Translating evidence into better sexual and reproductivehealth: how can we assess, improve andinstitutionalizeresearch use?

Summary
Despite the development of promising methods, strategies and infrastructures, the translation ofevidence about sexual and reproductive health (SRH) into policies and practices and ultimatelybetter health, remains a challenge. We aim to deliver a comprehensive evidence synthesis andtranslation research program through a unique consortium of key research units and networks inthe eastern-Mediterranean, West and Central Africa, the Erasmus University of Rotterdam and the global network of Cochrane, with expertise in systematic reviews, knowledge translation and SRH.
We hypothesize that demand-driven evidence syntheses that are contextualized in deliberativedialogues and supported by locally specific translation-into-action strategies will improve bothpolicies and service delivery in key areas of sexual and reproductive health.
Our research will build upon existing insights and experience in research translation, furtherdevelop promising methods, introduce and apply these methods in new contexts, study theirperformance and make them available for application elsewhere.
The 6 work packages will includeorganizing local deliberative dialogues with policy makers, researchers and stakeholders tocontextualize the results of a systematic review, further developing, transferring and testingthe Contribution Mapping method for assessing research uptake and documenting the evidence -into-action efforts and processes and the uptake of the results. Throughout the program, we willclosely collaborate with several international networks, such as Share-Net, Cochrane and the West-African Health Organization, who will help to disseminate the results and the developedmethods/tools.

Introduction
Organizations in the health sector have attempted for years to more effectively translate researchevidence into better policies and practices and ultimately better health [1]. Systematic reviews arean important tool for synthesizing research evidence. While thousands of high-quality reviews havebeen produced, their use in policy and practice remains a challenge.To facilitate the uptake of research and ensure that policy decisions are guided by the bestavailable evidence, a variety of, ‘knowledge translation’ platforms have been established, such asthe Evidence-informed Policy Network supported by the World Health Organization in countriesacross Africa, Asia and eastern-Mediterranean, and Share-Net International, which focusses onsexual and reproductive health (SRH) and has set up knowledge platforms in Bangladesh, Burundiand Jordan [2].

To support these platforms, various methods and strategies have been developed for settingpriorities, mapping stakeholders, synthesizing and contextualizing evidence and facilitating itstranslation into action [3–7].Some of the most common methods employed are the preparation of ‘evidence briefs’ in whichsystematic reviews and local evidence is synthesized, and the convening of deliberative dialogues’that use such briefs as their primary inputs [8]. Deliberative dialogues are group processes thataim to integrate and interpret scientific and contextual knowledge for the purpose of informingpolicy development. Recent evaluations in several countries indicate that the combination ofevidence-briefs and deliberative dialogues is highly regarded by policy makers and otherstakeholders and leads to intention to act upon the evidence [9].
While these findings are promising, important questions remain about the functioning of theseknowledge platforms and the methods and strategies that they employ.
A first question is what can be done to increasing the likelihood that the process of setting
priorities, synthesizing evidence, generating evidence briefs and convening deliberative dialoguesdoes not just lead to ‘intention to act’, but actually contributes to achieving the intendedchange. While different translation-into-action strategies are available, few studies explore theneed for re-contextualization, and the need for local guideline committees, for instance [10].Studies about the functioning of these strategies in low- and lower-middle income countries are stillscarce (L&LMIC) [11, 12].

A second question is how to efficiently assess the use of evidence and its contribution toaction. Recently, promising methods for assessing research use have been developed, howeverthese have not been used to evaluate the use of evidence synthesis and deliberative dialogues, andhave not been applied in normatively sensitive fields such as sexual and reproductive health [13, 14].

To address these questions we aim to deliver a comprehensive research program that builds uponexisting insights and experience in research translation, further develops promising methods,introduces and applies these methods in new contexts, studies their performance and makes themavailable for application elsewhere.
To deliver this program, we have convened a unique group of key research units in Central andWestern Africa, eastern-Mediterranean and the Netherlands and the global network of Cochrane.Together these partners have unique expertise and experience with evidence synthesis andknowledge translation and the field of SRH. The consortium will include the following partners:Erasmus University Rotterdam (Department of Health Policy and Management), Cochrane Nigeriaand Cochrane Cameroon, and will work closely with Share-Net International (hosted by the RoyalTropical Institute) and its knowledge platform in Jordan. The consortium will also collaborate withthe global Cochrane network and its relevant topic-related review groups and the Cochrane AfricaNetwork. In addition, connections are established with the West African Health Organisation, whichwill play a role in communicating and disseminating the results to other countries in the ECOWASregion.Analytically, our research strategy is inspired by ‘situated interventionism’, an approach to socialscience that aims to find a balance between ‘detached’ and ‘engaged’ scholarship and combinesintervening in practices and furthering scholarly understanding of them [15].

Research hypothesis and objectives of the project
We hypothesize that demand-driven evidence syntheses that are contextualized in deliberativedialogues and supported by locally specific translation-into-action strategies will improve bothpolicies and service delivery in key areas of sexual and reproductive health. This will help fosterbetter access to health services and ultimately help improve the health of girls and women in theinvolved countries and beyond. The program’s objectives are:
To organize local deliberative dialogues around selected SRH issues in Nigeria presented as evidence briefs, contextualizedtogether with stakeholders and translated into specific action plans.To further develop and transfer Contribution Mapping, a method for assessing the uptake ofresearch, and apply it to recent applied sexual and reproductive health related studies.

WP 4: Organizing Deliberative Dialogues on SRH The Deliberative Dialogue approach includes 1) local preparatory consultations toclarify the problem, its causes and ways to address it; preparation and circulation of an evidencebrief based upon the systematic review (before the event); convening of a group of 15-25 policymakers, stakeholders and researchers for an off-the-record dialogue about the SRH issue;preparation and circulation (after the event) of a dialogue summary and post-event briefings todialogue partners.
A particular emphasis will be placed on articulating the implicit or explicit scenarios in whichevidence is assigned a role, and the actions that participants intend to take to realize thesescenarios. We will use observations, interviews and documentanalyses to study these dialogues, scenarios and translation strategies.

WP5: transferring Contribution Mapping to assess research uptake
This work package focusses on optimizing, making transferable and field-testing ContributionMapping, a method for assessing the uptake of research [13, 14]. An important challenge is tomake this method more easily applicable and transferable. We will start with developing anupdated and transferable version of the method. Next, 10 recentlyfinalized, applied SRH studies will be selected. We will follow the steps ofContribution Mapping and assess how these studies were formulated and conducted and whetherand how the results were translated into action. The results of these assessments will be discussedwith relevant stakeholders in a research uptake dialogue. After a joint reflection, a final version ofContribution Mapping, with a protocol for the research uptake dialogue will be generated.

WP6: Monitoring the evidence-to-action processes and uptake of the results. We will tracein each country the entire process from priority setting, synthesis and contextualization, translationefforts and uptake in policy and practice. In addition, we will identify structures and dynamics inthe local context that shape these processes. We will analyse and compare process narratives,which will allow us to gain insight into the functioning and influence of the translation strategies inthe context.

References
1. Hanney SR, González-Block M a, Buxton MJ, Kogan M: The utilisation of health research inpolicy-making: concepts, examples and methods of assessment. Heal Res policy Syst 2003,1:1–28.
2. Hamid M, Bustamante-Manaog T, Truong VD, Akkhavong K, Fu H, Ma Y, Zhong X, Salmela R,Panisset U, Pang T: EVIPNet: translating the spirit of Mexico. Lancet 2005, 366:1758–60.
3. Lavis JN, Lomas J, Hamid M, Sewankambo NK: Assessing country-level efforts to link
research to action. Bull World Health Organ 2006, 84:620–8.
4. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE: Knowledge translation of researchfindings. Implement Sci 2012, 7:50.
5. Wehrens R, Bekker M, Bal R: Hybrid Management Configurations in Joint Research. SciTechnol Human Values 2014, 39:6–41.
6. Viergever RF, Olifson S, Ghaffar A, Terry RF: A checklist for health research priority
setting: nine common themes of good practice. Heal Res policy Syst 2010, 8:36.
7. Uneke CJ, Ndukwe CD, Ezeoha AA, Uro-Chukwu HC, Ezeonu CT: Implementation of a healthpolicy advisory committee as a knowledge translation platform: the Nigeria experience.Int J Heal Policy Manag 2015, 4:161–168.
8. Boyko JA, Lavis JN, Abelson J, Dobbins M, Carter N: Deliberative dialogues as a mechanismfor knowledge translation and exchange in health systems decision-making. Soc Sci Med2012, 75:1938–1945.
9. Moat KA, Lavis JN, Clancy SJ, El-Jardali F, Pantoja T: Evidence briefs and deliberative
dialogues: Perceptions and intentions to act on what was learnt. Bull World Health Organ2014, 92:20–8.
10. Burchett HED, Dobrow MJ, Lavis JN, Mayhew SH: The applicability and transferability ofpublic health research from one setting to another: a survey of maternal healthresearchers. Glob Health Promot 2013, 20(July 2011):16–24.
11. Puchalski Ritchie LM, Khan S, Moore JE, Timmings C, van Lettow M, Vogel JP, Khan DN,
Mbaruku G, Mrisho M, Mugerwa K, Uka S, G lmezoglu AM, Straus SE: Low- and middle-incomecountries face many common barriers to implementation of maternal health evidenceproducts. J Clin Epidemiol 2016, 76:229–237.
12. Ako-Arrey DE, Brouwers MC, Lavis JN, Giacomini MK: Health systems guidance appraisal-acritical interpretive synthesis. Implement Sci 2016, 11:9.
13. Kok MO, Schuit AJ: Contribution mapping: a method for mapping the contribution ofresearch to enhance its impact. Health Res Policy Syst 2012, 10:21.
14. Kok MO, Gyapong J, Wolffers I, Ofori-Adjei D, Ruitenberg J: Which health research getsused and why? An empirical analysis of 30 cases. Heal Res policy Syst 2016, 14.
15. Zuiderent-Jerak T: Situated Intervention: Sociological Experiments in Health Care. Cambridge,MA: The MIT Press; 2015.