Cross-cutting lessons from the Decision-Maker Led Implementation Research initiative

Background Almost 20 million children under one year of age did not receive basic vaccines in 2019, and most of these children lived in low- and middle-income countries. Implementation research has been recognized as an emerging area that is critical to strengthen the implementation of interventions proven to be effective. As a component of strengthening implementation, WHO has called for greater embedding of research within decision-making processes. One strategy to facilitate the embedding of research is to engage decision-makers as Principal Investigators of the research. Since 2015, the Alliance for Health Policy and Systems Research within the WHO and the United Nations Children’s Fund have supported decision-maker led research by partnering with Gavi, the Vaccine Alliance, in an initiative called "Decision-Maker Led Implementation Research". This synthesis paper describes the cross-cutting lessons from the initiative to further understand and develop future use of the decision-maker led strategy. Methods This study used qualitative methods of data collection, including a document review and in-depth interviews with decision-makers and researchers engaged in the initiative. Document extraction and thematic content analysis were applied. The individual project was the unit of analysis and the results were summarized across projects. Results Research teams from 11 of the 14 projects participated in this study, for an overall response rate of 78.6%. Most projects were carried out in countries in Africa and conducted at the sub-state or sub-district level. Seven enablers and five barriers to the process of conducting the studies or bringing about changes were identified. Key enablers were the relevance, acceptability, and integration of the research, while key barriers included unclear results, limited planning and support, and the limited role of a single study in informing changes to strengthen implementation. Conclusions Decision-maker led research is a promising strategy to facilitate the embedding of research into decision-making processes and contribute to greater use of research to strengthen implementation of proven-effective interventions, such as immunization. We identified several lessons for consideration in the future design and use of the decision-maker led strategy. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00706-0.


INTRODUCTION AND PROJECT DESCRIPTION 1) First, let's begin with some information about you. Can you please give me your name, your
2) Can you briefly describe to me your project? a) What problem are you solving? b) What are goals and objectives? c) What methods are you using? d) What were the desired outcomes from the project? e) What were the desired outcomes from knowledge translation and dissemination? f) Can you briefly describe to me the context in which your project exists: what level are you working in, who are the key stakeholders; and what are the local political and economic factors that could influence your project?

PRE-SUBMISSION PHASE
3) Please describe to me how the project came about before the submission to AHSPR? a) Who came up with the idea? How did you find out about the call for proposals? b) How was the decision made to conduct this project and submit a proposal to AHSPR? c) Who wrote the first draft of the proposal for submission to AHSPR? d) How did you define roles at this stage? Who was responsible for what task? Were these defined beforehand? e) How long did it take? f) What worked well and didn't work well at this time?

4) I would like to ask about the decision-maker-researcher relationship.
a) How was the co-PI selected? Did you know each other prior to this time? b) Do you have a history of working together? Please elaborate. c) Can you describe to me how you communicated throughout the process? How often did you communicate? d) How did you define your roles and working relationship? e) What do you think worked well and didn't work well about this format? f) How did you resolve any obstacles in the implementation of the project? g) Do you have plans to work together in the future? Please elaborate. c) What activities -written, oral, formal or informal -were done to introduce the evidence to partners and decision-maker? d) What was the response the findings? Was the response as anticipated? Why or why not? 9) What are the next steps in the project? How will the results and findings be used beyond the communication and reporting plan agreed to with AHSPR? a) Have the results been used by you or others in any way during or since the conclusion of the project? b) Have the findings changed or influenced how things are being done at the community level or by decision-makers? Please elaborate. c) Are there any tools, instruments or activities that have emerged from the findings of this project? Please elaborate.

SUBMISSION AND PROTOCOL DEVELOPMENT PHASE 5) I would like to discuss with you the time right after your protocol was accepted by AHSPR. Can you describe to me your experience at the Protocol Development
10) I would like to now know more about your experience working on this project a) What did you find worked well and did not work well in relation to how this embedded research led to improvements and action? b) What did you find worked well and did not work well in relation to conducting research, and the effectiveness of embedding research methods and approaches in the process? c) What was your experience working with AHSPR? What worked well or didn't work well? What could they have done differently to support or improve your project? d) What would you do differently if you had to do this project again? 11) Is there anything that we didn't discuss that you would like to add?
Thank you for your willingness to participate. If you have any questions about the interview or this study, please feel to contact me. We hope that you will be willing for us to follow up with any questions. We appreciate your time and valuable input.