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Journal ArticleDOI

Replacement of core team members on embedded implementation research teams: experiences from Latin America and the Caribbean

22 May 2023-Revista panamericana de salud pública (Impresa) (Revista panamericana de salud pública (Impresa))-Vol. 47, pp 1-1
TL;DR: In this paper , a qualitative study based on 39 interviews with 13 embedded research teams selected by financing agencies to explore team composition, interaction among members, and research results was conducted at three points during the study period from September 2018 to November 2019; data were analyzed from 2020 to 2021.
Abstract: To understand how replacement of decision-makers (DMs) serving as principal investigators (PI) or co-PIs on research teams may affect the feasibility and value of embedded implementation research (EIR) used to improve health policies, programs, and services in Latin America and the Caribbean.This was a descriptive qualitative study based on 39 semistructured interviews with 13 embedded research teams selected by financing agencies to explore team composition, interaction among members, and research results. Interviews were conducted at three points during the study period from September 2018 to November 2019; data were analyzed from 2020 to 2021.Research teams were found to be operating in one of three situations: (i) permanent core team (no change) with either active DM or inactive DM participation; (ii) replacement of DM-PI or co-PI that did not affect EIR research; and (iii) replacement of DM-PI that affected EIR.To ensure EIR continuity and stability, research teams should include high-level DMs together with more technical staff performing essential implementation activities. This structure could improve collaboration among professional researchers and ensure greater embeddedness of EIR to strengthen the health system.Comprender de qué manera la sustitución de los responsables de tomar decisiones (RTD) que se desempeñan como investigadores principales (IP) o coinvestigadores principales (coIP) en los equipos de investigación puede incidir en la viabilidad y el valor de la investigación integrada en materia de ejecución (IIME) utilizada con el objetivo de mejorar las políticas, los programas y los servicios de salud en América Latina y el Caribe.Este estudio cualitativo descriptivo se basó en 39 entrevistas semiestructuradas realizadas a 13 equipos de investigación integrada seleccionados por organismos de financiación con el objetivo de estudiar la composición de los equipos, la interacción entre sus miembros y los resultados de la investigación. Las entrevistas se realizaron en tres ocasiones durante el período de estudio, que se extendió de septiembre del 2018 a noviembre del 2019; los datos se analizaron entre el 2020 y el 2021.Se encontró que los equipos de investigación se desempeñaban en una de las siguientes tres situaciones: a) un equipo central permanente (sin cambios), sea con participación activa del RTD o sin participación activa del mismo; b) sustitución del RTD–IP o coIP, sin consecuencias para la IIME; y c) sustitución del RTD–IP, con consecuencias para la IIME.Para asegurar la continuidad y estabilidad de la IIME, los equipos de investigación deberían incluir RTD de alto nivel junto con más personal técnico que lleve a cabo actividades esenciales en materia de ejecución. Esta estructura podría mejorar la colaboración entre los investigadores profesionales y asegurar una mayor integración de la IIME con la finalidad de fortalecer el sistema de salud.Entender como a substituição de decisores atuando como investigadores principais ou co-investigadores em equipes de pesquisa pode afetar a viabilidade e o valor da pesquisa de implementação incorporada (EIR, na sigla em inglês), método usado para aprimorar as políticas, programas e serviços de saúde na América Latina e no Caribe.Estudo qualitativo e descritivo, baseado em 39 entrevistas semiestruturadas com 13 equipes de pesquisa incorporadas, selecionadas por agências de fomento, para explorar a composição das equipes, a interação entre os membros e os resultados das pesquisas. As entrevistas foram realizadas em três momentos durante o período de estudo, de setembro de 2018 a novembro de 2019. Os dados foram analisados de 2020 a 2021.Verificou-se que as equipes de pesquisa se encontravam em uma das seguintes três situações: (i) equipe essencial permanente (sem alteração), com participação ativa ou inativa do decisor; (ii) substituição do decisor (investigador principal ou co-investigador) não afetou a pesquisa EIR; e (iii) substituição do decisor (investigador principal ou co-investigador) afetou a pesquisa EIR.Para garantir a continuidade e estabilidade de pesquisas de EIR, as equipes de pesquisa devem incluir decisores de alto nível, juntamente com pessoal de perfil mais técnico, para realizar atividades essenciais de implementação. Tal estrutura poderia melhorar a colaboração entre pesquisadores profissionais e garantir uma incorporação ainda maior da EIR para fortalecer o sistema de saúde.
References
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Journal ArticleDOI
TL;DR: The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
Abstract: Background. Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. Objective. To develop a checklist for explicit and comprehensive reporting of qualitative studies (indepth interviews and focus groups). Methods. We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Results. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Conclusions. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

18,169 citations

Journal ArticleDOI
TL;DR: It is concluded that research should move beyond a narrow focus on the ‘know–do gap’ to cover a richer agenda, including the situation-specific practical wisdom that underpins clinical judgement and the complex links between power and knowledge.
Abstract: The literature on ‘knowledge translation’ presents challenges for the reviewer because different terms have been used to describe the generation, sharing and application of knowledge and different research approaches embrace different philosophical positions on what knowledge is. We present a narrative review of this literature which deliberately sought to highlight rather than resolve tensions between these different framings. Our findings suggest that while ‘translation’ is a widely used metaphor in medicine, it constrains how we conceptualise and study the link between knowledge and practice. The ‘translation’ metaphor has, arguably, led to particular difficulties in the fields of ‘evidence-based management’ and ‘evidence-based policymaking’ – where it seems that knowledge obstinately refuses to be driven unproblematically into practice. Many non-medical disciplines such as philosophy, sociology and organization science conceptualise knowledge very differently, as being (for example) ‘created’, ‘constructed’, ‘embodied’, ‘performed’ and ‘collectively negotiated’ – and also as being value-laden and tending to serve the vested interests of dominant elites. We propose that applying this wider range of metaphors and models would allow us to research the link between knowledge and practice in more creative and critical ways. We conclude that research should move beyond a narrow focus on the ‘know–do gap’ to cover a richer agenda, including: (a) the situation-specific practical wisdom (phronesis) that underpins clinical judgement; (b) the tacit knowledge that is built and shared among practitioners (‘mindlines’); (c) the complex links between power and knowledge; and (d) approaches to facilitating macro-level knowledge partnerships between researchers, practitioners, policymakers and commercial interests.

447 citations

Journal ArticleDOI
TL;DR: A framework for assessing country-level efforts to link research to action is developed and approaches to evaluation are addressed, how support is provided for rigorous evaluations of efforts tolink research toaction.
Abstract: We developed a framework for assessing country-level efforts to link research to action. The framework has four elements. The first element assesses the general climate (how those who fund research, universities, researchers and users of research support or place value on efforts to link research to action). The second element addresses the production of research (how priority setting ensures that users' needs are identified and how scoping reviews, systematic reviews and single studies are undertaken to address these needs). The third element addresses the mix of four clusters of activities used to link research to action. These include push efforts (how strategies are used to support action based on the messages arising from research), efforts to facilitate "user pull" (how "one-stop shopping" is provided for optimally packaged high-quality reviews either alone or as part of a national electronic library for health, how these reviews are profiled during "teachable moments" such as intense media coverage, and how rapid-response units meet users' needs for the best research), "user pull" efforts undertaken by those who use research (how users assess their capacity to use research and how structures and processes are changed to support the use of research) and exchange efforts (how meaningful partnerships between researchers and users help them to jointly ask and answer relevant questions). The fourth element addresses approaches to evaluation (how support is provided for rigorous evaluations of efforts to link research to action).

379 citations

Journal ArticleDOI
TL;DR: It is argued that embedding of research in real world policy, practice and implementation is needed to strengthen health systems worldwide and experience is consistent with evidence showing that embedded research facilitates the integration of scientific findings in policy implementation and health systems strengthening.
Abstract: Realizing the health-related sustainable development goals (SDGs) requires integrated action on system-wide challenges. To address gaps in health service delivery, we need evidence on which government agencies, research institutions, donors and civil society can act. (1) Unless research is relevant to specific health systems, the evidence that it generates can be dismissed by policy-makers. (2) For example, there is plenty of evidence for the effectiveness of standard interventions to prevent maternal and child deaths, but countries vary widely in the degree to which these interventions have been implemented. (3) We argue that embedding of research in real world policy, practice and implementation is needed to strengthen health systems worldwide. Embedded research conducted in partnership with policymakers and implementers, integrated in different health system settings and that takes into account context-specific factors can ensure greater relevance in policy priority-setting and decision-making. (4) Collaboration between researchers, implementers and policy-makers has been shown to improve uptake of health systems research. (5) However, in many places, prioritization and conduct of research is often done solely by academics. (6) Health research is also largely focused on biomedical and clinical interventions, while health systems and implementation research remains underfunded globally. (7) Often, knowledge translation is an add-on activity after the completion of research projects. The World Health Organization's report, Changing mindsets: strategy on health policy and systems research, called for the embedding of research into health systems processes. (6) This report explained that when embedding happens, researchers and decision-makers are linked through a system in which the need for evidence to inform policy is understood by decision-makers. The Alliance for Health Policy and Systems Research (AHPSR) and the United Nations Children's Fund (UNICEF) developed a model for implementation research that addresses research priorities identified by decision-makers and specific challenges of local health systems. (8) In this model, policy-makers and implementers at different levels in the health system are engaged as co-investigators and are involved in all phases of a research project. The approach is meant to enhance policymakers' and implementers' ownership of health systems and policy research. The collaboration is designed to prioritize research on empirical questions of local relevance, generate feasible recommendations and integrate evidence into policymaking and health system strengthening. Policy-makers, implementers and researchers are increasingly keen to collaborate on the design and conduct of research to ensure that it contributes to health policy-making. (9,10) Since 2013, AHPSR, UNICEF and Gavi, the Vaccine Alliance, have supported 26 embedded research projects in 15 low- and middle-income countries. These projects aim to foster a better understanding of health systems implementation issues linked to maternal, newborn and child health policies and programmes. (11) Through its African Health Initiative, the Doris Duke Charitable Foundation is also supporting embedded research that aims to enhance the performance of health systems in Africa. (12) In these contexts, embedding research in local health systems helped address real concerns of implementers and supports action to alleviate implementation barriers. Our experience is consistent with evidence showing that embedded research facilitates the integration of scientific findings in policy implementation and health systems strengthening. …

99 citations

Journal ArticleDOI
TL;DR: This pilot study demonstrated that front-line public health workers draw upon both tacit knowledge and explicit knowledge in their everyday lived reality and indicates a need to broaden the scope of knowledge translation to include other forms of knowledge beyond explicit knowledge acquired through research.
Abstract: All sectors in health care are being asked to focus on the knowledge-to-practice gap, or knowledge translation, to increase service effectiveness. A social interaction approach to knowledge translation assumes that research evidence becomes integrated with previously held knowledge, and practitioners build on and co-create knowledge through mutual interactions. Knowledge translation strategies for public health have not provided anticipated positive changes in evidence-based practice, possibly due in part to a narrow conceptualization of knowledge. More work is needed to understand the role of tacit knowledge in decision-making and practice. This pilot study examined how health practitioners applied tacit knowledge in public health program planning and implementation.

97 citations