This study was informed by a number of frameworks linking the research-policy interface. One such conceptual framework describes key elements as: processes of research generation and decision-making; the stakeholders; the products; the mediators; and the context [23
]. Mediators, individuals or institutions who foster linkages between different stakeholders are described as the most crucial component of the framework that encourages strong research-policy linkages [23
]. More recent efforts at framework construction have focused on country-level assessment of linkages between research and action [8
]. The proposed framework has four elements: 1) general climate; 2) research production; 3) a mix of push and pull factors; and 4) evaluation approaches. The critical role of a wide range of stakeholders, such as researchers, policymakers, funders and consumers and advocacy groups is also acknowledged in linking research to action. Another recent framework exploring health systems research and its influence on policy processes in low-income countries articulates four “streams of influence” on the research-policy interface: development contexts; stakeholders; accountabilities; and processes [24
]. For instance the development context encourages the examination of capabilities of the health system to support priority research as well as acting on evidence when available. In developing country context the external stakeholders – experts and donors may form part of the influence network. In this paper we used the range of variables espoused in these frameworks to help frame the analysis around the major influences of research on health policy in Uganda.
We employed two case studies to draw lessons on how to research influences policy developments in Uganda (Table ). The PMTCT and SMC were selected based on a consultation workshop in early 2009 in Kampala in which researchers, policy makers and donors participated. A comparison of both cases demonstrates the similarities and differences around HIV prevention in Uganda (Table ). For both these interventions, a national level network of stakeholders – researchers, policymakers and the media - were identified as critical to the generation, utilization and amplification of evidence respectively. These three categories of stakeholders form the groups that were interviewed in this study. Although the general public is a vital stakeholder in the research-to-policy development, time and logistical constraints did not allow us to pursue this stakeholder group.
Comparison of case studies-PMTCT and SMC–in Uganda
This was a qualitative study where in-depth interviews (IDI) were conducted with key stakeholders including policy makers, technical officers, funders, researchers, and print and media journalists (television, print and radio). The purpose of the in-depth interviews was to provide an understanding of the research to policy process, with a specific focus on PMTCT and SMC. We conducted 30 in-depth interviews with researchers (8), policy makers (12), and media journalists (10). The main selection criteria for researchers and policy makers was their involvement in the decision making around the PMTCT and or SMC process at any time since the year 2000. For the media, they were selected mainly because they were involved in health related reporting on a regular basis in Uganda.
A purposeful sampling frame for the in-depth interviews was constructed in consultation with peers in the PMTCT and SMC domain as well as those who have worked in health related policies in Uganda. First, brainstorming discussions were conducted with a reference group familiar with policy research to generate the initial sampling frame. Then, during interviews, snowball sampling strategy was applied and after each in-depth interview was conducted, the interviewee was requested to identify one to two other possible respondents that they deemed relevant to the study. The research team then updated the list of interviewees from which the respondents were drawn.
Interviews were conducted in English and audio recorded (with consent) and transcribed by the research team thereafter. In a few cases, individual were not willing to be audio recorded. In such circumstances, we took hand written notes of the interviews which were later expanded. During data collection phase de-briefing meetings were held with research team members at the end of each day to ensure good quality data and share new and emerging issues. All interviewers were trained in qualitative interview techniques. The interview tool was pilot tested with volunteer colleagues within MakCHS. Transcription was completed within 48 hours following interview.
The initial step for analysis was to read through all the interview transcripts several times while making notes in the transcript. All investigators participated in this process. Analysis was a mixture of Manifest and Latent content analysis techniques. At first manifest content analysis was done in reference to the study conceptual framework. This type of analysis technique allows one to explore what the text says, deals with the content aspect and describes the visible, obvious components. For a closer look of underlying meanings (Latent) content analysis was done and hidden meaning of text was brought forth [25
]. Data was therefore condensed without losing quality. Open coding was done and codes were categorized and then themes identified as stipulated by Graneheim and Lundman [25
This study was approved by the Institutional Review Boards (Ethics Committees) at Makerere University-School of Public Health, Uganda and Johns Hopkins Bloomberg School of Public Health, USA. Permission to conduct the study was also granted by the Uganda National Council of Science and Technology. Verbal consent was solicited from each individual identified as a respondent for the in-depth interview prior to starting the interview.