A total of 4,291 relevant documents were retrieved from studies conducted in LMICs that were grouped based on the World Bank’s country classification (29) (Fig. 1). Of which, 142 met the inclusion criteria (5, 11, 13, 30–158). Many of the publications indicated that implementation of research uptake for health policymaking and practice is still limited in LMICs (68–80, 82, 137). The challenges of research uptake for policymaking are presented thematically. Eight main themes emerged, and presented using a diagram (Fig. 2). Thematic narrative synthesis was performed based on the key findings.
Understanding context
We found several papers on understanding the research uptake context (41, 52, 63, 68–92, 94–114, 116, 137). This included understanding of the political dimension and interest (5, 30, 41, 66, 67, 72, 76, 79, 83, 88, 89, 93, 98, 99, 109, 117–125, 127–130), lack of political will (41, 52, 63, 107, 112, 131, 132), political commitment (69, 84, 104–106, 109, 122, 130, 132–136, 138, 139), leadership (70, 77, 97, 131, 135–137, 140–142), and health policy research priority setting (30, 69–71, 75, 77, 80, 84, 98, 106, 107, 109, 130, 134, 138, 139, 143–150). Poor understanding of the complexity of the health policymaking process including the social and political environment (52, 63, 81, 83–89) has limited the opportunity for evidence translation into policy. Recognizing the domains (process, content and outcome) of health policymaking is important so that useable evidence to inform policies and practices in local context is generated (71, 82, 90–92, 94, 95). Understanding the actual context in terms of political environment will enable actual use of evidence (70, 76, 77, 100, 137), encourage institutional budgetary allocations for research (73, 78), health research and policy priority setting (70, 76, 79), and support scale up for societal benefit (71, 72, 74–76, 80, 85, 96–101, 104). Conversely, lack of credible context-specific health evidence (75, 86, 102, 103), weak local evidence, misunderstanding of decision-makers, lack of consideration of sociocultural or religious practices (52, 63, 105–109), and weak involvement of advocacy coalitions, and evidence generators (110) have limited the translation of evidence into policy and practice. Additionally, policy translation needs mutual trust (41, 84, 111). Lack of application of a holistic approach to evidence-based practice (105), lack of historical context (96, 112), and lack of alignment to dynamic political interests (113, 114, 116) are important contextual barriers to research uptake in LMICs. Three areas that emerge from the broader research uptake context are presented below. These are political dimension, priority setting and leadership.
Political dimension
Mapping the political dimensions and policy demand (5, 30, 41, 66, 67, 72, 76, 79, 83, 88, 89, 93, 98, 99, 109, 117–125, 127–130), the existence of political will and commitment (41, 52, 63, 69, 84, 104–107, 109, 112, 122, 130–136, 138, 139), policy interest of decisionmakers’ (30, 89, 99, 120, 122), and key policy and governance features (41, 72, 83, 123) are key drivers in evidence-informed health policymaking and implementation in LMICs. An in-depth understanding of the role of politics, how societies organize themselves in achieving collective health goals, and how different stakeholders interact in the health policymaking process (5, 66, 67, 88, 119, 120, 124, 125, 127–129) is critical in evidence translation planning. The action of policymakers may be influenced by external factors (30, 76, 89, 98, 99, 109, 120, 130) including the nature of policymaking (93), a lack of political will (41, 52, 63, 107, 112, 131, 132), weak engagement of politicians (70, 135–137), and poor social service infrastructures (84, 105, 106, 132, 138, 139). Similarly, political barriers (104), bureaucratic budget management (122), difficulty in convincing policymakers, and stakeholders (69), leadership and unclear policy direction (77, 97), all affected use of evidence. National stakeholders' perceptions, political will supporting the use of research evidence in decision-making (140), and not paying attention to structural, institutional and political condition (131, 141, 142) are critical barriers to health research and use for policymaking in LMICs. Sustainable advocacy for coalition, effective implementation in real world setting with understanding of the key players (117), addressing stakeholders’ concern (118), identifying opportunities and mitigating constraints (119) are key actions to have evidence-informed health policymaking and implementation in LMICs.
Priority setting
Priority setting (5, 15, 17, 22, 29–156) has been reported to have important impacts on research uptake for policymaking and practice improvement (69, 70, 75, 98, 134, 139, 143, 144, 148) and needs the involvement of key experts (98, 134, 139, 145), and policymakers (69, 70, 107, 144–146, 148) to anticipate organisational need for policymaking (75, 80, 143, 144, 148), and create a shared data administration system (30, 98). Prioritized evidence that is aligned to ideas and actions of political priority (106, 109, 138) must be made readily available (80, 145). Nevertheless, lack of clarity on the required evidence from policymakers in the health sector (77, 107), scarcity of dedicated units that collate research needs (77, 150) and contradiction between the scope of data needed for policymaking (71, 147) are critical barriers to health evidence translation to policy and practice in LMICs. Personal, institutional, local/national, and global priorities may compete and drive evidence translation either positively or negatively (50, 82, 107). Stakeholders’ competing values on health research priorities have limited efforts to address the complexity of health research capacity for evidence translation (70, 106, 123, 139, 151). Policymakers' urgent needs for research evidence about health systems in LMICs have also been affected by personal financial interests, and groups competing for authority (123).
Leadership
Willingness and/or commitment of political leaders influence health research translation in LMICs (38, 49, 52, 63, 69–71, 73, 77, 79, 97, 101, 102, 109, 113, 120, 131, 135–137, 140–143, 146, 152, 155). Evidence-informed policymaking relies on good leadership (84, 130, 147, 149), leaders’ willingness and commitment (38, 69, 79, 131, 143, 146, 155), shared vision among decisionmakers (49) and decision-makers involvement (52, 63). Lack of supportive, integrated and participatory leadership for research (49, 71, 73), poor political leadership with low performance (102, 113), and poor research governance (80, 131) are some of the critical leadership related challenges. Identifying and fostering public health leaders (101) will help to reduce the bureaucratic and protracted nature of policymaking and practice (120, 152).
Stakeholder engagement and partnership
Engagement of key stakeholders is a crucial strategy in evidence to policy translation (11, 30–48, 67–69, 71–74, 76–78, 80, 82–89, 91–93, 97, 98, 100–102, 104, 106, 107, 109, 111–115, 121, 123–125, 128–133, 140–146, 148, 149, 151–158). Local stakeholders including communities, Civil Society Organizations, nongovernmental Organizations and others engagement has great importance for co-production of evidence for policy (74, 86, 101, 102, 113, 121, 123, 130, 141, 145, 151–154). Translating research into policy and practice needs the intersectoral collaborative efforts of key stakeholders in LMICs (33, 46, 74, 77, 80, 104, 106, 112, 130, 141, 155). The active engagement of funders, community organization, implementers and other stakeholders can be used to address the complex bureaucracy environment in LMICs (67, 68, 71, 74, 78, 82, 83, 101, 102, 107, 121, 124, 129, 143, 146, 152–157). These stakeholders should be involved from the inception of project and throughout the research process. Such involvement takes into account local needs, encourages interactions, strengthens relationships, creates mutual accountability and promotes uptake of the evidence for policymaking (68, 69, 73, 77, 93, 97, 144, 155). Likewise, evidence uptake for health policymaking needs strong public-private partnership (58, 91, 110, 115, 155), and advocacy for domestic funding, resource mobilization and collaboration (91, 155). Stakeholder engagement is important to mitigate unmet needs (31, 83, 86, 93, 100, 114, 133, 141, 142, 158), build trust in the evidence (30, 100), and avoid duplication of efforts (30, 112, 131). Lack of stakeholder involvement in evidence production is a major barrier to evidence uptake for health policymaking (32, 67, 132, 133). Some policymakers may not be willing to use research evidence (157). Lack of understanding of contextual factors among key players and the powers of stakeholders (33, 34, 41, 117) was identified as important challenges to using evidence for health policymaking. Polarized stakeholders’ interests (109), low level of interaction between producers and users of research (35–37, 124, 133, 140), slow response to stakeholders’ requests for feedback (41, 123), and low sense of ownership (87, 98, 107, 155) led to research uptake and implementation gaps. Relatively lower engagement of social scientists, and economists in the health research team (113, 151), and limited engagement of the media (89, 149) were also highlighted as important barriers.
Engagement of stakeholders is a critical step in establishing strong multisectoral collaborations and partnerships and has a key role in improving evidence uptake for (11, 40, 42, 88, 91, 92, 121, 125, 128, 129, 153, 154). Poor inter-sectoral collaboration (43–45, 121, 125, 133) among public health researchers and political scientists working on international development has remained a challenge to evidence uptake. Networking and collaboration are robust approaches to enhance professional transformation (77, 93), stakeholder buy-in (69), opportunities for transparency and communication (123, 146, 156), partnerships (47, 86, 109, 114), and community participation in implementation (87, 114, 115, 130, 149). Strong collaboration creates a good relationship between researchers, funders and policymakers (41, 48, 84, 85, 104), and enhance health innovation in LMIC (111).
Building trust and ownership
Concerns about the quality of evidence have limited research uptake for policymaking (11, 13, 35, 48, 50, 51, 54, 58–60, 66–69, 73, 76, 77, 84, 86, 89, 96, 97, 100, 101, 103, 104, 108, 109, 113, 115, 119, 120, 123, 131–133, 135–137, 140, 145, 148–150). Lack of access to good quality, timely, and relevant research outputs were barriers to evidence uptake (11, 35, 48, 58, 59, 68, 104, 133, 148). Lack of research literacy (48, 97), poor perceived data quality (51, 97, 148), and unavailable or inaccessible research findings (84, 148) have detrimentally influenced health evidence to policy translation in LMICs. Evidence use is limited by organizational issues, lack of robust research skills, and innovative research designs (51, 59, 89, 101, 134, 145). Lack of locally relevant contextual research production (13, 51, 66, 69, 108, 109, 119, 120, 132, 135, 136, 150), poor presentation of research findings (150), lack of cost-effectiveness evidence (48, 131), weak institutional capacity (109, 113, 137), and low stakeholder consultation (123) cause public distrust. In addition, the beliefs and power of diverse actors (60), perceptions around the quality of existing evidence (50, 67, 69), the resistant culture of evidence users’ (50, 54, 77, 103, 115, 148), low motivation of researchers’ (73, 89, 96), and lack of clarity (150) are major barriers to evidence uptake. Making good quality data readily available in a digestible format (51, 68, 76, 100, 140, 149) is recommended to improve research uptake in LMICs.
Building sense of ownership through co-production of evidence (48–51, 53–55, 76, 85, 88, 97, 98, 101, 102, 105, 107, 113, 120, 123, 140, 142, 143, 146, 147, 149–151, 156), and spanning research and policy communities (147) are essential for producing high-quality contextual evidence. Balancing personal, local, institutional, and global concerns and priorities tends to lead to a sense of ownership and responsibility concerning research findings (142). Establishing multidisciplinary research networks (102, 149), cross-learning for researchers (48, 120, 150), and integrated knowledge translation to advance engagement (149) are important strategies to ease research uptake for policymaking. On the other hand, weak support for science-based health innovation (85), absence of effective coordination, governance and supervision (54, 97, 113, 120), inadequate integration of research into translation (97, 101, 105) experts overload, and a weak health system (55, 113) are barriers to research uptake.
Research capacity
Limited research capacity is a major challenge to research uptake for policymaking in LMICs (32, 33, 35, 41, 43, 46–48, 50–55, 58, 59, 63, 68, 69, 73, 75–80, 82–84, 89, 90, 93, 96, 97, 101–105, 107–113, 115, 122, 123, 126–132, 137–139, 142–144, 146, 147, 149, 152, 154–157). Lack of technical competency among evidence producers and users (33, 51, 52, 63, 93, 101, 107, 113, 137, 138, 143) and lack of organizational capacity (32, 35, 39, 82, 96, 97, 109, 113, 123, 147) and inadequate infrastructure (52, 63) have significant impacts on research uptake. Untrained human resources (53, 54, 105), lack of research capacity portfolios (83), low capacity to produce and use evidence (77), and limited researchers’ knowledge about research funding (73, 84, 108, 131), have all influenced health evidence to policy translation. Extensive capacity building, at the individual and organisational level (47, 52, 58, 63, 76, 77, 79, 84, 103, 110, 111, 122, 123, 142, 146, 149, 152, 156), for skilled human resource for research development (46, 47, 97, 104, 105, 112, 131, 144, 149) through in-service training (77, 78, 82, 104, 105, 138) is urgently required to improve use of research evidence. Funders need strong technical skills from researchers and integrated evidence translation (33, 102, 147). Low level of research understanding among evidence users has weakened research uptake for policymaking in LMICs (117, 138, 147, 149, 157). Establishing a contextual model for capacity development will help to drive evidence uptake for policymaking (32, 35, 107, 127–129, 138, 146, 154, 155).
Researchers’ inadequate skills in research and translation (41, 43, 55, 58, 69, 89, 97, 126, 138), and skills gap among evidence users (43, 48, 50, 54, 59, 68, 77, 90, 96, 101, 115, 138, 149), both impact research uptake in LMICs. In addition, staff shortages, high turnover (43, 52, 54, 63, 75, 83, 101), poor coordination and management; inadequate pre-service training; insufficient specialist capacity. poor information-based planning and decision-making, weak monitoring and lack of accountability and transparency (43, 54) are identified as capacity related factors that create barriers to effective research uptake. Health research uptake for policymaking and practice has suffered from low awareness, and misconceptions among evidence users (52, 54, 63, 93, 96, 104, 105, 113, 130, 131, 139). Research and translation mentorship (47, 52, 54, 56, 57, 63, 73, 75, 97, 103, 144, 156) and supportive supervision (56, 57, 75) play key roles in identifying potential evidence for policy. However, weak research supervision (47, 54), lack of evidence-based mentorship on new interventions (54, 73, 97, 103), and inadequate peer support in the healthcare (52, 63, 73) negatively influence evidence production and local implementation.
Resource constraints and misdirection of resource
Resource constraint are major barriers to uptake of research for policy and practice in LMICs. (32, 38, 39, 47, 52, 53, 61–63, 71, 73, 75–77, 79, 82, 83, 89, 93, 97, 103–105, 107, 112–114, 122, 123, 130, 131, 134, 148, 150, 151, 157). Unreliable infrastructure (103, 104, 112, 131), scarce resources and increasing numbers of patients (39, 53, 71, 93, 103–105, 112), are identified barriers to research uptake. Inadequate long-term funding for research infrastructure (71, 73, 75, 76, 83, 89, 105, 107, 113, 131, 150) and lack of local research funds (39, 61, 62, 77, 105, 107, 114, 157) are major factors affecting evidence to policy translation. Budget process bureaucracy (97, 113), corruption (97), and limited transparency (113) also influence translation efforts. Rigidity in executing research budgets (61, 83, 122, 134, 157), and use of legal proceedings (122) have also worsened evidence uptake support in LMICs. Therefore, efficient use of scarce resources (104), mobilizing domestic funding (32, 83, 122), funding for good quality research (77, 79, 130), physical and economic infrastructure at research institutions (114), and global health diplomacy (103, 112) are suggested to improve evidence translation.
Platform for evidence production and translation
Research uptake for health policy and practice requires an enabling platform for research priority setting and dissemination of findings (30, 41, 46–49, 52–54, 56, 58, 63, 69, 70, 72, 73, 76, 77, 79, 80, 82, 85–87, 97, 99, 101, 104–107, 109, 116, 120, 131, 137, 138, 140, 143, 145, 146, 148, 155). A major gap has existed in the dissemination and implementation of research findings for policy (58, 77, 82, 97, 99), access to evidence (53, 77, 111, 120, 137, 138, 143), domestic research finding knowledge exchange (41, 76, 105), interaction between stakeholders (58, 76, 86, 104, 105) and generating demand for evidence (131). Capacity strengthening, and research leadership using research uptake platforms (30, 69, 77, 120) is key to improving evidence use for policymaking. Such research uptake platforms facilitate engagement so that policy-makers can outline their priorities and expectations from researchers (47, 56, 69, 79, 82, 101, 146), conceptualize health research findings (72, 79, 87, 146), and so dissemination and implementation (30, 72, 82, 145), networking (138), coordination (56, 77) and research utilization (58, 68, 76) are optimised. Inadequate health policy research infrastructure (52, 63, 70, 73, 77, 97, 101, 155), fragmentation of health information systems (87, 145, 148, 155), absence of robust institutional platforms (48, 77, 80, 106), poor access to health data (155), and lack of cost-effective technologies for health information (69, 97, 106, 109) negatively affected evidence to policy translation in LMICs.
Effective communication of research findings (41, 48, 58, 59, 68, 70, 74, 76, 77, 79, 89, 97, 101, 113, 120, 131, 133, 138, 142–145, 150, 152) allows policymakers to share their knowledge and experiences (70, 79, 144), and engage stakeholders (41, 131, 142, 143, 150, 152). Knowledge translation through better packaging of key findings using plain and easy language (48, 74, 89, 138, 145) facilitates active diffusion of innovation (101). Limited availability of local data of the desired quality (48), lack of feedback (58, 59, 97), researchers’ having communication and dissemination skills gaps (41, 48, 89), poor engagement of stakeholders (58, 68, 77, 113, 120, 145), and low media use (145) are common communication barriers in LMICs. In addition, establishing a research uptake advisory board (34, 41, 48, 68, 75–77, 79, 80, 96, 100, 102, 104, 112, 114, 116, 122, 145, 147, 151, 152, 155) is important for mobilisation and advocacy (68,75–77), stakeholder engagement (100), and understanding of the local context (76). Similarly, actively involving research uptake advisory group at institutional level (41, 68, 79) will facilitate in-person discussions between researchers and policymakers (34, 35, 41, 48, 53, 69, 84, 89, 116, 120, 154, 155), strengthen implementation (77, 116, 151), help co-design research agendas (41, 48, 53, 84, 147), strengthen advocacy (34, 96, 100, 102, 112, 114, 122), make better use of media, and increase links to government (34, 68, 96, 102, 112, 122).
Investment in research infrastructure development
Research infrastructure development (35–38, 52–54, 56, 59, 63, 66, 69–71, 73, 76, 78, 80, 82, 89, 93, 97, 100, 104, 105, 111, 113, 120, 121, 141, 143, 146, 147, 149, 155, 156), including financial support to acquire essential evidence (70,82,97), mobilize resources for research capacity building (69, 71, 93, 104, 105, 146, 147, 156), and cooperation with national and international institutions (105) is crucial for infrastructure development to improve research uptake. Lack of basic infrastructures for research (71, 73) and healthcare (52, 54, 56, 63, 113), widespread perceptions of unfriendly organizational environment (52, 54, 63), and structural and technical constraints between institutions (38, 53, 59, 147, 155) have negatively influenced research uptake for policy. Strengthening institutional platforms (35, 36, 78, 80, 111, 120, 121, 149), and integrated research capacity building (56, 59, 73, 76, 100, 141), are required to improve research uptake for policy in LMICs. The fact that large proportion of health research depends on donors’ priority (41, 47, 51, 56, 61, 62, 69, 70, 73, 75, 77, 83–85, 89, 101, 102, 107, 109, 122, 131, 132, 134, 138, 139, 146), and may not always allow for the use of evidence (70, 75, 83, 131), that might affect LMICs national health priorities. Donors research support ranged from 47–94% of research investment in LMICs (75). Co-investment with national and international funding (85) and engaging donors and policymakers in research priority setting and implementation (41, 77, 107, 109, 139) may minimize funders influence and achieve mutual interests. Even though increased funding for research (73) and long-term funding for better success (47) are desired, limited time and funding (146) affect the quality of evidence produced and its translation to policy. Donor investment in health and research has fallen below that required (134, 138), and funding sustainability concern (56, 61, 69, 84, 102, 132) will compromise evidence to policy translation in LMICs. Domestic and international resource mobilization for health research and its translation is crucial to halting constraints in LMICs (101, 122, 134).
Evidence uptake framework and accountability
Developing a testable evidence uptake framework (30, 35, 36, 44, 54, 60, 67, 72, 74, 87, 88, 92, 94, 98, 114, 120, 128, 155) that allows in-depth integrates the fragmented body of knowledge (30, 36, 43, 54, 60, 67, 88, 92, 94, 128) will help to guide evidence uptake. System mapping to understand users’ perspectives, consult stakeholders, secure different funding streams, and design clear governance structures, leadership and staffing (74, 92) is crucial component of effective evidence uptake. In addition, addressing bottle necks related to legal frameworks, and policy and system response are critical to guide evidence use for policy (32, 43, 52, 54, 55, 58, 63, 64, 68, 70, 77, 78, 93, 100, 102–105, 120, 123, 131). Enforcement and accountability of researchers and users (52, 58, 63, 68, 77, 80, 89, 100, 103, 104, 120, 123, 131) is not in place due to weak governance and regulation (52, 63, 78, 103, 105). Though there are policy and institutional efforts to promote knowledge translation (89, 143, 147), other institutions in the health system can block these efforts, as can financial and organization pitfalls (52, 63, 82, 147), and weak national policy (37, 66, 76, 80, 147).
Recommendations to improve research uptake
We have identified several recommendations to improve research uptake for policymaking and practice (33, 41, 46–48, 54–59, 65, 68–70, 73, 77, 79, 80, 82, 83, 85, 89, 96–98, 100, 102, 103, 105–107, 111–113, 120, 123, 126, 138, 140, 141, 143–147, 150, 152). Establishing knowledge translation platform (56, 57, 69, 77, 100, 140, 143), strengthening existing platform (46, 73), and developing health research literacy program (41, 48, 77, 89, 111, 120, 147) are crucial to enhance quality evidence production and use. Understanding political dimension and contexts (54, 55, 97, 98, 102, 113, 120, 126, 145, 152) and disseminating research findings to ensure accessibility and availability of evidence (48, 58, 59, 77, 104, 123) play crucial role in research uptake for policymaking. Alliances to raise capital and investment are vital (33, 97, 113, 141, 145) in strengthening partnerships and engaging stakeholders to promote use of research findings (33, 47, 54, 65, 68, 73, 77, 82, 97, 98, 103, 105–107, 123, 138, 143, 146, 150). Designing research translation frameworks (105, 144), and deliberate dialogue or diplomacy efforts to mainstream research uptake for policy (68, 77, 79, 83, 112) will also be important. Investments in research infrastructure to strengthen and sustain institutional research capacity (70, 83, 85, 96, 147, 150) will contribute to quality evidence generation and use in LMICs.