How relationship and dialogue facilitate evidence use: Lessons from African countries

Background: This article shares lessons from four case studies, documenting experiences of evidence use in different public policies in South Africa, Kenya, Ghana and the Economic Community of West African States (ECOWAS).Objectives: Most literature on evidence use in Africa focuses either on one form of evidence, that is, evaluations, systematic reviews or on the systems governments develop to support evidence use. However, the use of evidence in policy is complex and requires systems, processes, tools and information to flow between different stakeholders. In this article, we demonstrate how relationships between knowledge generators and users were built and maintained in the case studies, and how these relationships were critical for evidence use.Method: The case studies were amongst eight case studies carried out for the book entitled ‘Using Evidence in Policy and Practice: Lessons from Africa’. Ethnographic case studies drawn from both secondary and primary research, including interviews with key informants and extensive document reviews, were carried out. The research and writing process involved policymakers enabling the research to access participants’ rich observations.Results: The case studies demonstrate that initiatives to build relationships between different state agencies, between state and non-state actors and between non-state actors are critical to enable organisations to use evidence. This can be enabled by the creation of spaces for dialogue that are sensitively facilitated and ongoing for actors to be aware of evidence, understand the evidence and be motivated to use the evidence.Conclusion: Mutually beneficial and trustful relationships between individuals and institutions in different sectors are conduits through which information flows between sectors, new insights are generated and evidence used.

Assessing the impact of knowledge communication and dissemination strategies targeted at health policy-makers and managers: an overview of systematic reviews

Background The use of research evidence as an input for health decision-making is a need for most health systems. There are a number of approaches for promoting evidence use at different levels of the health system, but knowledge of their effectiveness is still scarce. The objective of this overview was to evaluate the effectiveness of knowledge communication and dissemination interventions, strategies or approaches targeting policy-makers and health managers. Methods This overview of systematic reviews used systematic review methods and was conducted according to a predefined and published protocol. A comprehensive electronic search of 13 databases and a manual search in four websites were conducted. Both published and unpublished reviews in English, Spanish or Portuguese were included. A narrative synthesis was undertaken, and effectiveness statements were developed, informed by the evidence identified. Results We included 27 systematic reviews. Three studies included only a communication strategy, while eight only included dissemination strategies, and the remaining 16 included both. None of the selected reviews provided “sufficient evidence” for any of the strategies, while four provided some evidence for three communication and four dissemination strategies. Regarding communication strategies, the use of tailored and targeted messages seemed to successfully lead to changes in the decision-making practices of the target audience. Regarding dissemination strategies, interventions that aimed at improving only the reach of evidence did not have an impact on its use in decisions, while interventions aimed at enhancing users’ ability to use and apply evidence had a positive effect on decision-making processes. Multifaceted dissemination strategies also demonstrated the potential for changing knowledge about evidence but not its implementation in decision-making. Conclusions There is limited evidence regarding the effectiveness of interventions targeting health managers and policy-makers, as well as the mechanisms required for achieving impact. More studies are needed that are informed by theoretical frameworks or specific tools and using robust methods, standardized outcome measures and clear descriptions of the interventions. We found that passive communication increased access to evidence but had no effect on uptake. Some evidence indicated that the use of targeted messages, knowledge-brokering and user training was effective in promoting evidence use by managers and policy-makers.

African Parliaments Volume 1: Evidence systems for governance and development

Parliaments play a pivotal role in governance, and yet little is known about how evidence is used for decision-making in these complex, political environments. Together with its practice companion volume, African Parliaments: Systems of evidence in practice, this volume explores the multiple roles legislatures play in governance, the varied mandates and allegiances of elected representatives, and what this means for evidence use. Given the tensions in Africa around the relationships between democracy and development, government and citizen agency, this volume considers the theories around parliamentary evidence use, and interrogates what they mean in the context of African governance.

Use of COVID-19 evidence in humanitarian settings: the need for dynamic guidance adapted to changing humanitarian crisis contexts

Background For humanitarian organisations to respond effectively to complex crises, they require access to up-to-date evidence-based guidance. The COVID-19 crisis has highlighted the importance of updating global guidance to context-specific and evolving needs in humanitarian settings. Our study aimed to understand the use of evidence-based guidance in humanitarian responses during COVID-19. Primary data collected during the rapidly evolving pandemic sheds new light on evidence-use processes in humanitarian response. Methods We collected and analysed COVID-19 guidance documents, and conducted semi-structured interviews remotely with a variety of humanitarian organisations responding and adapting to the COVID-19 pandemic. We used the COVID-19 Humanitarian platform, a website established by three universities in March 2020, to solicit, collate and document these experiences and knowledge. Results We analysed 131 guidance documents and conducted 80 interviews with humanitarian organisations, generating 61 published field experiences. Although COVID-19 guidance was quickly developed and disseminated in the initial phases of the crisis (from January to May 2020), updates or ongoing revision of the guidance has been limited. Interviews conducted between April and September 2020 showed that humanitarian organisations have responded to COVID-19 in innovative and context-specific ways, but have often had to adapt existing guidance to inform their operations in complex humanitarian settings. Conclusions Experiences from the field indicate that humanitarian organisations consulted guidance to respond and adapt to COVID-19, but whether referring to available guidance indicates evidence use depends on its accessibility, coherence, contextual relevance and trustworthiness. Feedback loops through online platforms like the COVID-19 Humanitarian platform that relay details of these evidence-use processes to global guidance setters could improve future humanitarian response.

A pragmatic evaluation of a Public Health Knowledge Broker mentoring education program: A convergent mixed methods study

Background: Public health professionals are expected to use the best available research and contextual evidence to inform decision making. The National Collaborating Centre for Methods and Tools developed, implemented, and evaluated a Knowledge Broker mentoring program aimed at facilitating organization-wide evidence-informed decision making in ten public health units in Ontario, Canada. The purpose of this study was to pragmatically assess the impact of the program.Methods: A convergent mixed methods design was used to interpret quantitative results in the context of the qualitative findings. Quantitatively, participants’ knowledge and skills for finding, interpreting, and using evidence were measured before and after program completion via multiple-choice tests. Changes in scores were assessed using paired t-tests. Qualitatively, program participants and management at enrolled public health units were interviewed to explore the effect of program participation. A secondary analysis of these interviews was conducted to determine whether organizations met their evidence use goals set at baseline, and to identify key factors related to implementation of EIDM within the organization.Results: Post-program scores for knowledge and skills for EIDM were higher compared to pre-program scores (mean difference = 14.0%, 95% CI 8.2%, 19.8%). Organizations met their goals for evidence use to varying degrees. Key themes identified that support an organizational shift to EIDM include definitive plans for participants to share knowledge during and after program completion, embedding evidence into decision making processes, and supportive leadership with organizational investment of time and resources. The location, setting or size of health units was not associated with attainment of EIDM goals; small, rural health units were not at a disadvantage compared to larger, urban health units.Conclusions: The Knowledge Broker mentoring program effectively increased participants’ knowledge and skill, allowing them to share their learning and support change at their health units. When paired with organizational supports such as supportive leadership and resource investment, this program holds promise as an innovative knowledge translation strategy for organization wide EIDM among public health organizations.

A Behavioral Design to Reform Italy’s Evaluation Policy

Drawing on the extensive ethnographic research I conducted on Italy’s performance evaluation system, this article highlights the cognitive biases associated with evidence use in decision making and institution working. Framing effects, status quo bias, motivated reasoning, and tacit conflicts between personal and organizational interests were only some of the behavioral phenomena policy makers, managers, and evaluators showed to limit their exposure to performance information. Integrating behavioral findings with theories of governance, evaluation utilization, and critical evidence–informed policymaking, this article discusses behavioral reform strategies to overcome (i) tacit conflicts of interests among evaluators, (ii) the compliance mentality with performance assessment among managers, and (iii) adversarial relationships between courts and administrative agencies as well as polarized politics with respect to evidence use and experts’ behavior. A behavioral design is relevant to reform evaluation policies, especially in countries where performance regimes have been criticized, contested, resisted, and/or perceived as red tape and surveillance mechanisms.