The problem the initiative set out to address is structural. Health policy and systems research is an interdisciplinary field focused on how health systems shape and implement policy, and it is considered critical to achieving the United Nations Sustainable Development Goals. Unlike clinical practice guidelines, which target care for individual patients, health systems guidelines aim to improve the efficiency, equity and quality of care across an entire system. Yet there is a persistent gap in the availability and quality of such guidelines designed within low- and middle-income countries. As a result, health system stakeholders in these settings often rely on guidelines produced by the World Health Organization or by high-income countries — documents that are frequently not adapted to local needs, contexts or political realities, and that often clash with the priorities of the policymakers expected to implement them.

To close this gap, the WHO Alliance for Health Policy and Systems Research funded six research teams from Colombia, Ghana, India, Mozambique, Nigeria and Zambia through the RAISE portfolio. Each team was required to partner with at least one policymaker or knowledge user — someone positioned to use research results to make informed decisions — to support the practical uptake of the guidelines. The projects were strikingly diverse: home visit guidelines in Ghana, prioritization of WHO guidelines in Colombia, antenatal care guidelines in tribal communities in India, cholera control guidelines in Zambia, a WHO digital intervention guideline for mental health system strengthening in Nigeria, and guidelines to reduce primary care waiting times in Mozambique. Selection followed a rigorous peer review process in which 21 eligible proposals out of 27 submissions were scored by 16 reviewers on team qualifications, methods quality, engagement strategy, impact potential, innovation, feasibility and value for money, with scores ranging from 45.00 to 90.67 before an international adjudication panel made the final choices.

Following a competitive process, the Alliance selected the Knowledge Translation Program at St. Michael’s Hospital–Unity Health Toronto, in partnership with the South African Cochrane Centre and the WHO Ethiopia country office, to act as the Technical Support Centre. Crucially, the centre’s approach was rooted in integrated knowledge translation, a methodology in which the knowledge users themselves — the RAISE researchers, trainees and policymakers — were engaged in designing the content and delivery of the support program. This matters because integrated knowledge translation is known to improve buy-in, increase evidence uptake and reduce research waste. It stands in deliberate contrast to the one-size-fits-all or so-called blueprint models that have dominated past capacity-strengthening efforts, which systematic reviews suggest are often driven by high-income country actors pursuing their own spotlight topics rather than the priorities identified by LMIC actors themselves.

The design process began with a needs assessment. In August 2019, 22 participants from the six countries — 10 men and 12 women, including seven principal investigators, six co-investigators, two knowledge users and six research staff — completed a survey with a 63 percent response rate. All teams reported difficulty identifying their specific methods needs before their projects had begun, but six teams requested rigorous training in evidence-based implementation methods, with additional requests covering barrier and facilitator assessments, stakeholder engagement and qualitative analysis. The resulting program had several components: a mandatory three-day in-person inception workshop in Istanbul, Turkey in September 2019; seven pre-recorded webinars delivered between November 2019 and January 2021 through the Canvas online learning platform; online discussion boards; virtual workshops held from April to July 2021 after the COVID-19 pandemic forced the cancellation of planned in-country visits; and ongoing one-to-one coaching calls and email support from methods experts.

The inception workshop covered the full methodological arc of guideline work: introduction to knowledge translation and health policy and systems research, identifying health system gaps, appraising guideline quality using established tools, prioritizing recommendations through Delphi processes, adapting guidelines, mapping barriers and enablers to implementation strategies, and evaluating implementation quality alongside ethical considerations. Participants rated the workshop a mean 6.30 out of 7, praising the quality and applicability of the content and the opportunity to collaborate across teams. The webinars were also well received, rated between 4 and 5 out of 5, with the session on the AGREE II approach to guideline development, evaluation and adaptation drawing the highest engagement. The on-demand format proved essential for teams working across time zones and, as it turned out, through a pandemic.

The evaluation used a mixed-methods design across three phases, applying the Durlak and Dupre process evaluation framework, validated self-efficacy surveys administered at baseline, 12 and 24 months, and semi-structured exit interviews coded thematically with inter-rater reliability checks. The headline quantitative finding was encouraging but nuanced: mean scores for eight of nine research capacity outcomes improved over time, and the improvement in researchers’ ability to develop evidence-based knowledge translation interventions reached statistical significance between 12 and 24 months (Z = −2.93, p < 0.05). The absence of significant change in the other outcomes was attributed to relatively high baseline scores, the small sample size, staff turnover and pandemic-related disruptions to participation. Twenty-one participants responded at baseline, eleven at 12 months and fourteen at 24 months, with only five completing all three time points — an attrition pattern the authors acknowledge as a limitation that may have introduced response bias.

The qualitative findings may prove the most valuable for the field. Teams identified consistent barriers to adapting and implementing health systems guidelines: competing health system structures and stakeholder interests, lack of available data, poorly maintained field equipment for data collection, and insufficient training among staff tasked with implementation. The COVID-19 pandemic compounded these with project delays, reduced human resources, difficulty engaging stakeholders virtually and community fears that study personnel might spread the virus. Yet the enablers the teams identified form a practical playbook. Partnering with health system stakeholders at project inception rather than at study end sustained engagement and buy-in throughout. Employing a multi-sectoral approach that reached beyond the health sector, allocating financial resources for data collection and partnership strengthening, adopting rapid analysis methods to keep qualitative work moving, and building the competencies of the implementation team — a role the Technical Support Centre itself played — all helped projects survive and, in many cases, thrive.

Participants were candid about the program’s friction points as well. Some felt overwhelmed by the sheer number of supports and activities, struggling to balance capacity-strengthening sessions with actual research implementation. Quarterly monitoring templates were seen as helpful for accountability but time-consuming and repetitive. Knowledge user participation in the evaluation was limited by turnover, heavy workloads and pandemic constraints, and internet connectivity varied enough by country that on-demand resources were not equally accessible — page view statistics likely undercount viewership because teams downloaded webinars and watched them together offline. These honest appraisals are part of what makes the study useful: it documents not just what worked but where the model strained.

The authors conclude that the Technical Support Centre offers a replicable model for supporting health policy and systems research capacity in LMICs, with three defining features: a user-driven approach that lets stakeholders determine priorities and activities, flexibility to adapt supports as needs evolve, and multi-modal delivery that extended benefits beyond the core teams to their networks, trainees and associated institutions. Participants recommended sustaining the network of RAISE teams and connecting WHO regional and in-country offices to keep the collaboration alive. As health systems worldwide continue to grapple with pandemic aftershocks and competing priorities, the study’s central lesson resonates well beyond its six countries: capacity strengthening works best when it is not something done to researchers in low- and middle-income countries, but something built with them, on their terms, from the very beginning.

Subject of Research: Implementation and evaluation of a technical support center for health systems guideline research capacity strengthening in low- and middle-income countries

Article Title: Implementation and evaluation of a technical support center for the Research to Enhance the Adaptation and Implementation of Health Systems Guidelines in LMICs [RAISE] initiative

Article References: Fahim, C., Pratt, J., Purewal, A., Marsot-Shiffman, L., de Launay, K. Q., Baddeliyanage, R., Davenport-Huyer, L., Yangchen, S., Gebregiorgis, A. H., Wiysonge, C. S., Tricco, A. C., Puchalski-Ritchie, L., Pham, B., Tuncalp, O., Langlois, E. V., Marten, R., & Straus, S. E. (2026). Implementation and evaluation of a technical support center for the Research to Enhance the Adaptation and Implementation of Health Systems Guidelines in LMICs [RAISE] initiative. Health Research Policy and Systems, 24(S1), Article 73. https://doi.org/10.1186/s12961-026-01462-9

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01462-9

Keywords: health policy and systems research, capacity strengthening, LMICs, knowledge translation, guideline adaptation, implementation research, WHO Alliance for HPSR, RAISE initiative, technical support centre, integrated knowledge translation, health systems guidelines, COVID-19

Research has increasingly revealed that traditional methods of disseminating findings, which often involve publishing articles in journals and waiting for their impact, fall short in achieving substantial change in practice or policy. In contrast, IKT encourages a collaborative dynamic where researchers and end-users co-develop research questions, methodologies, and dissemination strategies. This involvement not only elevates the relevance of the research being conducted but also fosters a sense of ownership among stakeholders, ultimately leading to better implementation of findings.

At the core of IKT is the recognition that knowledge creation is not a unidirectional process. Instead, it’s an interactive journey that benefits from diverse perspectives. When stakeholders contribute their insights at different stages of the research process, they provide valuable context that might be overlooked by researchers who are deeply entrenched in theoretical frameworks. This co-creation of knowledge enhances the applicability of findings and tailors them to the specific needs of target populations or communities, thereby increasing the likelihood of successful implementation.

Moreover, the realist review conducted by Kothari et al. sheds light on the mechanisms that make IKT effective. By examining existing literature and synthesizing findings, the researchers aim to identify key factors that facilitate successful integrated knowledge translation. One critical factor is the establishment of trust among stakeholders. Trust is foundational in fostering collaborative relationships, where researchers feel confident that their findings will be respectfully interpreted and utilized by practitioners and decision-makers.

The review also highlights that timing and context are crucial elements in IKT. Research must be conducted and disseminated in a manner that is responsive to the evolving challenges faced by health systems. For instance, if a research study uncovers important insights during a public health crisis, timely dissemination of those insights is vital. Furthermore, understanding the specific environment in which a study will be implemented allows researchers to tailor their findings to fit the unique challenges and opportunities present in that context.

Educational initiatives can also play a significant role in the successful implementation of IKT. Training programs designed for both researchers and stakeholders can equip them with the necessary skills and knowledge to effectively engage in this collaborative process. Workshops, webinars, and other forms of education can serve as platforms for dialogue and exchange, allowing all involved parties to express their needs, expectations, and concerns.

Another interesting aspect of IKT that the review touches upon is the role of technology in facilitating knowledge transfer. In our digitally connected world, various platforms can be utilized to enhance communication between researchers and stakeholders. Social media, webinars, and collaborative online spaces provide avenues for real-time interaction, knowledge sharing, and collective problem-solving. By harnessing these technologies, IKT can transcend traditional barriers and promote a more inclusive and participatory approach to research dissemination.

Despite the promise of integrated knowledge translation, its widespread adoption has not been without challenges. One major obstacle is the reluctance of some researchers to involve practitioners and policymakers early in the research process, often due to concerns that their academic rigor may be compromised. However, integrating the voices of these stakeholders does not diminish academic standards; rather, it enriches the research with practical insights and enhances its overall relevance.

The review also emphasizes the ongoing need for evaluating the outcomes of IKT approaches. Establishing clear metrics for success is imperative in order for researchers to understand the effectiveness of their engagement strategies. Such evaluations can provide evidence that may further incentivize researchers to engage in IKT, as well as empower stakeholders to invest in partnerships that yield meaningful health outcomes.

Furthermore, the review addresses the importance of funding mechanisms that support IKT initiatives. Research budgets often prioritize traditional dissemination strategies, leaving little room for innovative approaches that involve multiple stakeholders. Policymakers and funders must recognize the value of IKT and allocate resources to initiatives that prioritize stakeholder engagement and collaborative frameworks.

As our understanding of health and illness becomes increasingly complex, the need for integrated approaches to knowledge translation continues to grow. Moving forward, it is essential that researchers adopt a mindset that embraces inclusivity and collaboration. Only through a collective effort can we harness the full potential of scientific inquiry to inform practices and policies that genuinely benefit our communities.

In conclusion, the realist review by Kothari et al. presents a compelling case for integrated knowledge translation as an indispensable approach to research in health policy and systems. It underscores the need for a paradigm shift in how research is conducted and disseminated, advocating for deeper engagement among all relevant stakeholders. By fostering collaboration, trust, and timely communication, IKT can unlock the potential of research to translate theoretical insights into tangible health benefits for society.

In an age where public health challenges are more prominent than ever, the adoption of integrated knowledge translation can empower communities, enhance health systems, and ultimately pave the way for a healthier future. The journey toward effective knowledge translation may be multifaceted and complex, but the potential rewards are immeasurable, making it a worthy pursuit for researchers and stakeholders alike.

Subject of Research: Integrated Knowledge Translation in Health Research

Article Title: How does integrated knowledge translation work? A realist review.

Article References:

Kothari, A., Sibbald, S.L., McCutcheon, C. et al. How does integrated knowledge translation work? A realist review.
Health Res Policy Sys 23, 102 (2025). https://doi.org/10.1186/s12961-025-01374-0

Image Credits: AI Generated

DOI:

Keywords: Integrated Knowledge Translation, Research, Stakeholder Engagement, Health Policy, Collaboration.