IHPSR wrap-up
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This document provides an introduction to health policy and systems research (HPSR). It discusses how HPSR seeks to understand how societies organize themselves to achieve health goals and how different actors interact in the policy and implementation process. It emphasizes that HPSR takes an interdisciplinary approach and provides a comprehensive picture of how health systems respond to policies and vice versa. The document outlines the four steps of HPSR research and highlights issues like ensuring substantive relevance, valuing multiple perspectives, research rigor, and ethics. It discusses threshold concepts in HPSR and important skills like framing questions and identifying appropriate study designs.
IHPSR wrap-up
- 1. IHPSR wrap-up IHPSR Presentation 10 www.hpsa-africa.org @hpsa_africa www.slideshare.net/hpsa_africa Introduction to Health Policy and Systems Research
- 2. HPSR ‘seeks to understand and improve how societies organize themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes to contribute to policy outcomes. By nature, it is interdisciplinary, a blend of economics, sociology, anthropology, political science, public health and epidemiology that together draw a comprehensive picture of how health systems respond and adapt to health policies, and how health policies can shape − and be shaped by − health systems and the broader determinants of health’. Gilson (ed.), 2012
- 3. Being systematic, principled, ethical • The four steps of HPSR Step 1: Identify the research focus and questions Step 2: Design the study Step 3: Ensure research quality and rigour Step 4: Apply ethical principles
- 4. Research questions Purpose/s Theory Methods Sampling strategy Research design Study design Substantive relevance Rigour Ethics Practicalities Critical appraisal Generalisability and claims Valuing multiple perspectives Informing policy and practice
- 5. Issues and questions: Taking a systems perspective • Programme as tracer for policy/system issue, not object/focus OR • A systems issue (motivation, accountability ...) • Includes research on or of policy – addresses politics of health systems and health systems strengthening • Includes concern for global and international issues
- 6. Substantively relevant • Has potential to inform policy and practice in particular context – How identified? – Recognise various forms of influence! • Does not duplicate prior work – Under-researched area – Even where an issue already investigated, new angle, new place – Shows awareness of what gone before, what can be built on • Valuable/Important relative to other possible issues
- 7. Valuing multiple perspectives • Researcher & Practitioner & User • Disciplinary • In question • In design
- 8. Sticky points for multidisciplinary HPSR • Questions of interest and study designs • Generalisability approach and sampling criteria • Rigour and analysis strategy
- 9. Being rigorous/trustworthy • Research design fit for purpose – appropriate for topic, given its ‘nature’ and past work
- 10. Rigorous/trustworthy research design • R/Question appropriately and fully operationalised – Concepts defined > use of conceptual framework; programme/intervention theory outlined – Study design, given ‘nature’ of topic and past work – Phasing of work (mixed methods plus) – Duration of research – Appropriate sampling (e.g. case study) – Appropriate data proposed (types, people) – Data collection details – Data analysis approaches (given purpose, data and generalisability approach)
- 11. Ten questionable practices of 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
- 12. Specific ethical issues in HPSR • Substantive relevance • Who determines the questions? • Gaining consent and relative power: – from policy-makers to marginalised groups • Anonymity and small sample sizes • Acting ethically towards field workers • Recognising researchers’ privilege • Generating social value: Where does the researcher’s role end?
- 13. • Working towards being embedded – across the ebbs and flows of the policy process …
- 14. Threshold concepts HPSR A. HPSR is intentionally multidisciplinary and embraces multiple perspectives. B. Substantive relevance is critical for the development of sound and ethical HPSR questions. C. Phenomena that cannot be quantitatively measured are important to health policy and systems and can be researched. D. The precise wording of HPSR questions is important. E. Health care services/interventions/programmes provide a lens through which to investigate policy and systems issues in HPSR (i.e. they are not the primary focus of the research). F. Exploratory and explanatory research (that deepens our understanding of health policy and system phenomena) offers policy-relevant insight.
- 15. Threshold concepts, HPSR (continued) G. Flexible study designs are the most appropriate design for some HPSR phenomena. H. Good (i.e. sound) research design requires that the study design fits the question, issues and purpose. I. There is no hierarchy of study design in terms of quality and rigour in HPSR; and quality and rigour are always important. J. Researcher curiosity, attentiveness and reflexivity are the basis of rigorous HPSR. K. Analytic generalisability is legitimate. L. Theoretical ideas and concepts have value (as a guide for study design and analysis in HPSR). M. The researcher is the primary research instrument. N. Ethical HPSR requires the responsible use of power and accountability. O. The HPSR researcher is a policy activist.
- 16. Threshold skills for HPSR (that are addressed in this course) 1. Recognising where the boundaries of HPSR lie and the types of issues that are addressed (what is HPSR). 2. Conducting a literature review (becoming familiar with the field). 3. Framing various types of HPSR research questions. 4. The ability to identify a range of research strategies and study designs. 5. Knowing ‘the’ appropriate research strategy and study designs to use to address different types of HPSR issues and questions. 6. Critical analysis (knowing what is rigorous and relevant). 7. Being familiar/comfortable with different perspectives, and able to work with and across them. 8. Facilitation of small groups.
- 17. Copyright Funding You are free: To Share – to copy, distribute and transmit the work To Remix – to adapt the work Under the following conditions: Attribution You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work). Non-commercial You may not use this work for commercial purposes. Share Alike If you alter, transform, or build upon this work, you may distribute the resulting work but only under the same or similar license to this one. Other conditions For any reuse or distribution, you must make clear to others the license terms of this work. Nothing in this license impairs or restricts the authors’ moral rights. Nothing in this license impairs or restricts the rights of authors whose work is referenced in this document. Cited works used in this document must be cited following usual academic conventions. Citation of this work must follow normal academic conventions. Suggested citation: Introduction to Health Policy and Systems Research, course presentation, Presentation 10. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014, www.hpsa-africa.org www.slideshare.net/hpsa_africa This document is an output from a project funded by the European Commission (EC) FP7-Africa (Grant no. 265482). The views expressed are not necessarily those of the EC.
- 18. The CHEPSAA partners University of Dar Es Salaam Institute of Development Studies University of the Witwatersrand Centre for Health Policy University of Ghana School of Public Health, Department of Health Policy, Planning and Management University of Leeds Nuffield Centre for International Health and Development University of Nigeria Enugu Health Policy Research Group & the Department of Health Administration and Management London School of Hygiene and Tropical Medicine Health Economics and Systems Analysis Group, Depart of Global Health & Dev. Great Lakes University of Kisumu Tropical Institute of Community Health and Development Karolinska Institutet Health Systems and Policy Group, Department of Public Health Sciences University of Cape Town Health Policy and Systems Programme, Health Economics Unit Swiss Tropical and Public Health Institute Health Systems Research Group University of the Western Cape School of Public Health