Varallyay N Ilona, Bennett Sara C, Kennedy Caitlin, Ghaffar Abdul, Peters David H
Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States.
Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States.
Health Policy Plan. 2020 Nov 1;35(Supplement_2):ii98-ii111. doi: 10.1093/heapol/czaa126.
Innovative strategies are needed to improve the delivery of evidence-informed health interventions. Embedded implementation research (EIR) seeks to enhance the generation and use of evidence for programme improvement through four core features: (1) central involvement of programme/policy decision-makers in the research cycle; (2) collaborative research partnerships; (3) positioning research within programme processes and (4) research focused on implementation. This paper examines how these features influence evidence-to-action processes and explores how they are operationalized, their effects and supporting conditions needed. We used a qualitative, comparative case study approach, drawing on document analysis and semi-structured interviews across multiple informant groups, to examine three EIR projects in Bolivia, Colombia and the Dominican Republic. Our findings are presented according to the four core EIR features. The central involvement of decision-makers in EIR was enhanced by decision-maker authority over the programme studied, professional networks and critical reflection. Strong research-practice partnerships were facilitated by commitment, a clear and shared purpose and representation of diverse perspectives. Evidence around positioning research within programme processes was less conclusive; however, as all three cases made significant advances in research use and programme improvement, this feature of EIR may be less critical than others, depending on specific circumstances. Finally, a research focus on implementation demanded proactive engagement by decision-makers in conceptualizing the research and identifying opportunities for direct action by decision-makers. As the EIR approach is a novel approach in these low-resource settings, key supports are needed to build capacity of health sector stakeholders and create an enabling environment through system-level strategies. Key implications for such supports include: promoting EIR and creating incentives for decision-makers to engage in it, establishing structures or mechanisms to facilitate decision-maker involvement, allocating funds for EIR, and developing guidance for EIR practitioners.
需要创新策略来改善基于证据的健康干预措施的实施。嵌入式实施研究（EIR）旨在通过四个核心特征来加强证据的生成和利用，以促进项目改进：（1）项目/政策决策者在研究周期中的核心参与；（2）合作研究伙伴关系；（3）将研究置于项目流程之中；（4）聚焦于实施的研究。本文探讨了这些特征如何影响从证据到行动的过程，并探究它们是如何实施的、产生了哪些效果以及需要哪些支持条件。我们采用了定性比较案例研究方法，借助文件分析以及对多个信息群体进行的半结构化访谈，对玻利维亚、哥伦比亚和多米尼加共和国的三个嵌入式实施研究项目进行了考察。我们的研究结果是根据嵌入式实施研究的四个核心特征呈现的。决策者对所研究项目的权力、专业网络和批判性反思增强了他们在嵌入式实施研究中的核心参与。承诺、明确且共同的目标以及多元视角的代表促进了强大的研究 - 实践伙伴关系。关于将研究置于项目流程之中的证据不太确凿；然而，由于所有三个案例在研究利用和项目改进方面都取得了重大进展，取决于具体情况，嵌入式实施研究的这一特征可能不如其他特征关键。最后，聚焦于实施的研究要求决策者积极参与研究概念的构思，并确定决策者直接行动的机会。由于嵌入式实施研究方法在这些资源匮乏的环境中是一种新方法，需要关键支持来建设卫生部门利益相关者的能力，并通过系统层面的策略创造有利环境。此类支持的关键影响包括：推广嵌入式实施研究并为决策者参与创造激励措施，建立促进决策者参与的结构或机制，为嵌入式实施研究分配资金，以及为嵌入式实施研究从业者制定指导方针。
