Evidence-informed Health Policy Making: The Role of Policy Brief

The ultimate goal of a health system is community health promotion in an equitable manner. Various factors in the health system are all contributed in achieving this goal. Researchers in this system attempt to produce evidence to be used by decision makers in the health system including policy makers. Policy making is a complex task and though policy makers need scientific evidence, other factors such as values governing the health system, opinions of experts and community, and many other factors influence the final policy makers’ decisions.[1–3] Spreading and applying evidence in the health system is a complicated task and various individual and organizational factors affect it.[4]

To increase scientific evidence contribution in decision making, evidence-informed health policy making (EVIP) began in late 1990s. EVIP is in fact an approach to decision making, goal of which is assuring that policy makers are informed from the best available scientific evidence in decision-making process. The major characteristic of this approach is an explicit and systematic process of search, critical appraisal, and selection of scientific evidence.[5,6]

General confession on the gap between research and practice has led that today many activities are done for filling the research and decision-making gap. Review and search of scientific databases reveal that such activities are wide ranging from activities in research and researchers’ field (push activities) to activities in the field of users, decision makers, and policy makers (pull activities). There is a great set of activities within this range in the field of facilitators of science to practice (knowledge brokers).[6–8]

Despite the measures taken and progress made, yet the amount of using scientific evidence in policy makers’ decisions is not desirable. Several studies have been done aimed at identifying strategies to promote use of evidence in policy making. Various barriers have been identified in this area and multidimensional interventions are needed to promote EVIP.[9,10] Effective interaction between researchers and policymakers including appropriate methods of knowledge transfer to policymakers has been identified as one of the best ways of increasing use of evidence obtained in research in the policy-making process.[11,12]

Several studies about knowledge transfer to policy makers have indicated that policy makers prefer to have and obtain highlighted evidence needed for decision making such as advantages and disadvantages and costs of alternative interventions. In addition, they tend to have information gathered on contextual and structural features affecting local application of global evidence. Reports′ format is as important as their contents in use of evidence by policy makers. Policy makers like to have information in a brief format so that they can review it quickly and if relevant, they consider more information.[13,14]

By increasing knowledge in the field of transferring evidence to policy makers, a collection of papers was published in 2009 called “SUPPORT Tools for Evidence-Informed Health Policymaking (STP)” which provides strategies for enhancing EVIP as a practical and step-by-step tool. Key areas discussed in these articles include identifying needs for evidence, finding and assessing evidence, and going from evidence to decisions about health systems. Tools discussed in this collection are helpful for different audiences, including researchers, senior, and junior policy makers.[15,16]

The policy brief is a relatively new tool for providing scientific evidence to policy makers which is designed for facilitating knowledge transfer to policy makers and is discussed in these articles. The first section of policy brief is dedicated to identification and analysis of the problem that is carried out by the help of scientific and local evidence in interaction with policy makers and researchers. The main fact is that use of systematic reviews that are used in preparing policy brief makes evidence review processes quick and applicable.[17] And thus, policy brief timeliness increases, which improves use of evidence by policy makers.[12] Then, various options for intervention are specified using scientific evidence, and costs, benefits, loss and harms due to interventions, and other key points related to implementation of options are given for suggested interventions. Quality of scientific evidence is evaluated by researchers. It helps policy makers to address concerns about reliability and validity of research results and thus increasing their use of scientific evidence.[17] In terms of the writing format, a policy brief should be written in a graded-entry format. In other words, ideally a policy brief should be prepared in such a way that the readers can consider the whole issue and its relevance to their problem and local condition with a quick look and read more if necessary. Because readers are often busy individuals in their work, the graded-entry format has been suggested in various forms. For example, 1:3:25 is one of writing formats.[18] 1:12 or two-pager formats are other suggested ones.[19]

Following evidence collection and offering to the policy maker, the next step is policy dialogue meetings which inform policy makers about opinions of different stakeholders on the options obtained from evidence. These meetings will help policy makers to make a decision which is applicable and leads to optimal outcome.[20] The policy brief has been used in different countries and obtained results have been used for increasing its efficacy.[21]

Although the main audience of the policy brief are policy makers who order the issue, publication of policy briefs in peer-reviewed journals may help capacity building in this field through increasing tendency and motivation in authors and familiarizing policy makers with this tool.[22] Besides, journals must consider their different audiences by providing specific massages for them in order to promote research knowledge translation.[23,24] Also, the output obtained from the evidence has usability in other countries and communities. Reviewing scientific sources shows that reports of policy brief have been published in scientific journals in addition to specific web sites.[25]

For the first time in Iran, a policy brief will be published in this issue of International Journal of Preventive Medicine which is about increasing physical activity.[26] It is hoped that it will be introduction to more familiarization of the researchers and policy makers with this tool and promotion of using policy brief in EVIP in Iran.