How research funding agencies support science integration into policy and practice: an international overview.

BACKGROUND: Funding agencies constitute one essential pillar for policy makers, researchers and health service delivery institutions. Such agencies are increasingly providing support for science implementation. In this paper, we investigate health research funding agencies and how they support the integration of science into policy, and of science into practice, and vice versa. METHODS: We selected six countries: Australia, The Netherlands, France, Canada, England and the United States. For 13 funding agencies, we compared their intentions to support, their actions related to science integration into policy and practice, and the reported benefits of this integration. We did a qualitative content analysis of the reports and information provided on the funding agencies' websites. RESULTS: Most funding agencies emphasized the importance of science integration into policy and practice in their strategic orientation, and stated how this integration was structured. Their funding activities were embedded in the push, pull, or linkage/exchange knowledge transfer model. However, few program funding efforts were based on all three models. The agencies reported more often on the benefits of integration on practice, rather than on policy. External programs that were funded largely covered science integration into policy and practice at the end of grant stage, while overlooking the initial stages. Finally, external funding actions were more prominent than internally initiated bridging activities and training activities on such integration. CONCLUSIONS: This paper contributes to research on science implementation because it goes beyond the two community model of researchers versus end users, to include funding agencies. Users of knowledge may be end users in health organizations like hospitals; civil servants assigned to decision making positions within funding agencies; civil servants outside of the Ministry of Health, such as the Ministry of the Environment; politicians deciding on health-related legislation; or even university researchers whose work builds on previous research. This heterogeneous sample of users may require different user-specific mechanisms for research initiation, development and dissemination. This paper builds the foundation for further discussion on science implementation from the perspective of funding agencies in the health field. In general, case studies can help in identifying best practices for evidence-informed decision making.

Beyond resistance: exploring health managers' propensity for participatory evaluation in a developing country.

The evaluation of interventions is becoming increasing common and now often seeks to involve managers in the process. Such practical participatory evaluation (PPE) aims to increase the use of evaluation results through the participation of stakeholders. This study focuses on the propensity of health managers for PPE, as measured through the components of learning, working in groups, use of judgment and use of systematic methods. We interviewed 16 health managers to determine the meaning they ascribe to these four components in their practice in a developing country, Haïti. We found that learning was often informal and that all managers attached a negative meaning to the use of judgment. Working in groups was favored by all managers, while the health managers viewed the use of systematic methods differently than do evaluators. The administrative health managers generally ranked lower in propensity for PPE than did their clinical colleagues. Implications for the practice of evaluation are discussed in relation to the work styles exhibited by managers in everyday practice, the proactive repetition of actions, the control exercised by formal procedures, and the collective versus "solitary" image of one's environment of action.

A mixed method study of propensity for participatory evaluation.

One way to increase the use of evaluation results is practical participatory evaluation (PPE), which enables non-evaluator participants to join the evaluation process in a participatory mode. We examined the propensity for PPE of health professionals by focusing on four components: learning, working in groups, using judgment and using systematic methods. We interviewed the professionals at a Haitian health institution to determine their positioning on a scale of propensity (low, medium and high) for the four components. The professionals defined each component in relation to the energy puts into them, being more or less proactive. Facilitating elements for all three levels of propensity integration included past positive experiences, external pressure and a desire for better individual and organizational performance. Impeding factors included a lack of available resources perceived responsibilities and commitments toward private patients. The reported advantages included improved organizational performance and idea sharing, and the disadvantages included availability of, difficulty implementing solutions and altered human relationships.

Conceptualizing performance in accreditation.

OBJECTIVE: To compare the conceptualization of performance underlying different accreditation manuals. DATA SOURCES: Accreditation manuals were selected from the 2003 WHO report titled 'Quality and Accreditation in Healthcare Services'. We used manuals from WHO-listed countries that most influenced the standards: Canada, France, the USA and Australia. The fifth manual is published by the Pan American Health Organization (PAHO). EXTRACTION METHODS: Standards from each manual were classified by two independent reviewers. The coding grid, which was based on a Parsonian-based integrative framework on performance, was composed of performance dimensions and their interlinks/alignments. PRINCIPAL FINDINGS: The four dimensions of quality, goal-attainment, adaptation to the external environment and values, along with their alignments, were given differing levels of importance in the five manuals. The Australian manual emphasizes all four dimensions and their alignments. The PAHO accreditation focuses mainly on quality. The manuals from Canada, France and the USA fall somewhere between the two accreditation extremes of complete versus one-dimensional. Finally, we present a taxonomy of the conceptualization of performance in accreditation manuals that distinguishes between quality-oriented and alignment-oriented accreditation manuals. CONCLUSIONS: Specific conceptualizations of performance underlying accreditation manuals may not be neutral. Perhaps, more normative accreditation manuals are associated with authoritative management styles, or more balanced accreditation manuals with comprehensive management styles. Our comparative analysis is a first step toward better understanding the relationship between the conceptualization of performance and the management style adopted in a particular healthcare organization. This relationship could help explain the variation observed in healthcare organization performance.

Distribution of circulation-derived endothelial progenitors following systemic delivery.

Cells with an endothelial phenotype can be cultured from peripheral blood. These cells include cells of a monocytic origin with endothelial features (culture-modified mononuclear cells, CMMCs) and, at later time points, blood outgrowth endothelial cells (BOECs). Both are promising candidates for systemic cell-based cardiovascular therapies and each may have unique capabilities. Indeed, the combined use of both cell types has been shown to have synergistic therapeutic features requiring simultaneous delivery. However, the majority of preclinical studies of cell delivery have used splenectomized animals to increase systemic distribution. The goal of this study was to directly compare the distribution of these two cell types following systemic delivery in an intact animal model. A similar pattern of delivery was seen following delivery of both cell types with detection in the lung, liver, bone marrow, and spleen. Taken together, the data suggest that strategies using systemic delivery of circulation-derived cells must consider the distribution and efficiency of delivery in intact animals.