Table 4 Findings from descriptions of context and infrastructure*
Domain | Themes | Factors influencing weight given to themes | ||
|---|---|---|---|---|
Larger number of studies | Higher-quality studies | Studies in different contexts | ||
Context – Health system | No studies identified key features of the governance, financial and delivery arrangements of the health system where KT platforms are operating | NA | NA | NA |
Context – Political system where KT platforms are operating | Institutions  • Five studies identified that policy legacies have left policy-makers with limited capacity for finding and using research evidence in policy-making [28, 32, 35, 36, 49] – 2/3, 1/3, 0.5/3, 1.5/5, 1.5/3, respectively, and while one study identified a willingness among policy-makers to build their capacity [49] – 1.5/3, another study found that policy-makers rarely participate in such activities [28] – 2/3  • Four studies identified that policy-making processes have many veto points where key interests can block evidence-informed policy proposals or support competing alternatives [28, 31, 32, 49] – 2/3, 1/3, 1/3, 2.5/3, respectively, of which two studies indicated that this can be further complicated when there is public sector corruption [28, 32] – 2/3, 1/3, respectively  • Three studies identified a lack of administrative structures supporting evidence-informed policy-making processes [31, 32, 49] – 1/3, 1/3, 2.5/3, respectively, and three studies identified a more general lack of dedicated government budgets for research and for supporting evidence-informed policy-making, particularly at national and regional levels [32, 37, 54] – 1/3, 2.5/5, 2.5/3, respectively Interests  • Two studies identified that select stakeholders – mid-level policy-makers, donors, universities and media – were particularly important in supporting evidence use [42, 43] – 1.5/3, 1/3, respectively Ideas  • Three studies identified that policy-makers do not value research evidence as a source of ideas for policy-making [32, 37, 49] – 1/3, 2.5/3, 1.5/3, respectively, while three other studies identified that a political climate in which research evidence is valued could support knowledge translation [26] – 1.3/3, and influence the development and evolution of KT platforms [52, 54] – 1.5/3, 2.5/5, respectively External factors (i.e. factors external to the health sector)  • Two studies identified that the frequent turnover of top-level policy-makers hinders efforts to support evidence-informed policy-making [28, 30] – 2/3, 1/3, respectively  • One study found extremely limited media coverage of health-systems research evidence and/or systematic reviews [25] – 1/2 | Yes (4 or 5 for some) but no for rest | Yes (2 for institutions, 1 for ideas, 1 for external factors) | Yes for those with yes in number column |
Context – Research system where KT platforms are operating | Evidence availability  • Three studies identified small but growing production of health policy and systems research being produced [29, 34, 48] – 1/2, 1/3, 0.5/2, respectively, particularly in the areas of delivery arrangements and implementation strategies [29, 48] or financial arrangements [48]  • One study identified that research evidence is perceived as unavailable or, more specifically, to be lacking on priority topics or (when it is available) hard for policy-makers to access, poorly timed in relation to policy-making processes or not applicable to local contexts [49] – 1.5/3 Evidence synthesis capacity  • Two studies identified little evidence synthesis capacity [41, 53] – 1/3, 1/4, respectively, particularly in the area of health systems as opposed to clinical care or public health [41] Researcher engagement in KT  • Four studies identified low levels of researcher engagement in supporting evidence-informed policy-making [28,29,30, 56] – 2/3, 1/2, 1/3, 2.5/3, respectively Research funding agency support for KT  • One study found that most funding agencies include KT in their mandate (18 or 23), but only about one-third of funding agencies prioritise KT (8 of 23) and they allocate less than 20% of their budget to KT, and that national funding agencies give greater attention to KT than international agencies [26] – 1.5/3 | Yes (4 for one) but no for rest | Yes (1 for researcher engagement) but no for rest | Yes for those with yes in number column |
Infrastructure – KT platform governance arrangements | Decision-making authority  • Six studies identified the variability in whether decision-making authority for the KT platform was located in government or elsewhere, with several KT platforms operating as units within ministries of health or as units subject in other ways to ministry oversight (e.g. in a government hospital), while other KT platforms operated in academic institutions, private organisations and other settings, sometimes with governing boards having varying degrees of independence and at other times having no dedicated governance mechanism [23, 24, 33, 40, 52, 60] – 1.5/3, 1.5/5, 2/5, 2/3, 1.5/3, 1/3, respectively Networks/multi-institutional arrangements  • Three studies identified variability in whether KT platform created (or identified the need to create) a formal infrastructure to convene policy-makers, stakeholders and researchers or established informal contacts with these groups [24, 55, 56] – 1.5/5, 1/5, 2.5/3, respectively, and while one study identified that strong linkages between KT platforms and policy-makers were very important for KT activities [24] – 1.5/5, another study identified that these linkages could introduce conflicts of interest and be considered an organisational weakness [37] – 2.5/3  • Two studies identified that KT platforms benefited significantly from the support of EVIPNet, both through south–south collaborations (e.g. focused on rapid evidence services) or north–south collaborations (e.g. EVIPNet Cameroon, REACH Policy Initiative Uganda) [52, 60] – 1.5/3, 1/3, respectively  • One study found that most KT platforms did the work themselves ‘in house’, while some commissioned work externally [38] – 2/3 | Yes (6 for one) but no for rest | Yes (1 for each) | Yes for those with yes in number column |
Infrastructure – KT platform financial arrangements | Funding  • Four studies identified that short-term, unpredictable or scarce ongoing funding alongside high operating costs are major barriers to KT platform activities and sustainability [23, 33, 37, 54] – 1.5/3, 2/5, 2.5/3, 2.5/5, respectively, one study identified that financial independence facilitated effective policy engagement [24] – 1.5/5, and one study identified that many KT platforms do not have clear fundraising strategies [23] – 1.5/3  • Three studies identified that most KT platforms received money from funding agencies, donors or government to initiate and scale up their work [23, 52, 60] – 1.5/3, 1.5/3, 1/3, respectively  • One study identified that budgets varied widely in size (e.g. US$26,000 for the Health Policy Analysis Unit in Uganda in 2008 to US$1,300,000 for the Health Strategy and Policy Institute in Vietnam in 2007) [23] – 1.5/3, while another study found that costs were higher during early phases (awareness, experimentation and expansion phases) that were funded externally and then lower during the consolidation phase that is funded by the government [60] – 1/3 | Yes (4 for one) but no for rest | No | Yes for those with yes in number column |
Infrastructure – KT platform delivery arrangements | Human resources  • Four studies identified a lack of skilled human resources to draw upon as a key organisational weakness [23, 33, 37, 54] – 1.5/3, 2/5, 2.5/3, 2.5/5, respectively, and a fifth identified that earlier successes led to increased demand from policy-makers and stakeholders, which was difficult to meet because of the lack of skilled KT platform staff [60] – 1/3  • Four studies identified high turnover among KT platform staff [23, 33, 52, 54] – 1.5/3, 2/5, 1.5/3, 2.5/5, respectively, with one study noting that once staff develop the necessary skills they frequently move to better paid positions elsewhere [23] – 1.5/3  • Three studies identified the range in number of KT platform staff, with one being the lower end, 50 the higher end, and many with five or fewer full-time equivalent staff [23, 38, 40] – 1.5/3, 2/3, 2/3, respectively  • Two studies identified the breadth in backgrounds of KT platform staff (e.g. medical or social/population studies, research methods training, policy analysis and writing skills, and understanding of health systems and policy-making processes) [23, 46] – 1.5/3, 1/5, respectively  • One study identified the importance of KT platform leaders, particularly in facilitating links with policy-makers and stakeholders [55] – 1/5 Scope  • Two studies identified variability in the scope of KT platforms, with some focusing on one or two phases of the policy-making process (e.g. Policy BUDDIES programme in Cameroon and South Africa, respectively), some focusing on specific topic areas (e.g. public health or primary care), and some supporting policy-making about clinical practice (through guidelines) or technologies (through health technology assessments) as well as policy-making about health systems [36, 40] – 1.5/5, 2/3, respectively Phase of development  • One study identified key phases in the process of institutionalising a rapid evidence service, the different needs in different phases, and how changes within (e.g. staffing) and beyond (e.g. changes in the home directorate) the KT platform can affect the institutionalisation process [60] – 1/3 | Yes (4 for two) but no for rest | Yes (3 for human resources, 1 for scope) | Yes for those with yes in number column |