The evidence-base for improving health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Facilitating such translation is particularly important in low and middle-income countries that bear a disproportionate share of the global burden of ill-health.
The primary objective of this review was to assess the effects of interventions to improve the uptake of research into health policies in low and middle-income countries. A secondary objective was to identify the barriers and facilitators to the uptake of research evidence derived from intervention and non-intervention studies.
For the main objective of the review, observational or experimental studies were eligible if they assessed any intervention aiming to facilitate the transfer of health research into health policy in low and middle-income countries. Studies had to include policy-makers as a target group, but could also include a variety of other stakeholders. The primary outcome was a change in health policies based on evidence uptake; additional outcomes included other policy-related outcomes, practice-related outcomes and health outcomes (resulting from the policy-change). For the secondary objective of the review, non-intervention studies describing policy processes and barriers and facilitators to evidence uptake into policy were also included. A wide range of electronic databases was searched; additional searching included scanning of a range of websites, reference lists of included studies, and citation searching. Two reviewers independently selected the studies. Data extraction and quality assessment of intervention studies were carried out by one reviewer and a proportion of the data was checked by a second reviewer. Data were summarised narratively, using text and tables. Frequencies of intervention components and reported barriers and facilitators to knowledge translation were computed.
The final analysis included 25 intervention studies and 29 non-intervention studies describing barriers and facilitators to evidence-uptake either from observations of policy-making processes or from stakeholders' views. Most of the intervention studies were descriptive case-studies with inadequate detail on methodology and intervention design. The interventions were complex and many encompassed the whole cycle of research, policy development and implementation. All interventions had some positive effects in terms of policy-related outcomes. The most frequently cited components of interventions reporting positive effects on policy development included carrying out local research (e.g. for contextualisation), ensuring intensive stakeholder engagement and collaboration, including training and capacity-building activities, and fostering community participation. These elements were also identified in the non-intervention studies as common factors in the analysis of barriers and facilitators to evidence uptake. Few differences were seen between studies from low and middle-income countries in terms of barriers and facilitators. However, one important distinction cited was that low income countries tended to depend more on the support of large multilateral organisations, and that this dependence was also seen as a barrier to focussing on local priorities.
Although the intervention studies from low and middle-income countries included in this review were not of sufficient quality to provide strong recommendations, the findings are broadly consistent with the findings from high-income countries on the need for multi-faceted, tailored interventions and on the importance of contextual influences, particularly organisational. Effective interventions to increase uptake of evidence are likely to be those tailored to the context and include local research, extensive stakeholder engagement, and community participation. High-quality comparative studies reporting on a range of outcomes, with clear and comprehensive descriptions of methodology and of context, are still needed to strengthen understanding on how to improve uptake specifically in low and middle-income countries.
University of Aberdeen, Aberdeen, UK, 107 pp.