulletin and other initiatives, such as the Lancet Commission on Women’s Health, are intended to stimulate interest in women’s health beyond reproduction and to encourage joint, decisive action on the part of multiple stakeholders in promoting a life-course approach to women’s health.

Knowledge exchange systems for youth health and chronic disease prevention: a tri-provincial case study

The research teams undertook a case study design using a common analytical framework to investigate three provincial (Prince Edward Island, New Brunswick and Manitoba) knowledge exchange systems. These three knowledge exchange systems seek to generate and enhance the use of evidence in policy development, program planning and evaluation to improve youth health and chronic disease prevention. We applied a case study design to explore the lessons learned, that is, key conditions or processes contributing to the development of knowledge exchange capacity, using a multi-data collection method to gain an in-depth understanding. Data management, synthesis and analysis activities were concurrent, iterative and ongoing. The lessons learned were organized into seven "clusters." Key findings demonstrated that knowledge exchange is a complex process requiring champions, collaborative partnerships, regional readiness and the adaptation of knowledge exchange to diverse stakeholders. Overall, knowledge exchange systems can increase the capacity to exchange and use evidence by moving beyond collecting and reporting data. Areas of influence included development of new partnerships, expanded knowledge-sharing activities, and refinement of policy and practice approaches related to youth health and chronic disease prevention.

Participants’ perceptions of a knowledge-brokering strategy to facilitate evidence-informed policy-making in Fiji

BackgroundEvidence-informed policy-making (EIPM) is optimal when evidence-producers (researchers) and policy developers work collaboratively to ensure the production and use of the best available evidence. This paper examined participants’ perceptions of knowledge-brokering strategies used in the TROPIC (Translational Research in Obesity Prevention in Communities) project to facilitate the use of obesity-related evidence in policy development in Fiji.MethodKnowledge-brokers delivered a 12-18 month programme comprising workshops targeting EIPM skills and practical support for developing evidence-informed policy briefs to reduce obesity. The programme was tailored to each of the six participating organizations. Knowledge-brokering strategies included negotiating topics that were aligned to the goals of individual organizations, monitoring and evaluating time-management skills, accommodating other organizational and individual priorities, delivering practical sessions on use of appropriate research tools and supporting individual writing of policy briefs. Two qualitative methods were used to examine individuals’ perceptions of skills obtained, opportunities afforded by the TROPIC project, facilitators and inhibiters to planned policy brief development and suggestions for improved programme delivery. Forty-nine participants completed an electronic word table and then participated in a semi-structured interview. An independent interviewer conducted structured interviews with a high-ranking officer in each organization to examine their perceptions of TROPIC engagement strategies. Data were analyzed descriptively and thematically, with the first author and another experienced qualitative researcher analyzing data sets separately, and then combining analyses.ResultsMany participants believed that they had increased their skills in acquiring, assessing, adapting and applying evidence, writing policy briefs and presenting evidence-based arguments to higher levels. Many participants preferred one-to-one meetings to group activities to ensure early resolution of developing issues and to refine policy briefs. Perceived barriers to EIPM were lack of knowledge about data sources, inadequate time to develop evidence-informed briefs, and insufficient resources for accessing and managing evidence.ConclusionAn innovative knowledge-brokering approach utilizing skill development and mentorship facilitated individual EIPM skills and policy brief development. The TROPIC model could stimulate evidence-based policy action relating to obesity prevention and other policy areas in other Pacific countries and elsewhere.

Research on the association between per-capita tobacco consumption among the permanent residents and lung cancer mortality in Henan province

To study the relationship of per-capita tobacco consumption and lung cancer mortality in Henan province, and to provide evidence for policy development on tobacco control and reduction of lung cancer mortality. Data regarding lung cancer mortality and per-capita tobacco consumption among household residents from 1992 to 2011, was collected from published almanacs in Henan and Henan Tumor Institutes. Trend Method was used to analyze the development of lung cancer in Henan province and the trend of per-capita tobacco consumption of residents in the household. 'Spearman rank correlation' was used to analyze the correlation between per-capita tobacco consumption of residents in the household from 1992 to 2001 and the lung cancer mortality rates from 2002 to 2011, with the lag time unite as 10 years in this study. Cure Estimation was used to fit the model regarding the relationship between per-capita tobacco consumption of residents in the household and lung cancer. Lung cancer mortality among those permanent residents in Henan province increased from 14.75/100 000 in 1992 to 27.00/100 000 in 2011, with an increase of 83.05%. Both the trend of per-capita tobacco consumption among the permanent residents and the lung cancer mortality were uprising, with the tobacco consumption showing a lag effect to the lung cancer mortality. Correlation coefficient between the per-capita tobacco consumption of residents in the household from 1992 to 2001 and the lung cancer mortality from 2002 to 2011 was rs = 0.770, P = 0.009 < 0.05, with statistically significant difference. Along with the uprising trend of lung cancer mortality, the per-capita tobacco consumption of residents in the household was also parallelly rising with the equation of relevance between per-capita tobacco consumption of residents in the household in Henna province and lung cancer as ŷ = 2.60 x(0.46) (F = 576.483) and the R(2) was 0.667. Per-capita tobacco consumption of residents in the household in Henan province appeared a factor that influencing the lung cancer mortality and an association between the per-capita tobacco consumption of residents in the household and lung cancer was noticed. Tobacco consumption had a lag trend to the mortality of lung cancer.