Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main St West, HSC-2D3, Hamilton, ON L8N 3Z5, Canada.
Implement Sci. 2008 Dec 17;3:55. doi: 10.1186/1748-5908-3-55.
Only a small number of previous efforts to describe the experiences of organizations that produce clinical practice guidelines (CPGs), undertake health technology assessments (HTAs), or directly support the use of research evidence in developing health policy (i.e., government support units, or GSUs) have relied on interviews and then only with HTA agencies. Interviews offer the potential for capturing experiences in great depth, particularly the experiences of organizations that may be under-represented in surveys.
We purposively sampled organizations from among those who completed a questionnaire in the first phase of our three-phase study, developed and piloted a semi-structured interview guide, and conducted the interviews by telephone, audio-taped them, and took notes simultaneously. Binary or categorical responses to more structured questions were counted when possible. Themes were identified from among responses to semi-structured questions using a constant comparative method of analysis. Illustrative quotations were identified to supplement the narrative description of the themes.
We interviewed the director (or his or her nominee) in 25 organizations, of which 12 were GSUs. Using rigorous methods that are systematic and transparent (sometimes shortened to 'being evidence-based') was the most commonly cited strength among all organizations. GSUs more consistently described their close links with policymakers as a strength, whereas organizations producing CPGs, HTAs, or both had conflicting viewpoints about such close links. With few exceptions, all types of organizations tended to focus largely on weaknesses in implementation, rather than strengths. The advice offered to those trying to establish similar organizations include: 1) collaborate with other organizations; 2) establish strong links with policymakers and stakeholders; 3) be independent and manage conflicts of interest; 4) build capacity; 5) use good methods and be transparent; 6) start small and address important questions; and 7) be attentive to implementation considerations. The advice offered to the World Health Organization (WHO) and other international organizations and networks was to foster collaborations across organizations.
The findings from our interview study, the most broadly based of its kind, extend to both CPG-producing organizations and GSUs the applicability of the messages arising from previous interview studies of HTA agencies, such as to collaborate with other organizations and to be attentive to implementation considerations. Our interview study also provides a rich description of organizations supporting the use of research evidence, which can be drawn upon by those establishing or leading similar organizations in LMICs.
仅有少数先前的努力描述了制定临床实践指南（CPGs）、进行卫生技术评估（HTAs）或直接支持将研究证据用于制定卫生政策的组织（即政府支持单位或 GSUs）的经验，这些努力仅依靠访谈，并且仅针对 HTA 机构进行了访谈。访谈提供了深入捕捉经验的潜力，特别是对于那些在调查中代表性不足的组织的经验。
我们从参与我们三阶段研究第一阶段问卷调查的组织中进行有针对性的抽样，制定并试点了一份半结构化访谈指南，并通过电话进行访谈，同时进行录音和做笔记。尽可能对更结构化问题的二进制或分类回答进行计数。使用恒定性比较分析方法，从半结构化问题的回答中确定主题。选择说明性引文来补充主题的叙述描述。
我们采访了 25 个组织的负责人（或其指定人员），其中 12 个是 GSUs。所有组织中最常被引用的优势是使用严格、系统和透明的方法（有时简称为“基于证据”）。GSUs 更一致地将其与政策制定者的紧密联系描述为优势，而制定 CPGs、HTAs 或两者兼有的组织对这种紧密联系持有不同的观点。除了少数例外，所有类型的组织都倾向于主要关注实施中的弱点，而不是优势。为那些试图建立类似组织的人提供的建议包括：1）与其他组织合作；2）与政策制定者和利益相关者建立牢固的联系；3）保持独立并管理利益冲突；4）建立能力；5）使用良好的方法并保持透明；6）从小处着手并解决重要问题；7）关注实施考虑。为世界卫生组织（WHO）和其他国际组织和网络提供的建议是促进组织之间的合作。
我们的访谈研究是此类研究中最广泛的研究，其发现既适用于 CPG 制定组织，也适用于 GSUs，扩展了从以前对 HTA 机构的访谈研究中得出的信息，例如与其他组织合作并关注实施考虑。我们的访谈研究还提供了对支持使用研究证据的组织的丰富描述，这可以为在 LMIC 中建立或领导类似组织的人提供参考。
