Competency profiles for evidence-informed policy-making (EIPM): a rapid review

Abstract

Background

Evidence-informed policy-making (EIPM) requires a set of individual and organizational capacities, linked with background factors and needs. The identification of essential knowledge, skills and attitudes for EIPM can support the development of competency profiles and their application in different contexts.

Purpose

To identify elements of competency (knowledge, skills and attitudes) for EIPM, according to different professional profiles (researcher, health professional, decision-maker and citizen).

Methods

Rapid umbrella review. A structured search was conducted and later updated in two comprehensive repositories (BVSalud and PubMed). Review studies with distinctive designs were included, published from 2010 onwards, without language restrictions. Assessment of the methodological quality of the studies was not performed. A meta-aggregative narrative synthesis was used to report the findings.

Results

Ten reviews were included. A total of 37 elements of competency were identified, eight were categorized as knowledge, 19 as skills and 10 as attitudes. These elements were aggregated into four competency profiles: researcher, health professional, decision-maker and citizen. The competency profiles included different sets of EIPM-related knowledge, skills and attitudes.

Strengths and limitations

This study is innovative because it aggregates different profiles of competency from a practical perspective, favouring the application of its results in different contexts to support EIPM. Methodological limitations are related to the shortcuts adopted in this review: complementary searches of the grey literature were not performed, and the study selection and data extraction were not conducted in duplicate.

Final considerations: conclusions and implications of the findings

EIPM requires the development of individual and organizational capacities. This rapid review contributes to the discussion on the institutionalization of EIPM in health systems. The competency profiles presented here can support discussions about the availability of capacity and the need for its development in different contexts.

Background

In the context of health systems, evidence-informed policy-making (EIPM) results from systematic and transparent processes to access, assess, adapt and apply scientific evidence in decision-making processes [1]. EIPM promotes the use of scientific knowledge in decision-making processes and in the development of innovative methods and strategies in the field of health systems. It also fosters technical cooperation between organizations and other interested social groups that produce and apply this scientific knowledge [2].

Thus, EIPM advocates the incorporation of scientific evidence as an input for decision-making processes in the formulation and implementation of health policies. In this context, evidence-informed decision-making (EIDM) emphasizes that decisions should be informed by the best available evidence, as well as other factors such as context, public opinion, equity, feasibility of implementation, accessibility, sustainability and acceptability to stakeholders [3].

In the context of EIDM institutionalization efforts, knowledge translation (KT) is a prior foundation to be considered [3]. Knowledge translation is a dynamic and interactive process that includes synthesis, dissemination, exchange and ethical application of knowledge to improve population health, provide more effective health services and products, and strengthen the health system [4]. This definition is part of a complex system of interactions, also known as knowledge translation platforms [5], which articulates producers, mediators and users of scientific knowledge, in different intensities, complexities and levels of involvement, depending on the nature of the research and the needs in different contexts.

Therefore, four elements of knowledge translation are emphasized: synthesis, dissemination, exchange and practical application of knowledge in the formulation, implementation and evaluation of health policies, at any level of management of health systems and services.

To include scientific evidence in decision-making processes, through systematic, transparent and balanced knowledge translation approaches, it is necessary that individual and institutional capacities are recognized and available. These capacities aim not only to support the use of structured and replicable methods, but also to consider the distinct factors that influence a priority public health problem and the process of implementing interventions to address it. Thus, the decisions to act on the causes and consequences of the problem would be informed in a comprehensive way [6,7,8].

This set of capacities constitutes a profile, considered from the perspective of professional competencies [9, 10]. The concept of competency considers cognitive, psychomotor and attitudinal attributes as elements of a competent practice [11]. In this regard, competency includes the mobilization of different resources to solve, with relevance and success, problems of professional practice. These resources or attributes are the knowledge, skills and attitudes mobilized, in an integrated way, to conduct professional actions [12, 13].

Although there are studies on the different individual and institutional capacities needed, a global synthesis is not yet available that systematically brings together all these elements, following the logic of competency profiles. Defining the essential competencies for EIPM professionals is key for identifying individual and institutional capacity development needs. This is necessary for establishing knowledge translation platforms in different organizational contexts. In addition, an EIPM competency profile also contributes to the theoretical discussion, but from an applied perspective, supporting the planning and implementation of EIPM initiatives in different contexts.

This study is part of an initiative commissioned by the Brazilian Ministry of Health to support EIPM development in Brazil and aimed to identify EIPM-related competency (knowledge, skills and attitudes). The competency elements were classified according to different professional profiles (researcher, health professional, decision-maker and citizen), considered from a broad conceptual perspective, which can be applied to different socioeconomic contexts and organizational scenarios. The results of this study also supported the development of a specific competency profile for EIPM adapted to the Brazilian context.

Methods

This study is a rapid umbrella review, which followed a prospective protocol (https://zenodo.org/record/6539137), according to the steps described in this section, including deviations from the protocol. The planning and execution of this review followed the recommendations of the World Health Organization manual for rapid reviews [14] and its report adhered to PRISMA 2020 [15].

Selection criteria

The following study types were included: overviews of systematic reviews, systematic reviews, scoping reviews and (systematic or narrative) reviews of qualitative studies, that analyzed and/or described professional competencies (knowledge, skills and attitudes) for EIPM, without language restriction, from 2010 onwards (considered by the authors of this rapid review as the time when there has been a growth in global interest in the EIPM institutionalization).

Review question

The review question was: What are the general and specific competencies (knowledge, skills and attitudes) for professional performance in EIPM? The question was structured according to the population, concept, context (PCC) acronym, as presented in Table 1.

Table 1 PCC question (population, concept, context)

Search strategies and indexed databases

Searches were conducted on two comprehensive and up-to-date databases, BVSalud and PubMed, on 16 March 2022. The search strategies are presented in Table 2.

Table 2 Databases and search strategies used

The protocol of this review included hand searching reference lists of the selected studies and relevant institutional websites. However, we did not consider this necessary to perform because the retrieved studies provided sufficient information for the purpose of this rapid review.

Screening and selection of studies

Duplicates were excluded, and three reviewers (JOMB, DMMR, CS) independently screened titles, abstracts and full texts, but not in duplicate, supported by the Rayyan platform [16]. Individual doubts were resolved by consensus with a second reviewer (JOMB). Prior to data extraction, a reviewer (CS) read the full texts of selected studies to confirm eligibility.

Data extraction

One reviewer (CS) extracted data and two other reviewers (JOMB and DMMR) verified the extraction. An electronic spreadsheet was used to systematize the following data from the individual studies selected for inclusion: author, year of publication, purpose of the study, study design, country where the study was carried out, context, target population, competencies identified, barriers and facilitators (when mentioned), knowledge gaps identified by the study, study limitations, conflict of interests declared and funding (when available).

Data synthesis

We performed a meta-aggregative narrative synthesis [14], based on quantitative and qualitative data from included studies, to combine the individual findings. Two classifications were used to categorize the findings. The first, regarding the competency element, considered the following categories, usually applied in the definition of competency profiles, as the knowledge, skills and attitudes (KSA) model: (1) knowledge: different types of knowledge and information; (2) skills: improved movements and non-verbal communication intertwined with knowledge, expressed as the psychomotor domain in the manipulation and construction of processes and products; (3) attitudes: feelings, positioning and values linked to skills and knowledge in the performance of professional tasks [17]. The second classification considered four professional profiles of interest: (1) researcher: professional who works in the production of scientific research; (2) health professional: professional who works in the provision of health services; (3) health systems and services decision-maker: professional who works in the management of health services and/or systems, at any level; and (4) citizen: individual inserted in civil society, participating or not in organizations representing specific groups.

These categories were used to aggregate the different competency elements identified in this review. This process often led to overlapping elements in the different professional profiles, for example, the same element may be present in more than one profile.

Methodological quality assessment

We did not perform a methodological quality assessment of the included studies. Although it was included in the protocol of this review, we decided not to proceed with this step because the nature of the question of interest and the scope of this review, and because it would make little contribution to our practical goal.

Shortcuts adopted and deviations from the protocol

We adopted methodological shortcuts to reduce the time to conduct this rapid review, considering that its purpose was to inform institutional deliberations on a pre-defined schedule. Among the adopted shortcuts, those that potentially influence the completeness and reliability of the findings were: (1) the searches were only performed in the two repositories, including studies published from 2010 onwards, that is, we did not search the grey literature nor the reference list of included studies. This also is a deviation from the protocol, which included complementary searches. Restricting the grey literature search is a common shortcut for rapid reviews for policy topics, as well as tailoring (generally to adjust) the selection of literature databases to the topic, because the addition of a grey literature search depends on the topic, purpose and timeline [14]. In this review, we considered the potential contribution to the topic addressed and the time required for the complementary search, and decided not to extend the searches for grey literature; (2) selection and data extraction were not duplicated but performed individually and verified by another reviewer; (3) the assessment of the methodological quality of the selected studies was not conducted, and this was the second deviation from the protocol. While an assessment of the methodological quality of included studies is desirable in a review, scoping reviews do not require this step, given the potential variety of methodological designs and the nature of the topic or issue addressed [14]; and (4) the results were synthesized with a meta-aggregative approach and presented only descriptively in synthetic tables.

Although these shortcuts and deviations from the protocol suggest caution in the interpretation of the results of this review, they are recognized as potential opportunities to reduce the time spent for the development of rapid reviews that are still reliable [14, 18, 19].

Results

Study selection

The searches retrieved 714 documents. Nine duplicates were removed, 705 titles and abstracts were screened, and 35 documents were eligible for full-text reading, 25 of which were excluded for not meeting the inclusion criteria, and two were excluded after data extraction, by consensus of the authors on their eligibility. The list of excluded studies with the reasons for exclusion is provided in Additional file 1: Appendix 1. Ten studies were included in this rapid review (Fig. 1).

Fig. 1

PRISMA flowchart [15]

Studies’ characteristics

Among the ten studies included, seven were systematic reviews [7, 20,21,22,23,24,25], one scoping review [6], one rapid review [26] and one evidence map [8]. The countries of the studies were South Africa [8], Australia [7, 22, 25, 26], Canada [6], United States [24], the Netherlands [21], Iran [20], Norway and Spain [23]. Regarding the target audience, health professionals [6, 21, 22, 24,25,26], researchers [7], policy-makers [7, 8], managers [6, 20] and citizens [23] were found. Finally, about the researched context, health systems [6, 8, 25], healthcare services [6, 8, 20, 21, 23] and health education sites [7] were included.

Synthesis of findings

General elements of competency in EIPM

Most of the studies included in this rapid review did not explicitly present a framework of ideal competencies for EIPM professionals. However, all included studies reported, according to their purposes, elements that were interpreted to find competencies in EIPM. Thus, the allocation of competencies in the categories adopted (knowledge, skills and attitudes) was made observing the best suitability, according to the authors’ understanding and consensus, as presented in Table 3 and detailed in Additional file 2: Appendix 2.

Table 3 Main characteristics of the included studies in this review

Competencies were also coded and aggregated, whenever possible, to provide a summarized description of each identified element. The description resulting from this categorization and synthesis process is presented in Table 4, based on the findings of the included studies.

Table 4 General list and description of the competency elements (knowledge, skills and attitudes) identified

Specific elements of competency in EIPM, per professional profile

From the included studies, competency elements were identified and assigned to each professional profile in EIPM: (1) researcher, (2) health professional, (3) decision-maker and (4) citizen. The following Tables 5, 6, 7, 8 present this classification. The studies did not always explicitly associate the competencies with the different profiles. When this association was not mentioned, we assessed the relevance of the competency for each profile and classified them accordingly, based on our understanding of the EIPM field. In the tables, it is indicated whether the competency elements were assigned to each professional profile by the included studies (‘Assigned by the studies’) or, in a complementary way, according to the interpretation of the authors of this rapid review (‘Assigned by the authors’).

Table 5 Elements of competency in EIPM, researcher profile

Table 6 Elements of competency in EIPM, health professional profile

Table 7 Elements of competency in EIPM, decision-maker profile

Table 8 Elements of competency in EIPM, citizen profile

Discussion

This rapid review addressed a topic of high relevance for EIPM at a global level. The adoption of competency profiles is a critical strategy to support the institutionalization of scientific evidence as an input for decision-making in the formulation and implementation of health policies, in all contexts. A systematic and transparent process was adopted to identify the relevant elements to develop competency profiles for professionals who work in Knowledge Translation and EIPM.

Some earlier studies included in this comprehensive review presented competencies related to knowledge translation and EIPM, but with approaches limited to specific profiles [7, 20,21,22,23,24]. To our knowledge, this is the first study that aggregates different competency profiles.

The findings of this review showed that there are earlier frameworks of competencies in EIPM that can be incorporated into contextualized discussions, at various levels of health policies and systems. These frameworks present elements of competencies that can be classified as knowledge, skills and attitudes (KSA). These competencies, in turn, must be seen as an integrated and interactive set of individual capacities, which interacts with the organizational environment, to constitute professional profiles with different areas of activity. Despite the profiles being different from each other, the overlapping of some elements was common. Moreover, we acknowledge the need to conduct the reclassification and fill the gaps that a rigid classification may produce on these results.

It is also important to emphasize that the practical application of this competencies profile must be broadly anchored in the local needs of each institution and/or professional. Advancing the institutionalization of EIPM requires the recognition of the capacities already available in an institution, which must be compared with the organization’s tasks and attributions. It is this contextualization process that will generate the proper competency profile for each situation. Therefore, this study should be seen as a first input. Its application requires understanding the relevance of each element described here to each organization. For example, the competency elements presented above do not need to be associated with a single professional but can guide the composition of a team that has the necessary set of skills.

Within the EIPM scope, there is a relevant movement aimed at strengthening the institutionalization of knowledge translation processes within governments, civil society organizations and academic institutions [27,28,29]. However, the lack of tools and frameworks focused on institutional and individual capacities is still a barrier to be overcome. The results of this review provide an acknowledgement of the global literature related to the individual capacities needed, and information that can be immediately applied in discussions and deliberations on the institutionalization of EIPM, in all parts of the world.

Strengths and limitations

The strengths of this rapid review include: (1) being the first to cover different professional profiles, and adopting a friendly format in the categorization and presentation of the findings to allow the immediate use of its results; (2) adopting systematic and transparent methods to provide, in a timely manner, a body of evidence on an issue of high interest in the current EIPM field, inside and outside Brazil; and (3) contributing to identifying and filling gaps related to the situational diagnosis of individual and organizational competencies for EIPM.

As previously mentioned, methodological limitations include: (1) being a rapid review, we adopted shortcuts and deviations from the protocol, which may have led to the loss of relevant documents, especially from the grey literature. However, we believe that the set of published studies included in this review has sufficiently provided an overview of the available competency elements; (2) the meta-aggregative synthesis carried out to consolidate the results of the different studies included had a narrative character and may have oversimplified the concepts and definitions presented in the description tables of the competency elements. We believe that the guidance to apply the findings of this review in a manner adapted to each contexts’ needs can minimize this limitation, as it will imply a process of re-signification of the findings; (3) the categories used to classify the competency profiles may not be so distinguishable in practice, including elements that are dynamically and interactively correlated. Knowledge, skills and attitudes should be seen as an integrated set of capacities. In the same way, because often there are overlaps and intersections in the profiles presented here, areas of activity should be recognized, rather than actual professional profiles.

Conclusions

This rapid umbrella review presented elements for professional competency profiles applied to EIPM, contributing to the discussion on the institutionalization of scientific evidence as inputs to systematic, transparent and balanced processes, within the scope of public health policies. The use of these findings will show their usefulness to support strategic planning in health organizations as well as civil society and academic organizations.