The target of the intervention was Conitec, Brazil’s National Committee for Health Technology Incorporation, the body that advises on which technologies enter the unified public health system known as SUS. Conitec’s public consultations are a formal channel through which patients and citizens can voice their perspectives before reimbursement and coverage decisions are made. International bodies, including the International Network of Agencies for Health Technology Assessment, treat such participation as essential to legitimate, equitable, patient-centered policy. Yet the researchers found that meaningful engagement was constrained by three intertwined barriers: low health literacy, reliance on technical language in consultation materials, and a shortage of accessible educational content that would explain what health technology assessment, or HTA, actually is. The team framed these barriers as a structural weakness, because a learning health system, one that continuously improves by cycling evidence into practice, requires an informed public as a core enabling condition rather than an optional courtesy.

To address the problem, the researchers turned to knowledge translation, the discipline concerned with moving evidence from those who produce it to those who need to use it. They organized their project around the knowledge-to-action framework, a widely used model that treats implementation as a structured process rather than a single act of communication. The framework guided the work through seven phases between 2022 and 2025, beginning with the identification of priority topics and ending with the deployment and evaluation of the finished products. Crucially, the team did not decide on its own what the public needed to learn. Their first substantive step was a needs assessment survey of patient and civil society representatives, the people with the most direct stake in HTA decisions and the clearest sense of what their communities find opaque.

That survey, completed by sixteen participants, generated five thematic areas that became the backbone of the curriculum. From these, the team built ten educational video modules, each adapted from technical HTA content into plain language. The adaptation process was deliberately conservative in its epistemics: content was developed by researchers, reviewed internally by HTA specialists, and then subjected to a structured pilot evaluation with a prespecified acceptability threshold of 70 percent across five domains, including clarity, relevance, and usefulness. Setting a numeric threshold in advance matters, because it converted what is often a vague aspiration, making content comprehensible, into a testable criterion. The pilot collected 430 responses, and the acceptance rates across the five domains ranged from 75 to 97 percent, clearing the bar in every case.

The most scientifically interesting part of the study is what happened next. User feedback did not simply confirm the content; it reshaped it. Respondents’ comments directly triggered revisions, including the addition of Brazilian Sign Language interpretation, the creation of a glossary, and adjustments to the format of the materials. In other words, the intervention was built on a feedback loop in which the intended audience functioned as a source of validation and improvement rather than a passive recipient. This iterative design mirrors the logic of the learning health systems the project is meant to support: the educational platform itself learned from its users between iterations. The authors present this cycle of development, evaluation, and revision as the operational core of their knowledge translation approach, distinguishing it from one-off awareness campaigns that produce content once and hope it lands.

The delivery infrastructure consisted of two complementary channels. The first was a free, gamified virtual learning environment hosting the animated videos and interactive activities, an architecture chosen to lower the motivational cost of learning about an unfamiliar technical field. The second was a multichannel digital outreach strategy spanning social media platforms. The virtual learning environment recorded 4,355 accesses over the study period, with module completion rates ranging from 11.1 to 42.9 percent. Those completion figures are candidly reported and fall well short of universal engagement, a reminder that access to an educational resource is not the same as sustained use of it. Even so, several thousand citizens engaged with material that previously existed in no public form at all, and every piece of content remained freely accessible after the project’s funding ended, extending its useful life beyond the grant period.

The social media results, by contrast, show how sharply audience growth can respond to investment. The project’s Instagram account grew by 1,200 percent, from 576 to 7,514 followers, following a paid promotional campaign, with individual reels reaching as many as 47,000 views. LinkedIn accumulated 1,778 followers, and the project’s YouTube channel drew more than 5,000 views. The contrast between organic and paid reach is itself a finding with policy implications: in competitive digital ecosystems, technically valuable public-interest content does not automatically find its audience. For health agencies and research institutes operating in low- and middle-income countries, the lesson is that dissemination budgets are not decorative extras but structural components of participation infrastructure. A consultation process can only be as inclusive as the number of people who know it exists and understand what is being asked of them.

The study was conducted under Brazilian regulatory standards for human subjects research, approved by the Research Ethics Committee of the National Institute of Cardiology, with informed consent obtained from all participants, and it was funded by Brazil’s National Council for Scientific and Technological Development with no funder involvement in design, analysis, or publication decisions. These procedural details reinforce the study’s central claim, which is deliberately modest and replicable at once. The authors do not claim that the project transformed Conitec’s consultations or measured a downstream change in actual public submissions. What they demonstrate is feasibility and acceptability: that a knowledge-translation-informed intervention can be built, tested against prespecified criteria, refined through documented user feedback, and distributed at scale within a public institution’s constraints. Acceptance rates of 75 to 97 percent across 430 evaluators, combined with a twelvefold social media expansion, constitute measurable evidence on both counts.

The broader significance lies in the argument the data are marshaled to support. Patient and public participation in HTA is frequently endorsed in principle and underdelivered in practice, particularly in low- and middle-income countries where consultation infrastructure tends to be thin. The Participa SUS-ATS results suggest a concrete, transferable template: survey the affected community, adapt technical content into validated plain-language modules, deploy through a free gamified platform alongside targeted digital outreach, and build revision cycles from user feedback into the design from the start. Because the knowledge-to-action framework is generic and the materials are openly accessible, the model could be adapted by other national HTA agencies without starting from zero. If participation is indeed a structural enabling condition for learning health systems, then the unglamorous work of making a committee’s work comprehensible, one animated video and one glossary at a time, may turn out to be among the most consequential investments a health system can make. The Brazilian team has provided the first carefully documented demonstration that this work is feasible, acceptable to its audience, and capable of finding that audience when given the means.

Subject of Research: Knowledge translation intervention to strengthen patient and public participation in health technology assessment in Brazil

Article Title: Operationalizing knowledge translation to strengthen patient and public participation in health technology assessment: a multicomponent intervention to support enabling environments for learning health systems in Brazil

Article References: Braga, A., Dias, Q., Spada, D., Evangelista, J. R., Correia, M., & Santos, M. (2026). Operationalizing knowledge translation to strengthen patient and public participation in health technology assessment: a multicomponent intervention to support enabling environments for learning health systems in Brazil. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01530-0

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01530-0

Keywords: knowledge translation, health technology assessment, patient participation, public engagement, learning health systems, Brazil, Conitec, health literacy, capacity building, health policy, virtual learning environment, low- and middle-income countries

RESSA was developed by the Global Commission on Evidence to Address Societal Challenges, an international initiative convened to strengthen the use of evidence in decision-making at every level of government. The tool is not designed to evaluate a single policy decision. Instead, it assesses the entire evidence support system of a country or jurisdiction: the institutions, networks, processes and products that together determine whether policymakers have timely access to high-quality research when they need it. As evidence-informed policy-making has gained prominence worldwide, the commission and its partners have argued that such systems deserve the same scrutiny as the policies they inform. Until now, however, systematic process evaluations of system-level assessment methodologies have been scarce, particularly in the complex, politically charged environments where they are most needed.

The Irish assessment provided an ideal test case. It involved an unusually broad coalition of national institutions: the Department of Health, the Health Research Board, Evidence Synthesis Ireland, Cochrane Ireland and the Global Commission on Evidence itself. Researchers led from the University of Galway, including Marie Tierney and Declan Devane, conducted the process evaluation alongside the RESSA itself, asking three linked questions. Was the assessment delivered as intended? Did the stakeholders involved find it acceptable? And what did their experiences reveal about how such assessments should be run in future?

Methodologically, the study was a qualitative process evaluation with quantitative elements, framed by the Medical Research Council’s guidance on evaluating complex interventions. Three participant groups were recruited: key informants from the Department of Health and affiliated organisations, members of the project’s Oversight Group, and the RESSA lead who carried out the assessment. Delivery fidelity was measured in two ways. The research team qualitatively explored the RESSA lead’s preparedness for the task, and quantitatively compared the delivered assessment against the published RESSA protocol, checking whether each specified component had been implemented as written. Qualitative interviews were analysed using a hybrid inductive-deductive thematic approach anchored in pre-specified process evaluation domains, while acceptability findings were interpreted through the Theoretical Framework of Acceptability, a validated model covering constructs such as affective attitude, burden, perceived effectiveness and ethicality. Reporting followed the Consolidated Criteria for Reporting Qualitative Research, and the study received ethics approval from the University of Galway Research Ethics Committee in March 2024, with written informed consent obtained from all participants.

The headline result is striking in its simplicity. The RESSA was delivered with complete fidelity: all eight protocol components were implemented exactly as specified, a score of eight out of eight, or one hundred percent. In the world of complex interventions, where implementation drift is the norm rather than the exception, such perfect adherence to a published protocol is noteworthy. It suggests that the RESSA methodology, despite operating in the messy reality of a national policy environment, is specified clearly enough to be reproduced faithfully by a trained assessor. Equally important, the assessment proved acceptable to stakeholders across all three participant groups, indicating that the process did not feel extractive, opaque or burdensome to those whose system was being examined.

Beneath those headline findings, however, the qualitative analysis surfaced three cross-cutting themes that the researchers argue are essential to understanding how such assessments actually succeed. The first concerns internal advocacy and governance structures. Stakeholders’ engagement with the assessment, its implementation and its potential impact were shaped by whether champions inside the organisations involved could advocate for the process and whether governance arrangements gave it legitimacy and traction. An assessment of an evidence system, in other words, is not a neutral technical exercise dropped into a vacuum; it lands in an institutional landscape where sponsorship, authority and accountability determine whether its findings are absorbed or ignored.

The second theme centred on communication. Clear, sustained communication supported stakeholder understanding of what the RESSA was and why it was being conducted, fostered engagement throughout the process, and influenced the assessment’s potential to drive change. This may sound obvious, but in practice system-level assessments involve many actors with different expectations, vocabularies and levels of familiarity with evidence terminology. Misalignment at any point can erode trust and blunt the assessment’s usefulness. The third theme concerned relational dynamics: the patterns of trust, collaboration and interpersonal connection among stakeholders were described as central to successful implementation. Where relationships were strong, the assessment could surface candid information about how the evidence system worked; where they were fragile, the process risked becoming superficial.

Taken together, these findings carry a message that extends well beyond Ireland. The researchers conclude that the RESSA can be implemented with high delivery fidelity and in a manner acceptable to stakeholders within complex policy environments, which is precisely the context in which such tools must function. But they also conclude that successful implementation depends not only on methodological fidelity. Organisational context, governance structures, communication practices and stakeholder relationships all shape whether an assessment of an evidence support system delivers meaningful insight. For countries considering a RESSA, the practical implication is that preparation should extend beyond training the assessor and assembling documents: it should include mapping internal advocates, establishing clear governance, and investing deliberately in communication and relationship-building from the outset.

The study also fills a methodological gap. Process evaluation is well established for clinical and public health interventions, but it has rarely been applied to system-level assessment methodologies in the policy sphere. By demonstrating that fidelity can be measured against a published protocol, that acceptability can be systematically assessed using an established theoretical framework, and that qualitative themes can be rigorously derived and reported, the Irish team has provided a template that others can adapt. The authors offer practical recommendations to support the adaptation of RESSA-style assessments across diverse policy settings, from ministries of health in high-income countries to evidence units in low- and middle-income contexts where the Global Commission on Evidence has focused much of its attention.

There are, of course, limits to what a single process evaluation can establish. The study examined one assessment in one jurisdiction, with a small number of participant groups, and the findings about relationships and governance are context-dependent by nature. The research team was also transparent about competing interests: several authors are employed by the Health Research Board, which funded the work, and by the Department of Health, although the design, analysis and decision to publish were led independently by the research team. Even so, the study’s core contribution stands. It shows that the invisible infrastructure connecting research to health policy can be examined systematically, and that when it is, the most important variables may be human ones. As governments worldwide commit to evidence-informed decision-making, the Irish experience suggests that the tools to audit that commitment now exist, and that using them well requires as much attention to trust and communication as to protocol and method.

Subject of Research: Process evaluation of the RESSA methodology for assessing evidence support systems in Irish health policy-making

Article Title: Process evaluation of the Rapid Evidence Support System Assessment (RESSA) methodology for health policy-making in Ireland

Article References: Tierney, M., Byrne, P., Whelan, B., Burke, N. N., Creely, C., Gill, C., Horgan, M., Lavis, J. N., Maguire, T., O’Neill, J., Toomey, E., Waddell, K., & Devane, D. (2026). Process evaluation of the Rapid Evidence Support System Assessment (RESSA) methodology for health policy-making in Ireland. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01533-x

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01533-x

Keywords: RESSA, evidence-informed policy-making, health policy, Ireland, process evaluation, delivery fidelity, acceptability, knowledge translation, evidence support systems, Global Commission on Evidence, Health Research Board, governance

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

The research, conducted by Patrick Mapulanga of the Kamuzu University of Health Sciences Library in Lilongwe, set out to answer a deceptively simple question: how do health researchers in Malawi actually communicate their findings, and why does that communication so frequently fall short of influencing policy? The study was carried out between June and August 2021, at the height of the COVID-19 pandemic, a period that amplified both the importance and the complexity of getting health evidence into the hands of decision-makers quickly and accurately. Rather than treating communication as an afterthought to research, the study places it at the center of the scientific enterprise, arguing that findings locked in journals or conference slides are, from a public health perspective, findings that do not exist.

Methodologically, the study took the form of a cross-sectional survey administered to health researchers at Kamuzu University of Health Sciences. Participants completed a structured, self-administered questionnaire built around a 5-point Likert scale, a standard instrument for measuring attitudes and perceptions along a continuum from strong disagreement to strong agreement. The questionnaire probed three interlocking domains: researchers’ current communication practices, the challenges they face in disseminating their work, and their engagement with decision-making platforms, most notably the technical working groups, or TWGs, that operate within Malawi’s health policy apparatus. Descriptive and inferential statistics were then applied to map the relationships between research institutions and these policy-facing bodies, producing a quantitative portrait of where the pipeline from evidence to action runs smoothly and where it springs leaks.

The results reveal a system that is simultaneously promising and profoundly dysfunctional. On the encouraging side, the technical working groups demonstrated statistically significant awareness of new health research evidence, with a P value of 0.007, and were actively engaged in evidence-based decision-making, reflected by a P value of 0.013. In plain terms, these groups are not asleep at the switch; they are paying attention to the research landscape and trying to incorporate what they learn into policy deliberations. This is a crucial finding because it locates the bottleneck not in the willingness of policymakers to listen, but in the machinery that connects researchers to those listeners.

That machinery, the study found, is badly misaligned. Health researchers reported limited involvement in policy engagement activities and persistent constraints in disseminating their findings within policy-relevant timelines. The problem is partly structural: policy windows open and close on legislative and budgetary calendars, while research projects run on academic timelines that rarely coincide with either. A study that takes two years to complete and another year to publish may arrive at a ministry’s doorstep just as the relevant policy debate has concluded, its findings rendered moot by decisions already made. The pandemic made these delays especially costly, as evolving evidence about transmission, treatment, and vaccination needed to inform decisions in weeks, not years.

The data also illuminate a division of labor that works well at the start of the research process and poorly at the end. Universities, research centers, and institutes were significantly involved in formulating study objectives, with a P value of 0.005, in developing research methods, at P = 0.029, and in analyzing results, at P = 0.010. Yet these same institutions struggled to tailor research outputs for policy use. In other words, Malawian research institutions excel at producing science but falter at translating it. A rigorous epidemiological analysis, dense with confidence intervals and methodological caveats, is not the document a district health officer needs when deciding how to allocate a limited vaccine supply. The absence of intermediaries, such as knowledge translation specialists, policy briefs, or structured briefing sessions, means that valuable findings often die in translation, or more accurately, never undergo translation at all.

Between the technical working groups and the research community, the study identified a cluster of persistent barriers: misaligned priorities, differing communication styles, time constraints, and institutional bureaucracy. Each of these deserves attention. Misaligned priorities arise when researchers pursue questions of academic interest while policymakers need answers to operational problems; the two communities rarely sit down together to negotiate a shared agenda. Differing communication styles reflect deep professional cultures: researchers value nuance, hedging, and completeness, while policymakers value brevity, clarity, and actionable recommendations. Time constraints compound both problems, as neither researchers nor TWG members have slack in their schedules for the slow, relational work of building trust and mutual understanding. Institutional bureaucracy, finally, adds layers of approval and protocol that can delay the release of findings until their policy moment has passed.

The study’s most consequential contribution is the framework it develops in response to these findings. Rather than importing a generic communication model from high-income settings, Mapulanga used the survey insights to construct a context-specific, evidence-based communication framework tailored to Malawi’s institutional landscape. The framework is designed to enhance alignment between research production and evidence dissemination, embedding communication considerations earlier in the research cycle and strengthening the channels through which findings flow to technical working groups and, ultimately, to the Ministry of Health. By supporting collaboration between researchers and TWGs, the framework aims to promote evidence-informed policy-making and, in the longer arc, to improve population health outcomes across Malawi.

The broader significance of the work extends well beyond one country’s borders. Malawi’s experience mirrors that of many low- and middle-income countries, where research capacity has grown substantially in recent decades but the systems for moving evidence into policy have not kept pace. The national research agenda, which the new framework is explicitly designed to support, depends on this connective tissue. Without it, investments in research yield publications rather than policies, and the populations who ultimately fund and participate in research see few returns. The study suggests that the fix is not simply more training for researchers or more demands on policymakers, but a deliberate redesign of the interfaces between them, with dedicated structures, timelines, and formats that respect the operational realities of both worlds.

Ethical rigor underpinned the research throughout. Approval was obtained from the University of Cape Town Library and Information Studies Center, the Malawi National Commission for Science and Technology, and the institutions involved, with informed consent secured from all participants. Fourth-year MBBS students assisted with data collection, distributing questionnaires both online and in print without remuneration to participants. The author declares no conflicts of interest, and the article is published open access under a Creative Commons license, ensuring that the findings, fittingly for a study about dissemination, are themselves freely available to the researchers, policymakers, and practitioners who can use them. As health systems worldwide continue to grapple with infodemics, misinformation, and the slow erosion of public trust in science, Malawi’s framework offers a grounded reminder that evidence communication is not a soft skill appended to research, but a core discipline that determines whether science serves society.

Subject of Research: Development of an evidence-based framework for communicating health research evidence to policymakers in Malawi

Article Title: Moving toward evidence-based research framework for communicating health research evidence in Malawi

Article References: Moving toward evidence-based research framework for communicating health research evidence in Malawi. (n.d.). https://doi.org/10.1186/s12961-026-01534-w

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01534-w

Keywords: health research, research communication, knowledge translation, evidence-based policy, Malawi, technical working groups, evidence dissemination, health policy, COVID-19, Kamuzu University of Health Sciences, policy making, low- and middle-income countries

The study was conducted as the second, qualitative phase of a sequential explanatory mixed-methods project. Twenty-one experts were recruited through snowball sampling from eleven Type I medical universities, the highest tier of Iran’s medical education system. The participant pool deliberately spanned the organizational hierarchy: faculty members who produce research, senior administrators who allocate resources and set strategy, and knowledge translation specialists who sit at the interface between the two worlds. Between February and August 2023, the researchers conducted semistructured interviews lasting between forty-five and ninety minutes, allowing participants to describe in their own words what helps and what hinders the movement of evidence into policy and practice within their institutions.

Analysis followed the inductive content analysis framework of Elo and Kyngäs, proceeding through open coding, categorization, and abstraction with the qualitative analysis software ATLAS.ti. Rigor was addressed through several established safeguards: member checking, in which participants reviewed the researchers’ interpretations; peer debriefing among the analytic team; and audit trails documenting how codes and categories evolved. Inter-coder reliability was quantified using Cohen’s Kappa, reaching a value of 0.82, which is conventionally interpreted as almost perfect agreement between independent coders. The study was conducted in accordance with the Declaration of Helsinki, with ethics approval from the Kerman University of Medical Sciences Ethics Committee and written informed consent from all participants.

From this analysis, five overarching dimensions of organizational readiness for knowledge translation emerged. The first is organizational culture and research climate, encompassing the norms, values, and informal expectations that determine whether evidence is genuinely valued or merely tolerated. The second is human resource development and training, the formal and informal structures through which staff acquire the skills to find, appraise, summarize, and communicate research findings. The third is knowledge production and sharing, the pipelines through which new evidence is generated, stored, and circulated inside and beyond the institution. The fourth is evidence-based policy and strategy, the extent to which institutional decision-making processes are explicitly designed around research findings. The fifth, and for the authors the most consequential, is monitoring and evaluation mechanisms, the systems that track whether knowledge translation efforts are actually functioning.

What elevates this study beyond a conventional checklist of readiness factors is its second-order analysis of how these five dimensions relate to one another. Rather than treating monitoring and evaluation as the final step of an implementation sequence, the researchers found that feedback loops function as the connective tissue of the entire system. In their formulation, feedback mechanisms act as the nervous system of knowledge translation readiness, continuously sensing what is happening across culture, training, production, and policy, and transmitting signals that allow the organization to learn and adapt. Without those loops, the other four dimensions operate in isolation; with them, the organization develops the dynamic capacity to correct course, reinforce what works, and abandon what does not.

This reframing carries real theoretical weight. Many existing knowledge translation frameworks, inherited from linear models of research uptake, position monitoring as a subsequent and largely administrative stage that occurs after the substantive work of translation is complete. The Iranian findings invert that logic: the feedback apparatus is not downstream of implementation but upstream of it, because organizations that cannot perceive the consequences of their own actions cannot become ready for anything. In systems terms, feedback converts a static bundle of resources into a learning system, and it is precisely that learning capacity, the authors argue, that distinguishes institutions where evidence routinely shapes decisions from institutions where reports accumulate unread.

The expert interviews also yielded a sobering catalogue of the barriers currently undermining this capacity in Iranian medical universities. Participants described siloed communication, in which departments, faculties, and administrative units exchange information poorly or not at all, fragmenting the very loops that the readiness model depends upon. They reported limited incentives for the use of evidence, meaning that career advancement, recognition, and reward structures do not encourage either researchers to engage with practice or managers to engage with research. They cited a lack of managerial commitment, insufficient capacity-building structures for developing the specialized skills that knowledge translation demands, and weak linkages between research units and the practice environments, such as hospitals and public health programs, that the evidence is meant to inform.

The authors conclude that enhancing organizational readiness for knowledge translation in this setting requires a multifaceted approach that strengthens cultural, structural, and leadership capacities simultaneously, rather than addressing any single factor in isolation. Most pointedly, they argue that establishing structured feedback mechanisms must be viewed as the core driver, not an afterthought, of sustainable knowledge translation implementation. In practical terms, that would mean designing deliberate channels through which evidence use is observed, questioned, and evaluated: routine forums where researchers and decision-makers exchange information, evaluation systems that generate usable information about how evidence flows, and leadership practices that treat feedback as a resource rather than a threat.

The study’s authors are careful to specify the limits of their claims. The findings identify enabling conditions for knowledge translation rather than providing direct evidence that strengthening these conditions improves health outcomes, a distinction that matters for anyone tempted to treat the five-dimension model as a guaranteed prescription. The research is also confined to Type I medical universities in one national context, and organizational readiness in smaller institutions or different health systems may depend on a different balance of factors. Nevertheless, the implications travel beyond Iran. Knowledge translation challenges are well documented across low- and middle-income countries, where research production has often expanded faster than the organizational machinery needed to apply it. By proposing feedback as the organizing principle of readiness, the study offers a testable hypothesis for implementation science: that the first question any research institution should ask is not how much evidence it produces, but how effectively it hears the signal of its own experience. By addressing these readiness factors, the authors suggest, medical universities can strengthen their role in evidence-informed policy and practice, turning the institutional pyramid of training, production, and strategy into a genuinely self-correcting system.

Subject of Research: Organizational readiness for knowledge translation and feedback loops in Iranian medical universities

Article Title: Feedback loops as a core driver: rethinking organizational readiness for knowledge translation in Iranian medical universities

Article References: Rezaei, F., Saberian, M., Ghasemi, S., Gharibi, Z., & Hosseinzadeh, H. (2026). Feedback loops as a core driver: rethinking organizational readiness for knowledge translation in Iranian medical universities. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01537-7

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01537-7

Keywords: knowledge translation, organizational readiness, feedback loops, implementation science, medical universities, Iran, qualitative study, evidence-based policy, monitoring and evaluation, organizational learning, health policy, Feedback

Systematic maps occupy a distinctive place in the evidence synthesis landscape. Unlike systematic reviews, which seek to answer a narrowly defined question by appraising and combining the results of individual studies, systematic maps are designed to describe the breadth of a research field. They catalogue what has been studied, where, how, and with what methods, providing a structured overview that can reveal clusters of activity and, just as importantly, blind spots. For a topic as sprawling as evidence use in policy—a field that draws on political science, public administration, sociology, psychology, and evaluation studies—such a cartographic exercise is not merely useful but arguably essential.

The updated map described in the article builds on earlier systematic mapping work in this domain, reflecting a field that has grown rapidly over the past two decades. The movement often labelled evidence-based policy has generated an enormous volume of empirical and conceptual scholarship, examining everything from the role of think tanks and knowledge brokers to the impact of research funding incentives and the cognitive biases of decision-makers. The task facing the authors of the map was to impose order on this abundance: to search systematically across academic databases, apply transparent inclusion criteria, screen thousands of records, and code the studies that survived screening according to a consistent framework.

That framework matters. A systematic map is only as good as its coding scheme, and the categories used to classify factors influencing evidence use inevitably shape the picture that emerges. Common clusters in this literature include the characteristics of the evidence itself—its perceived quality, relevance, timeliness, and accessibility; the characteristics of the policy context, including political will, institutional capacity, and the presence of formal requirements for evidence in decision-making; the characteristics of individual actors, such as policymakers’ trust in researchers and their training in interpreting quantitative findings; and the characteristics of the interactions between the two worlds, encompassing knowledge translation mechanisms, intermediaries, co-production arrangements, and personal networks.

One of the most robust findings across decades of research in this area is the persistence of what scholars have long called the gap between the production of evidence and its use. Early models assumed a linear process in which researchers generate knowledge and policymakers apply it, but the empirical literature has repeatedly shown that policy is driven by a far messier set of influences. Ideology, public opinion, lobbying, fiscal pressures, and electoral cycles all compete with research findings for attention and authority. As a result, contemporary scholarship tends to conceptualize evidence use not as a simple transfer but as a social process of exchange, negotiation, and sense-making, in which different forms of knowledge—including professional experience, stakeholder input, and political judgement—interact with scientific research.

The updated map’s contribution lies partly in its comprehensiveness and partly in its currency. Fields evolve, and a map that seemed current a few years ago can quickly become outdated as new studies multiply. By refreshing the search and incorporating recent literature, the authors were able to capture developments such as the growing interest in knowledge brokering organizations, the expansion of behavioural insights units within governments, and the intensified scrutiny of evidence use that accompanied policymaking during global crises. Each of these developments has generated new empirical work, and mapping it allows the field to see whether emerging themes are merely fashionable or whether they represent sustained areas of investigation.

Methodologically, the map also sheds light on how researchers have studied evidence use. The literature is dominated by qualitative approaches—case studies, interviews, and documentary analysis—alongside a substantial body of conceptual and theoretical writing. Quantitative measurement of evidence use remains comparatively rare, in part because use itself is notoriously difficult to define and observe. Does evidence use mean that a citation appears in a policy document, that a policymaker reports being influenced by research, that a programme design reflects a specific finding, or that outcomes improve after an evidence-informed intervention is adopted? Each definition leads to different methods and different conclusions, and the map makes these methodological patterns visible in a way that individual studies cannot.

The practical implications of such mapping are considerable. For funders, a systematic map indicates where investment in new research is most likely to yield genuine advances rather than duplicating existing work. For practitioners—knowledge brokers, science advisors, and research-impact officers—it provides an organized inventory of the factors that empirical studies have linked to successful evidence uptake, which can inform the design of translation activities and partnership programmes. For policymakers themselves, the map is a reminder that the barriers to evidence-informed decisions are rarely about the absence of research alone; they are frequently embedded in institutional incentives, time pressures, and the structure of the policy process.

The gaps revealed by the map are as instructive as its clusters. Coverage is uneven across policy domains, with education, health, and environmental policy attracting disproportionate attention while other sectors remain understudied. Much of the literature originates in high-income, English-speaking countries, raising questions about the transferability of findings to different political and administrative cultures. Longitudinal studies that trace evidence use over time are scarce, as are studies that follow specific pieces of research from publication to policy outcome. And the perspectives of certain actors—frontline implementers, citizens, and marginalized communities—are underrepresented relative to those of senior officials and academic researchers.

Ultimately, the updated systematic map serves as both a stocktaking exercise and an agenda-setting device. It consolidates what the field knows about the factors influencing evidence use in policy, makes that knowledge navigable, and highlights the questions that remain open. In an era when governments face contested information environments and heightened demands for accountability, understanding how research actually enters—and sometimes fails to enter—the machinery of government has never been more consequential. Maps of this kind do not resolve those questions, but they ensure that the next generation of researchers begins its work with a clear-eyed view of the terrain already travelled.

Subject of Research: Factors influencing the use of evidence in public policy, examined through an updated systematic map of the research literature

Article Title: What factors influence evidence use in policy? An updated systematic map

Article References: What factors influence evidence use in policy? An updated systematic map. (n.d.). https://doi.org/10.1038/s41599-026-08391-6

Image Credits: AI Generated

DOI: 10.1038/s41599-026-08391-6

Keywords: evidence use, policy, systematic map, evidence-based policy, knowledge translation, knowledge brokering, evidence synthesis, policy process, research uptake, science-policy interface, factors, influence

The research team, led by Chanda Mwamba and Tikulirekuti Banda of the Centre for Infectious Disease Research in Zambia, together with collaborators from the Zambia National Public Health Institute, the Ministry of Health, Unity Health Toronto and the World Health Organization’s Alliance for Health Policy and Systems Research, evaluated the implementation of Zambia’s Multisectoral Cholera Elimination Plan, or MCEP. The plan, running from 2019 to 2025, aims to reduce cholera-related mortality by ninety percent, in line with the global roadmap. To understand how the plan moved from paper to practice, the researchers applied six phases of the Knowledge-to-Action framework, a widely used implementation science model that tracks how evidence is adapted to local contexts, how barriers are assessed, how interventions are put in place, and how knowledge use is monitored, evaluated and sustained over time.

The study combined several qualitative methods to build a layered picture of implementation. The researchers independently reviewed the MCEP document itself, examining how global guidance had been contextualized for Zambian conditions. They then triangulated this documentary evidence with 24 key informant interviews involving policy-makers and implementers at national, provincial, district and facility levels, 12 in-depth interviews with cholera survivors, and four focus group discussions with 28 members of community-based neighbourhood health committees. Fieldwork took place between April 2020 and May 2021 in two contrasting cholera hotspots: Mpulungu District, a swampy lakeside setting, and Lusaka District, a densely populated periurban environment. Thematic analysis, guided by the Knowledge-to-Action domains, was used to organize and interpret the data, and findings were cross-checked across sources to strengthen credibility.

Zambia’s vulnerability to cholera is well documented. Between 1977 and 2018, the country endured 29 cholera emergencies, with recorded cases ranging from 14 to 13,500 and case fatality rates between 0.5 and 9.3 percent. These outbreaks occurred chiefly in periurban areas and fishing camps that share waters with the Democratic Republic of Congo, Mozambique, Tanzania and Zimbabwe, and are characterized by poor sanitation, inadequate water supply, deficient drainage and weak solid waste management. Rapid urbanization intensifies these pressures, while high cross-border movement with cholera-prone neighbours complicates control efforts. The 2017 to 2018 outbreak that preceded the study period affected seven of Zambia’s ten provinces, producing 5,905 suspected cases and 98 deaths, an experience that sharpened political attention on the elimination agenda.

The document review revealed that the MCEP strategically targets twelve identified cholera hotspots for oral cholera vaccine campaigns, aiming for quick, visible results and public confidence before embarking on larger infrastructure and behaviour-change projects. These hotspots were identified through epidemiological, geographical and contextual analyses, encompassing areas with recurrent outbreaks, poor water, sanitation and hygiene services, transit points, slums, flooding, fishing camps and refugee influxes. The plan rests on a decentralized multisectoral governance structure anchored in national frameworks such as Vision 2030 and the Seventh National Development Plan, and it operationalizes its strategy through technical working groups covering water, sanitation and hygiene, case management, surveillance and laboratory capacity, community engagement and vaccination. Local adaptations emerged as well: in Mpulungu, revitalized community-led total sanitation projects target open defecation around lakeshores, while in Lusaka, interventions included installing pipes and drainage systems, burying shallow boreholes, and creating designated rubbish collection points after outbreaks.

Despite this thoughtful design, the study uncovered formidable barriers that have produced fragmented implementation. Perhaps the most consequential is the absence of a dedicated budget line for the MCEP, which left financing dependent on ministries with different priorities and vulnerable to redirection, particularly during the COVID-19 pandemic. Participants described how funds arrived late and flowed toward temporary emergency measures, such as water tanks during outbreaks, rather than durable infrastructure. ‘Cholera is seen as health rather than a development issue,’ one non-governmental organization actor explained, noting that funding only materializes during outbreaks, which is expensive and diverts resources from developmental activities. Underfunding of water, sanitation and hygiene infrastructure shaped how communities received cholera guidance, since hygiene recommendations are difficult to follow where piped water, sewerage and drainage simply do not exist. Community health volunteers, meanwhile, reported demotivation stemming from a lack of allowances, protective equipment and transport.

Knowledge translation emerged as another critical weak point. National and provincial health leaders demonstrated solid understanding of the MCEP’s strategic direction, but facility-level implementers and non-governmental actors, particularly in Mpulungu, knew far less about the plan itself, with one participant admitting they were ‘learning of that document today’ despite being familiar with district and provincial cholera taskforces. Stakeholders even disagreed about whether implementation was fundamentally bottom-up or top-down, revealing inconsistent internal communication. Coordination also faltered because the response was perceived to be driven predominantly by the Ministry of Health, leaving other sectors with variable responsibility and resources. Participants consistently argued that stronger accountability, commitment and shared ownership across ministries were essential, and some pointed to the COVID-19 response, with its rapid policy-making and enforcement, as a model for how cholera guidelines might be more effectively communicated and upheld.

Nevertheless, the study documents meaningful progress. The appointment of a national cholera elimination coordinator and the formation of multisectoral technical working groups improved coordination and strengthened the case for investment in laboratory capacity, vaccines and infrastructure. Zambia became one of the first four countries to receive Global Task Force on Cholera Control funds in recognition of its elimination efforts, and the leadership team continues to lobby parliamentarians for inclusion of the MCEP in the national budget. Each level of the health system now maintains emergency preparedness plans, and a monitoring framework with strategic and programmatic indicators tracks case fatality, early detection, coordination, financing and vaccine coverage. Encouragingly, Zambia has recorded no cholera outbreak since 2019, which national informants attribute to high vaccine uptake in hotspot areas during and after the 2017-2018 outbreak, intensified environmental cleaning, and increased community knowledge about chlorine use and preventive measures.

The sustainability of these gains, however, is not assured. The researchers found gaps in evidence synthesis for knowledge users, limited monitoring and evaluation capacity, and no earmarked funds for locally determined operational research. The National Health Research Authority, which is responsible for knowledge synthesis, was integrated into technical working groups only after the MCEP was developed and is still building its systems. Drawing comparisons with Zimbabwe and Ethiopia, where multisectoral cholera elimination plans similarly face large funding gaps, the authors caution that global attention and resources diverted to COVID-19 may further threaten resource mobilization. The authors conclude that a multisectoral approach can generate the momentum and efficiencies needed to eliminate cholera in Zambia, but only if stakeholders are fully committed and funding is secured. They call for comprehensive advocacy, national and international budget commitments, robust monitoring and evaluation, and an adaptive collaborative strategy embedded within national guidelines that genuinely includes target communities in local translation and adaptation of the elimination agenda.

Subject of Research: Translating global cholera elimination guidelines into national multisectoral policy and local implementation in Zambia

Article Title: Raising the bar: translating global guidelines to achieve local policy on cholera elimination in Zambia—a qualitative case study

Article References: Mwamba, C., Banda, T., Mazaba, M., Mukonka, V., Malama, K., Hamweemba, E., Syulikwa, M., Chilengi, R., Sharma, A., Fahim, C., Marten, R., Yangchen, S., Straus, S., & The RAISE Project (2026). Raising the bar: translating global guidelines to achieve local policy on cholera elimination in Zambia—a qualitative case study. Health Research Policy and Systems, 24(S1), Article 71. https://doi.org/10.1186/s12961-026-01464-7

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01464-7

Keywords: cholera elimination, Zambia, multisectoral approach, Knowledge-to-Action framework, Global Task Force on Cholera Control, oral cholera vaccine, water sanitation and hygiene, health policy implementation, knowledge translation, qualitative case study, sub-Saharan Africa, community engagement

The editorial introducing the special issue, authored by Seraphine Zeitouny, Christine Fahim, Robert Marten and colleagues, sets out the rationale with unusual candour. Health guidelines have traditionally concentrated on clinical practice and service delivery, but there is growing recognition that the most consequential guidance now addresses structural and policy-level challenges: governance, financing, and the organization of care across whole systems. When such guidance is integrated into policy and practice, studies have linked it to significant improvements in health outcomes for target populations, and effective implementation is widely seen as critical for strengthening health systems and advancing the Sustainable Development Goals. Yet empirical knowledge about the factors shaping the adaptation and implementation of health system recommendations remains thin, particularly in low- and middle-income countries, where most of the world’s population receives care. The new studies are an attempt to fill that evidence gap with real-world, policy-relevant data rather than theoretical frameworks alone.

Colombia offers the most systematic case. Researchers led by Claudia Marcela Velez at the Universidad de Antioquia analysed the country’s implementation of clinical practice guidelines alongside thirteen World Health Organization health systems guidelines covering governance, financial and delivery arrangements. Through document analysis, the team identified access to care as the single largest obstacle to effective implementation. Even where guidelines explicitly endorsed approved and publicly funded technologies and services, those resources remained inaccessible or unavailable to significant segments of the population, especially people living in rural areas or on low incomes. The finding is a blunt reminder that a recommendation on paper is not the same as a service on the ground, and that equity gaps can persist even when policy language promises universal access.

The Colombian team then moved from diagnosis to action. Working with the country’s Ministry of Health, the researchers prioritized two groups of health system recommendations for implementation and, using the SUPPORT methodology’s systematic process for searching and synthesizing evidence, developed evidence briefs to inform planning. The first brief addressed early fibrinolysis for patients with ST-elevation myocardial infarction, a time-critical intervention for heart attacks. The second examined rehabilitation services for patients with amputations, where the brief highlighted the urgent need to improve timely access, particularly for people in rural areas and low-income settings. Barriers included patient sociodemographic characteristics and a scarcity of trained clinicians. Notably, the analysis suggested that establishing integrated healthcare networks linking community facilities with hospitals could be a promising strategy for improving both health outcomes and patient experiences, offering a concrete structural remedy rather than a vague exhortation to do better.

In Ghana, Samuel Adjorlolo of the University of Ghana and colleagues turned their attention to home visits, a foundational but often invisible component of primary healthcare. Studying practice in a rural-urban setting in the Greater Accra region, they documented the challenges nurses and other health professionals face when delivering care to people in their homes. The obstacles were mundane but debilitating: transportation difficulties, poor road infrastructure, fragmented residential address systems that make it hard to locate households, a lack of basic logistics such as home visit bags and essential medical tools, inadequate financing, and sociocultural practices that complicate service delivery. These are barriers familiar across many low- and middle-income countries, and their persistence undermines one of primary care’s most valuable functions. In developing and piloting future home visit guidelines, the team proposed multifaceted measures including targeted training, allocation of human and financial resources, and provision of safety and security measures for both male and female staff, recognizing that workforce protection is a precondition for community-based care.

Nigeria’s contribution tackles one of the most topical questions in global health: how to adapt guidance on digital health interventions without losing its universal applicability. Abiodun Olugbenga Adewuya of Lagos State University College of Medicine and colleagues contextualized the World Health Organization’s 2019 guideline recommendations on digital interventions for health system strengthening to the specific needs of mental health services in Lagos State. They then piloted implementation across five randomly selected primary care centres, assessing perceived effectiveness, acceptability, appropriateness and feasibility among clients, health workers, mental health professionals and health managers, while also measuring readiness for implementation change. The results were instructive in their nuance. Recommendations such as drug stock notifications, health worker supervision and targeted client communication appeared effective and feasible for strengthening digital mental health services. But health workers expressed reservations about client-to-provider communication and clinical decision support, revealing that stakeholders’ readiness to accept changes varies considerably even within a single health system. The study underscores a key tension in guideline adaptation: the balance between preserving the integrity of evidence-based recommendations and reshaping them to fit local needs.

Zambia’s case demonstrates how implementation science frameworks can be applied to epidemic control. Chanda Mwamba of the Centre for Infectious Disease Research in Zambia and colleagues evaluated the country’s multi-sectoral cholera elimination plan using the knowledge-to-action framework, a widely cited model for translating research into practice. Following a comprehensive review of the plan and engagement with key stakeholders, their analysis found that appointing a coordinator and establishing technical working groups enhanced coordination and strengthened the case for increased investment. Yet implementation remained fragmented by slow institutionalization, weak coordination, inadequate funding and poor infrastructure. The authors argued that commitment from all stakeholders, genuine political will and dedicated funding could help eliminate cholera, and they recommended developing a collaborative, multi-sectoral strategy rooted in national guidelines and policies to empower communities in eradication efforts. The message is that global elimination targets depend less on new science than on the unglamorous machinery of coordination and finance.

Running beneath the country studies was an explicit investment in research capacity itself. Christine Fahim of the Knowledge Translation Program at St. Michael’s Hospital-Unity Health Toronto and colleagues described the implementation and evaluation of a technical support program designed to strengthen the RAISE teams’ ability to conduct guideline adaptation and implementation research. The program used an integrated knowledge translation approach, emphasizing a user-driven model in which study teams determined their own priorities and support needs. Its components included an in-person capacity-strengthening workshop, personalized coaching sessions with methods experts, and a virtual ecosystem of webinars, discussion boards and workshops. Teams rated the program highly and identified significant barriers impeding guideline work: conflicting health system and stakeholder interests, scarcity of available data, inadequate equipment for data collection, and limited capacity and knowledge. They also identified enablers, including forging partnerships with health system stakeholders at a project’s inception, employing multi-sectoral approaches to implementation, and investing in the competencies of implementation teams.

Taken together, the studies converge on several lessons that the editorial authors argue should reshape how guidelines are produced and used. Engagement with policymakers, beginning at project initiation and continuing throughout the research process, emerged as a decisive factor regardless of the guideline’s focus area. Effective implementation requires contextualization through early and meaningful stakeholder engagement, and the research repeatedly encountered the same structural barriers: limited resources and contested resource allocation, weak coordination, and inadequate infrastructure. Facilitators were equally consistent, including the use of evidence briefs to translate recommendations into policy-ready formats, appraisal of international guidelines to ensure local adaptability, and user-driven capacity building. Multi-sectoral governance and collaboration surfaced as essential ingredients in every setting studied, from cholera control in Zambia to digital mental health in Nigeria. Many teams also called for sustained efforts to strengthen research capacity and to synthesize insights from diverse user perspectives, recognizing that one-off projects rarely change systems on their own.

The implications reach well beyond the six countries involved. As health systems worldwide grapple with pandemic preparedness, aging populations and the integration of digital tools, the demand for guidance that actually functions in resource-constrained environments will only intensify. The RAISE findings point toward a future research agenda built on co-creation and co-production with policymakers, sustained partnerships rather than transactional consultations, strengthened implementation capacity, and genuinely multi-sectoral support for guideline adoption. They also highlight a growing recognition that health policy and systems research itself needs capacity strengthening, so that the countries facing the toughest implementation challenges are equipped to generate, adapt and apply the evidence they need. Guidelines, the special issue ultimately argues, are essential tools, but their effectiveness depends entirely on context-specific integration into policies and practices, collaborative multidisciplinary approaches, and the willingness to treat adaptation not as an afterthought but as the core of the scientific enterprise.

Subject of Research: Adaptation and implementation of health systems guidelines in low- and middle-income countries

Article Title: Adapting and implementing health systems guidelines: learning lessons from countries

Article References: Zeitouny, S., Fahim, C., Adewuya, A. O., Adjorlolo, S., Mwamba, C., Velez, C. M., Straus, S. E., & Marten, R. (2026). Adapting and implementing health systems guidelines: learning lessons from countries. Health Research Policy and Systems, 24(S1), Article 69. https://doi.org/10.1186/s12961-026-01460-x

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01460-x

Keywords: health systems guidelines, guideline adaptation, guideline implementation, RAISE initiative, Alliance for Health Policy and Systems Research, low- and middle-income countries, knowledge translation, health policy, digital health interventions, health systems strengthening, evidence briefs, capacity strengthening

The study focused on occupational therapists, physiotherapists, and registered nurses working in a large Swedish municipality of roughly 150,000 inhabitants. These professionals deliver the bulk of municipal primary healthcare, including home healthcare, residential care facilities, and services for adults needing special support. Under Swedish law and their professional codes of ethics, all three groups are obliged to use science and proven experience in their daily work. Yet the researchers found that few had completed advanced-level education, the uptake of new knowledge was low, and care was more often grounded in personal experience than in research-based knowledge, leaving patients potentially exposed to out-of-date assessments and treatments.

Methodologically, the study combined five audio-recorded dialogue meetings with a web-based survey sent to all 290 employed registered healthcare professionals in the municipality. The survey drew 102 valid responses, a response rate of 35 percent overall, with notably higher participation among occupational therapists at 54 percent and physiotherapists at 50 percent compared with 27 percent among nurses. The qualitative strand used inductive, latent thematic analysis following Braun and Clarke’s six-step procedure, while the quantitative strand applied single-item logistic regression analyses to identify which attitudes and conditions were statistically associated with basing work on research. Convergent design principles guided the integration of the two data streams in joint display tables.

The qualitative analysis yielded one overarching theme: a struggle between personal and organizational conditions to use research and work according to evidence-based practice. This struggle unfolded along two dimensions. The first captured clinicians being torn between personal ambitions and a lack of skills to use research. The second described how organizational conditions and limited access to support challenged any attempt to translate evidence into practice. Participants were acutely aware of their professional obligations to use science and proven experience, but when they could not fulfil those obligations because of missing resources, structures, and support, many resigned themselves to relying on experience-based knowledge.

The skills gap emerged as a strikingly consistent finding. Slightly more than half of survey respondents said they did not feel confident searching for and interpreting research results. Advanced-level education made a measurable difference: 63 percent of those with education beyond the bachelor’s level felt confident interpreting research findings, compared with only 37 percent of those with a bachelor’s degree or less. Clinicians described research as hard to understand and generalize, noting that studies are typically conducted at the group level while their patients present complex, individualized problems. One physiotherapist wrote that it can be difficult to judge how reliable a result is and how to apply group-level findings to a single patient.

Despite these struggles, the regression analyses revealed that several individual attitudes and conditions were significantly associated with actually basing work on research. Clinicians who believed that evidence-based work saves time were more than three and a half times as likely to base their work on research. Finding research interesting nearly quintupled the odds, active searching for work-relevant research increased them eightfold, and feeling confident in searching for, reviewing, and interpreting studies each roughly tripled the likelihood. Critically, holding an advanced-level education was itself significantly associated with evidence-based working, with an odds ratio of 3.7, echoing earlier findings among physiotherapists and occupational therapists in Sweden and internationally.

The organizational picture was bleaker. Only a minority of participants said evidence-based practice was highly valued in their workplace, with the smallest proportion among occupational therapists, at just 24 percent, compared with 53 percent of nurses and 41 percent of physiotherapists. Fewer than 15 percent experienced that their manager encouraged the use of research results, and a similarly small share reported any ongoing systematic implementation of evidence-based methods. A lack of allocated time emerged as the single most-cited barrier: 91 percent said they had no time to read research during working hours, and 88 percent lacked access to research at work. When clinicians did carve out time, they described it as coming directly at the expense of hands-on patient care, creating a culture of busyness in which reading research could induce guilt.

Organizational conditions that did support evidence-based working were statistically meaningful. Having access to research results at work increased the odds of basing work on research more than fourfold, having support to try new methods nearly tripled them, and perceiving that evidence-based work was valued at work nearly tripled them. Participants also pointed to structural confusion: unclear boundaries between municipal primary healthcare and county council-run health centres, underutilized professional competencies, and missing structures for multi-professional teamwork. Occupational therapists and physiotherapists described being unable to initiate health-promoting or preventive interventions they had identified, because responsibility fell to another provider under Sweden’s so-called threshold principle, which directs patients who can travel to local health centres instead.

The researchers situate these findings within the knowledge-to-action gap, the well-documented chasm between what research produces and what clinical practice adopts. They draw on prior scholarship describing organizational cultures oriented toward doing, focused on tasks and outcomes, rather than being, which allows reflective time for assessing, reading, and critiquing research. In such cultures, direct patient care is valorized and evidence work is sidelined. The study also notes a troubling ethical dimension: although clinicians were aware they were falling short, there was a consistent absence of reflection on their individual responsibility to fulfil professional codes of ethics, and on the potential consequences for patients of receiving care not grounded in current evidence.

The authors conclude that strengthening clinicians’ competence, particularly through advanced-level education, is essential, but insufficient on its own. Managerial support, education, clinical goals, allocated time, access to research, and clear strategies for implementing evidence-based practice are all needed to shift the organizational culture. Participants themselves called for planning and management that clarifies professional roles and responsibilities, and for structures that make teamwork and evidence-based development possible. As Sweden’s national reform toward local, integrated care moves advanced care out of hospitals and into municipalities, the stakes of closing this gap rise. Without deliberate action, the study warns, the very professionals expected to anchor the new model of care will continue to run, in one participant’s words, like hamsters in a wheel, well-intentioned but unable to move the system forward.

Subject of Research: Evidence-based practice and research usage among registered healthcare professionals in Swedish municipal primary healthcare

Article Title: Ambitions and obstacles for evidence-based municipal primary healthcare – a mixed- methods study

Article References: Gustafsson, M., Zingmark, M., Iwarsson, S., & Ekstam, L. (2025). Ambitions and obstacles for evidence-based municipal primary healthcare – a mixed- methods study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2451265. https://doi.org/10.1080/11038128.2025.2451265

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2451265

Keywords: evidence-based practice, municipal primary healthcare, research usage, occupational therapy, physiotherapy, nursing, knowledge translation, organizational culture, integrated care, mixed methods, health promotion, advanced-level education