1. On the whole, I am satisfied with myself. SA A D SD 2.* At times, I think I am no good at all. SA A D SD 3. I feel that I have a number of good qualities SA A D SD 4. I am able to do things as well as most other people SA A D SD 5.* I feel I do not have much to be proud of SA A D SD 6.* I certainly feel useless at times SA A D SD 7. I feel that I'm a person of worth, at least equal to others SA A D SD 8.* I wish I could have more respect for myself SA A D SD 9.* All in all, I am inclined to feel that I'm a failure SA A D SD 10. I take a positive attitude toward myself SA A D SD

日本語版Rosenberg Self-Esteem Scaleの検討と新たな翻訳版の作成

There is growing interest in how different forms of knowledge can strengthen policy-making in low- and middle-income country (LMIC) health systems. Additionally, health policy and systems researchers are increasingly aware of the need to design effective institutions for supporting knowledge utilisation in LMICs. To address these interwoven agendas, this scoping review uses the Arskey and O’Malley framework to review the literature on knowledge utilisation in LMIC health systems, using eight public health and social science databases. Articles that described the process for how knowledge was used in policy-making, specified the type of knowledge used, identified actors involved (individual, organisation or professional), and were set in specific LMICs were included. A total of 53 articles, from 1999 to 2016 and representing 56 countries, were identified. The majority of articles in this review presented knowledge utilisation as utilisation of research findings, and to a lesser extent routine health system data, survey data and technical advice. Most of the articles centered on domestic public sector employees and their interactions with civil society representatives, international stakeholders or academics in utilising epistemic knowledge for policy-making in LMICs. Furthermore, nearly all of the articles identified normative dimensions of institutionalisation. While there is some evidence of how different uses and institutionalisation of knowledge can strengthen health systems, the evidence on how these processes can ultimately improve health outcomes remains unclear. Further research on the ways in which knowledge can be effectively utilised and institutionalised is needed to advance the collective understanding of health systems strengthening and enhance evidence-informed policy formulation.

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A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries

Knowledge translation (KT) platforms are organisations, initiatives and networks that focus on supporting evidence-informed policy-making at least in part about the health-system arrangements that determine whether the right programmes, services and products get to those who need them. Many descriptions and evaluations of KT platforms in low- and middle-income countries have been produced but, to date, they have not been systematically reviewed. We identified potentially relevant studies through a search of five electronic databases and a variety of approaches to identify grey literature. We used four criteria to select eligible empirical studies. We extracted data about seven characteristics of included studies and about key findings. We used explicit criteria to assess study quality. In synthesising the findings, we gave greater attention to themes that emerged from multiple studies, higher-quality studies and different contexts. Country was the most common jurisdictional focus of KT platforms, EVIPNet the most common name and high turnover among staff a common infrastructural feature. Evidence briefs and deliberative dialogues were the activities/outputs that were the most extensively studied and viewed as helpful, while rapid evidence services were the next most studied but only in a single jurisdiction. None of the summative evaluations used a pre–post design or a control group and, with the exception of the evaluations of the influence of briefs and dialogues on intentions to act, none of the evaluations achieved a high quality score. A large and growing volume of research evidence suggests that KT platforms offer promise in supporting evidence-informed policy-making in low- and middle-income countries. KT platforms should consider as next steps expanding their current, relatively limited portfolio of activities and outputs, building bridges to complementary groups, and planning for evaluations that examine ‘what works’ for ‘what types of issues’ in ‘what types of contexts’.

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Lessons learned from descriptions and evaluations of knowledge translation platforms supporting evidence-informed policy-making in low- and middle-income countries: a systematic review

The last 5–10 years have seen significant international momentum build around the field of health policy and systems research and analysis (HPSR + A). Strengthening post-graduate teaching is seen as central to the further development of this field in low- and middle-income countries. However, thus far, there has been little reflection on and documentation of what is taught in this field, how teaching is carried out, educators’ challenges and what future teaching might look like. Contributing to such reflection and documentation, this paper reports on a situation analysis and inventory of HPSR + A post-graduate teaching conducted among the 11 African and European partners of the Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA), a capacity development collaboration. A first questionnaire completed by the partners collected information on organisational teaching contexts, while a second collected information on 104 individual courses (more in-depth information was subsequently collected on 17 of the courses). The questionnaires yielded a mix of qualitative and quantitative data, which were analysed through counts, cross-tabulations, and the inductive grouping of material into themes. In addition, this paper draws information from internal reports on CHEPSAA’s activities, as well as its external evaluation. The analysis highlighted the fluid boundaries of HPSR + A and the range and variability of the courses addressing the field, the important, though not exclusive, role of schools of public health in teaching relevant material, large variations in the time investments required to complete courses, the diversity of student target audiences, the limited availability of distance and non-classroom learning activities, and the continued importance of old-fashioned teaching styles and activities. This paper argues that in order to improve post-graduate teaching and continue to build the field of HPSR + A, key questions need to be addressed around educational practice issues such as the time allocated for HPSR + A courses, teaching activities, and assessments, whether HPSR + A should be taught as a cross-cutting theme in post-graduate degrees or an area of specialisation, and the organisation of teaching given the multi-disciplinary nature of the field. It ends by describing some of CHEPSAA’s key post-graduate teaching development activities and how these activities have addressed the key questions.

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Strengthening post-graduate educational capacity for health policy and systems research and analysis: the strategy of the Consortium for Health Policy and Systems Analysis in Africa

Background Health research institutions in the Eastern Mediterranean Region (EMR) can play an integral role in promoting and supporting Knowledge Translation (KT) Assessing institutions' engagement in KT and bridging the "research- policy" gap is important in designing context-specific strategies to promote KT and informing funding efforts in the region Aims The objective of this study was to explore the engagement of EMR institutions in KT activities Methods A cross-sectional survey of institutions undertaking health research in the 22 EMR countries was undertaken The survey covered institutional characteristics, institutional planning for research, national planning for health research, and knowledge management, translation and dissemination Results 575 institutions were contacted of which 223 (383%) responded Half the sampled institutions reported conducting priority-setting exercises, with 602% not following a standardized approach Less than half institutions reported frequently/ always (405%) involving policymakers and stakeholders in setting priorities for research on health Only 265% of respondent institutions reported that they examine the extent to which health policymakers utilize their research results Moreover, only 233% reported measuring the impact of their health research Conclusions There is still misalignment between national health research priorities and actual research production, and KT activities are still rarely undertaken by institutions in the EMR National governments and international funding agencies are called to support research production and translation in the EMR Institutions and researchers are also called to produce policy-relevant research and be responsive to the needs and priorities of policy-makers

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Engagement of health research institutions in knowledge translation in the Eastern Mediterranean Region.

The use of health policy and systems research (HPSR) to support decision making in health systems is limited in the Eastern Mediterranean Region (EMR). This is partly due to the lack of effective initiatives to strengthen regional HPSR capacities and promote its use in decision making. This paper offers a structured reflection on the establishment and core functioning of a HPSR Nodal Institute for the EMR with specific focus on the approach used to support the conduct and use of HPSR. It seeks to gain better understanding of the activities conducted by the Nodal Institute, the methods by which the Nodal Institute implemented these activities, and the outcomes of these activities. A multi-faceted approach was implemented by the Nodal Institute in collaboration with regional academic/research institutions, Sub-Nodes. The overall approach was a phased one that included the selection of Sub-Nodes, mapping of academic/research institutions in the EMR, stakeholders’ meetings, and HPSR capacity building workshops, and culminated with a regional meeting. The mapping of academic/research institutions in the EMR resulted in the identification of 50 institutions, of which only 32 were engaged in HPSR. These institutions have the highest HPSR involvement in information/evidence (84%) and the lowest in human resources for health (34%). Their main HPSR focus areas included quality of healthcare services, patient safety, management of non-communicable diseases, and human resources for health. Regional HPSR challenges among these institutions were identified. The validation and ranking questionnaires resulted in the identification of country-specific HPSR priorities according to stakeholders in three countries. From these results, cross-cutting HPSR priorities among the countries related to primary healthcare, non-communicable diseases, human resources for health, as well as cross-cutting HPSR priorities among stakeholders and according to stakeholders of the countries, were extracted. The Nodal Institute in the EMR is a promising initiative to support the conduct and use of HPSR in health policies. The approach and findings reported in this paper allow for the development of opportunities towards the building of capacity for HPSR in the region and other countries and provide a roadmap for academic/research institutions interested in HPSR in the region.

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An institutional approach to support the conduct and use of health policy and systems research: The Nodal Institute in the Eastern Mediterranean Region

Objectives Globally, there is emerging evidence on the use of community health workers and volunteers in low-income and middle-income settings for the management of non-communicable diseases (NCDs), provision of out-of-clinic screening, linkage with health services, promotion of adherence, and counselling on lifestyle and dietary changes. Little guidance exists on the role of this workforce in supporting NCD care for refugees who lack access to continuous care in their host country. The goals of this work were to evaluate the current roles of community health volunteers (CHVs) in the management of diabetes and hypertension (HTN) among Syrian refugees and to suggest improvements to the current primary care model using community health strategies. Setting and participants A participatory, multistakeholder causal loop analysis workshop with representatives from the Ministry of Health of Jordan, non-governmental organisations, United Nations agencies, CHVs and refugee patients was conducted in June 2019 in Amman, Jordan. Primary outcome This causal loop analysis workshop was used to collaboratively develop a causal loop diagram and CHV strategies designed to improve the health of Syrian refugees with diabetes and HTN living in Jordan. Results During the causal loop analysis workshop, participants collaboratively identified and mapped how CHVs might improve care among diagnosed patients. Possibilities identified included the following: providing psychosocial support and foundational education on their conditions, strengthening self-management of complications (eg, foot checks), and monitoring patients for adherence to medications and collection of basic health monitoring data. Elderly refugees with restricted mobility and/or uncontrolled disease were identified as a key population where CHVs could provide home-based blood glucose and blood pressure measurement and targeted health education to provide more precise monitoring. Conclusions CHV programmes were cited as a key strategy to implement secondary prevention of morbidity and mortality among Syrian refugees, particularly those at high risk of decompensation.

https://bmjopen.bmj.com/content/bmjopen/11/4/e045455.full.pdf

Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis.

Purpose: To investigate (1) the effectiveness of educational interventions in reducing the risk for developing type 2 diabetes mellitus (DM) among Jordanian adults at high risk, and (2) whether lev...

Raeda Abu Al Rub

Papers

An institutional approach to support the conduct and use of health policy and systems research: The Nodal Institute in the Eastern Mediterranean Region

Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis.

The impact of lifestyle modification in preventing or delaying the progression of type 2 diabetes mellitus among high-risk people in Jordan