The Use of Research Evidence in Public Health Decision Making Processes: Systematic Review

Abstract

BackgroundThe use of research evidence to underpin public health policy is strongly promoted. However, its implementation has not been straightforward. The objectives of this systematic review were to synthesise empirical evidence on the use of research evidence by public health decision makers in settings with universal health care systems.MethodsTo locate eligible studies, 13 bibliographic databases were screened, organisational websites were scanned, key informants were contacted and bibliographies of included studies were scrutinised. Two reviewers independently assessed studies for inclusion, extracted data and assessed methodological quality. Data were synthesised as a narrative review.Findings18 studies were included: 15 qualitative studies, and three surveys. Their methodological quality was mixed. They were set in a range of country and decision making settings. Study participants included 1063 public health decision makers, 72 researchers, and 174 with overlapping roles. Decision making processes varied widely between settings, and were viewed differently by key players. A range of research evidence was accessed. However, there was no reliable evidence on the extent of its use. Its impact was often indirect, competing with other influences. Barriers to the use of research evidence included: decision makers' perceptions of research evidence; the gulf between researchers and decision makers; the culture of decision making; competing influences on decision making; and practical constraints. Suggested (but largely untested) ways of overcoming these barriers included: research targeted at the needs of decision makers; research clearly highlighting key messages; and capacity building. There was little evidence on the role of research evidence in decision making to reduce inequalities.ConclusionsTo more effectively implement research informed public health policy, action is required by decision makers and researchers to address the barriers identified in this systematic review. There is an urgent need for evidence to support the use of research evidence to inform public health decision making to reduce inequalities.

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda

“…These included observational evidence showing the existence of a problem; narrative accounts of the impacts of policies from the household perspective; controlled evaluations; natural policy experiments; and historical evidence. The emphasis on research evidence, systematic reviews and randomized controlled trials as the ideal evidence in several studies in the past may be a reflection of the fact that very few studies had explored the views of policy-makers on the subject of what evidence is, and their day-to-day use of it in policy and decision-making (28). Policy-makers seek robust dialogue, critical and creative thinking, and will value tacit knowledge like expert opinion alongside research which may often be necessary but insufficient for decision-making (27).…”

“…This may highlight the fact that evidence should be applicable and acceptable. Several studies involving policy-makers' views have emphasized this (28) and in fact, Quazi et al (30) advise that researchers must understand that the evidence they generate needs to be contextualized for applicability and utility. Indeed, it is advised that evidence be interpreted with the backdrop of the local context in which the research was carried out (31).…”

Building capacities of elected national representatives to interpret and to use evidence for health-related policy decisions: A case study from Botswana

“…Studies have documented hindrances to evidence-informed health policymaking in both low-and high-income countries 13,23 and two systematic reviews reported many barriers to health policymakers using evidence: decision makers' perceptions about research evidence; lack of contact between researchers and policymakers; research that was not timely or relevant; mutual mistrust; competing influences; and power and budget struggles. 24,25 If elected representatives had a better understanding of the evidence they need to support rational decision making, instead of being passive recipients, they could start to demand different kinds of evidence. For example, they might start to demand evidence on population as well as individual benefit; also on the NNT (to prevent one adverse outcome) and the unit costs of different programmes.…”

Challenges of integrating evidence into health policy and planning: linking multiple disciplinary approaches

“…We assume that research into evidence utilisation that describes the evidence needs of policy makers in terms of succinct, understandable, timely evidence is well known 2,3,13 , as is the literature that describes financial, organisational, temporal and political constraints on individual decision making in the policy environment. 4 We therefore aim to highlight key theoretical insights from four different disciplinary approaches as exemplars that could strengthen research and action around these assumptions.…”

“…Systematic reviews have uncovered a large number of studies recounting the limited use of evidence in policy making, and descriptive studies attempting to unpick the problem of low uptake of evidence, and the specific barriers and facilitators for it. [1][2][3][4] Recent critiques identify a dominant thread in this literature that takes the problem of EIPM and narrows it to a nexus between evidence production (figuratively positioned outside the policy world) and specific policy targets (usually within government), leading to a dearth of studies that seek a broader understanding of policy processes and how they actually work. 1,[5][6][7] In this article, we seek to highlight some of the research and actions from multiple disciplines that contribute to a comprehensive understanding of EIPM, with the intention of creating an accessible starting point for a more interdisciplinary approach to the subject.…”