Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
Department of Health Services Management, School of Medical Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Int J Health Policy Manag. 2017 Aug 1;6(8):457-465. doi: 10.15171/ijhpm.2016.158.
SUPPORT tools consist of 18 articles addressing the health policy-makers so that they can learn how to make evidence-informed health policies. These tools have been particularly recommended for developing countries. The present study tries to explain the process of evidence utilization for developing policy documents in the Iranian Ministry of Health and Medical Education (MoHME) and to compare the findings with those of SUPPORT tools.
A qualitative research was conducted, using the framework analysis approach. Participants consisted of senior managers and technicians in MoHME. Purposeful sampling was done, with a maximum variety, for the selection of research participants: individuals having at least 5 years of experience in preparing evidence-based policy documents. Face-to-face interviews were conducted for data collection. As a guideline for the interviews, 'the Utilization of Evidence in Policy-Making Organizations' procedure was used. The data were analyzed through the analysis of the framework method using MAXQDA 10 software.
The participants acquired the research evidence in a topic-based form, and they were less likely to search on the basis of the evidence pyramid. To assess the quality of evidence, they did not use standard critical tools; to adapt the evidence and interventions with the local setting, they did not use the ideas and experiences of all stakeholders, and in preparing the evidence-based policy documents, they did not take into consideration the window of opportunity, did not refrain from using highly technical terms, did not write user-friendly summaries, and did not present alternative policy options. In order to develop health policies, however, they used the following innovations: attention to the financial burden of policy issues on the agenda, sensitivity analysis of the preferred policy option on the basis of technical, sociopolitical, and economic feasibility, advocacy from other scholars, using the multi-criteria decision-making models for the prioritization of policy options, implementation of policy based on the degree of readiness of policy-implementing units, and the classification of policy documents on the basis of different conditions of policy-making (urgent, short-term, and long-term).
Findings showed that the process of evidence utilization in IR-MoH enjoys some innovations for the support of health policy development. The present study provides IR-MoH with considerable opportunities for the improvement of evidence-informed health policy-making. Moreover, the SUPPORT process and tools are recommended to be used in developing countries.
支持工具包括 18 篇文章，旨在向卫生政策制定者传授如何制定循证卫生政策，这些工具尤其推荐给发展中国家使用。本研究旨在解释伊朗卫生部和医疗教育部（MoHME）制定政策文件的证据利用过程，并将结果与支持工具进行比较。
采用框架分析法进行定性研究，参与者包括 MoHME 的高级管理人员和技术人员。采用目的性抽样，对研究参与者进行最大程度的多样化选择：至少有 5 年制定循证政策文件经验的个人。采用“政策制定组织中的证据利用”程序进行面对面访谈以收集数据。访谈指南使用 MAXQDA 10 软件对框架方法进行分析。
参与者以主题形式获取研究证据，不太可能根据证据金字塔进行搜索。他们没有使用标准的批判性工具来评估证据质量；为了使证据和干预措施适应当地情况，他们没有利用所有利益攸关方的意见和经验；在编写循证政策文件时，他们没有考虑到机会之窗，没有避免使用技术术语，没有编写便于用户使用的摘要，也没有提出替代政策选择。然而，为了制定卫生政策，他们采用了以下创新措施：关注议程上政策问题的财政负担；根据技术、社会政治和经济可行性，对首选政策选项进行敏感性分析；争取其他学者的支持；利用多准则决策模型对政策选项进行优先排序；根据政策实施单位的准备程度实施政策；根据政策制定的不同情况（紧急、短期和长期）对政策文件进行分类。
研究结果表明，IR-MoH 的证据利用过程为支持卫生政策发展提供了一些创新。本研究为 IR-MoH 提供了改进循证卫生政策制定的重要机会。此外，建议在发展中国家使用支持工具和流程。
