Date Published: November 17, 2009
Publisher: Public Library of Science
Author(s): John N. Lavis
Abstract: John Lavis discusses how health policymakers and their stakeholders need research evidence, and the best ways evidence can be synthesized and packaged to optimize its use.
Partial Text: In the last few years the landscape has changed dramatically for policymakers seeking to use research evidence in the policymaking process. The landscape has also changed for the many stakeholders seeking to use research evidence to influence the policymaking process. The task once seemed overwhelming given the dearth of synthesized research evidence on the “big”, typically multifaceted, questions that matter to policymakers and stakeholders ,. Now it isn’t uncommon for these groups to find dozens of systematic reviews that address the governance, financial, and delivery arrangements within health systems that can determine whether a cost-effective program, service, or drug reaches those who need it. For example, teams of African policymakers, stakeholders, and researchers drew on 30 reviews for what at first glance seems a straightforward question: how to support the widespread use of artemisinin-based combination therapy (ACT) to treat uncomplicated falciparum malaria. The review of qualitative studies of people’s views about and experiences with medicine sellers provided insights that were as central to the process as reviews of the effectiveness of a particular ACT formulation or the home-based management of malaria –.
Policymakers and stakeholders need many types of reviews to inform any given policymaking process (Table 1). For example, reviews of observational studies can help to establish the magnitude of the problem (or the factors that contribute to it), characterize the harms and key elements of policy and program options for addressing the problem, and identify potential barriers to implementing a preferred option ,. Reviews of qualitative studies can help to identify alternative framings of the problem, understand how or why a policy or program option works (particularly if local adaptation is being considered), appreciate stakeholder’s views about and experiences with particular options, and identify potential barriers to implementing a preferred option –. Reviews of effectiveness studies can help to characterize the benefits and sometimes the harms of each option being considered . And finally, reviews of economic evaluations can help to characterize the cost-effectiveness of options . Policymakers and stakeholders can find increasing numbers of all of these types of reviews.
Policymakers and stakeholders now have access to at least three types of review-derived products: (1) summaries of systematic reviews that highlight decision-relevant information; (2) overviews of systematic reviews that provide a “map” of what policy questions have been addressed by systematic reviews and where additional reviews are needed and that derive insights from these reviews; and (3) policy briefs that draw on many systematic reviews to better understand a problem, policy or program options to address the problem, and possible implementation strategies for these options (Table 2). Some summaries add significant value to a review by highlighting key findings, evaluating the review’s quality ,, grading the strength of evidence contained in it , identifying local applicability and equity considerations –, and/or providing commentaries by select users of the reviews. Identifying local applicability considerations is particularly important for reviews that address governance, financial, and delivery arrangements in health systems because the lessons learned from these reviews are likely to be context-sensitive ,. One key challenge lying ahead will be to ensure that summary-production processes keep up with the review-production/updating processes, which should include working through whether and when an apparent duplication of effort in the production of these summaries at the international level is problematic, and not simply the result of experimentation or appropriate targeting to particular audiences and contexts.
A range of activities are being piloted to support the use of reviews and review-derived products in policymaking (Table 3) ,. Few evaluations of the effectiveness of these activities have been undertaken; however, a group led by researchers at the Melbourne School of Population Health is registering a title for a systematic review on this topic with the Cochrane Collaboration. All that is available to inform decisions about the relative emphasis to give to these options are systematic reviews of the factors that influence the use of research evidence in policymaking ,,. A small number of factors emerged in these reviews with some frequency:
Supporting the use of systematic reviews in policymaking has received growing attention in recent years. More of the types of reviews needed by policymakers and stakeholders are being produced, which reduces the burden placed on policymakers and stakeholders to find and synthesize the research evidence on their own. Similarly, more review-derived products targeted at policymakers and stakeholders are being produced, and these products increasingly help to address the unique challenges faced by these groups, namely assessing the local applicability of reviews and mobilizing the range of reviews that are needed in different steps in the policymaking process. Finally, many activities to support the use of reviews are being piloted. Future challenges include working through whether and when an apparent duplication of effort in the production of these summaries is problematic and scaling up activities that are found to be effective in supporting the use of reviews and review-derived products.