Abstract:

This article identifies local barriers and potential promoters of healthcare evidence-based management decision-making in Uganda’s local government context. It puts to local context feasible measures for increasing research evidence utilization by healthcare decision-makers, as part of the efforts to make research more beneficial to intended users, and ultimate recipients of the services. The findings were a result of a cross- sectional semi-structured questionnaire survey of 225 clustered healthcare authorities[1] in Arua District Local Government, West Nile Sub-region of Uganda. The survey data were triangulated with nine key informant interviews (KIIs). Analysis reveals existence of multiple barriers at individual, organizational and system’s levels of the local government healthcare management. Standing out prominently were barriers related to attitude, perceptions and beliefs of healthcare managers, dissemination, accessibility, communication, participation, engagement, capacity, knowledge, skills, cost, time, staffing, workload, leadership, policy enforcement, and culture. Other barriers related to researchers were their competence, authority and level of mutual trust. Fortunately, most of these barriers are consistent with those reported previously by other studies in developing countries. Through a critical logical analysis, recommended strategies for increasing utilization of research evidence were combined into five broad categories; stakeholders’ engagement and participation, contextualized dissemination, capacity building, local leadership and democracy, and knowledge marketing, awareness and visibility. Again, these are not naïve, but important is the manner and details in which they have been contextualized. Hence, this article adds to existing knowledge about multifactorial contextual nature of barriers and promoters of research evidence utilization, and the importance of action research in providing evidence for improving quality of healthcare service delivery.

Keywords: barriers, promoters, research evidence, healthcare authorities.

References:

[1].     Albert, M. A., Fretheim, A., & Maïga, D. (2007). Factors influencing the utilization of research findings by health policy-makers in a developing country: the selection of Mali’s essential medicines. Health Research Policy and Systems, 5 (1), 2.

[2].     Amanda, J. F., Dennis, F., Tara, J. S., Joseph, G.D., LeAnn, E.B., Shawn, C. O.& Bibhuti, K.S. (2009). The Challenges of Implementing Evidence Based Practice: Ethical Considerations in Practice, Education, Policy, and Research. Social Work and Society International Online Journal, 7 (2).

[3].     Amin, M. F. (2005). Social Science Research: Conceptions, methodology and Analysis. Makerere University, Kampala.

[4].     Bamberger, M (2012). Introduction to mixed methods in impact evaluation. InterAction. Retrieved from http://www.interaction.org/sites/default/files/Mixed%20Methods%20in%20Impact%20Evaluation%20%28English%29.pdf.

[5].     Barends, E., Rousseau, D. M., & Briner, R. B. (2014). Evidence Based Management: The Basic principles. Center for Evidence-Based Management.

[6].     Caracelli, V., Greene,J., & Jennifer, C. (1997). "Crafting mixed-option evaluation design." In J. C. Greene and V. J. Caracelli (eds.), Advances in mixed-option evaluation: The challenges and benefits of integrating diverse paradigms. New Directions for Program Evaluation, No. 74. San Francisco, CA: Jossey-Bass, pp. 19-32.460

[7].     Dobbins,M., Paula, R., Donna, C., Steve, H., Roy, C., Linda O'Mara., Kara, D., & Shawna, M. (2009). "A description of a knowledge broker role implemented as part of a randomized controlled trial evaluating three knowledge translation strategies". Implementation science, 4, 23.

[8].     Fraser, I. & Clancy, C. M. (2007). Forward: Importance of adopting evidence-based management in healthcare. https://www.ache.org/pubs/pdf_preface/Kovner_Foreword.pdf.

[9].     Gwenyth R. Wallen, G. R., Sandra A. Mitchell, S.A., Melnyk, B., Fineout-Overholt, E., Miller-Davis, C., Yates, J. & Clare Hastings, C. (2010). Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme. J Adv Nurs, 66(12): 2761–2771. doi: 10.1111/j.1365-2648.2010.05442.x

[10]. Hsu, D.H., & Lim, K. (2014). Knowledge Brokering and Organizational Innovation: Founder Imprinting Effects. OrganizationScience , 25 (4), 1134-1153.

[11].      JEBMH (2014). Journal of evidence based medicine (JEBMH). Retrieved from: http://www.jebmh.com/bibliographic.php.

[12].      Kelle, U. (2008). Combining qualitative and quantitative methods in research practice: purposes and advantages. Qualitative Research in Psychology, 3 (4), 293-311.

[13].      Kline, P. (2000). Handbook of Psychological Testing (2nd Ed). London: Routledge.

[14].      Kothari, C. R. (2004). Research Methodology: Methods and Techniques (2nd ed.). New Age International Publishers.

[15].      Kyohairwe, S. (2014). Local democracy and public accountability in Uganda: The need for organizational learning. Commonwealth Journal of Local Governance, Issue 15, Retrieved from: http://epress.lib.uts.edu.au/ojs/index.php/cjlg.

[16].      Lansang, M. A., & Rodolfo, D. (2004). Building capacity in health research in the developing world. WHO, 82 (10).

[17].      Lavis, J. N (2006). "Research, public policymaking, and knowledge-translation processes: Canadian efforts to build bridges". The Journal of continuing education in the health professions, 26 (1), 37-45.

[18].      Lavis, J., Davies, H., Oxman, A., Denis, J. L., Golden-Biddle, K., & Ferlie, E. (2005). Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy 10 (1), 35-48.

[19].      Lomas, J. (2007). "The in-between world of knowledge brokering". BMJ (Clinical research ed.) 334 (7585), 129-132.

[20].      Lyons, R., Warner, G., Langille, L., & Phillips, S.J. (2006). "Piloting knowledge brokers to promote integrated stroke vare in Atlantic Canada.". Canadian Institutes of Health Research (CIHR) Institute for Population and Public Health, editor. Moving population and public health knowledge into action: A casebook of knowledge translation stories. Ottawa, ON: Canadian Institutes of Health Research (CIHR) Institute for Population and Public Health.

[21].      Meyer, M. (2010). The Rise of the Knowledge Broker Science Communication, 32 (1), 118-127

[22].      Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. The Journal of Nursing Administration, 42(9), 410–417.

[23].      Mulrow, C. D (1995). Rationale for systematic reviews. Systematic Reviews. Edited by: Chalmers I, Altman DG. 1995, London: BMJ Publishing Group, 1-8.

[24].      Nabyonga, J., Bataringaya-Wavamunno, J., Bakeera, S. K., & Criel, B. (2012). Do guidelines influence the implementation of health programs? - Uganda’s experience. BioMed Central, 7(98), 1-16.

[25].      ODI (2009). Overseas development Institute (ODI) planning tools: Stakeholder Analysis: Toolkits. Retrieved from: http://www.odi.org/publications/5257-stakeholder-analysis

[26].      Oliver, K., Innvar, S., Lorenc, T., Woodman, J & Thomas, J. (2014). A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Services Research, 14, 2, 1-12.

[27].      Paula, R., Dobbins, M., & Decorby, K. (2008). "Life as a knowledge broker in public health". Journal of the Canadian Health Libraries Association (JCHLA/JABSC), 29, 78-82.

[28].      Pfeffer, J., & Sulton. I, R. (2006a). Decision-making: Evidenced-based Management. Harvard Business Review, 84 (1), 63-74. Retrieved from https://hbr.org/2006/01/evidence-based-management

[29].      Pfeffer, J. & Sutton, R. (2006b). Hard Facts, Dangerous Half-Truths and Total Nonsense: Profiting from Evidence-Based Management. Boston, MA: Harvard Business School Press.

[30].      Sauerborn, R., Nitayarumphong, S., & Gerhardus, A. (1999). Strategies to enhance the use of health systems research for health sector reform. Tropical Medicine and International Health. 4(12), 827-835.

[31].      Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B. & Richardson, W. S. (1996). Evidence Based Medicine: What It Is and What It Isn’t, in: British Medical Journal, 312, 71-72.

[32].      Squires, J. E., Hayduk, L., Hutchinson, A. M, et al. (2013). A protocol for advanced psycho-metric assessment surveys. Nurs Res Pract.

[33].      Squires, J. E., Estabrooks, C. A., Gustavsson, P., & Wallin, L. (2011a). Individual determinants of research utilization by nurses: a systematic review update. Implementation Science, 6 (1),1.

[34].      Straus, S. E., Richardson,W. S., & Glasziou, P et al. (2005). Evidence-based medicine, how to practice and teach EBM. Third edition. Edinburgh: Churchill Livingstone.

[35].      Tumushabe, G., Muyomba-Tamale, L., Ssemakula, E. & Lukwago, D. (2010). Uganda Local Government Councils Score-Card Report 2008/09: A Comparative Summary of Findings, Conclusions and Recommendations. ACODE Policy Briefing Paper Series, Kampala.

[36].      Verona, G., Prandelli, E., & Sawhney, M. (2006). "Innovation and virtual environments: Towards virtual knowledge brokers". Organization Studies, 27 (6), 765-788.

[37].      Zohrabi, M. (2013). Mixed Method Research: Instruments, Validity, Reliability and Reporting Findings. Theory and Practice in Language Studies, 3(2), 254-262.