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Day 3, 2 May 2012

In Uncategorized on May 2, 2012 by Centre for Evidence-based Health Care

This morning we resumed where we left off yesterday: working group feedback. Among the presenters were PhD students who shared their proposals.  They were privileged to get valuable input. Engaging in embedded knowledge translation (see blog post earlier today) increase your chance of having your (PhD) research been taken up in policy and practice. Again there was a lot of discussion which took us to our well-earned tea break.

Prof Lavis then presented a lecture about implementation considerations.  Following the same approach than the past two days, we were introduced to a set of questions to work through within our respective Units/Centres:

  1. What are the potential barriers to the successful implementation of the policy or programme?
  2. What strategies should be considered in order to facilitate the necessary behavioural changes:
    1. Among patients/consumers?
    2. Among healthcare workers?
    3. Within organisations?
    4. Within the health system as a whole?
  3. What evidence is available about the effectiveness of the strategies?
  4. Which stakeholders are likely to actively support the change and which stakeholders are likely to oppose the change?

We were given time before and during the session after lunch to work on addressing these questions.

 

The afternoon session presented by Prof Lavis was titled “Writing evidence briefs for policy and convening policy dialogues”.  In an earlier blog post there is a short summary of what gets addressed in a policy brief and at the end of this post we will come back to that.  A fellow workshop participant, Dr Rhona Mijumbi, explained to me what ‘dialogue’ refers to in the context of policymaking:

  • After the policy brief was written and distributed to various decision-makers, they get together (physically or virtually) to discuss the policy brief.  These discussions then get recorded and written down, forming the ‘dialogue’.

From the presentation I learned that the following are some of the potential features that come out in such a dialogue:

  • Whether it is a priority issue
  • Discussion of the problem
  • Discussion of the different options that were taken up in the evidence brief as possibilities to address the problem
  • Discussion of implementation of the options
  • Discussion around who could do what

 

Prof Lavis shared interim results from a study he and colleagues is doing to assess the visual depiction of policy briefs and dialogues.   What stood out for me is that in the 9 policy briefs from African countries assessed so far, only 47%  used a systematic approach (i.e. they stated what methods they used in order to come up with the brief) and only 27% considered the quality of the evidence that were included in the brief.  I find it interesting that one of the features that varied most between the 9 evidence briefs is whether the brief included recommendations.  Sixty percent of the sampled briefs did not include recommendations.  The main argument for not including recommendations is that recommendations have the risk of being contaminated with authors’ personal views and interests.  I can imagine that the other group will feel that recommendations done by experts but which are based on research evidence ease the task of the final decision-makers.  But I take the stand with the ‘no recommendations’ group.

Interim results for dialogue evaluations (N = 7) showed inter alia that only in 31% decision-makers discussed who should do what.  I would say that on the prospect of uptake and implementation it is important that specific people take responsibility for specific actions and are held accountable for that.

 

Before moving on to preparing a draft one-page summary of our policy briefs, Dr Ongolo-Zogo, Prof Sewankambo and Prof Lavis provided us with good writing tips.  I already shared with you the class exercise that Dr Ongolo-Zogo gave us to do (see blog post titled “2 minutes with your country’s President”).  Prof Sewankambo emphasised the importance of stating what you have to say clearly, but as short as possible.  Busy policymakers do not want to read 40-page documents!  Prof Lavis shared with us the following:

  • Use sign postings to sketch your reader the bigger picture and to point out what issue in this bigger picture are you discussing now.  In practice this relates to using bullet points and numbering to list the steps, options, etc.
  • Write in the active voice, i.e. the subject of the sentence should come before the verb:  “We used purposive sampling to…” instead of “Purposive sampling were used to…”.  Most medical journals nowadays demands writing in the active voice.
  • Paragraphs should start with strong sentences, meaning that by only reading the first sentence the reader should get the core of what this paragraph will be about.  It is known that some professors and academics admit to reading only the first sentence of long documents such as reports and student theses (as they have quite a lot of reading to get through during each day).   If the document is written well, the reader will be able to get the clear picture by only reading the opening sentence of each paragraph.

Prof Lavis concluded with ‘do what you have to do to engage your reader’s attention, and to keep them following’.  The above tips will help you with this.

 

The presentation and third workshop day ended with Prof Lavis providing us with a set of issues that we must work through in our working groups.  The end-product should be a one-page summary of your policy brief.  The issues are:

  1. Sketch the context (including referring to the health system and political system)
  2. State the problem
  3. Provide three options that can address the problem
  4. Provide the available evidence for the different options (for exercise purposes only for one option) regarding the benefits, risks, costs or cost-effectiveness, adaptions required, and views and experiences
  5. Provide the available evidence about one possible implementation strategy, including pointing out the benefits, risks, etc.

We were reminded to employ the good writing tips when preparing this summary policy brief.  Happy writing!

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2 Responses to “Day 3, 2 May 2012”

  1. Thank you dear Anel for sharing your learning, time and experience!

  2. Thanks, Anel. I really like the writing tips, especially number 3 – starting paragraphs with strong sentences. Very important if some readers only read that one sentence!

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