Integrating evidence from research into decision-making for controlling endemic tropical diseases in South East Nigeria: perceptions of producers and users of evidence on barriers and solutions.

BACKGROUND: Endemic tropical diseases (ETDs) constitute a significant health burden in resource-poor countries. Weak integration of research evidence into policy and practice poses a major challenge to the control of ETDs. This study was undertaken to explore barriers to the use of research evidence in decision-making for controlling ETDs. It also highlights potential strategies for addressing these barriers, including the gaps in research generation and utilisation in the context of endemic disease control. METHODS: Information on barriers and solutions to integrating research evidence into decision-making for controlling ETDs in Anambra State, Nigeria, was collected from 68 participants (producers and users of evidence) during structured discussions in a workshop. Participants were purposively selected and allocated to groups based on their current involvement in endemic disease control and expertise. Discussions were facilitated with a topic guide and detailed notes were taken by an appointed recorder. Outputs from the discussions were synthesised and analysed manually. RESULTS: Cross-cutting barriers include a weak research linkage between producers and users of evidence and weak capacity to undertake health policy and systems research (HPSR). Producers of evidence were purported to conceptualise and frame their research questions based on their academic interests and funders' focus without recourse to the decision-makers. Conversely, poor demand for research evidence was reported among users of evidence. Another user barrier identified was moribund research units of the Department of Planning Research and Statistics within the State Ministry of Health. Potential solutions for addressing these barriers include creation of knowledge networks and partnerships between producers and users of evidence, institutionalisation of sustainable capacity-building of both parties in HPSR and revival of State research units. CONCLUSIONS: Evidence-informed decision-making for controlling ETDs is limited by constraints in the interactions of some factors between the users (supply side) and producers (demand side) of evidence. These constraints could be solved through stronger research collaborations, institutionalisation of HPSR, and frameworks for getting research into policy and practice.

Decision-Making in Mental Health Care: Measuring Provider and Supervisor Use of Evidence.

Use of evidence to inform clinical decisions has been shown to improve the quality and effectiveness of services. This study piloted an observational coding system for understanding providers and supervisors' use of evidence in their clinical decision-making. The Action Cycle and Use of Evidence Behavioral Observation Coding System (ACE-BOCS) is based on Graham et al. (Contin Educ Health Prof 26:13-24, 2006) conceptual framework for knowledge management, which articulates a sequence relevant to integrating evidence into decisions and actions, including identifying and selecting a problem and choosing, planning, and rehearsing a solution or action. Using the ACE-BOCS, two coders rated the extensiveness with which evidence was used to inform decisions made in clinical supervision sessions. In these clinical supervision sessions, supervisor-provider dyads discussed cases (N = 30; age range 8-19 years; 80% Latino/a or Hispanic ethnicity) that were identified as potentially being at risk for low treatment engagement in school mental health services. Results indicated that the ACE-BOCS can reliably and validly measure use of evidence and distinguish between strategic and indiscriminate use of evidence. The ACE-BOCS has value and utility for studying use of evidence, as it incorporates multiple actions related to service delivery and has the potential to be adapted for other aspects of mental healthcare decision-making beyond clinical supervision, as well as decision making within fields outside of mental health.

Translating Prevention Research for Evidence-Based Policymaking: Results from the Research-to-Policy Collaboration Pilot.

The importance of basing public policy on sound scientific evidence is increasingly being recognized, yet many barriers continue to slow the translation of prevention research into legislative action. This work reports on the feasibility of a model for overcoming these barriers-known as the Research-to-Policy Collaboration (RPC). The RPC employs strategic legislative needs assessments and a rapid response researcher network to accelerate the translation of research findings into usable knowledge for policymakers. Evaluation findings revealed that this model can successfully mobilize prevention scientists, engage legislative offices, connect policymakers and experts in prevention, and elicit congressional requests for evidence on effective prevention strategies. On average, the RPC model costs $3510 to implement per legislative office. The RPC can elicit requests for evidence at an average cost of $444 per request. The implications of this work, opportunities for optimizing project elements, and plans for future work are discussed. Ultimately, this project signals that the use of scientific knowledge of prevention in policymaking can be greatly augmented through strategic investment in translational efforts.

Harmonisation and standardisation of health sector and programme reviews and evaluations - how can they better inform health policy dialogue?

BACKGROUND: Health sector and programme performance assessments provide a rich source of contextual data directly linked to implementation of programmes and can inform health policy dialogue, planning and resource allocation. In seeking to maximise this opportunity, there are challenges to overcome. A meeting convened by the World Health Organization African Region discussed the strengths, weaknesses and challenges to harmonising and standardising health sector and programme performance assessments, as well as use of evidence from such processes in decision making. This article synthesises the deliberations which emerged from the meeting. Discussing these in light of other literature we propose practical options to standardising health sector and programme performance assessment and improve realisation of using evidence in decision making. DISCUSSION: Use of evidence generated from health sector and programme performance assessments into regular country processes of sectoral monitoring, dialogue and policy modification is crucial. However, this process faces several challenges. Identified challenges were categorised under several themes, namely the weak institutional capacities for monitoring and evaluation in reference to weak health information systems, a lack of tools and skills, and weak accountability mechanisms; desynchronised planning timeframes between programme and overall health sector strategies; inadequate time to undertake comprehensive and good quality performance assessment; weak mechanisms for following up on implementation of recommendations; lack of effective stakeholder participation; and divergent political aspirations. CONCLUSION: The question of what performance assessment is for in a country must be asked and answered clearly if the utility of these processes is to be realised. Standardising programme and sector reviews offers numerable opportunities that need to be maximised. Identified challenges need to be overcome through strengthened Ministry of Health leadership, effective stakeholder engagement and institutionalising follow-up mechanisms for agreed recommendations. In addition, health sector performance assessments need to be institutionalised as part of the accountability mechanism, and they must be planned for and funding secured within annual budget and medium term expenditure frameworks.

Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches.

BACKGROUND: There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings. METHODS: The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals' abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a 'buddying' process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design. RESULTS: In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge. CONCLUSIONS: The collaborative evidence-to-policy approaches underline the importance of iterations and continuity in the engagement of researchers and policymakers/programme managers, in order to account for swift evolutions in health policy planning and implementation. In developing and supporting evidence-to-policy interventions, due consideration should be given to fit-for-purpose approaches, as different needs in policymaking cycles require adapted processes and knowledge. Greater consideration should be provided to approaches embedding the use of research in real-world policymaking, better suited to the complex adaptive nature of health systems.

The adaptation and fidelity tool to support social service practitioners in balancing fidelity and adaptations: Longitudinal, mixed-method evaluation study.

Background: Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs. Methods: The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed. Results: Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach. Conclusion: Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.

This study describes practitioners' perceptions of an intervention that aims to support them in fidelity and adaptation management when working with evidence-based interventions (EBIs). This is an important issue because social services practitioners are expected to use EBIs that seldom fit seamlessly into a specific setting and are often adapted. The practitioners perceived the intervention as relevant for their fidelity and adaptation management and states that it helped them develop a plan and increased their knowledge on the topic. Professionals require practical guiding tools not only to adhere to intervention content but also to balance them with fidelity and adaptation. This proposed intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. We propose that researchers further evaluate this intervention as a potential next step.

An exploratory case study investigating the implementation of a novel knowledge translation strategy in a pandemic: the Pandemic Practice Champion.

BACKGROUND: The clinical Pandemic Practice Champion (PPC) role was created in a large tertiary pediatric hospital as a knowledge translation (KT) strategy for implementing COVID-19 evidence-based knowledge. We aimed to describe the core components of the PPC role, the process of implementing the role, and the factors that hindered or facilitated role implementation. METHODS: An exploratory case study was undertaken. Semi-structured interviews were conducted virtually with stakeholders including PPC, managers, and front-line health care professionals (HCP). A directed approach to qualitative content analysis consistent with the Consolidated Framework for Implementation Research (CFIR) guided the analytic process. Inductive analyses and three stages of thematic synthesis were also conducted. RESULTS: Four PPC, 3 managers, and 6 HCP were interviewed. The core components of the PPC role consisted of (a) acting as knowledge experts and educators, (b) problem-solving for complex patient care issues, (c) conducting crisis management, and (d) acting as a resource to management, HCP, and families. Facilitators for successful implementation included access to external information, a supportive organizational context and culture, dedicated time and resources, and leadership support. Lack of clarity of role definition, insufficient time, pandemic uncertainty and fatigue, inability to change infrastructure, and access to external information hindered implementation. CONCLUSION: The PPC role was successfully implemented within a crisis context. Key barriers (role clarity, time, resources) and facilitators (organizational and leadership support) need to be considered when implementing the PPC role in practice. Future studies are needed to determine the intervention effectiveness of the champion role in changing HCP behavior and health outcomes and further examine implementation processes and mechanisms.

The Science of Lie Detection by Verbal Cues: What Are the Prospects for Its Practical Applicability?

There is agreement among researchers that no simple verbal cues to deception detectable by humans have been demonstrated. This paper examines the evidence for the most prominent current methods, critically considers the prevailing research strategy, proposes a taxonomy of lie detection methods and concludes that two common types of approach are unlikely to succeed. An approach to lie detection is advocated that derives both from psychological science and common sense: When an interviewee produces a statement that contradicts either a previous statement by the same person or other information the authorities have, it will in many cases be obvious to interviewer and interviewee that at least one of the statements is a lie and at the very least the credibility of the witness is reduced. The literature on Strategic Use of Evidence shows that features of interviews that foster such revelatory and self-trapping situations have been established to be a free account and the introduction of independent information late and gradually into the proceedings, and tactics based on these characteristics constitute the best current general advice for practitioners. If any other approach 1 day challenges this status quo, it is likely to be highly efficient automated systems.

Verbal Lie Detection: Its Past, Present and Future.

This article provides an overview of verbal lie detection research. This type of research began in the 1970s with examining the relationship between deception and specific words. We briefly review this initial research. In the late 1980s, Criteria-Based Content Analysis (CBCA) emerged, a veracity assessment tool containing a list of verbal criteria. This was followed by Reality Monitoring (RM) and Scientific Content Analysis (SCAN), two other veracity assessment tools that contain lists of verbal criteria. We discuss their contents, theoretical rationales, and ability to identify truths and lies. We also discuss similarities and differences between CBCA, RM, and SCAN. In the mid 2000s, 'Interviewing to deception' emerged, with the goal of developing specific interview protocols aimed at enhancing or eliciting verbal veracity cues. We outline the four most widely researched interview protocols to date: the Strategic Use of Evidence (SUE), Verifiability Approach (VA), Cognitive Credibility Assessment (CCA), and Reality Interviewing (RI). We briefly discuss the working of these protocols, their theoretical rationales and empirical support, as well as the similarities and differences between them. We conclude this article with elaborating on how neuroscientists can inform and improve verbal lie detection.

When the Evidence Is Incorrect: an Exploration of What Happens When Interviewers Unwittingly Present Inaccurate Information in Interviews with Suspects.

Skillfully presenting evidence/information to suspects is one of the few interviewing techniques that increases the likelihood of guilty suspects providing information or making a confession, without making innocent ones do so as well. It is important that this evidence/information is correct, since deliberately disclosing incorrect evidence poses some risks. Also, in real-life interviews, police interviewers may unwittingly disclose incorrect evidence, for example when a witness was mistaken and provided the police with incorrect information. The present study examined the behavior of fifty police interviewers in interviews with "suspects" of a scripted crime: what is their response when the interviewees try to explain to them that some of the evidence/information just disclosed by them is incorrect? Eleven interviewers responded adaptively (by actively picking up on this new information), 35 responded in a neutral way and four responded maladaptively (by discrediting the interviewee's claim). Experience and a full interview training had a significant negative relationship with adaptiveness. These results indicate that, when preparing and conducting interviews with suspects, greater awareness is needed of the possibility that some of the evidence/information that is to be disclosed could be incorrect, and therefore it is crucial that suspects' responses which suggest such may be the case are taken into account.

Upholding Scientific Duty Amidst Poisonous Disinformation.

Because of a recent politically-biased Lancet editorial, the world's opinion has been directed against the Brazilian government over the rising numbers of COVID-19 cases in the country. This is an example of reporting data without accounting for important covariates. Epidemiological figures should always be corrected for population size. In fact, Brazil is not even on the list of the 10 countries with the highest number of deaths per 100,000 people. Belgium, the United Kingdom, and Spain are the most affected countries in this regard. The disinformation presented by a renowned medical journal has ignited severe criticisms against a Chief-of-State for not promoting a generalized lockdown in a country of continental size. As scientists, we have a duty to stress the caveats of science instead of fueling political attacks, and we should refrain from jumping to uninformed conclusions without considering well-analyzed data. Moreover, while there is no evidence to endorse the efficacy of a generalized lockdown in socioeconomically vulnerable populations, it is undoubtedly associated with severe nationwide adverse effects.

Does the Narrative About the Use of Evidence in Priority Setting Vary Across Health Programs Within the Health Sector: A Case Study of 6 Programs in a Low-Income National Healthcare System.

BACKGROUND: There is a growing body of literature on evidence-informed priority setting. However, the literature on the use of evidence when setting healthcare priorities in low-income countries (LICs), tends to treat the healthcare system (HCS) as a single unit, despite the existence of multiple programs within the HCS, some of which are donor supported. OBJECTIVES: (i) To examine how Ugandan health policy-makers define and attribute value to the different types of evidence; (ii) Based on 6 health programs (HIV, maternal, newborn and child health [MNCH], vaccines, emergencies, health systems, and non- communicable diseases [NCDs]) to discuss the policy-makers' reported access to and use of evidence in priority setting across the 6 health programs in Uganda; and (iii) To identify the challenges related to the access to and use of evidence. METHODS: This was a qualitative study based on in-depth key informant interviews with 60 national level (working in 6 different health programs) and 27 sub-national (district) level policy-makers. Data were analysed used a modified thematic approach. RESULTS: While all respondents recognized and endeavored to use evidence when setting healthcare priorities across the 6 programs and in the districts; more national level respondents tended to value quantitative evidence, while more district level respondents tended to value qualitative evidence from the community. Challenges to the use of evidence included access, quality, and competing values. Respondents from highly politicized and donor supported programs such as vaccines, HIV and maternal neonatal and child health were more likely to report that they had access to, and consistently used evidence in priority setting. CONCLUSION: This study highlighted differences in the perceptions, access to, and use of evidence in priority setting in the different programs within a single HCS. The strong infrastructure in place to support for the access to and use of evidence in the politicized and donor supported programs should be leveraged to support the availability and use of evidence in the relatively under-resourced programs. Further research could explore the impact of unequal availability of evidence on priority setting between health programs within the HCS.

Interviewing Suspects in Denial: On How Different Evidence Disclosure Modes Affect the Elicitation of New Critical Information.

This study examines how different evidence disclosure modes affect the elicitation of new critical information. Two modes derived from the Strategic Use of Evidence (SUE) framework were compared against an early disclosure mode (i.e., the evidence was disclosed at the outset of the interview). Participants (N = 88) performed a mock crime consisting of several actions before they were interviewed as suspects. In both SUE conditions the interviewer elicited and disclosed statement-evidence inconsistencies in two phases after an introductory phase. For the SUE-Confrontation (SUE-C) condition, the interview was introduced in a business-like manner, and the interviewer confronted the suspects with the in/consistencies without giving them a chance to comment on these. For the SUE-Introduce-Present-Respond (SUE-IPR) condition, the interviewer introduced the interview in a non-guilt-presumptive way, presented the in/consistencies and allowed the suspects to comment on these, and then responded to their comments; at all times in a non-judgmental manner. Both SUE conditions generated comparatively more statement-evidence inconsistencies. The SUE-IPR condition resulted in more new critical information about the phase of the crime for which the interviewer lacked information, compared to the Early disclosure condition. A likely explanation for this was that (for the SUE-IPR condition) the interviewer used the inconsistencies to create a fostering interview atmosphere and made the suspects overestimate the interviewer's knowledge about the critical phase of the crime. In essence, this study shows that in order to win the game (i.e., obtaining new critical information), the interviewer needs to keep the suspect in the game (i.e., by not being too confrontational and judgmental).