Health Research Policy and Systems最新文献

Background: Governmental action in Mexico has sought to understand and address the health situation of Indigenous Peoples (IPs) primarily through an intercultural perspective. However, intercultural approaches focused mainly on cultural aspects may obscure the historical and structural origins of health inequalities. Since the 1980s and during the early years of the new millennium, a series of political and institutional processes shaped a context that was central to incorporating IPs into the national health agenda.

Objective: The aim of this article is to conduct a critical analysis of health initiatives targeting IPs developed within this context (2000-2012).

Methodology: We carried out a qualitative critical analysis on the basis of a multi-source documentary review to analyse four specific initiatives, selected because they sought to include the participation of Indigenous leaders and explicitly incorporated an intercultural perspective.

Results: The government-led initiatives APV, PROSANI and EEM reproduced cultural essentialisms through a functional and relational intercultural approach and did not contribute to improving the situation of traditional medicine actors, such as midwives. In contrast the CAMIA initiatives have a community-based origin and, for more than two decades, have been a fundamental space for the health and rights of Indigenous women.

Discussion and conclusions: The incorporation of interculturality in most initiatives appears to respond to a State discourse strategy embedded in narratives of what is considered "politically correct," aimed at legitimizing programs and actions. The perspective from which health initiatives targeting Indigenous Peoples are designed, developed and implemented, as well as the actors involved in these processes and the degree of power and control exercised by both governmental actors and potential users/beneficiaries, determine their transformative potential. Initiatives built upon critical interculturality and with strong community foundations have had a significant impact on health and on other areas of Indigenous women's lives. There is an urgent need to rethink healthcare approaches for Indigenous Peoples in Mexico by adopting more critical intercultural frameworks that enable Indigenous self-determination and decolonial health perspectives.

Background: Effective collaboration between public health researchers and policymakers is critical for translating evidence into actionable policies. However, such collaboration is often undermined by misaligned priorities, structural barriers, and fragmented systems. This scoping review synthesizes global evidence on the strategies, facilitators and barriers shaping these collaborations, with a focus on how they enhance the uptake and use of research in policymaking.

Methods: A scoping review was conducted using a systematic search across four electronic databases (SCOPUS, Embase, Web of Science and Medline via PubMed), targeting studies published between 2019 and 2024. Eligible studies discussed strategies, barriers and facilitators for collaboration between researchers and policymakers in public health. Data were extracted on study context, collaboration mechanisms, enabling conditions and reported impacts.

Results: A total of 24 studies were included, revealing four interdependent strategies for effective collaboration. Most notably, co-production of knowledge emerged in two distinct forms: as a deliberately structured intervention and as an emergent outcome of sustained engagement over time. This dual nature of co-production offers a critical lens for understanding how collaboration evolves in practice. Other key strategies included capacity building at both individual and organizational levels, the use of structured communication and feedback mechanisms to align research with policy needs, and the establishment of governance frameworks to institutionalize research-policy partnerships. Collaborations that were formalized, embedded within institutions, and maintained through iterative engagement were more likely to result in increased research uptake and enduring policy impact.

Conclusions: These findings underscore that structured collaboration, particularly when supported by institutional mechanisms, ongoing capacity building and iterative engagement, plays a critical role in increasing the use of research in public health policymaking. By distinguishing co-production as both a deliberate strategy and an emergent outcome, this review offers new insight into how collaborative models can be designed or evolved to strengthen evidence-informed decision-making.

Introduction: Evidence on safety, clinical and cost-effectiveness forms a key part of Health Technology Assessment (HTA) value appraisal for new health technologies and is often used to inform reimbursement and market access decisions. However, value may depreciate over the lifecycle of technologies, requiring reassessment to inform disinvestment decisions. This scoping review aimed to synthesise the evidence on tools that address Health Technology Reassessment (HTR) and disinvestment decision-making processes, with a view to identifying the key elements of an appropriate HTR and disinvestment model.

Methods: The scoping review was guided by the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Using the keywords "tool" "disinvestment" and "health technology reassessment", studies published in the English language were identified from the following databases: EMBASE, Medline, CINAHL, Web of Science Core Collections, and Google Scholar. Additional sources of unpublished studies and grey literature included websites and databases of Health Technology Assessment International (HTAi), International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and members of the International Network of Agencies for Health Technology Assessment (INAHTA). The studies were screened, and the data extracted from the included studies were mapped to our predefined conceptual framework and synthesised narratively.

Results: Nineteen studies conducted in nine different countries were included in the scoping review. Most of the studies were conducted in high-income countries with formal HTA processes and nine studies conducted in or by researchers in Canada. The studies proposed different frameworks to guide the HTR and disinvestment process, only four of which have been validated in a real-world setting. There was generally underreporting of the sustainability component in proposed models as only three studies considered sustainability.

Conclusion: This scoping review synthesised available evidence on HTR and mapped the attributes of tools in the included studies to our predefined conceptual framework. Our results suggest that a stronger focus on sustainability and a consistent stakeholder engagement process may improve implementation of disinvestment frameworks and tools. Further work on contextualising models to the local setting and beyond HTA-related processes would be required.

Background: People from ethnically diverse backgrounds are underrepresented in clinical trials, reinforcing healthcare inequity. Co-production involves users of research (knowledge users) as partners in the research process. A premise of co-production is that it enhances ethicality of research by responding to the needs and preferences of those it is designed for while facilitating adoption and impact. Research reporting co-production in ethnically diverse communities is emerging; however, reporting of specific strategies to support effective co-production remains sparse, particularly when designing interventions for clinical trials. We draw on our experience of co-production with ethnically diverse communities to address this gap in the research literature using the exemplar, MOVE Together: Reduce falls, a co-produced intervention to support people aged over 65 years from ethnically diverse communities to develop exercise habits and reduce their risk of falls.

Methods: Utilizing an integrated knowledge translation (IKT) approach to co-production, our team of 24 partners, including people aged over 65 years from ethnically diverse communities, representatives from ethnically diverse community groups and service providers developed our intervention over five stages. Two stages engaged 75 participants including 63 (84%) people aged over 65 years from three ethnically diverse communities (Chinese, Italian and Arabic-speaking) and 12 service providers. The remaining three stages involved the co-production research team.

Results: Strong participant satisfaction (96%) and co-production team consensus regarding the readiness of our intervention for progression to clinical trial (100%) support the success of our approach. Strategies to optimize communication and uphold the principles of co-production were identified by our team as important to the process. Drawing on research evidence and our experience we highlight potential strategies to support alignment with the principles of co-production when co-producing with people from ethnically diverse communities. These include additional time and financial resources, tailored approaches to information provision and a culturally responsive approach.

Conclusions: When co-producing interventions for clinical trials with ethnically diverse communities, co-production teams must be prepared for the additional resources necessary to ensure genuine partnership. In this exemplar, we describe an iterative approach to health research co-production that may inform future health research involving under-served populations.

Background: Area-level socioeconomic deprivation is a key determinant of health disparities and quality of life. This study aimed to develop and validate the Thailand district-level Socioeconomic Deprivation Index (TSDI)-a nationwide, district-level index to identify deprived areas and their specific deprivation dimensions using national census data.

Methods: In this methodological cross-sectional study, we constructed the TSDI from a 20% stratified random sample of the 2010 Thai national census (63 478 990 individuals across 928 districts). Domains and indicators were selected on the basis of a scoping review and theoretical frameworks of relative deprivation. Principal component analysis (PCA) was used to create a composite index, which was visualized through choropleth mapping.

Results: The TSDI comprises six principal components encompassing 29 indicators, explaining 73.82% of the total variance. The components represent: (1) overall socioeconomic deprivation, (2) housing and assets, (3) demography and family composition, (4) foreign and elementary workers, (5) household crowding and (6) access to tap water. Spatial analysis revealed severe deprivation clusters in the northern, lower northeastern and southern regions, while central (including Bangkok) and eastern coastal areas were less deprived.

Conclusions: The TSDI is a novel, validated tool that provides a comprehensive and spatially explicit measure of socioeconomic deprivation in Thailand. It offers critical data for targeting public health interventions, informing resource allocation and investigating the pathways linking social inequality to health and development outcomes.

Background: Although dementia research agendas increasingly prioritize dissemination and implementation (D&I) of research findings, there is still limited understanding of the role and activities of dementia research funders. Implementation science literature offers theories, frameworks and tools to integrate diverse stakeholder perspectives, supporting the translation of research evidence into practice and policy. This study identifies and categorizes the D&I strategies and related challenges, faced by public and private dementia research funders in the Netherlands. This study aims to provide evidence that clarifies the roles of public and private dementia research funders and offers guidance for planning and executing dementia research D&I. This study contributed to evidence and perspectives generated outside the traditional clinical settings, which are essential to advance implementation science.

Methods: Semi-structured qualitative interviews were conducted with 20 individuals, selected through purposive snowball sampling. Respondents involved representatives of three public and four private funding agencies in the Netherlands. Interviews were conducted in-person or virtually, audio-recorded and transcribed verbatim. Data extraction and data analysis were conducted using an iterative abductive thematic coding approach on the basis of the methodology of Timmermans and Tavory.

Results: The strategies and related challenges of public and private funders of dementia research were clustered into three themes: "dissemination", "implementation support" and "research ecosystem capacity-building". Strategies for dissemination and implementation support were facilitated through brokering knowledge and providing financial incentives, procedural guidance and action mandates. Public and private funders contributed significantly to research ecosystem capacity-building through strategies such as establishing research consortium models, implementation training programs and professional connective networks. Results suggested that both types of funders are guided by distinct value systems and contribute different resources and expertise to the D&I process. Collaborative capacity between public and private funders was hindered by D&I role ambiguity and conflicting value systems, which emphasizes the lack of insights in how and when to engage each type of funder in D&I.

Conclusions: This study provides contextual insight into the opportunities to invest in developing D&I professional competencies and leveraging strategic public-private partnerships to optimize D&I processes. Future research could develop this research ecosystem concept to overcome persistent contextual D&I challenges.

Background: Research funders, such as the UK National Institute for Health and Care Research, are committed to capacity-building for the health and social care workforce in addition to that provided for doctors and dentists. Programmes designed to build capacity offer research training and collaborations with academia. This paper reports findings from a process evaluation of capacity-building research internships and predoctoral fellowships provided through a research-practice partnership in one region in England. The aim of the study was to explore experiences from multiple perspectives and ascertain factors influencing the development of research capacity and impact of the schemes.

Methods: A total of 29 individual qualitative, semistructured interviews were undertaken with (i) interns and predoctoral fellows (health, social care or quality improvement professionals based in the regional health and social care system), (ii) health and social care managers (mostly line managers of the interns and predoctoral fellows) and (iii) supervisors (university academics). Data analysis followed a thematic approach, informed by Cooke's framework for the evaluation of research capacity-building.

Results: Our analytical framework was based on Cooke's framework for research capacity-building; all six principles were relevant. (i) The schemes facilitated the building of skills and confidence and exposure to the academic research environment. (ii) The research facilitated was close to practice; trainees pursued their research interests sparked by their practice experience. (iii) The schemes fostered linkages, collaborations and partnerships by bringing together practitioners from the regional health and social care system with researchers at the university; many effective and enduring collaborations were forged. (iv) Trainees achieved dissemination and impact via publishing research and leveraging funding, generating outputs traditionally recognized as metrics of capacity-building success; they also created impact in practice. (v) In terms of continuity and sustainability, the schemes provided a first step in research for some and a next step for others. Trainees shared and cascaded newly acquired skills, coaching and encouraged practice colleagues to get involved in research. Programme infrastructure, including organizing staff cover and support from managers in practice, were necessary.

Conclusions: Our findings aligned with all of Cooke's principles. Individual managerial support, infrastructure and research culture were crucial for the development of research capacity. Subsequent research should develop theories of change and apply them in evaluations of research capacity-building.

Background: India conducts all three tiers of the Field Epidemiology Training Program (FETP). During the coronavirus disease 2019 (COVID-19) pandemic, the country committed to rapid scale-up of its frontline public health workforce capacity through the 3-month in-service Frontline FETP.

Implementation, achievements, challenges and lessons learned: Between January 2021 and May 2023, 300 district-level public health workers and 73 mentors were trained across 124 districts in eight states. Frontline FETP officers successfully completed 236 field assignments, nearly half of which were surveillance systems evaluations or surveillance data analyses and another half of which were case, cluster or outbreak investigations. Acute diarrhoeal disease (ADD) was the most frequently assessed or investigated condition and was one of many diseases exemplifying how FETP officers may need to work across multiple sectors (for example, health, water and sanitation) to help mitigate the public health impact of disease on the affected communities. Challenges (for example, time-consuming process of tailoring learning content, attrition, identification of qualified mentors and task-shifting) and lessons learned (for example, pivoting to a self-paced learning model, using case studies with real-world examples, and a blended learning approach) are described.

Conclusion: This paper portrays the feasibility of not only implementing a 3-month FETP in India's diverse context but, given the complexity of health challenges in an increasingly interconnected environment, its flexibility to be naturally transitioned towards One Health FETP (named SectorConnect in India). It highlights a milestone in India's journey towards realizing the goals set under the One India FETP Roadmap for having at least one trained field epidemiologist per district.

Background: Interstitial lung diseases (ILDs) constitute a heterogeneous group of diffuse parenchymal lung disorders characterized by varying degrees of inflammation and fibrosis. Global estimates indicate that the incidence of ILDs has risen by over 50% in the recent years. In India, epidemiological data remain limited and inconsistent due to heterogeneity in diagnostic criteria and regional disparities, impeding accurate burden estimation and policy prioritization.

Main text: Among ILDs, progressive fibrotic forms, idiopathic pulmonary fibrosis (IPF) in particular, cause substantial morbidity and mortality. Many ILDs progress to irreversible fibrosis, leading to declining lung function, impaired quality of life and shortened survival. Timely and precise diagnosis of progressive fibrotic (PF)-ILDs is imperative to facilitate early therapeutic intervention and potentially slow down fibrotic progression. Diagnostic evaluation necessitates high-resolution computed tomography, histopathological examination and multidisciplinary team consensus, all of which are often unavailable or prohibitively expensive outside tertiary care centres in India. Therapeutic options are confined primarily to two antifibrotic agents approved for IPF, which modestly attenuate disease progression but do not significantly improve survival in patients. Access to these therapies is limited by cost, lack of proper insurance coverage and non-uniform healthcare infrastructure. Clinical presentation is often delayed owing to low disease awareness and referral gaps. Although, pulmonary fibrosis following novel coronavirus disease 2019 has attracted recent attention, it constitutes a minor fraction of the PF-ILD burden. Despite the high morbidity and mortality associated with PF-ILDs, these conditions are inadequately represented in India's health policy instruments, research agendas and funding priorities.

Conclusions: The burden of PF-ILDs in India demands an urgent policy response, which involves integrating ILDs into national non-communicable disease frameworks, expanding diagnostic capacity in secondary care, improving affordability and access to antifibrotic drugs and supporting multicentre registries for surveillance and research. Addressing these gaps could reduce disease impact domestically and provide a model for other low- and middle-income countries confronting similar challenges in tackling fibrotic lung diseases.

Background: There is a known disconnect between scientific knowledge and its application in routine practice, known as the research-practice gap. A potential strategy to encourage research engagement among end-users is embedding researchers within an organization. This study set out to understand the views and experiences of senior managers, middle managers, and frontline staff in one department accessing and using research in a large organization with embedded researchers. We also investigated staff capacity to engage with research to identify opportunities to strengthen the use of research-based evidence in practice.

Methods: We conducted 14 semi-structured in-depth interviews between November 2022 and April 2023 with senior managers, middle managers, and frontline staff working in the blood collection department at Australian Red Cross Lifeblood. Directed qualitative content analysis and the SPIRIT Action Framework were used to interpret the data.

Results: Capacity to engage with and use research varied greatly between participants and appeared to be affected by their role, training, and prior work experience. Participants valued research highly. However, only a few felt confident in their knowledge and skills to engage with research. Participants described a lack of visibility of research within the organization as well as systems and structures to access research. Experiences with accessing research, generating research, and interacting with researchers were mostly limited to senior managers. Research was chiefly used by senior managers to support changes, followed by understanding blood collection issues, and informing policy development. Although present, research use was often not visible to frontline staff.

Conclusions: To increase research engagement and use, organizations should invest in strengthening their tools and systems, providing opportunities to increase individual knowledge and skills to engage with research, and increase the visibility of research and how it has been used.