Evidence & Policy最新文献

Background: Clinical practice guidance (CPG) needs to be developed following robust standards that are acceptable to end users.

Aims and objectives: This descriptive qualitative study aimed to explore stakeholder experiences and perceptions of standards for CPG development in Ireland.

Methodology: Twenty stakeholders (senior decision-makers, evidence synthesis specialists, healthcare providers and guideline developers) participated in semi-structured interviews, conducted remotely via Microsoft Teams between November 2023 to January 2024 by one interviewer. The topic guide was informed by a previous scoping review and an existing 2015 standards document. All interviews were audio-recorded and transcribed verbatim. Data analysis followed a framework approach.

Results: Many participants recognised the value of having standards for CPG development but expressed limited familiarity with specific documents. They described a complex landscape of CPG development and use in Ireland, causing confusion due to ambiguous terminology and uncertainty regarding which guidance is required/takes precedence in various healthcare scenarios. Participants spoke to the importance of governance, particularly planning robust audit processes when developing CPGs. They also highlighted variation in CPG implementation and felt that those developing CPGs often failed to adequately consider implementation and communication planning. The need for more resources, particularly personnel like methodologists, to support developing evidence-based CPG was a recurring theme.

Discussion: This qualitative study underscores stakeholders' appreciation of manuals and documents on developing CPG, yet it also highlights gaps in awareness and practical application. There is a pressing need for better promotion and dissemination of resources for development and implementation within the guidance development ecosystem.

Integrated systems of care are increasingly seen as the means to bridge gaps between organisations, services and professions, increase quality, and decrease costly duplication across the health and care landscape. Integration and integrated health and care teams, composed of locality-oriented health and social care practitioners, have become central to global health policies. Integrated teams are expected to share distinct bodies of knowledge, evidence and expertise and use this to create holistic care plans. However, little research has examined how they achieve these knowledge-related goals. This research uses organisational knowledge creation theory to examine the discursive practices within integrated teams. Observational data from case management meetings across five integrated teams highlight four key themes: (1) Instrumental questioning dominated discussions, often making participants feel criticised and leading to the imposition of questioners' opinions. (2) Interactions were typically unstructured and unreflective, hindering clear objectives and limiting knowledge sharing and creation. (3) Teams often failed to retain and apply prior learning, struggling to identify cross-case insights. (4) Teams relied heavily on internal knowledge sources, rarely seeking evidence from patients, families or other professionals. These discursive practices undermine the policy goals of integrated care, particularly with regard to knowledge and evidence. To address this, teams need support to expand the forms of knowledge and evidence they draw upon, discuss contradictions and uncertainties, and value reflective, curiosity-driven dialogue.

Background: Educators' use of research evidence (URE) from intermediary websites is not well understood. Current studies measure URE through periodic, retrospective user reports or by passively tracking website usage, neither of which adequately inform the continuous improvement efforts of intermediaries. This study examines the feasibility of microsurveys - brief, behaviour-triggered surveys embedded within websites - as a tool for assessing and informing the improvement of URE. Specifically, this article explores configurations to optimise microsurvey response rates.

Methods: A plug-in embedded microsurveys across web pages. Microsurveys included a five-point Likert emoticon rating scale and an open-ended follow-up. Four pilot studies tested variations in: (a) question wording, (b) time delays before triggering, (c) number of clicks, and (d) optimised conditions integrating the best configurations. Chi-square tests and logistic regression analysed differences in response rates and relationships between conditions, scores and response rates.

Results: Response rates improved by discarding low-performing (that is, low response rate) questions, selecting better time delays, and reducing the number of clicks to complete the microsurvey. Likert scale response rates increased from 4.18 per cent to 11.31 per cent under optimised conditions. Follow-up response rates remained stable, with higher engagement associated with favourable Likert scores.

Conclusions: This study establishes the potential of microsurveys for measuring URE from intermediary websites, achieving response rates understood to yield reliable estimates for informing the promotion of evidence in practice. Future research should explore additional configurations to further optimise response rate, integrate microsurveys with observational and behavioural data to assess validity, and study integrating microsurvey feedback into organisational change processes.

Background: The idea and need for knowledge mobilisation (KM) have gained traction in research and practice, but the long-term sustainability of KM practices remains challenging. Recent research suggests shifting from sustainability as an end-goal to 'sustaining' as actors' work to keep knowledge translation practices productive. However, little is known about sustaining work, especially in street-level public welfare organisations.

Aims and objectives: This article explores (a) how organisational systems for sustainable KM can be built in street-level organisations, and (b) how knowledge brokers in these organisations support the development of such structures.

Methods: We draw on ongoing research collaboration between researchers and five Danish municipal public employment services. Data includes extensive qualitative data from interviews, fieldwork and observations. Data are analysed using concepts of translating, contexting, and institutionalising KM.

Findings: We identify three axes of a sustaining KM infrastructure: a horizontal axis focused on mobilising knowledge at the professional level; a vertical axis focused on mobilising knowledge between organisational levels; and an extra-organisational axis focused on mobilising knowledge between the organisation and the outside world, specifically research.

Discussion and conclusion: This article highlights sustaining KM as ongoing and multifaceted work, emphasising the role of street-level organisation knowledge brokers. Their embeddedness in professional practice enables them to translate, context and institutionalise KM. By outlining three axes of sustaining infrastructure, we suggest a framework for further research on sustaining in organisational practices.

Background: This study aimed to evaluate public health researchers' perceptions of policy-informed research, self-efficacy, knowledge and training needs both before and after participating in an initiative to improve their engagement with legislative offices during the January-May 2021 Texas Legislative Session.

Methods: A total of 111 researchers were contacted about participating in the initiative, and 45 expressed interest and were thus enrolled. After receiving training on communication skills specific to legislative audiences, 27 researchers were matched with participating legislative offices based on location, availability and expertise. Self-administered surveys assessed policy informed research, self-efficacy, knowledge and training needs pre- and post-session. Paired t-tests compared pre- and post-session mean scale scores. Two-sample t-tests compared scale scores between matched and unmatched researchers.

Findings: Most researchers (66 per cent) communicated with legislative offices fewer than five times during the previous two years. Compared to pre-session (baseline), there was a significant increase in reported policy knowledge and a significant decrease in perceived training needs in the post-session (follow-up) survey among all researchers. At baseline, legislator-matched researchers had significantly higher policy-related self-efficacy and lower perceived training needs than the unmatched researchers; however, scores between matched and unmatched researchers were not significantly different at follow-up.

Discussion and conclusions: Our findings show that actively applying learned skills through the research-to-policy framework is beneficial in building researchers' policy-related knowledge and their preparedness to engage with state legislators. The resulting potential for researcher-legislator partnerships to transform our public health system is highlighted.

Background: Deepening democratic engagement in socio-economic policy domains is of increasing interest to the health inequalities research community. However, there is a recognised gap between theory and the practical application of public participation. Viewing income security as a fundamental determinant of health, this article investigates how, when and where participatory-deliberative processes (PDPs) were applied in policy making connected to income, in the UK, from January 2007 to June 2022.

Methods: The review applied the PRIMSA-ScR checklist. Searches were conducted in: EconLit, SOC Index, Sociological Abstracts, MedLine; and grey literature sources: BASE database, government, non-governmental organisation websites for articles related to PDPs in income-related policy making in the UK, published after 1 January 2007. Articles were synthesised through a conceptual framework combining Whitehead's typology of actions to tackle health inequalities and Smith's categorisation of democratic goods.

Findings: The review found 20 articles relating to 13 PDPs. A majority of PDPs took place in Scottish Government/ Parliament or at Local Authority/NHS Trust level in England and Wales. A variety of types of PDPs were used by policy-making institutions across a range of socio-economic domains, with varying degrees of information provided about participants and policy outcomes.

Discussion and conclusions: Findings demonstrate a multitude of disconnects between participatory rhetoric and reality. There is no evidence of PDPs influencing macro socio-economic policy making, with participatory decision-making instead dispersed across less empowered, downstream spaces. Democratising socio-economic policy domains requires critical reflection on the fractured nature of participatory policy making, the locus of decision-making power and how inclusion is realised in participation spaces.

Background: Mindfulness-Based Stress Reduction (MBSR) is a well-studied treatment that health insurers typically do not cover in the United States. To understand how research can best support efforts towards coverage, researchers must partner with individuals who occupy diverse roles within a health system (for example, policy makers and practitioners).

Purpose: We sought to understand from key informants (policy makers, health insurers, healthcare administrators, clinicians, MBSR students/patients and teachers): the barriers/facilitators of MBSR coverage, how they use research to make decisions, and which research outcomes they find most important. We also sought to understand whether perspectives for individuals with direct policy influence differed from those without.

Methods: We conducted qualitative interviews informed by the SPIRIT Action Framework with a role-diverse advisory group. Data were analysed using a rapid data condensation approach.

Results: Responses of those with and without direct policy-making influence were generally aligned. Research was framed as important to coverage decisions. When considering coverage decisions, participants reported wanting information about: (1) MBSR's worthiness as a covered treatment (is it 'good', usable and a sound financial investment?) and (2) a clearer definition of the service and its coverage. Barriers were identified related to both the billing code being created as well as being used, although MBSR's ability to address the policy priority of mental health in an un-stigmatising way could facilitate coverage. Participants also recommended next steps to advance the case for coverage.

Conclusions: Our findings suggest that research is frequently integrated into decision making across roles, though other factors are weighed in coverage decisions.

The aim of this themed section is to demonstrate the conceptual and empirical contribution that comparative perspectives offer in advancing scholarship on the evidence-policy interplay. It is motivated by our sense that a lack of comparative analysis within this area of research risks conceptual confusion and contributes to limited engagement with the more political dimensions of evidence use. It brings together four papers which, between them: examine evidence use across different government ministries within the same country; provide a cross-national comparison of parliamentary institutions to support evidence use; explore variations in evaluation approaches within different national settings; and reflect on how perspectives on evidence shift when researchers become politicians, trying to navigate complex policy environments. We use this editorial to reflect on three cross-cutting themes that emerge from these four contributions. First, a tendency for dominant disciplines to shape evidence cultures in policy settings. Second, the complexity of policy making, which, in democracies, necessarily includes political dimensions. These two themes inform a third, the need for realism when working to support the use of evidence in policy. We conclude by arguing that this themed section highlights the contextual, divergent and contingent nature of evidence use in policy. By showcasing four contrasting approaches to comparative analysis of evidence use, we hope to encourage a desire to learn from, and reflect on, the insights provided by less familiar contexts and disciplines, while also underlining the necessity of considering the political and democratic dimensions of evidence use in policy.

Background: Interventions to support engagement between academics and policy professionals have proliferated, yet little evidence is available to guide what works, how, or for whom.

Aims and objectives: To evaluate the activities, outcomes and impacts of the Capabilities in Academic Policy Engagement (CAPE) programme and identify enabling conditions, using a modified framework for academic-policy engagement.

Methods: Mixed methods evaluation across four intervention types (seed funding, policy fellowships, training, knowledge exchange events), between 2021 and 2024. We interviewed academics, research support staff and policy professionals (n=129), observed 32 activities, and distributed a survey (n=42, 27 per cent response rate). We analysed data using inductive and framework analyses.

Findings: CAPE interventions focused at the linear (training) or relational (fellowships, seed funding and knowledge exchange) levels. Interventions led to outcomes in capacity-building, connectivity, conceptual and attitude change, and tacit knowledge development. Interventions were resource-intensive and required responsive intermediary skills, particularly fellowships. We found influencing factors at individual, organisation and system levels. The most experienced participants preferentially benefited from opportunities, potentially perpetuating or even exacerbating inequalities. We did not find evidence of impact on policy processes or outcomes.

Discussion and conclusions: CAPE led to an increase in academic-policy engagement activities, mostly as linear and relational interventions. These generated costs as well as benefits and often advantaged individuals with significant prior experience of academic-policy engagement. Future academic-policy engagement interventions should consider motivations, capabilities, goals and resources at the individual and organisation levels, while using strategic planning and coordination to maximise their value, and address diversity and inclusion.