Based on the interviews, the necessary interventions for empowering researchers and knowledge-producing organizations to produce and translate the appropriate evidence for health policy in Iran can be divided into four themes: health system interventions, community-based interventions, organizational interventions, and individual interventions. Description of each theme is provided below (Also table 2 shows the themes and subthemes).
Health System Interventions
Review of the documents and analysis of interviews indicate that one of the most important measures for empowering researchers and knowledge-producing organizations is to hold relevant specialized training. According to most interviewees, training is a key step in developing a skilled workforce and a useful tool for improving the quality of policy-related research. Formal education in universities (e.g. through specifically designed courses and/or by including relevant discussions in other courses), shorter training programs, workshops, and on-the-job training are some of the suggestions made by the participants.
"Any change in this aspect must begin from the top, that is, from the national education system." (I-3)
Research cycle management
Issues related to research cycle management include developing national strategies aimed at continuous and constructive cooperation for strengthening EIPM among knowledge producers (including researchers and knowledge-producing organizations) and knowledge users, providing support for policy-related data collection, archival, maintenance and distribution, and facilitating access to relevant data by users such as students and researchers.
"Evidence-production networks in the country are faced with poor management. For example, research priorities in the networks of the Ministry of Health and the way these priorities are established are unclear." (I-14)
Evaluation and assessment
According to many of the interviewees, changing the evaluation and assessment system, defining motivators, changing the reward system, especially for faculty members and researchers with respect to policy-focused knowledge translation, and changing researcher ranking method in the Research Department of the Ministry of Health play a significant role in the promotion of this policy approach.
"An issue that must be addressed is the evaluation system. faculty members and students are only concerned with producing articles, not being responsive to the needs of different groups and the society as a whole." (I-10)
The interviewees believed that evidence-based health interventions and policies must be promoted and accepted by the wider community. If this becomes the prevailing practice, it will lessen the impact of conflicts of interest and political inclinations on decision making.
"We all know the significant impact and role of pressure groups in the world of policies. We must force policy making toward demanding appropriate evidence from researchers and research centers. Once we build this culture, researchers and knowledge producers will also have to improve to keep pace with policymakers' demands." (I-7)
According to the interviewees, the media plays a key role in promotion of EIPM. Transparency and reporting the results of policies and plans that are informed or uninformed by evidence can contribute to these efforts.
"The media, just like people and experts, can discuss policy topics. If the media are familiar with the literature, they will consider the extent to which policy making is evidence-based whenever a policy is made at any level." (I-4)
Organizational interventions include training programs, knowledge management and organizational communication management, and research cycle management.
According to some of the participants, one of the most appropriate educational methods is short-term specialized training programs which can be defined at the organizational level. The nature of these programs and the course subjects and contents will develop the skills required by researchers and other people involved in knowledge production, allowing them to meet the needs of policymakers. In most cases, short-term training programs are designed and implemented for two main reasons: to teach scientific and technical skills and change organizational behavior.
"It's necessary to assess the needs of the consumers of knowledge products and develop training programs accordingly." (I-9)
Use of modern teaching techniques such as distance education and defining and planning training programs based on policymakers' expectations were other issues raised by the participants of this study.
Knowledge management and organizational communication management
According to the interviewees, in the context of EIPM, knowledge management is a systematic approach to understanding and using knowledge or information and making it available to policymakers at the right time, thus allowing them to make informed decisions. The findings of the present research indicate that achieving evidence-based or evidence-informed policy making requires knowledge management to be focused on projects and knowledge development, establishing the relevant knowledge base, the exchange and sharing of knowledge among the employees of the organization, and training.
"There should be a system in place for registering policy researchers and monitoring their scientific and professional activities." (I-1)
Research cycle management
Effective research cycle management is an important consideration in interventions for empowering researchers to strengthen EIPM. Research cycle begins with the proposal of a research idea and design and continues until evidence production and application. By focusing on the production of credible evidence, effective research cycle management leads to identification of more influential and higher quality research and prepares the ground for better use of evidence by users such as policymakers.
"It’s especially important to pay attention to the quality of data produced in organizations." (I-12)
The findings indicated that research cycle management emphasizes the adoption of strategies for directing knowledge creation toward more influential and higher quality research and preventing the unhindered publication of “pseudo-research”.
Motivational interventions play a key role in the performance of researchers and knowledge-producing organizations and are critical to strengthening EIPM. Knowledge about the personal characteristics of individuals in an organization and the use of various motivators will enable them to communicate more effectively with their audience and strengthen this policy approach. According to many of the participants, multidimensional behavioral-motivational interventions have a significant effect on individual performance.
Knowledge of policy making and policy analysis
According to the interviewees, one of the issues that is often ignored in discussions about strengthening EIPM is the fact that there is a considerable gap between the world of research and the world of policy making, which acts as a major barrier to expanding this policy approach. To reduce this gap, researchers and faculty members need to become familiar with the basic concepts and principles of policy making and policy analysis and apply them in their research endeavors.
"Individuals and organizations that seek evidence-informed policy making must possess both policy making and evidence-related knowledge." (I-3)
The participants believed that problem for science and evidence-based policy comes when politicians and other political actors decide to discredit the science on which a conclusion is based or bend the science to support their policy position. This is called policy-based evidence as opposed to evidence-based policy. Researchers who possess the knowledge of policy making can prevent this and use policymakers’ language to promote EIPM.
Knowledge of policy evidence production and translation
The interviewees were of the opinion that the gap between the knowledge produced by researchers and organizations and, the decisions and policies made by senior officials is a key challenge in the implementation of EIPM. Interventions are needed to bridge this gap, including the provision of skills and knowledge of policy-related evidence production and translation. Knowledge of knowledge translation was highlighted by the participants as a key factor in strengthening the adoption and application of research results by policymakers, which will enable them to make informed, knowledge-based decisions and policies.
"Instruments that can contribute to informed policy making and decision making and translating evidence into the language of policymakers aren't used extensively. Policy makers don't receive the necessary skills. Employees almost never reach the level of knowledge translation in evidence-informed policy making and remain at the level of producing articles, mostly at the national level." (I-5)
Knowledge of science communication
Communicating science to policymakers is one of the skills that were underscored by the interviewees. They argued that science communication must be in both oral and written format. Use of instruments in the language of policymakers can attract their attention to a specific problem and prompt them to implement appropriate interventions.
"In our country, there is a weak link between knowledge producers and policymakers. Each policymaker must be guided by a number of researchers. We can argue that these two groups are still in dire need of better communication." (I-14)
According to the participants, familiarity with the characteristics of research data users (i.e. policymakers and decision makers) and the nature of their work allows for establishing more effective science communication, conducting research with the participation of decision makers, and identifying the social barriers to changing evidence users' behavior.
Knowledge of the health system
To institutionalize and strengthen EIPM, researchers and knowledge-producing organizations need to understand and be aware of the functions and goals of the health system, its different sections and components, how it affects and is affected by other sectors, and the history and outcomes of important actions and policies implemented within the health system. Some interviewees believed that some issues such as systems’ thinking and systems’ dynamics can also be influential in better understanding of the outcomes and effects observed within the health system and using this knowledge to inform policies.