Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
Health Policy Plan. 2020 Jul 1;35(6):735-751. doi: 10.1093/heapol/czaa038.
Because health systems are conceptualized as social systems, embedded in social contexts and shaped by human agency, values are a key factor in health system change. As such, health systems software-including values, norms, ideas and relationships-is considered a foundational focus of the field of health policy and systems research (HPSR). A substantive evidence-base exploring the influence of software factors on system functioning has developed but remains fragmented, with a lack of conceptual clarity and theoretical coherence. This is especially true for work on 'social values' within health systems-for which there is currently no substantive review available. This study reports on a systematic mixed-methods evidence mapping review on social values within HPSR. The study reaffirms the centrality of social values within HPSR and highlights significant evidence gaps. Research on social values in low- and middle-income country contexts is exceedingly rare (and mostly produced by authors in high-income countries), particularly within the limited body of empirical studies on the subject. In addition, few HPS researchers are drawing on available social science methodologies that would enable more in-depth empirical work on social values. This combination (over-representation of high-income country perspectives and little empirical work) suggests that the field of HPSR is at risk of developing theoretical foundations that are not supported by empirical evidence nor broadly generalizable. Strategies for future work on social values in HPSR are suggested, including: countering pervasive ideas about research hierarchies that prize positivist paradigms and systems hardware-focused studies as more rigorous and relevant to policy-makers; utilizing available social science theories and methodologies; conceptual development to build common framings of key concepts to guide future research, founded on quality empirical research from diverse contexts; and using empirical evidence to inform the development of operationalizable frameworks that will support rigorous future research on social values in health systems.
由于卫生系统被视为社会系统，嵌入社会背景并受人类行为的影响，因此价值观是卫生系统变革的关键因素。因此，卫生系统软件——包括价值观、规范、理念和关系——被认为是卫生政策和系统研究（HPSR）领域的一个基础焦点。一个探索软件因素对系统功能影响的实质性证据基础已经发展起来，但仍然支离破碎，缺乏概念上的清晰性和理论上的一致性。这尤其适用于卫生系统内“社会价值观”的工作——目前没有实质性的审查可用。本研究报告了一项关于 HPSR 中社会价值观的系统混合方法证据映射综述。该研究重申了社会价值观在 HPSR 中的核心地位，并强调了显著的证据差距。在低收入和中等收入国家背景下，关于社会价值观的研究极为罕见（而且主要由高收入国家的作者撰写），尤其是在关于该主题的有限实证研究范围内。此外，很少有 HPS 研究人员借鉴现有的社会科学方法，这些方法可以使对社会价值观进行更深入的实证研究。这种组合（高收入国家观点的过度代表和很少的实证工作）表明，HPSR 领域有风险形成没有经验证据支持且不能广泛推广的理论基础。本文提出了 HPSR 中社会价值观未来工作的策略，包括：反对重视实证范式和以系统硬件为重点的研究的研究层次观念，认为这些观念更严格，更与决策者相关；利用现有的社会科学理论和方法；概念发展，建立关键概念的共同框架，以指导未来来自不同背景的高质量实证研究；并利用实证证据为可操作框架的发展提供信息，以支持对卫生系统中社会价值观的严格未来研究。
