Health Research Policy and Systems最新文献

Introduction: Lebanon's healthcare system, historically reliant on privatization and public-private partnerships, faces unprecedented challenges owing to a compounded crisis environment. Since 2019, economic collapse, the coronavirus disease 2019 (COVID-19) pandemic and the Beirut port explosion have placed immense strain on an already fragile system, highlighting the necessity to understand its resilience in sustaining service provision. This study aims to examine the capacities of the local health system to absorb, adapt and potentially transform in response to ongoing crises, in Majdal Anjar, a municipality located in the Zahle District.

Methods: This qualitative study employed key informant interviews (KIIs) with nine local healthcare stakeholders, including healthcare providers, officials from the Ministry of Public Health (MoPH) and representatives from the United Nations and non-state actors, and was conducted from May to June 2022. The interviews focused on stakeholders' insights into the actions taken to address challenges triggered by the crisis. Data were coded according to the Health System Resilience Framework, developed by the Rebuild Consortium, and analyzed through a deductive approach to classify identified responses according to the resilience capacities of absorption, adaptation and transformation.

Results: Within the adopted resilience framework, the capacities identified in the responses appear as follows: Absorption: International organizations and non-state actors provided crucial financial and operational support, compensating for the government's disengagement from funding and regulation. While this support sustained essential services, it had also introduced inequities and coordination challenges, as aid priorities sometimes diverge from local needs. Adaptation: The MoPH and municipal entities have implemented policy adaptations, including tolerating informal healthcare providers and allowing contracting of health institutions with humanitarian actors directly, while healthcare facilities innovated to manage medication shortages. The MoPH sought to bolster local pharmaceutical production and reform reimbursement policies. Transformation: Local stakeholders, particularly municipalities, demonstrated capacity to manage healthcare services independently during COVID-19 crisis cells, but this autonomy remained underutilized.

Conclusions: Lebanon's healthcare system has demonstrated resilience through absorptive and adaptive responses amidst multiple crises. However, these strategies have been insufficient to ensure equitable and sustainable access. Reliance on humanitarian funds and centralized, profit-driven governance has deepened structural weaknesses, hindering long-term resilience. Achieving genuine resilience requires governance reforms, strategic resource allocation, decentralization and a shift towards a needs-based health approa

Background: Using data for policy design, program implementation and accountability is a priority among nutrition stakeholders in Nigeria. However, the capacities of decision-makers to use data are not well-defined.

Objective: This study used mixed methods to assess the capacity of institutions within Nigeria's health sector to demand and use data for decision-making on nutrition policies and programs.

Methods: A quantitative scale capturing organizational and individual factors related to the capacity to demand and use data was administered to 92 nutrition stakeholders in Nigeria across federal government (n = 33), state government (n = 21) and local government areas (LGAs) (n = 29) and development partner organizations (n = 9). We compared scores across sub-groups. Key informant interviews (KIIs) with a subset of the federal (n = 13), state (n = 17), LGA (n = 30), and development partner (n = 11) respondents complemented the quantitative scale and were analysed thematically.

Results: Mean institutional capacity to demand and use data was 78.6 out of 100 [95% confidence interval (CI) 75.9, 81.3]. The mean organizational capacity score was 51.4 out of 60 (95% CI 49.9, 52.9); individual capacity was 27.2 out of 40 (95% CI 25.7, 28.7). Development partners (mean 85.7; 95% CI 78.9, 92.4) had the highest score, followed by state-level respondents (mean 82.3; 95% CI 76.9, 87.6), but differences were not significant. Both quantitative and qualitative results showed recognition and support for nutrition data demand and use but weak organizational mechanisms to ensure data use. Accessing available nutrition data was a challenge, especially for administrative data. Quantitative and qualitative results identified infrastructural and technological resource barriers for government respondents, especially at the LGA level, but not for development partners. Skills to synthesize and use nutrition data were also a challenge across respondent groups.

Conclusions: Government and non-government stakeholders in Nigeria's health sector recognize the importance of data for nutrition decision-making, but gaps remain in individual capacity, resources and data use processes. To strengthen data use for nutrition policy process, investments to address gaps are needed.

Background: The outbreak of coronavirus disease 2019 (COVID-19) has prompted significant changes in health policies worldwide. Policy-makers from various countries have responded by adopting and implementing diverse policy measures aimed at combating the spread and impact of COVID-19. The aim of this study is to assess people's satisfaction with the primary policy responses and their perceptions of the success of their implementation and monitoring.

Methods: A cross-sectional online survey was conducted in Kerman, Iran, spanning the period of 2021-2022. The sample included adults aged 18 years and older who had access to the Internet and smartphone devices. An online platform was used to develop the questionnaire and collect the data. The face validity, comprehensibility and content validity of the questionnaire were tested and met. Descriptive statistics and multivariable logistic regression were conducted. Data were analyzed using STATA 14.0 software.

Results: In total, 3192 participants completed the questionnaire, resulting in a completion rate of 67%. More than half of the participants were female (55.51%), with a mean age of 37 ± 11.72 years, and the majority held an academic degree (74.97%). Overall, 54.79% of participants expressed satisfaction with the adopted policy responses, while 56.61% were dissatisfied with their implementation and monitoring. In multivariable logistic regression, factors positively associated with satisfaction included having a diploma [adjusted odds ratio (AOR) = 1.46; 95% confidence interval (CI) 1.05-2.04], an academic degree (AOR = 1.71; 95% CI 1.26-2.31) and middle socioeconomic status (AOR = 1.34; 95% CI 1.07-1.69). In contrast, being male (AOR = 0.68; 95% CI 0.58-0.79) and having high trust in others (AOR = 0.75; 95% CI 0.61-0.92) were associated with lower odds of satisfaction.

Conclusions: The results of the study showed that more than half of the participants expressed satisfaction with the adopted policy responses made by the National Committee to Combat COVID-19. However, it seems that the government has performed poorly in implementing and monitoring adopted policy responses, leading to a decrease in people's satisfaction.

Background: Healthcare systems are increasingly complex given devolution of powers, decentralization of decision-making, and escalating fragmentation of effort. This indicates a role for governments in how they can bring this together, oversee and improve across the system. Goals pertaining to the safety and quality of clinical care are advanced by governments using stewardship and agent-based strategies that increasingly place reliance on being evidence based. In Australia, clinical networks are a safety and quality stewardship model that convenes multidisciplinary and intersectoral actors to define evidence-based expectations for clinical practice, management and policy. Yet understandings of the role that evidence is intended to play within clinical networks remain under investigated. Despite vast literature examining the contribution of stewardship, networks and evidence use in healthcare, research on these topics have occurred in relative isolation. There lacks an integrative approach to these concepts to advance stewardship research and practice.

Methods: By employing a theory generating approach, this research outlines the determinants of evidence use by Australian clinical networks as safety and quality stewards. A conceptual framework is developed, informed by examination of the theoretical and empirical literature, findings from mixed methods research involving interviews, documentary analysis and Q-methodology, and validation of findings with research partners.

Results: The Clinical Network Safety and Quality Stewardship Conceptual Framework situates the determinants of evidence use by networks within understandings of safety and quality stewardship. It encompasses three layers: (i) the model of health system coordination and governance, (ii) network inputs and understandings of evidence, and (iii) points of influence. Within each layer, several attributes are identified that are explained with reference to agency and stewardship theory. We describe the interactions within and between the layers incorporated in the framework that are of importance in order to explain how evidence can shape the decisions that contribute to safety and quality.

Conclusions: Theoretical contributions offer greater conceptual clarity with regard to the role of evidence within the context of networked stewardship models and systems where foundations are in agent-based approaches of coordination and governance. The conceptual framework seeks to advance scholarly research and practice. Merits, limitations and considerations for further testing of the framework are outlined.

Background: The crossing of planetary boundaries, such as climate change and biosphere integrity, threatens human health, while healthcare systems paradoxically contribute substantially to these environmental challenges. Although research on the environmental impact of care activities and pathways is expanding, it remains unclear how this information is used in clinical practice. This study explores healthcare professionals' views on the environmental impact of hospital care, the role of environmental impact data and research and implementation priorities to support sustainability in clinical practice.

Methods: Semi-structured focus groups and interviews were conducted between April and July 2024 with 31 Dutch healthcare professionals working across 12 medical (hospital) specialities with the highest care volumes and expenditures. Participants were selected on the basis of their involvement or interest in green healthcare initiatives. Focus groups and interviews were transcribed verbatim and analysed using reflexive thematic analysis.

Results: Participants have a general sense of environmentally impactful care activities, including surgical procedures, medication and outpatient visits. However, they reported a lack of quantitative environmental impact data at the clinical level, limiting their ability to make informed, sustainable choices. While participants recognized multiple uses for environmental impact data and supported integrating sustainability considerations into healthcare decision-making, they emphasized the need to balance these factors with other priorities, such as clinical effectiveness, patient safety and costs. Several research gaps were identified, including the need for comparative pathway analyses and standardized metrics. Additionally, implementation priorities, such as focusing on high-volume care, leveraging healthcare co-benefits and driving systemic changes to overcome barriers in the sustainability transition, were defined.

Conclusions: Healthcare professionals lack the quantitative data needed for sustainable healthcare decision-making. Targeted research and implementation efforts should focus on high-impact, modifiable care. These findings may support better alignment between environmental research and clinical priorities, thereby informing evidence-based sustainability efforts in hospital care.

Background: Knowledge translation platforms (KTP) are partnerships comprising policy-makers, national researchers, and civil society, serving as organizational knowledge brokers to foster the use and uptake of evidence in evidence-informed policy-making (EIPM) processes. Recent evidence suggested that KTP institutionalization requires leadership, commitment, political engagement, shared ownership, monitoring and evaluation, participatory approaches and multi-institutional collaboration within a policy-stable context. However, limited evidence from the Eastern Mediterranean region (EMR) has confirmed, disconfirmed or refuted these theoretical assumptions. In this review, we set out to refine, confirm or disconfirm these theoretical assumptions and explore the barriers and facilitators to institutionalizing and sustaining (KTPs) in the EMR.

Methods: We followed the scoping review methodological guidance. We searched three databases (Scopus, Web of Science and PubMed) for articles published in French, English or Arabic addressing knowledge translation platforms (KTP) in healthcare in countries from the Eastern Mediterranean region published between 2010 and 2022.

Results: A total of 55 studies were included out of 2585. Most studies reported KTP initiatives from Pakistan (n = 11), Iran (n = 9), Jordan (n = 8), Lebanon (n = 9) and Egypt (n = 16), whilst North African countries were underrepresented. Review findings suggest that stakeholder, community engagement and political commitment are key underlying social mechanisms for translating evidence into action. Our review highlights contextual barriers such as rigid hierarchical structures, inadequate protected research time, delayed financial disbursements and cultural resistance to evidence use.

Conclusions: Researchers might explore the political and structural barriers, such as overarching political forces, and the sensitivity of research findings that impede the uptake of evidence into policy in the region. Our findings underscore the need for multilayered interventions to address these challenges and support the need for systemic capacity-building interventions to promote the institutionalization of KTPs in the Eastern Mediterranean region.

Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, an emerging public health crisis with global impact, various artificial intelligence (AI)-enabled devices for pandemic-prevention emerged, highlighting the urgent need to understand public leverage of AI-enabled digital technologies.

Methods: This study constructs a comprehensive model, the Risk Prevention-centred and AI-enabled Anti-pandemic Technology Acceptance Model (RPAA-TAM), to elucidate public adoption of anti-pandemic digital tools, contributing to innovative governance. Integrating TAM, social influence theory and risk perception theory, RPAA-TAM analyses technology development and explores factors influencing public acceptance of AI in pandemic prevention.

Results: The study identifies seven key factors impacting public acceptance, including external variables, public trust, perceived benefit, perceived risk, attitude toward use, behavioural intention to use and system usage, offering insights into the integration of AI in managing emerging public health crises. The study offers seven novel propositions derived from a literature review on the basis of the RPAA-TAM.

Conclusions: The Risk Prevention-centred and AI-enabled Anti-pandemic Technology Acceptance Model (RPAA-TAM) offers a comprehensive framework for understanding public acceptance of AI in pandemic prevention. Identifying seven key factors impacting acceptance, our study provides novel propositions on the basis of literature review. RPAA-TAM contributes to innovative governance strategies, guiding the ethical and socially acceptable integration of AI in managing public health crises.

Background: With the increasing use of the term "impact evaluation" in healthcare and the absence of an exhaustive review on this general theme, this research aims to map available evidence and methods associated with impact evaluations in healthcare by conducting a scoping review.

Methods: This exhaustive review included peer-reviewed studies of healthcare interventions with no restrictions on language or time of publication.

Results: In total, 324 studies met the inclusion criteria from 4372 single registries retrieved from Medline, Embase, Scopus, WoS and Econlit in August 2024, with no time restriction. Only ex-post studies were identified; as expected from guidelines, most studies used counterfactuals (58%) and only 7% did not use any comparison. Furthermore, natural experiments or quasi-experiments were the most applied designs (37%), followed by observational (26%) and experimental (17%) designs.

Conclusions: Impact evaluations of healthcare interventions seem to be predominantly associated with methods of strong comparison (counterfactuals) designs as seen in guidelines; however, there are exceptions.

Many retrospective assessments of the wider, societal impacts from health research funding use the Payback Framework or other frameworks. Much of this experience was collated in the 2018 Statement by the International School on Research Impact Assessment (ISRIA). Despite increased interest, especially in engaged research and a wider range of evaluation approaches, rarely do health and other research funders take a prospective approach and analyse the potential impact from a proposal to inform an impact management approach aimed at boosting impact. In this paper, experts from the Novo Nordisk Foundation, a leading philanthropic funder of research, describe how they are developing and applying such a pioneering approach. The five steps form a continuum from project inception to data collation and assessment. The first step entails preparing the project's narrative in alignment with the project's vision. The second, building the logic model, includes defining success factors and effect chains. The third is an early assessment of the initiative's potential impact, conducted on a case basis. The fourth is implementing the data model by integrating specific indicators. The fifth focuses on monitoring, impact management and creating impact products, including developing a comprehensive plan for data reporting and assessment, with scope for adjustments based on experience. This approach aligns with ISRIA guidelines, but further steps are needed. Whilst the Foundation is driving innovation in impact assessment by successfully introducing a new approach that uses prospective impact analysis to inform impact management to enhance the levels of impact achieved, further progress is needed on stakeholder engagement expanding towards a more inclusive stakeholder involvement.

Background: Lower-level private for-profit health service providers form part of the pluralistic health systems delivering immunization services in urban areas of sub-Saharan Africa. However, their operational context is less documented since the conventional national Expanded Programme on Immunization (EPI) programmes tend to support delivery through public structures. Yet, private providers contribute greatly to immunization service coverage in urban settings. This paper explores the operational level context and stakeholders' perspectives regarding immunization data among lower-level private for-profit service providers in the city of Kampala, Uganda. The objective of this baseline assessment was to document the current implementation context of immunization data among urban lower-level private for-profit immunization service providers to inform implementation research to improve immunization data in Kampala, Uganda.

Methods: The study adopted an exploratory qualitative design where key informant interviews and in-depth interviews were conducted. Analysis was guided by the health systems building-block framework, which informed the design of the codebook with coding done in Atlas.ti, a qualitative data management software.

Results: Overall, private for-profit immunization service providers reflected a context consisting of both barriers and opportunities underlying immunization data management practices. The barriers identified included: high staff turnover; data overload and manipulation tendencies; a transient population that access immunization services from different service providers without data linkage systems; computation of catchment populations, which affects utilization coverage data; financial barriers to the collection of community-level data; and inadequate facilitation leading to lean human resources at EPI departments managing immunization data from private providers. Nonetheless, opportunities to improve immunization data included the ability to widen data coverage through their services, enhanced public-private-partnership through data sharing arrangements, linkage of urban data among providers, improved recording of urban surveillance data, additional human resource to record data, widened scope for capturing adverse events data, improved community data linkages, and transitioning from paper-based to electronic data capture.

Conclusions: Opportunities to improve urban immunization data management through private for-profit providers exist amidst numerous barriers. This calls for innovative strategies by the programme managers to design interventions with specific emphasis on addressing barriers inherent among urban lower-level private for-profit service providers if immunization data management among these entities is to be improved.