Health Research Policy and Systems最新文献

Background: Abortion policy is a highly contested area of health policy. Despite international recognition of abortion as a human right, legal restrictions persist in many countries, and recent decades have seen both liberalization and retrenchment of abortion laws. While much research has examined the politics and outcomes of abortion policy reform, less attention has been paid to the upstream process of how abortion emerges on the policy agenda. This study addresses this gap by focusing on agenda setting for abortion policy, using Kingdon's multiple streams framework (MSF) and systems thinking.

Methods: This exploratory study integrates MSF with systems thinking and causal loop diagramming to map the dynamic interactions among government characteristics, policy communities, policy-maker attributes and external events. A purposive review of 19 key works from the MSF literature was conducted, selected for their theoretical contributions and detailed descriptions of stream interactions. Qualitative text coding and quotation analysis were used to identify causal relationships, which were then aggregated into a causal loop diagram. Model validation focused on micro-structure elements, and the framework was tested against two case studies: Ireland and Nicaragua.

Results: Analysis yielded 167 unique elements and 338 causal links, distilled into 81 key variables. The causal loop diagram demonstrates that convergence of the problem, policy and politics streams is shaped by reinforcing and balancing feedbacks, rather than random chance. Key factors influencing agenda setting include party institutionalization, policy entrepreneur effectiveness, social inequality and the gravity of focusing events. The case studies illustrate how variations in political institutions, mobilization efforts and external events can lead to divergent policy trajectories.

Conclusions: This study provides theoretical validation that the parsimonious MSF can account for the complexity of abortion policy agenda setting when integrated with systems thinking. The causal loop diagram identifies actionable leverage points for advocacy and policy reform and offers a dynamic, testable model for understanding agenda setting in contentious policy domains. These findings bridge theoretical innovation with practical relevance, laying a foundation for future empirical research and offering insights for scholars, advocates and decision-makers seeking to influence the policy agenda for abortion and other complex health issues.

Background: Evidence-informed decision-making (EIDM) is essential for developing and implementing health policies and public health measures that promote, maintain and protect population health. Effective EIDM requires equitable collaboration between academia and practice to foster bilateral knowledge translation and exchange (KTE). This study analyses the barriers and facilitators influencing engagement in such research collaborations within Germany's public health service (PHS).

Methods: We conducted 23 key informant interviews with 24 experts engaged in or collaborating with Germany's PHS to explore experiences with PHS research, knowledge transfer, collaboration and training. The interviews, conducted in pairs, were transcribed verbatim and analysed thematically via a coding frame developed through a deductive‒inductive approach. The COM-B Model of Behaviour Change was applied to categorize barriers and facilitators affecting individuals' and organizations' capability, opportunity and motivation to engage in academia‒practice collaboration.

Results: The analysis revealed the importance of combined approaches that integrate informal networks, formal partnerships, research collaborations and capacity-building initiatives to foster local evidence ecosystems, ensuring bilateral KTE between academia and practice to support EIDM at the local level. Ten key barriers and 35 facilitators capable of addressing these challenges were identified. Strategies to address capability and opportunity barriers included workforce development with dedicated research time, on-the-job training, streamlined administrative processes, long-term funding mechanisms, strengthened relationships between academia and PHS and improved access to research infrastructure and local settings. Financial and educational incentives, adequate incentive structures, an evidence-informed culture within the PHS, and equitable partnerships based on mutual recognition were highlighted as essential motivators. Based on these findings, we developed a conceptual framework reflecting the interconnected nature of barriers and facilitators.

Conclusions: Sustainable academia‒practice collaboration is crucial for bridging the knowledge‒action gap and thereby strengthening EIDM in PHS. However, Germany's PHS lacks institutionally anchored partnerships to strengthen bilateral KTE and EIDM at the local level. The proposed KTE framework provides actionable pathways to bridge gaps between academia and PHS, fostering sustainable and effective collaboration. It can be used to systemically assess factors influencing engagement in equitable partnerships and guide the development of solutions tailored to local needs, supporting EIDM processes at the local level.

Background: Autistic adults experience disproportionately high rates of mental health challenges and encounter substantial barriers to care. While initiatives aimed at improving mental health literacy (MHL) offer one strategy for addressing these disparities, the processes through which such initiatives are co-produced with autistic adults and caregivers remain underexplored. Co-production - the collaborative development of resources or knowledge between researchers and community members - can enhance the relevance, authenticity, and impact of health initiatives. The central aim of this study was to understand how autistic adults and caregivers experienced their involvement in the co-production of an applied health research initiative. To inform future initiatives, there is a need to understand stakeholder experiences of the co-production process.

Methods: This study examined the experiences of stakeholders engaged in the co-production of a Canadian MHL resource for autistic adults and their families. Although the context of the project focused on MHL, the central aim was to understand how autistic adults and caregivers experienced their involvement in the co-production process. Semi-structured interviews were conducted with 24 autistic adults and caregivers who served as advisors in the Autism Mental Health Literacy Project (AM-HeLP). A reflexive thematic analysis approach was used to identify key experiential themes related to their involvement.

Results: A thematic analysis identified four main stakeholder experience themes: (1) the elements of co-production, (2) the collaboration process, (3) insights gained and (4) emotional impact of involvement.

Conclusions: These findings highlight the critical importance of intentional, inclusive and trauma-informed co-production practices in applied health research. They offer practical guidance for researchers, service providers and policymakers seeking to authentically engage autistic adults and families in the development of health-related resources. Supporting equitable partnerships with autistic adults and caregivers is essential to advancing responsive and person-centred health policy and practice.

Health researchers are increasingly encouraged to engage with nonacademic stakeholders and provide evidence of their engagement. However, evidencing research engagement and advancing the evidence base is challenging, partly because of the lack of available tools to prospectively track research engagement activities. To fill this gap, this Commentary introduces PROcess for Systematic Prospective Engagement Capture and Tracking (PROSPECT), a novel process based on event logging that offers a systematic way to track and measure research engagement activities. The development of PROSPECT was informed by a literature search, a series of reflective practice sessions and application to one of our research programs. PROSPECT includes five phases: (1) determine the purpose, (2) define research engagement and categories of research engagement, (3) determine the information to be recorded for each research engagement activity, (4) determine the data collection system and (5) analyse, present and report. We provide examples of how we are applying each phase. We have used the data collected through PROSPECT in funder reports to describe our engagement activities and to gain insights into patterns of engagement throughout our research program. Whilst PROSPECT offers a promising approach to capturing research engagement data, we have encountered a range of practical, conceptual and technical challenges in applying this process. We suggest some next steps in its development to address these challenges. Once the challenges of applying the process are addressed, PROSPECT will be a valuable tool for researchers, leaders of research institutions and funders.

Background: Large pharmaceutical companies are evolving their innovation strategies, moving from closed R&D models towards open, collaborative ecosystems. Innovation labs have emerged as key organizational infrastructures in this shift, designed to accelerate the development, validation and adoption of new healthcare solutions. However, a systematic understanding of industry-led innovation labs remains limited.

Objective: This study aims to comprehensively characterize the structure, strategic focus, activities and outputs of innovation labs promoted by major pharmaceutical companies, and to identify patterns and divergences across different organizational models.

Methods: We conducted a structured literature review in PubMed and an original mapping of innovation labs established by the top 20 global pharmaceutical companies. Data were collected from peer-reviewed publications, official corporate reports and grey literature. Innovation labs were analyzed according to their digital orientation, geographical structure (unicentric versus multicentric), activity domains, stakeholder engagement and innovation outputs.

Results: A total of 102 innovation centres promoted by 14 pharmaceutical companies were included. Most centres demonstrated a strong digital focus, particularly on digital health solutions and remote patient monitoring. Collaboration activities were widely reported (98%), mainly involving universities (92%) and other industries (65%). Support for entrepreneurship was a major theme, reflected in mentoring programs (87%), co-development opportunities (85%) and access to funding (40%). A comparative analysis revealed that multicentric initiatives were significantly more engaged in external collaborations, entrepreneurship promotion and educational activities, and produced higher rates of patents and spin-offs compared with unicentric initiatives. However, unicentric labs were more associated with internal capacity building and early-stage clinical research.

Conclusions: Pharmaceutical innovation labs are pivotal in healthcare transformation, integrating scientific, technological and entrepreneurial approaches. Multicentric and unicentric models offer complementary strengths: multicentric hubs enhance external engagement and scalability, while unicentric labs foster organizational learning and focused research. Understanding and strategically balancing both models could maximize the impact of pharmaceutical innovation infrastructures. Future research should explore longitudinal impacts, patient involvement and the interaction of innovation labs with venture capital ecosystems and regulatory frameworks.

Background: Evidence ecosystems play a vital role in informing and shaping policy; however, little is known about how these systems function, particularly in diverse national contexts. This article presents a mixed-methods study designed to be the first to systematically map and characterize Brazil's health evidence ecosystem, focusing on key institutions, actors, and practices across the country. We aim to map, describe and analyse the ecosystem of production, use and dissemination of policy evidence in Brazil's five regions.

Methods: We will adopt a five-step mixed-method approach to understand Brazil's health evidence ecosystem comprehensively. Five steps will be undertaken: (a) cultural adaptation of two published situation analysis tools, (b) digital ethnography to identify and categorize organizations that are evidence producers, users, or intermediaries as well the types of evidence demanded, (c) autoethnography workshops with selected organizations, (d) interviews to apply an evidence institutionalization and (e) focus groups to produce a situation analysis of institutional practices, governance and the overall environment for evidence use in policy in each of the five Brazilian regions.

Discussion: This study combines diverse tools to understand how evidence is produced, disseminated and utilized in Brazil. The study of regional differences and institutional practices can help to identify barriers and facilitators to the effective use of evidence in policy. Furthermore, it may inform the development of strategies to strengthen the evidence ecosystem in Brazil and serve as a roadmap for other countries that aiming to conduct a comprehensive evidence ecosystem analysis.

Background: The European Joint Programme on Rare Diseases (EJP RD) was an initiative that sought to integrate different rare disease strategies into a research ecosystem. This paper summarizes the work of the dedicated work package on Integrative Research and Innovation Strategy and outlines recommendations to facilitate alignment with National Plans and Strategies for Rare Diseases.

Methods: We carried out three periodic surveys (in 2020, 2021 and 2023) on the status of national plans and strategies (NP/NS) for rare diseases in EJP RD member countries. Using the feedback from the surveys and other sources, we developed an annual mapping of research and innovation needs and their alignment with the EJP RD programme. A review of the findings and progress from these approaches - including two strategic policy workshops and the development of National Mirror Groups - informed the recommendations to bridge the gap between national efforts and European strategies.

Results: A total of 34 countries responded to at least one survey. Implementation is uneven: 76% of countries have had their NP/NS approved at some point, but renewals are irregular. For EU13 countries, the most frequent barrier to developing, improving and translating rare disease (RD) research results was funding. In terms of the Programme's activities covering mapped needs, we achieved global coverage of 65.8%, with greater coverage of needs for both the diagnostic pathway and the treatment pathway (71%). Four National Mirror Groups were developed during the Programme's first 5 years, and a further seven were established by mid-2024.

Conclusions: Despite recent progress in establishing a research ecosystem for rare diseases in Europe, several challenges remain and should be addressed. These include availability and accessibility of diagnostics, medicines and medical devices across Europe, inequalities between and within countries, compliance with the FAIR data principles and the lack of a comprehensive policy framework to integrate different rare diseases initiatives. Next actions need to strengthen the coordination and alignment of funding and national policies, innovation in the translation of research results and the reach of a holistic research ecosystem. National Mirror Groups will play an important role in this respect.

Background: Shared decision-making (SDM) is widely endorsed in international guidelines for the treatment of valvular heart disease (VHD). Despite evidence that the process improves outcomes and does not increase the burden of consultations, SDM has not been adopted as a standard of care across regions and diverse health systems.

Methods: We conducted a 3-phase study co-led by clinicians and people with lived experience using an integrated knowledge translation approach guided by the knowledge-to-action framework. In a preparatory phase, we conducted exploratory semi-structured interviews with 19 international and diverse experts to identify barriers and enablers to SDM in VHD; we used thematic analysis to identify the major issues to inform project development. We convened an in-person meeting of patients and patient advocates (n = 9), clinicians (n = 11) and researchers (n = 3) from 10 countries to build joint recommendations. Lastly, we conducted a series of local and international meetings to validate the findings and inform future initiatives.

Results: Challenges identified included (1) concerns about clinicians' availability and time requirements, (2) uncertainty about how to practice SDM and (3) absence of regional data to evaluate SDM in VHD. The joint recommendations clustered on five global areas of focus and six sets of recommendations tailored to regional contexts and cultural norms. Final recommendations on (1) preparing patients and carers, (2) training healthcare teams and (3) creating a supportive system were further enhanced by VHD knowledge users' input in various regional settings.

Conclusions: This first report co-led by diverse stakeholders offers a practice and policy-ready roadmap to strengthen the implementation and evaluation of SDM in VHD.

Background: There is a need to critically examine both how research infrastructures interact with the populations they serve and the perceived effects of these interactions. This paper reports on a contribution analysis-informed study of a research infrastructure and its place-based approach to working with local communities - the National Institute for Health and Care Research Applied Research Collaboration East of England (NIHR ARC EoE). The aims were (1) to understand the perceived impact of the NIHR ARC EoE place-based approach and (2) to explore its processes and challenges.

Methods: From April-June 2023, we interviewed 11 research staff from the infrastructure (NIHR ARC EoE) and nine community-based partners who had worked with NIHR ARC EoE since 2019. The interviews explored experiences of developing research partnerships, learnings, outcomes and challenges. The interviews were audio-recorded, transcribed and subject to a thematic analysis. The findings were subsequently mapped onto a Research Contributions Framework.

Results: The place-based approach was characterized as relationships-driven and community-focused in building research infrastructure, which improved motivation and commitment to local involvement in research. Three perceived impacts were highlighted: working with underserved communities, cross-sector relationship development and building skills and research capacity. Key barriers included differing expectations of research timescales, a fear of problematizing communities, and intensive resource requirements for developing foundational level relationships.

Conclusions: The place-based approach enabled opportunities to work with (rather than do to) communities previously underserved by research and where the development of trusting relationships was key. However, strategic efforts to dismantle bureaucratic barriers must be developed to maximize reach and potential. The findings present an effective approach to understanding the impact of a place-based approach to working with communities. The value of a place-based approach is widely applicable to any research infrastructure aiming to collaborate, involve and engage communities in research.

Objective: This study investigates operational efficiency in public general hospitals using a system dynamics (SD) model, focusing on resource allocation, patient flow and policy interventions. It explores the interactions between human resources, financial subsidies and patient visitation rates and their impact on hospital performance.

Methods: An SD model was developed to simulate various scenarios, incorporating data on hospital capacity, staffing and financial inputs, along with patient flow dynamics. Key performance metrics, including bed occupancy rate (BOR), average length of stay (ALOS), average cost per visit and workload index, were analysed under different policy scenarios.

Results: Simulation of four policy scenarios revealed that increased fiscal subsidies (scenario 2) consistently improved operational efficiency by reducing ALOS, staff workload and cost per visit. In contrast, scenarios involving human resource cuts or rapid patient growth triggered adverse feedback loops that undermined performance.

Conclusions: The SD model effectively captures the dynamic interactions within hospital operations and enables assessment of policy interventions over time. Enhanced government funding contributes most positively to efficiency, while demand surges and resource reductions introduce system strain and performance trade-offs.