Health Research Policy and Systems最新文献

Background: Schools play a key role in mental health problem prevention, reaching most children during critical periods. Leveraging this opportunity requires understanding the complex system underlying school-based prevention, comprising various connections between multiple stakeholders. This study charts the structure and dynamics of a school-based mental health problem prevention system in Estonia using a novel collaborative system mapping method.

Methods: Stakeholder workshops were conducted with teachers, support specialists and school leaders to co-create system maps reflecting participants' perceptions of the system's actors and connections.

Results: The resulting system map identified 19 key actors, ranging from local-level organizations to state-level institutions, and four types of connections: direct prevention delivery, funding, provision of materials and training and general cooperation. Findings also revealed some challenges within the system, such as roles being distributed between many actors without clear central oversight, which leads to abundant but difficult to navigate materials and training offers. At the same time, schools emphasise a lack of sufficient guidance for engaging parents, reflecting that the system might not adapt to the needs of the schools.

Conclusions: This work highlights that enhancing the prevention system requires addressing broader issues, such as different stakeholders' roles, partnerships and resource flows within the system. The system map can serve as a foundation for further studies exploring different perspectives on the prevention system, quantifying its properties, and identifying leverage points for system improvement.

Zoonotic disease dynamics (ZDD), encompassing pathogen spillover, transmission pathways and host-pathogen interactions, are widely acknowledged as drivers of emerging infectious diseases. Yet, the extent to which recent pandemic prevention, preparedness and response (PPPR) policies - the integrated frameworks guiding international efforts to anticipate and manage infectious disease threats - are grounded in this expanding body of scientific research remains unclear. This study examines how research on ZDD is cited in six influential global policy reports published between 2021 and 2023. We employed citation network analysis and qualitative profiling to compare references cited in these reports with those cited by a systematically identified set of broad-scope scientific publications on ZDD. Of the 313 references across the six reports, only 59 (19%) pertained to ZDD, a relatively small proportion considering that zoonotic diseases are framed as primary drivers of pandemic risk in these same reports. The academic literature is highly diverse and predominantly focused on specific pathogens (66%), with few studies offering a broad-scope perspective (4%) that addresses the complexity of ZDD. The citation network of the selected broad-scope literature was fragmented revealing low convergence of the knowledge base. Shared references between reports and scientific literature (n = 31) were mostly modelling studies (45%) or reviews (35%). Secondary data predominated (45%), and only 6% relied primarily on original field or laboratory data. Foundational studies were often overrepresented. This narrow and selective evidence base risks obscuring key uncertainties and limiting the diversity of perspectives that inform global PPPR strategies. Our findings highlight the value of more systematic approaches to scientific evidence use in PPPR policy documents. Strengthening the science-policy interface in PPPR requires greater engagement with emerging research, epistemic diversity, and the acknowledgment of uncertainty - essential steps toward building more adaptive, equitable and resilient strategies.

Background: Health-system leaders are increasingly faced with making decisions about whether and how to use a wide range of current and emerging health-system innovations to address complex system and policy challenges. Health-system innovations can broadly include new ways of doing things at a system level, such as new approaches to govern health systems, care delivery, funding models, health policy or better ways to integrate health and social services. However, Canada has historically struggled with the adaptation and uptake of health-system innovations. This multicomponent study aimed to explore the challenges, approaches and implementation considerations for creating an integrated innovation system that enables the adaptation and uptake of health-system innovations from the perspectives of citizens and health system leaders in Canada.

Methods: We synthesized the best-available evidence into an evidence brief and a subsequent plain-language version (a citizen brief) in consultation with a steering committee and key informants, including policymakers, leaders of systems, organizations and professional organizations, industry representatives, citizen leaders and researchers. These briefs informed deliberations in four citizen panels (n = 48 participants) and a national stakeholder dialogue with health-system leaders (n = 23 participants) to identify key challenges, approaches, implementation considerations and next steps that could be taken.

Results: Citizen panel participants and health-system leaders highlighted barriers such as culture and mindsets that resist health-system innovations, limited targeted funding for health-system innovations and processes that encourage sustainability, lack of mechanisms to adapt health-system innovation in local contexts and limited health human resources due to competing interests across health systems. Both groups emphasized the need for people-centred approaches to establish shared goals and vision, identify gaps and map what has worked to drive health-system innovations, set priorities and discuss how each stakeholder group can contribute to building and reviewing implementation considerations such as resources and funding related for the adaptation and uptake of health-system innovations.

Conclusions: The findings provide insight for ongoing efforts to improve the development, implementation and evaluation efforts to enhance and harness health-system innovation to strengthen health systems in Canada. Collaboration from within and between governments and sectors will ultimately help to increase the value gained from health-system innovations.

Background: Corporate social responsibility (CSR) activity in the pharmaceutical industry is frequently directed towards improving patient access to medicines amongst low-income populations. This research reports on findings from a mixed literature and key informant study of pharmaceutical sector CSR activity and its applicability in the high-cost novel therapeutics space.

Methods: Academic and grey literature documents were extracted from online databases in a rapid literature review, focusing on four key areas of interest: (i) CSR or benefit company activity, (ii) the pharmaceutical industry, (iii) the development and sale of high-cost novel medicines and (iv) the role of government and civil society in this space. Ten semistructured interviews amongst key informants, including medical activists, pharmaceutical industry representatives, patient advocates, employees at nongovernmental organizations (NGOs), consultants for international organizations and academic researchers were also conducted related to these topics.

Results: We find that CSR strategies vary depending on partner identity and country ability to pay. Differential pricing schemes and flexible patent approaches tend to be pursued unilaterally by companies, whereas companies frequently partner with local private sector, government, nongovernmental organizations and academic actors when implementing patient support programs, medicines donations, medicines delivery programs and rare and neglected disease research and development (R&D) initiatives. Patient support programs are more prevalent in high-income countries with minimal state-subsidized healthcare, whilst differential and tiered pricing strategies are more frequently pursued in lower-income countries.

Conclusions: Pharmaceutical CSR strategies may benefit from greater coordination with government and civil society actors. Opportunities for government and civil society actors to take an active role in better aligning CSR activity with patient needs and universal health coverage include promoting greater adoption of alternative corporate structures and providing active external recognition of successful CSR initiatives through reputational and funding awards.

Background: Health technology assessment sets explicit priorities to maximize health gains and support universal health coverage. Health Technology Assessment in India (HTAIn) was set up to ensure efficient allocation of public health expenditure impacting 1.4 billion Indians. We conducted an analysis to summarize the research undertaken by HTAIn thus far and recommend the way forward.

Methods: We shortlisted 33 of the 39 studies published by HTAIn on their website in October 2023. We analysed diseases treated, types of interventions evaluated, aspects of HTA addressed and whether the intervention was cost effective. The quality of each study was rated against Drummond's checklist and the Indian Reference Case. Results were charted and tabulated where possible, and a narrative synthesis of findings was set down.

Results: Overall, 24.2% (n = 8) of the studies focused on interventions for maternal and neonatal disorders, 33.3% (n = 11) of the interventions were devices, and 45.5% (n = 15) were intended for screening. All of the studies addressed economic efficiency, 75.8% (n = 25) evaluated clinical efficacy, and 54.5% (n = 18) spoke of effectiveness; 45.5% (n = 15) addressed all three. Against the Indian Reference Case, six studies scored above 8, and the rest scored between 4.55 and 7.95. Equity and heterogeneity (population subgroup analysis) are the parameters that fared worst.

Conclusions: A formal framework for choosing interventions for evaluation would make the decision-making process explicit. While difficult to evaluate, operational feasibility, equity and heterogeneity need to be appraised to ensure that policy-makers draw considered conclusions. We recommend that areas for disinvestment be identified, given health budget constraints.

The ways in which we understand and respond to perinatal substance use are explicitly and implicitly driven by policy. Perinatal substance use is a visible manifestation of intersecting systems of oppression, shaped by racist, colonial and sexist discourses surrounding mothering and drug use. Policies related to perinatal substance use and mental health have far-reaching impacts on families, communities and generations. This scoping review examined the conceptualization and operationalization of equity within foundational perinatal policies in one Canadian province, British Columbia (BC), between 2005 and 2025. Documents were included if they were: (1) provincial-level policy documents that either (a) guided perinatal service delivery generally or (b) focused on mental health promotion, prevention of mental disorders or harms of substance use; (2) publicly available; and (3) published within the study timeframe. Inductive content analysis and sensitizing questions were used to explore how equity concepts were conceptualized and integrated. In total, 30 documents met inclusion criteria. Equity was mentioned in 15, but only 4 provided explicit definitions. Often, implied proxy terms for equity were substituted to discuss equity considerations, such as risk, disadvantage, social determinants of health, vulnerable, marginalized and harm reduction, with limited direction on public health system roles or accountability in addressing root causes of inequities. Content analysis yielded the following missed opportunities in the results: an absence of clear definitions; focus on accessibility; inattention to structural conditions; and incoherent concepts of equity. Given BC's reputation as a leader in equity-oriented perinatal substance use policy, these gaps are notable. In the context of an expanding drug poisoning crisis and increasing global recognition of equity as foundational to public health, it is imperative to examine how equity is understood and actioned in policy to strengthen alignment between intentions and outcomes.

Background: People experiencing marginalisation tend to be systematically excluded from policy decisions. Engaging people with lived experiences of marginalisation is increasingly considered critical for developing equitable and effective noncommunicable disease (NCD) policies. It remains unclear how the voices and experiences of people who are harmed by systems of marginalisation due to gender, ethnicity, sexuality, disability and social position have been included in NCD prevention policies.

Methods: We conducted a systematic scoping review, grounded in constructivist epistemology and critical theory. Five overarching search terms were applied across Medline, Academic Search Complete, CINAHL, and Global Health to describe priority populations, lived experience, participatory research, NCDs and policy. Articles were included if they involved research engaging the lived experiences of local communities and people experiencing marginalisation in high-income countries to inform equitable NCD prevention policies. Factors affecting the inclusion of lived experience were meta-analysed thematically across included studies.

Results: In total, 49 articles met the eligibility criteria - focused on NCD prevention related to nutrition (35% of studies), NCDs in general (20%), physical activity (12%), tobacco (10%), obesity (10%), mental health (8%) and alcohol (4%). The majority (67%) of research was conducted in the United States, followed by Canada (14%), Australia (6%), Europe (8%), and the United Kingdom (4%). Study participants included Black, Hispanic, and other multicultural communities (52% of studies), people in regional or rural areas (37%), First Nations peoples (22%), residents in low-income areas (28%), people receiving a low income (20%), women only (9%) and people experiencing disability (2%). Studies typically involved policy advocacy to local governments (79%), often supported by local coalitions (22%). Factors underpinning inclusive NCD prevention policymaking included having a strong purpose for engaging with lived experiences of marginalisation, fostering a deep understanding of culturally safe practices, addressing institutional tensions and power imbalances, and co-creating mechanisms for impact (e.g. policy networks and safe spaces).

Conclusions: Best practice approaches for including people with lived experiences of marginalisation in NCD prevention policies and research are lacking and should continue to be developed. National-level leadership, genuinely supporting communities, and being aware of one's own role in social change are necessary to improve institutional practices that systemically exclude diverse experiences.

Background: Photovoice is an innovative community-based participatory research methodology that uses photography to capture key issues in a local setting. In Photovoice, photographs are taken to record and reflect on community strengths and challenges, facilitate critical dialogue among participants and researchers, and reach various stakeholders to make change. Although the use of Photovoice has increased in recent years, its utilisation in health policy and systems research is still limited.

Main body: In this article, we give an overview of the use of Photovoice in health systems research based on literature including methodological considerations, ethical concerns, benefits, and challenges. The Photovoice methodology is based on three theoretical underpinnings: empowerment education theory; feminism and notions of voice; and documentary photography. Photovoice provides power to the participants to share their own insights hence amplifying community voices. Adequate training of Photovoice participants is crucial including on consent for taking and use of photographs. Keeping Photovoice participants engaged throughout the research process and the time commitment required are key challenges of the methodology. The article ends by providing an illustrative example of a study that used Photovoice to explore the roles of community health workers (CHWs) from their perspective in Wakiso district, Uganda. Through Photovoice, CHWs were able to reflect on their day-to-day activities, which methodology can be used among other cadres and settings to inform practice, policy and programming.

Conclusions: Photovoice is a feasible, appropriate and empowering approach in health policy and systems research.

Background: Effective health policy is informed by research evidence; however, there are challenges to using up-to-date research evidence to inform policy decisions. The living evidence syntheses (LES) approach aims to overcome some of these challenges by providing decision-makers with summaries of the research evidence on topics of interest, updated as new evidence becomes available. As yet, little is known about when, why and how policymakers use LES, and the implications of this use. The aim of this study was to describe policymakers' perceptions of LES and characterize opportunities for, and challenges to, using LES to inform health policy in Australia.

Methods: Health policymakers at Australian federal and state or territory health departments participated in semistructured online interviews exploring their motivations and experiences for using LES and factors that may influence their future use. Preliminary themes were clarified and interpreted at an online roundtable. A purposive sample was used to obtain views across diverse policy settings and geographical locations. The interviews and roundtable findings were triangulated using an applied thematic analysis approach.

Results: In total, 22 policymakers participated and provided insights on five broad themes relevant to health policy: varied understanding but consistent expectations of LES; criteria for when to use LES; key merits of using LES; perceived risks associated with LES; and considerations for future use of LES. The use of LES was motivated by the need for current research to inform imminent policy decisions. It was most useful in the context of an evolving issue which requires a government response, where research evidence on the issue is emerging and when LES are accessible, trustworthy and available. The key merits of using LES were the currency and trustworthiness of this approach, and a key risk was damage to credibility from potentially changing evidence. Policymakers were enthusiastic about the future use of LES and discussed health system factors, resources, communication, collaboration and technological factors that could enhance the optimal use of LES in policy.

Conclusions: This study demonstrated that most policymakers who had used LES valued it. It highlighted opportunities for improvement to enable ongoing LES to inform health policy. By working in partnership, policymakers, knowledge users and evidence producers can further understand and optimize this approach to realize the potential to strengthen health systems by enabling the use of up-to-date evidence in policy decisions.

Evidence, communication, critical thinking and participation are the cornerstones of informed decisions. In this article we discuss each of these in relation to decisions about public health and social measures (PHSM) during the coronavirus disease 2019 (COVID-19) pandemic and implications for future research. Reliable research evidence of the effects of interventions is particularly important for decisions about what to do because it provides the best basis for estimating the wanted and unwanted effects of doing something. There was little reliable research of the effects of PHSM during the pandemic. For research evidence to be useful to decision-makers, it must be effectively communicated, including how sure we can be about effects or other research findings. Research evidence is essential for making informed decisions, but it is not sufficient. Decision-makers and those affected by the decision must be able to think critically about what to believe and what to do. Many people lack competences and dispositions for thinking critically about PHSM or other interventions. Judgements about PHSM require democratic input, not just expert input. However, there was little public participation in deliberative or decision-making processes about PHSM during the pandemic. There are important uncertainties about the effects of PHSM, how to effectively communicate decisions and evidence about PHSM, how to foster critical thinking about PHSM and how to effectively engage the public in deliberative and decision-making processes about PHSM. Pandemic research and preparedness planning should address those uncertainties.