Integrated knowledge translation to advance noncommunicable disease policy and practice in South Africa: application of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework

Abstract

Background In response to the “know–do” gap, several initiatives have been implemented to enhance evidence-informed decision-making (EIDM). These include individual training, organizational culture change management, and legislative changes. The importance of relationships and stakeholder engagement in EIDM has led to an evolution of models and approaches including integrated knowledge translation (IKT). IKT has emerged as a key strategy for ensuring that engagement is equitable, demand-driven, and responsive. As a result, the African-German Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) incorporated an IKT approach to influence noncommunicable diseases (NCD) policy and practice. We documented the phased process of developing, implementing, and monitoring the IKT approach in South Africa; and explored the appropriateness of using the exploration, preparation, implementation, and sustainment (EPIS) framework for this purpose. Methods We mapped the South Africa IKT approach onto the EPIS framework using a framework analysis approach. Notes of team meetings, stakeholder matrices, and engagement strategies were analysed and purposefully plotted against the four phases of the framework in order to populate the different constructs. We discussed and finalized the analysis in a series of online iterations until consensus was reached. Results The mapping exercise revealed an IKT approach that was much more iterative, dynamic, and engaging than initially thought. Several constructs (phase-agnostic) remained important and stable across EPIS phases: stable and supportive funding; committed and competent leadership; skilled and dedicated IKT champions; diverse and established personal networks; a conducive and enabling policy environment; and boundary-spanning intermediaries. Constructs such as “innovations” constantly evolved and adapted to the changing inner and outer contexts (phase-specific). Conclusions Using the EPIS framework to interrogate, reflect on, and document our IKT experiences proved extremely relevant and useful. Phase-agnostic constructs proved critical to ensure resilience and agility of NCD deliberations and policies in the face of highly dynamic and changing local contexts, particularly in view of the current coronavirus disease 2019 (COVID-19) pandemic. Bridging IKT with a framework from implementation science helps to reflect on this process and can guide the development and planning of similar interventions and strategies.

Using Citizen Science Within an Integrated Knowledge Translation (IKT) Approach to Explore Cardiovascular Disease Risk Perception in Rwanda

“…Furthermore, budget for stakeholder engagement activities was taken into considerations in the project design phase. One of the CEBHA+ sites, South Africa, stable and supportive funding was recognized among constructs favouring the implementation of IKT processes and strategies (18). This also underpins how allocating financial resources is paramount for applying IKT approach in research process (11).…”

Bridging the gap from knowledge to action: Implementation of the data to policy (D2P) training program at sub-national levels in Zambia

“…like Zambia. Effective translation of research evidence into policy and practice is important for improving health outcomes and reducing health inequities, and this essentially addresses the "know-do" gap (12); one of the barriers to the utilization of research results is that researchers misunderstand the needs of decision-makers and consequently, decision-makers may not use existing research evidence in their decision-making. The D2P program provided an opportunity for researchers, practitioners and decision-makers to engage in an effort to close the "know-do" gap.…”

Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review

“…Understanding the actual context in terms of political environment will enable actual use of evidence (70,76,77,100,137) , encourage institutional budgetary allocations for research (73,78) , health research and policy priority setting (70,76,79) , and support scale up for societal bene t (71, 72, 74-76, 80, 85, 96-101, 104) . Conversely, lack of credible context-speci c health evidence (75,86,102,103) , weak local evidence, misunderstanding of decision-makers, lack of consideration of sociocultural or religious practices (52,63,(105)(106)(107)(108)(109) , and weak involvement of advocacy coalitions, and evidence generators (110) have limited the translation of evidence into policy and practice. Additionally, policy translation needs mutual trust (41,84,111) .…”