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Inaugural KEYSTONE Course on Health Policy and Systems Research 2015

Health Policy & Systems Research Frameworks – 3

(Knowledge translation, rigour and ethics)

   

 

KEYSTONE

Health Policy & Systems Research Frameworks – 3

(Knowledge translation, rigour and ethics)

Kabir Sheikh

24 Feb 2015 

   

 

KEYSTONE

KNOWLEDGE TRANSLATION IN HPSR

   

 

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The change we want to see

Creation of useful knowledge about the system

Utilization of that

knowledge for real world

improvementsSystems ‘Software’Ideas and interests, 

Relationships and power, Values and norms

Systems ‘Hardware’Human Resources, 

Finance, Medicines & technology, Organizations, 

Services Information systems

SOCIAL, POLITICAL, ECONOMIC CONTEXT

Policy decisions

THE HEALTH SYSTEM

   

 

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But how successful is HPSR in informing real-world change? 

Its hard to say… but there are many gaps

Unfortunately, the current understanding of how research influences change is flawed

• ‘Research to Policy’ implies schism between knowledge and action

• Our thoughts and actions mimic this and reinforce schism

• But, world of knowledge and world of action cannot be neatly separated

   

 

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HPSR can inform health systems change more effectively, by becoming more people-centred

   

 

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Health Systems: people-centred view

1. Health systems are made up of people, ALL of whom make decisions that shape its performance

2. People in the health system are both sources and users of knowledge about the health system

3. Researchers are an integral part of the health system

   

 

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People constitute systems

THE HEALTH SYSTEM

(People who are) sources of knowledge about system

(People who are) users of

knowledge about

system

PLANNERS

FINANCERS, ADMINISTRATORS

ADVOCATES

SERVICE USERS

FRONTLINE PROVIDERS

RESEARCHERSINTERCHANGEABLE CATEGORIES

   

 

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A dialogic practice – unlike some other sciences

THE HEALTH SYSTEM

RESEARCHERS

Promote inclusion of 

excluded voices

Promote reflection 

and learning

Stimulate discourse

Inform policy choices

Reframe debates

Synthesize and analyze knowledge

KNOWLEDGE UTILIZATION

KNOWLEDGE CREATION

OTHER HEALTH POLICY / SYSTEM 

ACTORS

   

 

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NOTES ON RIGOUR AND ETHICS IN HPSR

   

 

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• System: a demonstrable system of collecting, analyzing and interpreting data (RItchie and Spencer 2004)

• Reflexivity: sensitivity to the role of the researcher and the research process in influencing the way the data is collected or interpreted (Mays and Pope 2000)

• Fair dealing: ensuring that views of a particular group or groups are not presented as the sole truth about a situation (Dingwall 1992). 

• Credibility: ensuring “the compatibility of the constructed realities that exist in the minds of respondents, with those that are attributed to them” (Fischer 2003)

Rigour and ethics in HPSR

   

 

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1Q = Broad View of Quality• Does my methodology match my question?• Have I applied parameters appropriate to 

methodology?• Respect for knowledge ecology: What is the existing 

knowledge on this issue in the setting? Beyond PUB-MED? (If poorly explored) Does my research have an exploratory, open-ended component? 

• Policy-mindedness: Have I considered consequences of application of findings in context? Intended and unintended?  For other priorities / sectors?

   

 

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2Q – Qualifying one’s work and position

Research ResearcherHealth System

Have I discussed my interest in and approach in the topic?Have I discussed my value and philosophical base?

Audience: Have I considered who my research is for?

Who has influenced my research? How?Have I discussed my position and power in the

health system?Do I have autonomy of ideas and action?

   

 

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Researcher reflexivity Robson, 2002

• Identify your personal issues in relation to topic

• Clarify your value system

• Identify areas of possible role conflict

• Identify gatekeepers and how they will influence you

• Identify where you are not neutral

   

 

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3Q - Foregrounding Human Qualities• Does the research advance understanding of specific 

human attributes of systems in the setting? Does it go beyond ‘the machine’?

• Does the research address system complexity?

• Does the research acknowledge, if not address, equity, justice and power in the system?

• Have I located the subject in its broader social, political and economic contexts?

   

 

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Ethical concerns in real world research Robson, 2002

• Involving people without consent• Coercing them to participate• Withholding information about true nature of research• Otherwise deceiving participants• Inducing participants to commit acts diminishing of their self-esteem• Violating rights of self-determination• Exposing participants to physical or mental stress• Invading privacy• Withholding benefits from some participants• Not treating participants fairly or with respect

   

 

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Readings• Gilson, L. et al., 2011. Building the Field of Health Policy and Systems 

Research: Social Science Matters. PLoS Med, 8(8), p.e1001079.• Sheikh, K., George, A. & Gilson, L., 2014. People-centred science: 

strengthening the practice of health policy and systems research. Health Research Policy and Systems, 12, p.19.

• Gilson, L. ed., 2012. Health policy and systems research: a methodology reader, Alliance for Health Policy & Systems Research, WHO. 

• Introduction to Health Policy and Systems Research, course presentation, Presentation 5. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014

• Introduction to Health Policy and Systems Research, course presentation, Presentation 6. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014

   

 

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Groupwork

• Facilitated work towards defining health system problem, and thinking about research questions

• Collation of finalized health system problems

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