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Table 1 The 30 research projects, process summaries and identified contributions to action

From: Which health research gets used and why? An empirical analysis of 30 cases

Research subject and embedding Process summary Identified contributions to action
1. The contributing factors to high treatment defaulter rates among tuberculosis (TB) patients in Ghana Health Service (GHS) regional hospitals; data collected in hospitals with patients from villages in the region A user-investigator played a key role in mobilizing results; one of the investigators was the head of the regional TB program and utilized the results at the regional level through this function The results showed that financial constraint and distance were important reasons for defaulting treatment; five new treatment locations were opened and the research findings were used in a successful grant application for defaulting prevention programmes in other districts
2. The role of stigma in the spread of HIV/AIDS in a district; GHS district health administration; data collected in various communities in a rural district The research project led to a better understanding of the role of stigma; the results were described as not directly applicable, but warranting further research No contributions to action were identified; a new research proposal was drafted and funded
3. Resistance to anti-microbial drugs in Ghana Medical School University Dept. of Microbiology; samples collected in various hospitals in nine regions The investigators gave technical advice about the research subject to policymakers at both the local and national level; the results were discussed with several potential key-users, which seemed to have led to their eventual use The results showed that drug resistance was a problem in various regions; hospital laboratories received feedback about their technical performance and some initiated a training in using standardized techniques and controls for laboratory tests; the results informed discussions and decision making about essential medicines at the GHS
4. Community satisfaction, equity in coverage and implications for the sustainability of a health insurance scheme; GHS district health administration and research centre; data collected at four health centres and households in a rural district A user-investigator played a key role in mobilizing results; one of the investigators was a regional director of the GHS, advised the committee drafting the National Health Insurance Scheme (NHIS) policy, and was involved in implementing health insurance at several levels The study is part of a group of studies that contributed to the formulation of the NHIS policy; among others, it revealed reasons why the poorest of the poor were not enrolling; the study also provided information that was used to develop a method for identifying poor people which was used in a program that provided premium subsidies to the poorest of the poor
5. Evaluations of informal mutual health organizations in Southern Ghana; NGO involved in educational research; mutual health schemes in four districts were assessed No potential key users were involved during the study; the finalization of the study coincided with formulation of the NHIS policy; the results and recommendations were extensively discussed with NHIS policymakers Several recommendations were incorporated in NHIS policy; two examples are (1) providing districts with additional funding to start the NHIS in their district and (2) including the option to opt out and get involved in a personal scheme
6. What the communities think about financing health through community health insurance; GHS district health administration; study was conducted in various communities in a rural district Based upon this research project it was recommended that health insurance should be community based; at the national level, the choice was made for a district-based health insurance scheme; no one from the national level was involved in the study No contributions to action were identified; the community-based health insurance scheme that was set up as part of the research project is still being used 5 years after the study ended
7. The perception of and demand for mutual health insurance in a district; GHS research centre/study was conducted in various communities in a rural district No potential key users were involved in the research processes but the research proposal and the results were discussed and interpreted together with relevant district level policymakers The study identified existing decentralized structures that were used to improve the premium collection for health insurance; education about the insurance was intensified in areas of low enrolment that were identified
8. Communication and HIV/AIDS prevention messages through unorthodox community-based means; NGO involved in educational research; study was conducted in a rural district The research activities involved HIV prevention, which seems to have had the desired direct impact in the local situation; no actions to use the results elsewhere were identified; the principal investigator (PI) of the study was not working in the health sector No contributions to action were identified; there were anecdotes that board games and other educational materials were still being used at schools in the district, but his could not be confirmed
9. Assessing service delivery factors contributing to preventable maternal mortality in a region; GHS regional health administration; data were collected in 17 health facilities in a deprived region A user-investigator played a key role in mobilizing results: one of the investigators was the regional director of the GHS, who used the results at regional level The results were used to improve the provision and stores of consumables for obstetric care and the local drug procurement cycle; in addition, the results were used to improve the patient documentation system in a number of clinics in the region
10. Assessing the quality of immunization in a district; GHS district health administration and health research centre; data were collected in various health facilities and communities A user-investigator played a key role in mobilizing results: one of the investigators was involved in regional and district health policy as technical advisors and regional officer for public health (including EPI) and used the results in his own work The overall organization of the immunization in the region was improved, the communication to the communities about the immunization was improved and a policy to abolish selling food products and drugs in combination with vaccination was implemented in the region
11. Better matching the training, support and incentive systems for leaders of sub-district health teams to the requirement of the GHS at the sub-district level; GHS district administration; study in GHS metropolitan, rural and semi-urban sub-districts A user-investigator played a key role in mobilizing results: one of the investigators was a regional director of the GHS and used the results; the results were also discussed with and sent to influential policymakers, including the deputy director general of the GHS The research findings were used to design an initiative to strengthen sub-district-level health administrations and sub-metro-level health administrations in the Greater Accra region; discussions were initiated with the School of Public Health for a Masters of Public Health program that would be open to students without a Bachelor degree
12. Improving the quality of healthcare delivery in a district in Ghana; University Dept. of Agriculture; GHS district health administration; five health centres and communities A user-investigator played a key role in mobilizing results: one of the investigators was a district director of the GHS and used the results; the proposal and results were discussed with the District Health Management Team and involved health institutions As a result of the study, hospitals have established, trained and institutionalised quality assurance teams; district-wide parameters for quality assurance have been implemented; uniforms of nurses were changed to lower rivalry between regular and enrolled nurses
13. Assessing the impact of community-based health planning and services (CHPS) initiative in a district; GHS district health administration; conducted in households in a deprived rural district A user-investigator played a key role in mobilizing results: the PI was a district director of the GHS and became the head of the nationwide CHPS program; he used the results through these functions; the proposal and results were discussed with the head of planning, monitoring and evaluation from the Ministry of Health (MOH) The study findings were used to facilitate the nationwide implementation of the CHPS programme; the findings and experiences were used to develop a toolkit and a training programme for implementing the CHPS programme in other districts and regions
14. The contribution of public health postgraduate students’ research recommendations to districts to quality of healthcare improvement. University School of Public Health; 20 district health administrative area’s The research revealed limited use of research from Masters of Public Health students; the project only involved university employees; no systematic changes in the organization of the research practice interface were implemented at the time No contributions to action were identified
15. Communication channels and strategies and the potential role of community members in HIV/AIDS awareness creation and behavioural change; GHS district health administration and research centre; various communities in a rural district The results were described as not directly applicable, but warranting further research; the project led to a proposal for an intervention study with regard to the stigmatization of HIV/AIDS patients No contributions to action were identified; there were indications that the research project has improved the HIV education in the district but this could not be confirmed
16. Detection, assessment and prevention of adverse events following immunization with a new pentavalent vaccine; University Centre for Pharmacology; conducted in a teaching hospital, two urban polyclinics and a centre for immunization A user-investigator played a key role in mobilizing results: the research findings were used through the roles of the investigators in policy as head of the national immunization program and as technical advisor A multi-disciplinary advisory group to advice on AEAI was set up and continues to exist with sustainable funding from the MOH; baseline data on adverse events following immunization have been collected for the first time in Ghana to the pentavalent vaccine and will guide policymaking on immunization
17. Prevalence of HIV, hepatitis B, hepatitis C viruses, infections, TB and syphilis among prisoners in Accra; University Department of Pathology; conducted among prisoners and prison officers in three prisons in Ghana Two investigators were influential technical advisors to health policy on various subjects (though not specifically prison health); the proposal, process and results were extensively discussed with potential key users such as the prison council, director general of the prison services, Ministry of the Interior, MOH and the parliament committee on health Several contributions to action were identified; results played a role in the decision to include prisoners in the NHIS, provide anti-retroviral treatment and contributed to the closure of a prison that was housed in an old fortress; involved parties were advocating for more systematic medical screening of inmates and a medical facility for prisoners; these discussions were still ongoing
18. Assessment of male involvement in family planning decision-making and practice and its influence on the uptake of family planning in a district; GHS research centre and district health administration; conducted in two health centres and communities in a rural district The research indicated that more male health workers should be trained to inform men about family planning; investigators with influence at the district and regional level were involved, but influencing the actual training of male health workers required action at national policy level, to which they had no access No contributions to action were identified; there was little dissemination at the time of the assessment; a lack of resources for dissemination was given as the primary reason
19. An assessment of the knowledge, attitudes, beliefs and practices on HIV/AIDS as a basis for integrating prevention and care services into the CHPS in a GHS district; district health administration; conducted in 11 rural communities in isolated and deprived areas A user-investigator played a key role in mobilizing results: one of the investigators was a district director and head of the nationwide CHPS program; he used the results in his own work through these functions The study revealed that the perception of HIV/AIDS in the communities was little effected by CHPS; specific messages for HIV/AIDS education for within CHPS were developed and implemented in the district
20. Cost analysis and efficiency in selected hospitals in Ghana; University Department of Finance; using data from a district hospitals, mission hospitals and regional referral hospitals The study was conducted in an academic institute; there was no substantial involvement of potential key users in the study; the results were disseminated to the administrations of three hospitals No contributions to action were identified
21. Incidence of adverse drug reactions from anti-TB drugs among patients treated for active TB and their impact on compliance; University Department of Clinical and Social Pharmacy; 13 health facilities in two regions Investigators gave technical advice about, amongst others, medication and TB policy; the results were presented at two academic conferences; according to the investigators, the results confirmed existing knowledge and did not imply change No contributions to action were identified
22. Sustaining the safe motherhood clinical skills of midwives; regional health administration; health facilities and midwives spread throughout a region A user-investigator played a key role in mobilizing results: one of the investigators was a district director and headed the safe motherhood team in the region and used the results in his own work; results were also disseminated to the health facilities and midwives involved The research led to the identification of shortages of specific equipment and consumables necessary for safe motherhood in health facilities in the region and lapses in the safe motherhood clinical skills of midwives; the results were used to address these shortages and to provide training for midwives during supervisory visits and were discussed which the schools where midwives were trained
23. Comparative study of risk characteristics of successful and unsuccessful Mutual Health Organizations and implications for improving the success of health insurance; GHS district health administration and research centre A user-investigator played a key role in mobilizing results: one of the investigators was involved in the development and formulation of the NHIS policy processes and stimulated the use of the findings This research project contributed information, together with other studies, to the formulation of the district-wide-based structure of the NHIS; it also inspired the set-up of a policy advisory council in a new research project, which was to include representatives from the GHS, the National Health Insurance Council and MOH
24. Delivery of integrated pro-poor health services in the decentralized politico administrative (assembly) context; University Institute of Local Government Studies; four district assemblies A user-investigator played a key role in mobilizing results: the study was conducted by a team from an institute that provided training, consultations, advice and support to local governments; the findings were used in the programs developed and implemented by the institute The results were used in the design and delivery of a nationwide course for district and regional level environmental health functionaries; in addition, the results were used to shape proposals made to the Local Government Service on integrating health and local government services at the district level
25. Participation of the urban informal sector in the National Health Insurance Scheme; University Department of Medical Biochemistry; data was gathered in two urban areas known for informal trade Involvement of potential key users, including members of the NHIS management, occurred throughout all phases of the research project; the results were discussed during a forum with the deputy director of the NHIS that was organized by the Health Research for Development Program The results were discussed with representatives from the NHIS and were described as contributing to some reforms that were made to health insurance schemes, such an increased focus on the informal sector; though reforms were in line with the study recommendations, other factors also played a role
26. The allocative and technical efficiency of public health centres; GHS health research centre; data were gathered in multiple districts The PI was involved in the district assembly and discussed the proposal with the district director of the GHS; there was little dissemination as the main investigator went abroad for further studies; according to the investigators, the results should be used in national level policy No contributions to action were identified; the research project did, however, generate further interest in the area of technical efficiency such that a study on hospital efficiency was undertaken by the GHS, of which the findings were later discussed by policymakers
27. Developing unit cost data for health facilities to achieve cost standardization for an effective national health insurance scheme; GHS national headquarters A user-investigator played a key role in mobilizing results: the PI was involved in various working groups in which national health financing policy was developed; the PI used the results to initiate and accelerate changes in financing policy; influential policymakers were engaged in interpreting and simplifying the results The results were used in the development of the kind of flat fee system that will be used by the GHS for payments made to hospitals and health centres; the results were also used in influencing GHS hospitals funding arrangements
28. A community-based survey on the utilisation of healthcare services for gastroenteritis in children in a district; GHS health research centre; conducted in villages and health centres in a rural deprived district The study proposal and findings were discussed with the district health administration and utilized by the investigators in the formulation and implementation of a large trial No contributions to action were identified; the findings were used by researchers to monitor and predict the clinical attendance and behaviour of mothers seeking healthcare for their children with gastroenteritis in the district, which was a prerequisite for effective recruitment for a Rota-virus vaccination trial
29. A comparison of two approaches to increasing access and improving equity to malaria treatment among children under 5 years; GHS regional health directorate A user-investigator played a key role in mobilizing results: one of the investigators was a regional director and advisor to the national health insurance council The results informed the development and organization of the insurance card that was used in some districts; the results were also used to support advocacy to reduce the delay in payment to health service providers under the national health insurance scheme
30. A pragmatic randomized control trial into the compliance to artesunate-amodiaquine therapy for uncomplicated malaria in rural Ghana; GHS health research unit; data collected in a large number of communities in a rural district A user-investigator played a key role in mobilizing results: one of the investigators gave technical advice at the district and national level related to the study subject; the study findings were discussed with the head of the national malaria control program The study showed that patients often did not take the required dose of the therapy; education was provided to the communities through health promotion radio messages; health workers were instructed to better educate patients; a new therapy with fewer pills was under review