Establishing research impact assessment in Iran: The first report from a non-high-income country.

Background: This study presents the first report on research impact assessment (RIA) in non-high-income countries, undertaken as a pilot initiative in 2021. Within it, we aimed to explore the feasibility of employing the 'payback' model for evaluating the impact of health research and enhancing the accountability of universities. We focussed on three key impact domains: 'production of decision support documents and knowledge-based products,' 'implementation of research results,' and 'health and economic impact.' Methods: We adopted a case study approach to assess the impact of 5334 health research projects conducted by researchers from 18 universities from 2018 to 2020. Researchers were required to submit evidence related to at least one of the specified impact domains; six scientific committees verified and scored claimed impacts at the national level. Results: Only 25% of the assessed projects achieved impact in at least one domain, with the production of decision support documents and knowledge products being the most reported impact. Notably, economic impact was verified in only three projects, indicating room for improvement in this area. Technology research exhibited the highest acceptance rate of claimed impact, suggesting a positive correlation between technology-focused projects and impactful outcomes. Conclusions: This study demonstrates the feasibility of employing a case study approach and the 'payback' model to evaluate the impact of health research, even within the constraints of a moderately equipped research infrastructure. These findings underscore the potential of integrating RIA into the governance of health research in Iran and other non-high-income countries, as well as the importance of using RIA to assess the accountability of health research systems, guide the allocation of research funding, and advocate for the advancement of health research. The study sets a precedent for future assessments in similar contexts and contributes to the ongoing global dialogue on the societal impact of health research.

Assessing the impact of small-research grants supported by WHO in the Eastern Mediterranean Region 2010-2018.

Background: For decades, WHO has been providing targeted funding for health research on priority areas of public health in the Eastern Mediterranean Region through different grant schemes. Aims: This paper investigated the impact of WHO/EMRO's funding schemes and factors facilitating or hindering such impact. Methods: We assessed the impact of health research funded by WHO/EMRO during 2010-2018 from the health, economic, decision-making, and knowledge translation perspectives, emphasizing accountability and analysis, using the Payback framework, mixed-method approach (quantitative, qualitative), and triangulation. Results: Principal investigators of 45 (45.9%) out of the 98 funded projects responded to the questionnaire. Almost all (88.0%) the 45 projects reported developing at least one decision-making document. Less than half reported producing peer-reviewed documents and conducting target group empowerment, while 24.0% said they secured research funds from other organizations. For 23 projects (51.0%), research results could have had a direct impact on health and on economy, and 25 (56.0%) projects conducted at least one active knowledge translation activity. Using multiple logistic regression, there was no significant association between the country of research and impact on decision-making and implementation of result if health or economic impact was expected. Conclusion: To strengthen the impact of research, WHO/EMRO should embark on a series of interventions to guide and empower countries in the use of research results. Discrepancies between health research systems in the Eastern Mediterranean Region and differences in individual and organizational capacities in the different countries require targeted interventions.

Policy options for strengthening evidence-informed health policy-making in Iran: overall SASHA project findings.

BACKGROUND: The institutionalization of evidence-informed health policy-making (EIHP) is complex and complicated. It is complex because it has many players and is complicated because its institutionalization will require many changes that will be challenging to make. Like many other issues, strengthening EIHP needs a road map, which should consider challenges and address them through effective, harmonized and contextualized strategies. This study aims to develop a road map for enhancing EIHP in Iran based on steps of planning. METHODS: This study consisted of three phases: (1) identifying barriers to EIHP, (2) recognizing interventions and (3) measuring the use of evidence in Iran's health policy-making. A set of activities was established for conducting these, including foresight, systematic review and policy dialogue, to identify the current and potential barriers for the first phase. For the second phase, an evidence synthesis was performed through a scoping review, by searching the websites of benchmark institutions which had good examples of EIHP practices in order to extract and identify interventions, and through eight policy dialogues and two broad opinion polls to contextualize the list of interventions. Simultaneously, two qualitative-quantitative studies were conducted to design and use a tool for assessing EIHP in the third phase. RESULTS: We identified 97 barriers to EIHP and categorized them into three groups, including 35 barriers on the "generation of evidence" (push side), 41 on the "use of evidence" (pull side) and 21 on the "interaction between these two" (exchange side). The list of 41 interventions identified through evidence synthesis and eight policy dialogues was reduced to 32 interventions after two expert opinion polling rounds. These interventions were classified into four main strategies for strengthening (1) the education and training system (6 interventions), (2) the incentives programmes (7 interventions), (3) the structure of policy support organizations (4 interventions) and (4) the enabling processes to support EIHP (15 interventions). CONCLUSION: The policy options developed in the study provide a comprehensive framework to chart a path for strengthening the country's EIHP considering both global practices and the context of Iran. It is recommended that operational plans be prepared for road map interventions, and the necessary resources provided for their implementation. The implementation of the road map will require attention to the principles of good governance, with a focus on transparency and accountability. Video abstract.

Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project.

BACKGROUND: SASHA, which stands for "evidence-informed health policy-making (EIHP)" in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidence-based and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran. METHODS: This was a qualitative study, which was informed by a literature review of pull efforts' capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method. RESULTS: We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context. CONCLUSION: To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.

Policy options to increase motivation for improving evidence-informed health policy-making in Iran.

BACKGROUND: Current incentive programmes are not sufficient to motivate researchers and policy-makers to use research evidence in policy-making. We conducted a mixed-methods design to identify context-based policy options for strengthening motivations among health researchers and policy-makers to support evidence-informed health policy-making (EIHP) in Iran. METHODS: This study was conducted in 2019 in two phases. In the first phase, we conducted a scoping review to extract interventions implemented or proposed to strengthen motivations to support EIHP. Additionally, we employed a comparative case study design for reviewing the performance evaluation (PE) processes in Iran and other selected countries to determine the current individual and organizational incentives to encourage EIHP. In the second phase, we developed two policy briefs and then convened two policy dialogues, with 12 and 8 key informants, respectively, where the briefs were discussed. Data were analysed using manifest content analysis in order to propose contextualized policy options. RESULTS: The policy options identified to motivate health researchers and policy-makers to support EIHP in Iran were: revising the criteria of academic PE; designing appropriate incentive programmes for nonacademic researchers; developing an indicator for the evaluation of research impact on policy-making or health outcomes; revising the current policies of scientific journals; revising existing funding mechanisms; presenting the knowledge translation plan when submitting a research proposal, as a mandatory condition; encouraging and supporting mechanisms for increasing interactions between policy-makers and researchers; and revising some administrative processes (e.g. managers and staff PEs; selection, appointment, and changing managers and reward mechanisms). CONCLUSIONS: The current individual or organizational incentives are mainly focused on publications, rather than encouraging researchers and policy-makers to support EIHP. Relying more on incentives that consider the other impacts of research (e.g. impacts on health system and policy, or health outcomes) is recommended. These incentives may encourage individuals and organizations to be more involved in conducting research evidence, resulting in promoting EIHP. TRIAL REGISTRATION: NA.

How to utilize tacit knowledge in health organizations: An Iranian perspective.

Background: Studies show that 90% of an organization's knowledge is embedded and synthesized in its employees' minds. Thus, when employees leave the organization or their positions change, their valuable knowledge, skills, and experiences are lost, however, if used properly, tacit knowledge can be a source of innovation and competitive advantage in an organization. This study aimed at exploring the methods for sharing and utilizing tacit knowledge in health organizations. Methods: In this study, qualitative approach was adopted to explore ways of utilizing tacit knowledge in health organizations. Tacit knowledge experts, who had published at least one relevant article, conducted 17 individual and 2 group interviews. Purposeful sampling was used to select the participants. Methods for sharing and utilizing tacit knowledge were explored by holding in-depth semi-structured interviews. Data were analyzed using thematic analysis. Results: The results were summarized into 5 categories and 18 themes. The categories included 'identification of different dimensions of organizational knowledge', 'prerequisites of tacit knowledge utilization', 'defining the process of tacit knowledge utilization', 'converting tacit to explicit knowledge', and 'converting tacit to tacit knowledge'. Participants believed that the process of converting tacit to explicit knowledge was a cyclical process that included the understanding the existing situation and detecting knowledge entry points, identifying knowledge items and harvesting them, assessment, codification, and standardization, entry into knowledge repository, and updating. Conclusion: Our results revealed that health organizations need the prerequisites of tacit knowledge sharing to acquire the capacity to utilize this kind of knowledge. Because the themes extracted in this study are rarely used in health organizations, the results will be helpful in guiding the development of knowledge utilization strategies and planning in these organizations.

Impact of Health Research Systems on Under-5 Mortality Rate: A Trend Analysis.

BACKGROUND: Between 1990 and 2015, under-5 mortality rate (U5MR) declined by 53%, from an estimated rate of 91 deaths per 1000 live births to 43, globally. The aim of this study was to determine the share of health research systems in this decrease alongside other influential factors. METHODS: We used random effect regression models including the 'random intercept' and 'random intercept and random slope' models to analyze the panel data from 1990 to 2010. We selected the countries with U5MRs falling between the first and third quartiles in 1990. We used both the total articles (TA) and the number of child-specific articles (CSA) as a proxy of the health research system. In order to account for the impact of other factors, measles vaccination coverage (MVC) (as a proxy of health system performance), gross domestic product (GDP), human development index (HDI), and corruption perception index (CPI) (as proxies of development), were embedded in the model. RESULTS: Among all the models, 'the random intercept and random slope models' had lower residuals. The same variables of CSA, HDI, and time were significant and the coefficient of CSA was estimated at -0.17; meaning, with the addition of every 100 CSA, the rate of U5MR decreased by 17 per 1000 live births. CONCLUSION: Although the number of CSA has contributed to the reduction of U5MR, the amount of its contribution is negligible compared to the countries' development. We recommend entering different types of researches into the model separately in future research and including the variable of 'exchange between knowledge generator and user.'

An assessment of health research impact in Iran.

BACKGROUND: In recent years, Iran has made significant developments in the field of health sciences. However, the question is whether this considerable increase has affected public health. The research budget has always been negligible and unsustainable in developing countries. Hence, using the Payback Framework, we conducted this study to evaluate the impact of health research in Iran. METHODS: By using a cross-sectional method and two-stage stratified cluster sampling, the projects were randomly selected from six medical universities. A questionnaire was designed according to the Payback Framework and completed by the principle investigators of the randomly selected projects. RESULTS: The response rate was 70.4%. Ten point twenty-four percent (10.24%) of the studies had been ordered by a knowledge user organization. The average number of articles published in journals per project was 0.96, and half of the studies had no articles published in Scopus. The results of 12% of the studies had been used in systematic review articles and the same proportion had been utilized in clinical or public health guidelines. The results of 5.3% of the studies had been implemented in the Health Ministry's policymaking. 62% of the studies were expected to affect health directly, 38% of them had been implemented, and among the latter 60% had achieved the expected results. Concerning the economic impacts, the most common expected impact was the reduction of 'days of work missed because of illness or disability' and impact on personal and health system costs. About 36% of these studies had been implemented, and 61% had achieved the expected impact. CONCLUSION: In most aspects, the status of research impact needs improvement. A comparison of Iran's ranking of knowledge creation and knowledge impact in the Global Innovation Index confirms these findings. The most important problems identified were, not conducting research based on national needs, and the lack of implementation of research results.