Co-development of a research-to-policy framework for Indonesia’s health policy-making: a multiperspective approach

Abstract

Introduction

Despite the global promotion of evidence-informed health policy-making, translating research into actionable policy remains a challenge across settings. While global frameworks have provided guidance, adaptation to local contexts remains limited. This study aimed to co-develop a practical, context-specific, stakeholder-informed research-to-policy (R2P) framework for Indonesia.

Methods

A multilevel qualitative study (May 2024–May 2025) combined a narrative literature review, expert consultations, and cognitive debriefing interviews. Literature searches in the WHO Library and PubMed, supplemented by reference list screening were conducted to explore barriers, enablers, and steps in evidence translation. Consultations involved researchers, policy-makers (national and subnational), and civil society to capture multi-stakeholder perspectives. A follow-up round of cognitive debriefing was conducted to refine the draft framework and guidance. All sessions were transcribed and analysed thematically using the Steps for Coding and Theorization (SCAT) approach. Findings were mapped against factors identified in the WHO EIDM framework on evidence uptake to inform the development of the final R2P framework.

Results

Seventeen participants contributed to framework co-development. The literature confirmed the absence of a formal R2P framework in Indonesia. Barriers included weak infrastructure, fragmented governance, low research capacity outside major centres, limited dissemination, and misalignment between research outputs and policy needs. Enablers included political commitment, knowledge-to-policy units, policy-relevant outputs, and collaborative relationships. For early researchers, policy-maker engagement, knowledge brokering, and institutional capacity building emerged as key needs. The resulting R2P framework comprises two interlinked domains: evidence generation and the policy process, highlighting continuous, multidirectional collaboration among academia, policy-makers, and communities.

Conclusions

The co-developed R2P framework offers a practical pathway to strengthen trust, accelerate translation, and promote inclusive, evidence-informed health policies. While tailored to Indonesia, its principles of early engagement, coproduction, contextual adaptation, and institutional capacity-building may be adapted across diverse health system settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-026-01512-2.

Introduction

Health policy is shaped by complex socioeconomic, epidemiological, and political dynamics, as well as by the capacity to translate evidence into implementation [1]. While evidence-informed health policy-making has been widely promoted to improve health system outcomes, translating research into actionable policy remains a global challenge, affecting both high-income and low- and middle-income countries (LMICs) [2, 3]. Key barriers include governance structures, the influences of private corporations, political ideology and interests, and the limited availability of relevant research [4, 5]. Translating evidence into effective programme implementation is a particular challenge. For instance, although insecticide-treated nets are a well-established malaria prevention strategy, only 19% of children in LMICs slept under such nets in 2021 [6–8]. This highlights that, in addition to strong evidence, implementation capacity, stakeholder engagement, and contextual relevance are equally critical [9].

To bridge the gap between evidence, implementation, and policy practice, several evidence-based health policy frameworks and guidance documents have been developed, such as WHO Evidence-Informed Decision Making (EIDM) and Supporting the Use of Research Evidence (SURE) [10, 11]. Despite growing awareness and availability of such resources, countries often continue to face significant challenges in bridging research and policy-making in their local contexts. This has also occurred in Indonesia, particularly given its vast geography, diverse health burdens, varying research and policy capacities across provinces, and decentralised political system.

Several studies in Indonesia have identified persistent gaps between evidence generation and health policy-making across diverse health areas [12–19]. For example, in tobacco control, the use of available evidence has been hindered by multiple factors, including limited political commitment, fragmented policy approaches across government institutions, and external influences such as tobacco industry interference [17–20]. In tuberculosis control, although communication between Indonesian researchers and the government is relatively well established, ensuring the uptake of evidence into policy practice remains difficult due to institutional challenges, including high turnover among government staff and differing interests, languages, and approaches between researchers and policy-makers [18].

Structural features of Indonesia’s health system also shape its policy-making processes, including fragmented governance, power imbalances between national and subnational actors, and limited inter-agency coordination [21, 22]. At the national level, health development planning is led by the National Development Planning Agency (Bappenas) and further operationalised through the Ministry of Health (MoH) at the national level and the local development planning agency (Bappeda) at provincial and district levels. Despite these formal planning structures, decentralisation allows provincial and district governments to make adjustments and innovations, mainly through their respective provincial and district health offices (PHOs and DHOs). While PHOs and DHOs are hierarchically positioned under the authority of the governor and mayor/regent, local political interests often shape health policy-making, sometimes complicating the use of evidence in decision-making.

In addition, Indonesia’s pursuit of universal health coverage has introduced another key actor, the Social Security Agency for Health (BPJS Kesehatan), which administers the national health insurance scheme and exerts significant influence over health policy at both national and subnational levels [23]. These complex governance structures, involving multiple actors with diverse interests, mean that health-related policy-making does not consistently follow a predictable or linear policy cycle, including how and when evidence is expected, or even mandated, to be used [24]. This often leaves researchers frustrated by the persistent gap between evidence and policy development. Despite these challenges, there remains no structured framework to facilitate systematic communication among policy-makers, researchers, and the broader community to better align evidence with health policy and practice.

Given these challenges and the limitations of existing frameworks in addressing the Indonesian context, there is a clear need for more practical guidance to support the effective translation and communication of research evidence to inform health policy-making. Engaging multiple stakeholders and perspectives is essential for co-developing a nationally relevant and context-specific framework. To address this gap, this study aims to co-develop a practical, nationally relevant, stakeholder-informed research-to-policy (R2P) framework in Indonesia that can enhance the evidence translation and facilitate multidirectional communication between researchers and health policy-makers.

Methods

To develop the framework, we conducted a multilevel qualitative study comprising a narrative literature review, expert panel discussions, and cognitive debriefing interviews. This was carried out between May 2024 and May 2025 and involved diverse perspectives from a range of experts.

Narrative review

For the narrative literature review, we searched articles and documents describing frameworks related to evidence-based health policy-making in the PubMed [https://pubmed.ncbi.nlm.nih.gov/] database. We used keywords “evidence-informed policy” OR “research-to-policy” OR “knowledge translation” OR “evidence-based health policy” in the context of “Indonesia” OR “low- and middle-income countries”, OR “developing countries”. We also retrieved grey literature through handsearching relevant organisational websites (e.g., WHO, Ministry of Health, donor agencies) and through snowballing from the reference lists of included studies. Inclusion criteria were applied to studies describing frameworks, processes, or empirical cases of R2P translation in health, published in English or Indonesian, and relevant to LMIC or Indonesian contexts. Exclusion criteria were studies not related to health policy, purely clinical or biomedical research without policy relevance, and commentaries lacking substantive methodological or empirical contribution. All collected documents were screened independently by AF and NG. From each selected document, we extracted information on challenges, enablers, steps in evidence translation and policy development, and key concerns related to translating evidence into health policy. Data extraction and coding were conducted independently by AF and NG using predefined criteria to avoid bias. Any discrepancies were resolved through discussions among the reviewers.

Expert panel discussion series

A series of expert panel discussions was conducted to gather deeper insights into the current state of Indonesia’s policy-making process and research involvement in it, enablers and barriers influencing evidence generation and the policy process, and proposed mechanisms to facilitate adoption of research in policy-making process. Participants were purposively selected based on their individual and/or institutional track record, regional location, and level of experience (national or subnational) to capture diverse perspectives across stakeholder groups involved in the R2P process, institutional levels, and geographic regions, thereby reducing bias and enriching the insights obtained. We invited representatives of multiple stakeholders into an expert panel meeting: (1) health policy-makers at the national level (Ministry of Health, Ministry of Development Planning, House of Representative's Commission on Health); (2) health policy-makers at the subnational level; (3) researchers with expertise in health policy, public policy, and health research in general, including one researcher from the Eastern part of Indonesia; (4) community members and non-government organisation focusing on health policy-making (see Supplementary Table 1). Participants were contacted by email and text message through their institutions or personal contact, and a follow-up was conducted to confirm attendance. The expert panel discussions were held in a hybrid (in-person and virtual) format via Zoom meetings to ensure accessibility for participants across regions. For those who were unable to join the meeting, we invited them to an online in-depth interview to facilitate the incorporation of their insights into the analysis.

Cognitive debriefings

After the initial data analysis, a consolidated draft of the framework and guidelines in Indonesian was developed. The draft was then reviewed through cognitive debriefings by four experts with different backgrounds: (1) a former high-ranking official in the MoH and a provincial health office on Java Island with vast experience in health policy-making at the national and subnational levels; (2) a professor in administration policy and former high-ranking official in the Ministry of Bureaucratic Affairs; (3) a head of a non-government policy agency, and (4) a head of a political party thinktank agency. All separate debriefing sessions were conducted online using Zoom. We stopped inviting experts to panel meetings and debriefing sessions when data were saturated, indicating that no new information/insights were found.

Data analysis

The development of the framework was iterative. In the first round of data analysis, two researchers (AF and NG) developed initial versions of the framework based on a narrative review to be proposed to the expert panel.

All discussions and cognitive debriefing sessions were recorded, transcribed, and analysed by thematic analysis using the Steps for Coding and Theorization (SCAT) approach through a structured process: identifying and labelling meaningful units of text, abstracting these into broader categories, and formulating them into a framework. The SCAT approach also allowed dependability through a structured and documented analytical process. Analysis was conducted independently by four researchers (NG, DAS, KR, SK). Disagreements regarding thematic analysis were reconciled among the research team members through internal discussions, moderated by AF and NG.

The expert panel discussions focused on enablers of and barriers to the R2P process in the Indonesian context. Enablers and barriers were mapped using predetermined themes as defined by Oliver et al. and the WHO EIDM guideline on factors facilitating evidence-informed decision-making and research uptake: organisational resources, policy-maker and practitioner characteristics, research and researcher characteristics, policy characteristics, and contact and relationships between research producers and users [10, 25]. After the expert panel discussions, the draft was consolidated by three researchers (AF, NG, DAS) into two main predetermined areas of R2P: evidence generation (research) and the policy process. The consolidated framework and guideline were then proposed for cognitive debriefing. The debriefing focused on feedback on each area of the framework (evidence generation and policy process) and improving the framework and guidance. The steps of the study design and data analysis are shown in Supplementary Fig. 1.

Ethical considerations

Ethics approval was granted from the Health Research Ethics Committee, Faculty of Medicine Universitas Indonesia (no. KET-663/UN2.F1/ETIK/PPM.00.02/2024). Before the discussions and debriefing sessions, participants were provided with a written explanation and gave their consent to participate.

Results

In the narrative review, we identified 319 documents but found no framework, guideline, or specific regulation aimed at developing or institutionalising the use of research and evidence in evidence-based policy-making in Indonesia. During the expert panel discussions, 15 experts participated: 13 via an FGD and two via in-person interviews. Another 13 invited participants did not respond to the invitation, and no reasons were provided. In addition, five experts took part in the cognitive debriefing sessions.

Current state of research to policy (R2P) in Indonesia: framework and regulations, enablers, and barriers

At the time this study was conducted, there was no framework, guideline, or specific regulation governing the use of research and evidence in policy-making in Indonesia. However, there are several academic processes during policy-making, such as (1) the development of an academic draft for legislation (naskah akademik) as a prerequisite for enacting regulation at both the national and subnational levels [26–28], (2) background studies conducted by selected commissions and experts to provide evidence to inform the national medium-term development plan, and (3) formulating policy recommendations within the Ministry of Health by the Health Development Agency [29]. Despite these existing legal provisions, planning mechanisms, and institutional structures, there is still no publicly available regulation or formal protocol governing the systematic use of research evidence in policy-making processes.

From the review and expert discussions, we identified a complex interplay of barriers and enablers that shape the R2P process in Indonesia (Supplementary Table 2). Weak infrastructure, high operational costs in remote areas, fragmented governance, limited methodological rigour, and inadequate dissemination mechanisms often undermine the uptake of evidence. These challenges are further compounded by low demand for research at the local level and unstructured policy processes. Conversely, the existence of dedicated knowledge-to-policy units, strong managerial commitment, political and financial support, timely and policy-relevant outputs, clear legal frameworks, and active collaboration among researchers, policy-makers, and communities emerge as potential key enablers that can strengthen the link between research and decision-making.

Evidence generation

Experts recognised academia and researchers as the primary actors in generating evidence. However, policy-makers were also noted as “contributing to evidence generation, particularly through background studies and academic legal draft developed during the early stages of the policy process, often with expert advisory support” (PM05). The R2P process was acknowledged to begin as early as the research planning phase. While certain types of research are well positioned to inform policy, participants emphasized that not all research, such as fundamental or theoretical studies, is directly applicable to policy-making. This underscores the importance of classifying and identifying research types before attempting to translate findings into policy.

The importance of early engagement between researchers and policy-makers was consistently highlighted. Participants emphasized that proactive communication, initiated by either academia or policy-makers, can facilitate the smoother translation of evidence into policy. Although early engagement is perceived as ideal, researchers’ prevailing perceptions that research and politics belong to different “worlds” and that “(politics is) often seen as something dirty” (RS01) hinder meaningful collaboration. Therefore, many researchers tend to step back and confine their roles to the technical domain. On the other hand, policy-makers typically reach out to researchers only when further exploration and analysis are needed, often in a “demand-driven” and time-constrained manner. They tend to contact experts they are already familiar with or trust, based on the experts’ credentials or previous collaboration (RS03, PM05). This dynamic often results in a mismatch: researchers with strong capacities may not proactively engage with policy-makers, while policy-makers may struggle to identify those with the appropriate expertise and knowledge.

We also identified differing interests between researchers and policy-makers. According to one policy-maker, researchers are perceived as primarily focused on “novelty, identifying gaps, and raising questions” and taking a strategic advisory role. Researchers’ primary interest is often to publish their findings, and it “ends up as scientific publications, without ever reaching the centre of power that shapes policy decisions” (RS07). This limits the practical use of evidence in policy-making and underscores the need for more accessible formats, clearer language, and targeted dissemination strategies. On the other hand, policy-makers tend to concentrate on “finding solutions” and expect “targeted, actionable recommendations” (PM05), along with familiarity with regulatory development and its technical aspects. Only a few researchers were perceived as understanding these differences in language and interests, which often hinders mutual comprehension and collaboration. In addition, experts highlighted the importance of tailoring research and policy to relevant local contexts and scope and therefore require equal resources across the country to promote evidence generation beyond urban settings and reduce disparities.

To address the disparities, experts emphasized the need for “institutional capacity building” and the formal integration of R2P processes within research institutions (RS01, RS07). This involves not only strengthening individual researchers' competencies, such as policy communication skills, but also establishing structural mechanisms to support their work. Examples include the creation of university-based “policy labs” comprising “legal experts, legislative specialists, and also subject-matter experts” (RS01, PM04), as well as the development of academic health systems that foster collaboration between universities and governments at the subnational level to identify and conduct policy-relevant research.

Policy process

Experts emphasized that policy-making in Indonesia “follows a diverse and often non-linear set of processes”, shaped by “varying institutional contexts, political dynamics, and levels of urgency” (CO03, RS01, RS07). To further illustrate the complexity of Indonesia’s policy process, experts described how policy-making is shaped by three distinct forces: the technocratic approach, political directives, and bottom-up initiatives. The technocratic approach may be undertaken by invited academic institutions or by the government’s internal teams, but it can also be influenced, and at times compromised, by political directives that are “driven by leadership vision and priorities” and “bottom-up inputs from subnational governments and communities” (PM05).

The complexity of Indonesia’s sociopolitical landscape was frequently cited as a barrier to the effective use of evidence. The policy-making process often follows politicians’ interests, and politicians, in turn, respond to what people want. This dynamic leads to decision-making driven by non-evidence considerations, including ideology, pragmatism, personal interests, public opinion, or even business-driven motives. Due to vote-based elections, policies are frequently formulated reactively after public issues gain traction, rather than proactively and through a well-designed process. Limited guidance on using evidence often led to “viral-based policies”, a term used in Indonesia to describe policies driven by public opinion, social media trends, or viral online issues rather than by systematic evidence or expert analysis.

“Once an issue goes viral and creates public anxiety, then it gets addressed. But because it has already gone viral, the policy response is often emotional or rushed, rather than grounded in evidence” (PM06).

While evidence is essential, it alone does not guarantee optimal policy outcomes. Only the pieces of evidence that “reach decision-makers", often those at the “centre of power”, have potential to influence policy, highlighting the importance of “strategic communication and delivery” (RS07). Moreover, the successful execution of policies is frequently hindered by gaps in human resource capacity, particularly at the subnational level, where technical expertise and policy-making literacy may be lacking.

Knowledge brokering emerged as an instrumental intermediary function in the policy process. Researchers, policy analysts, or even non-traditional actors, such as those from “industry” (CO03), were identified as potential knowledge brokers due to their ability to bridge evidence generation and policy-making. Effective knowledge brokers must possess a sound understanding of both domains, communicate clearly, and earn the trust of stakeholders. However, their role should not replace the long-term need for researchers to strengthen their own capacity to translate and convey research findings to policy audiences. Encouraging researchers to act as “policy entrepreneurs” who “really understand the substance of the proposed policy and know how to adapt that substance into actual policy” was viewed as a strategic way to enhance evidence uptake (RS07). Policy analysts were also highlighted as key actors who can mediate evidence to deliver the message to policy-makers, interpret complex findings, and present them in formats that are more accessible to decision-makers (PM 06, RS07).

Co-design was identified as a promising approach to translate the evidence into policy. Its success depends on early engagement, shared responsibility, and trust—often built through prior collaborative experiences. Experts noted that the public’s role is primarily to articulate problems, not necessarily to propose solutions, and that researchers have varying degrees of involvement with and relationships to government bodies (CO03). An inclusive policy-making process was perceived as lacking, particularly in high-level regulation development, for example, law. While public consultations are intended to capture diverse perspectives, the prevailing culture often discourages dissenting views. Experts noted those who express disagreement “stop being invited to meetings—that happens quite often”, limiting the opportunity for constructive debate before policies are finalised (CO01, CO02).

Community members also face challenges in accessing formal policy mechanisms. Engagement in policy formulation “isn’t always automatic”; therefore, community members should be “developing channels to voice our perspectives and help broaden public attention toward policy issues” (CO01, CO02). While mechanisms for public hearings do exist, such as those used in the development of the Health Law (No. 12 of 2023), there is little transparency regarding which public inputs are ultimately adopted, as they do not “really know which inputs were actually taken up and which were not” (CO01). Moreover, experts highlighted the absence of a formal mechanism for researchers and communities to provide feedback largely due to limited access to policy-making processes. The public, including researchers and affected communities, often becomes aware of policies only after they have been enacted. In practice, even when community members attempt to contribute to programme design, they face data limitations, making it difficult to generate evidence-based recommendations (CO01, CO02).

Development of a research-to-policy (R2P) framework

In co-developing the framework, experts acknowledged that policy decisions are not always explicit; they may take the form of ministerial directives or administrative adjustments. Given the diversity of actors within the policy-making community, it is essential to navigate the policy ecosystem effectively and identify strategic points of intervention, “how we mediate differences with other groups, how we strategically convince policymakers” (RS07).

Experts emphasized the need for a clear framework and practical guidance not only for experienced researchers and policy-makers who are already familiar with policy-related terminology, but also “set the stage” for those who are “not familiar with fairly technical (policy-related) terms” (RS01, PM06). The proposed adjustment to the framework and guidance included refining tone and structure to accommodate varying levels of policy literacy, simplifying language, and clarifying technical terms. Experts also stressed that the objective of such a framework should be made explicit, whether it serves primarily as a research guide, a policy translation tool, or a bridge between programme design and decision-making (PM06, PM07, RS01). Providing background information that highlights how evidence-based policy-making is shaped not only by technical merit but also by the dynamic nature and contextual factors of Indonesia’s political landscape, such as “timing, accessibility, interest, sometimes even business interests”, is also essential to ensure relevance and realism (CO03).

To foster meaningful engagement, the framework and guidance must also embody humility and mutual respect between researchers and policy-makers. Although researchers are often academically advanced, in terms of policy development, it does not necessarily mean that “the researcher knows more than the people actually doing the work”, and this humility “really helps with engagement. They (policy-makers) tend to be more open, and the engagement becomes more effective too” (CO03). Building trust also requires recognising diverse entry points within the policy window, including identifying and engaging stakeholders who have a direct interest in research as allies (CO03).

The research-to-policy (R2P) framework in the Indonesian context

We then developed a framework explaining two simultaneous processes: evidence generation and the policy process (Fig. 1). These processes involve two key stakeholder groups: academia, researchers, and the community in one group and policy-makers from both the health sector and other relevant inter- and multisectoral fields in the other. Evidence generation is not confined to certain phases of the policy process and, rather, pushes for equal engagement of both stakeholders in co-design, co-creation, and co-production of both the research and policy products. Both stakeholder groups actively engage throughout the entire process, with early engagement starting even from the early steps of each process.

Fig. 1.

Co-developed research-to-policy framework in Indonesia

Generating evidence is not an exclusive endeavour limited to researchers; it can also be carried out by academia, communities, and policy-makers. Communities play important roles in contributing tacit evidence derived from the lived experience, ensuring the quality of the R2P process, and promoting contextually relevant outcomes in the resulting evidence and policy or programmes they help implement. Policy-makers can also generate high-quality evidence, mainly for programme evaluation, to inform and improve decision-making. They have access to rich data sources from routine reporting systems, monitoring and evaluation activities, national surveys, and surveillance systems, all of which can be analysed to strengthen policy formulation and refinement.

Policy-makers can reach out to academia, researchers, and communities to help generate the evidence they need. Conversely, as previously highlighted by experts, academia, researchers, and communities are encouraged to consult and engage with policy-makers from the early stages of study design to ensure that their research is aligned with policy needs and to increase the likelihood of uptake. This reciprocal process strengthens the initial stages of policy development: problem identification and prioritisation, solution design, and implementation planning.

Evidence generation and use are not limited for policy formulation but are rather a continuous process including when policy-makers implement the policy or programmes. At this phase, policy-makers play the main role, as they have the authority to design solutions, develop policies, and oversee their implementation. The policy process is structured into several key stages : problem identification and prioritization, solution design, implementation planning, programme and health intervention execution, and monitoring and evaluation. Knowledge brokers serve as strategic intermediaries that could catalyse communication between the evidence generation and the policy-making processes and the actors involved.

Figure 2 shows the interaction among primary and secondary research findings, intermediary products, and policy outputs. Evidence can be derived from both primary and secondary research. Primary research is based on data collected directly from sources, while secondary research involves analysing and interpreting existing data. However, data obtained through primary or secondary research is often neither immediately accessible nor user-friendly for non-academic audiences, including policy-makers. Intermediary products package research findings from primary and secondary studies in formats that policy-makers can easily understand and integrate into their agendas.

Fig. 2.

Evidence from primary and secondary sources, intermediate policy products, and policy products

Discussion

This study assessed the current state of the R2P process in Indonesia’s policy-making, along with its enablers and barriers, which together informed the development of an R2P framework tailored to the Indonesian context. The framework offers guidance for researchers, communities, and policy-makers on how to communicate and collaborate effectively—from study conception, programme planning, and implementation to monitoring and evaluation—to optimie health policy-making supported by strong and relevant evidence.

Our study findings indicate that, despite some progress, evidence generation and uptake in Indonesia remain poorly connected. This challenge is not unique to Indonesia; even in high-income countries, policy-makers often struggle to access high-quality and policy-relevant research [30, 31]. The process is inherently complex, requiring policy-makers to assess the clarity, relevance, and reliability of research findings in relation to policy needs [25]. Conversely, researchers are sometimes frustrated by the low uptake of evidence but must recognise the need to develop skills beyond research, particularly in communicating and advocating for the policy application of their findings. Researchers need to cultivate their ability to describe existing bodies of research, the implications of such research, and corresponding policy recommendations in the form of legal or policy language that are different from scientific reports [30]. The timing between evidence generation and the policy window adds further complexity, as aligning the supply of evidence with policy demand remains difficult.

The framework we developed (Figs. 1 and 2) considers the differing interests and languages of researchers, the community, and policy-makers. To ensure the effective translation and uptake of evidence, researchers need to cultivate skills that include building trust and sustaining relationships with policy-makers, which in turn facilitate the use of evidence in decision-making [25]. The trust also stems from the credibility of both the researchers and their research [32]. As this study found, researchers and policy-makers alike should explore practical ways to communicate and build trust with one another, despite differences in professional culture and communication styles.

Our R2P framework, despite being initially developed in the Indonesian context, contributes to global policy R2P framework and fills conceptual and operational gaps. It highlights and explicitly states the reciprocity and mutualism in evidence generation and the framework and extends beyond a cyclical, linear, or sequential process, as shown by the WHO Evidence-Informed Decision Making (EIDM) and the Supporting the Use of Research Evidence (SURE) frameworks (see Table 1). Notably, the policy translation is not a unidirectional endeavour by researchers toward decision-makers, as many researchers in LMICs assume, because many complete the study and then attempt to communicate the findings to policy-makers, without having engaged them adequately from the outset. To bridge the gap between evidence and health policy decisions, early engagement from either side is essential. From the researchers’ perspective, participatory research has emerged as an effective approach to ensuring the relevance of evidence in addressing policy and public needs. This involves engaging diverse, relevant stakeholders, including community members, researchers, and policy-makers, throughout the research process. Its core objective is to promote democratic co-creation of knowledge, ensuring that evidence generation is not exclusive to researchers but instead a collaborative effort involving those who will ultimately use and be affected by the findings (knowledge users) [33].

Table 1.

Comparison of key elements: WHO EIDM, SURE, and the proposed Indonesian R2P framework

Dimension	WHO EIDM framework	SURE framework	Indonesian R2P framework (this study)
Conceptual model	Linear, cyclical process, general concept	Context-sensitive, but largely unidirectional	Reciprocal, non-linear, co-production model
Direction of evidence flow	Mainly researcher to policy-maker (and communities)	Mainly researcher to policy-maker (and communities)	Bidirectional: researcher ↔ policy-maker ↔ community
Role of communities	Limited, not explicitly stated	Limited, not explicitly stated	Active co-producers of knowledge and policy
Knowledge broker	Not formalized	Not formalized	Explicitly operationalised as an ‘alternative’ intermediary role

Conversely, policies are often developed without sufficient engagement with academia, researchers, and communities, from conception through evaluation. Academics, researchers, communities, and policy-makers are, therefore, co-producers of both knowledge and decision-making. This reframing acknowledges that evidence does not speak for itself; rather, its uptake is mediated by power relations, institutional capacities, and the relational dynamics between knowledge producers and users. In many cases, implementation research, which focuses on understanding how interventions function in real-world settings, offers valuable insights into contextual challenges and enabling factors that shape policy outcomes [34, 35]. This approach is relevant not only during study design or programme planning but also throughout implementation, monitoring, and evaluation. In Indonesia, this approach, previously referred to as operational research, has been initiated but remains limited, primarily to infectious disease control programmes, such as HIV/AIDS, malaria, and tuberculosis [36, 37].

For an effective and reciprocal relationship between evidence generation and its use throughout the R2P process—from design to evaluation—both institutional and individual factors play critical roles. Institutional factors, including research infrastructure, funding availability, and system-wide support, are particularly influential. Stewart et al. argued that efforts to promote evidence-based policy transformation should shift focus toward strengthening the broader “evidence system” rather than solely concentrating on the “policy system”. Institutional reforms aimed at establishing systematic and collaborative pathways between evidence generators and implementers are therefore essential [38]. For example, the establishment of the National Institute for Health and Care Excellence (NICE) in the United Kingdom shows how research and policy-making can be effectively institutionalised to support the healthcare delivery and health system [39]. Similar models have been implemented in LMICs, such as the Knowledge Translation activities at the Kenya Medical Research Institute (KEMRI), which have been reported to improve policy-makers’ motivation to use evidence in decision-making [40]. In Indonesia, the establishment of the Indonesian Health Technology Assessment Committee demonstrates an ongoing effort to institutionalize evidence-informed policy-making, although this process remains iterative and evolving [41]. Previous literature supports our finding that the lack of timely research outputs remains a significant barrier to the adoption of evidence in policy-making. To maximize impact, researchers and policy-makers must ensure that evidence is available within the critical policy window [42]. However, this poses a challenge, as producing rigorous and robust research within short timeframes is often difficult. In times of crisis, Greenhalgh and Engebretsen argue that public health policy-making should allow greater room for pragmatism, especially when evidence is rapidly evolving and uncertainty is high [43]. Lessons from the COVID-19 pandemic show that rigid adherence to traditional evidence-based approaches may be counterproductive to urgent public needs. These contextual realities underscore the importance of flexibility in translating evidence into policy. Nonetheless, we argue that methodological rigour must not be compromised. While adaptations to study design may be necessary to meet time-sensitive demands, the integrity and quality of research must be preserved. Therefore, it is essential that researchers are equipped to incorporate policy considerations into the design phase, ensuring both scientific robustness and practical relevance to policy-making.

Methodologically, our R2P framework was developed using a robust co-development approach, ensuring that all relevant dimensions of the policy process were captured through active participation of multi-stakeholder groups. Cognitive debriefing was further employed to validate the comprehensiveness, clarity, and contextual appropriateness of each instrument component—a methodological rigour that is rarely applied in the development of similar tools.

Through this methodological process, which addresses how policy is developed in Indonesia as an LMIC, we also acknowledge the critical role of science communication and intermediary actors—often referred to as “knowledge brokers”. Brokers, whether individuals, small teams, or dedicated interdisciplinary centres, act as intermediaries, negotiators, and interpreters between parties who might not otherwise understand each other [44]. Their roles are bidirectional: supporting policy-makers through knowledge synthesis and decision-support tools while contributing to academic activities such as joint proposals, data analysis, capacity building, and network development for both parties.

Brokerage roles, however, vary by context. In implementation research aimed at helping policy-makers (re)shape the programme, brokers often function as narrow "science arbiters", focused on technical support with limited policy influence [45]. Beyond this, they can act as an 'issue advocate’ and the ‘honest broker of policy alternatives’; these roles require navigating the dynamic, value-laden nature of policy-making, a competency many researchers in LMICs lack. Brokers help tailor research messages to diverse audiences by using varied formats, tones, and channels to distil complex findings into concise, accessible formats that align with political priorities and policy windows so that they can build trust and relevance [46, 47]. In Indonesia’s dynamic policy environment, integrating these mediators into the R2P process offers a strategic pathway to improve the relevance, accessibility, and impact of research in health policy formulation and implementation [25, 48].

However, as this framework captures the knowledge broker role within a dashed boundary, we acknowledge that the role of knowledge brokers needs not necessarily be institutionalised. Rather, it can fill the gap when researchers feel insufficiently equipped or do not fully understand how to communicate effectively within the policy process. Most critically, what must be developed is researchers’ capacity in the strategic communication of study findings and their translation into policy; this is precisely how the findings of this study should be followed up with practical guidance and training for researchers, as the primary intended users of this framework, and alongside other users, on how to use and apply this R2P framework (see Table 2).

Table 2.

How to use the research-to-policy (R2P) framework

Phase	Policy process step	Intended users	How to use the framework	Illustrative vignette
Evidence generation	Problem identification and prioritization	Academics, researchers, community representatives	Engage communities and policy-makers early to co-identify priority problems. Use the framework to align research questions with real policy needs and ensure affected communities are active participants, not merely subjects	When developing a research protocol for tuberculosis, a research team invites health care officers, community health volunteers and TB-affected communities (patient organisations) to ensure that the research questions reflect both community needs and experience, as well as local policy priorities
	Design solution	Researchers, policy-makers, knowledge brokers (where applicable)	Facilitate structured dialogue between researchers and policy-makers on study design. Use the bidirectional communication pathway to ensure that proposed solutions are technically sound and contextually feasible for implementation	A public health researcher shares preliminary findings on childhood pneumonia with the Provincial and District Health Offices and invites the Offices (and other relevant stakeholders) to discuss locally contextual design solutions to fit the existing health system and social aspects for a more implementable solution
	Design implementation	Researchers, programme managers, policy-makers	Use the framework to co-develop implementation protocols with policy-makers. Researchers contribute technical rigour; policy-makers contribute operational knowledge of the health system, governance structures, and resource constraints	A research consortium works with the Ministry of Health and provincial and district Health Offices to map existing service delivery channels before designing the roll-out plan for a new immunization intervention, reducing duplication and increasing ownership
Implementation	Implementation of health programme and interventions	Programme managers, policy-makers, academics (as embedded implementation researchers)	Researchers actively participate in implementation research, feeding back real-time evidence to policy-makers. The framework positions academics and communities as engaged partners; not external evaluators, throughout programme delivery	During a maternal health programme roll-out in a province, an embedded researcher identifies a bottleneck in community acceptance. Findings are communicated swiftly to the district health team, who adjusts the delivery approach mid-implementation
Monitoring & Evaluation (M&E)	Monitoring and evaluation	Researchers, policy-makers, community representatives, knowledge brokers (where applicable)	Use the framework to close the feedback loop: M&E findings flow back to the evidence generation phase, informing new research questions and policy refinements. Communities and affected groups contribute to validating evaluation findings against lived experience	Following an evaluation of a zero-dose vaccination programme in three provinces, researchers present disaggregated findings to national and subnational policy-makers in a structured dialogue. Community representatives validate findings and co-prioritize the next research cycle

This framework has utility beyond the Indonesian context. While the co-development process was grounded in the Indonesian setting, the framework itself, including the knowledge brokerage element, is, to a considerable extent, universal and transferable to other country contexts. Nevertheless, the practical operationalisation of this framework will need to be adapted to each country's specific context, particularly regarding how stakeholder engagement and partnership are fostered, and how trust and ownership are cultivated through a bidirectional research-to-policy process—capacities that remain underdeveloped in many low- and middle-income countries (LMICs) [49].

Strengths and limitations

This study provides novel insights into how to contextualise the global evidence-to-policy approach at the national level of R2P to improve evidence-based health policy, bridging the gap between research or evidence generation and policy-making. This study has several stages, from review, expert panel meeting, and debriefing, that comprehensively complement the existing global frameworks, e.g., the WHO EIDM. However, despite the efforts to capture multiple perspectives, the expert panel did not include members from district-level policy-makers, industry, and the private sector, who might offer valuable insights from local and business perspectives.

Conclusion

This study presents a co-developed, contextually grounded R2P framework tailored to Indonesia’s health policy-making landscape. By integrating insights from diverse stakeholders and emphasising multidirectional engagement, the framework offers practical pathways to bridge the persistent gap between evidence generation and policy implementation. While further testing is needed to assess its real-world impact, the framework lays a foundation for more inclusive, responsive, and evidence-informed health policies. Its principles may also be adapted to other settings seeking to strengthen research-policy linkages. To strengthen the R2P process in practice, Indonesia’s research and policy actors should institutionalise dedicated knowledge-to-policy units and formalise mechanisms for (early) engagement among researchers, policy-makers, and communities. In parallel, Indonesia needs to invest in capacity-building at both the national and subnational levels to ensure that timely, policy-relevant evidence is consistently generated, communicated, and applied in decision-making.

Author contributions

Conceptualization: AF, NG; Methodology: AF; Software: -; Validation: AF; Formal Analysis: AF, NG, DA, KR; Investigation: AF, NG, DAS; Resources: MK, AF; Data curation: AF; Writing – Original Draft: NG, DA; Writing – Review & Editing: AF, NG, DA, AG, FQ, AA, TJ; Visualization: AF, NG; Supervision: MK; Project administration: NG, PP; Funding acquisition: AF, NG, MK.

Funding

This research is funded by the Directorate of Research and Development, Universitas Indonesia, through Hibah (grant) PUTI 2024 (grant no. NKB-010/UN2.RST/HKP.05.00/2024).

Data availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

The authors declare no competing interests.