CONCEPTUAL FRAMEWORK
2.7 IMPEDIMENTS TO RESEARCH USAGE
imposed by their own operational environments. It has become apparent therefore that research must be made more relevant to stakeholder needs and policy maker priorities.
The theoretical, methodological and context consideration as presented by Davis and Howden-Chapman (1996:865-872) is relevant for the eThekwini Health research policy framework.
The crucial consideration is the context, as it ensures the participation of stakeholders.
be ignored or will lead to incremental changes in the policy as it exists. It is rare for an evaluation to lead to the termination of a policy or programme.
CONCEPTUAL CONFUSION
Interpreting results may be problematic because the original policies are often characterised by vague goals, phoney promises and weak effects. Findings may be undermined because they cannot show programmes achieving what they set out to do and policy makers may be unclear about what to make of them. The extent to which research delivers unambiguous results is problematic and is usually caused by conceptual problems. Science does not always lead to the same explanation for the same observed phenomenon; when people reach scientific conclusions about the reasons for a particular natural phenomenon their explanations are not always the same. This scientific uncertainty can thus lead to distortions and lack of clarity in policy making.
Individual conceptions of risk can also impede the influence of science on health policies. Greenberg in Walt (1994:191) points out that the psychological meaning attached to different hazards often mitigates against known public-policy research.
Reluctance to take risks is important in relation to public health measures affecting large numbers of people; policy makers and scientists may take different roles. For instance, policy makers may be willing to act more quickly than a scientist who demands high standards of reliability and validity of results.
However, at times, policy makers are sometime unwilling to act even where scientists believe evidence is clear and risk is low.
For example, policy makers were impatient to act on the results of the first trials suggesting that vitamin A supplements decreased mortality in young children, while scientists wanted clearer evidence.
IDEOLOGICAL INFLUENCES
Ideologies are a set of assumptions and ideas about social behaviour and social systems which researchers evaluate; these findings can be noted and acted upon. Walt (1994:196) argues that "of course research can be driven by a current ideological ethos." For example, in the past decade in the United States (US) the key ideology or economic model, which advocated a direct role for government in the economy, was very influential in the utilisation of research results. Researchers are clearly not immune to ideology or fashion and are aware that founders (who may be government policy-makers) are interested in certain types of research. Furthermore, researchers tend to be resource-driven and might be much more inclined towards donor-driven research and a policy agenda.
T H E USEFULNESS O F T H E RESEARCH
Policy makers are often critical of research for taking too long, not being sufficiently applicable or not addressing primary
ascendancy of issues about economic efficiency and effectiveness, and past criticism of much social science research, has been an attempt by many researchers to make their research more useful. Higo in Walt (1994:198) suggests that much of the social science research in the United Kingdom (UK) in the 1970s was neither useful nor sufficiently informative for policy makers to use. Scientific research during this period was considered to be obvious, common sense, naive and consisting of unique anecdotes.
T I M I N G A N D COMMUNICATION
Another impediment to research findings is the timing and the way results are communicated. The research process may take too long and commissioned research may be too protracted for policy makers who are being pressurised into act on a specific issue. There may be a trade-off between timeliness and quality of research. However, studies that are timely in terms of
decision making can be dismissed if methodological inadequacies are apparent.
Communicability will also affect the extent to which policy makers use research. Dramatic, clear-cut, tangible results that answer questions directly and are of interest to decision makers are likely to get broader coverage than research that is more opaque. But however clear the result is, if it challenges the status quo or proposes structural changes, policy makers may ignore it (Walt, 1994:199).
The perceived quality of the research and the managing of the institution from which it emanates, will also affect the attention it receives from policy makers. For instance, policy makers will have more confidence in research results from well-established institutions than from newly-established ones.
OTHER ISSUES
The following issues advocated by Sauerborn (1999:827-835) are also barriers to health research usage:
> Lack of Knowledge
There is a tendency for researchers to focus on the actual research (thus satisfying their own needs) and to ignore the requirement for the actual results and the fact that they are to be used to improve the health status of the public.
> Lack of Ownership by Key Stakeholders
Key stakeholders, consisting of councillors, the eThekwini community and health sector management, are not regarded as equal partners by other stakeholders such as research institutions, researchers and founders and this leads to a loss of a sense of ownership.
> Inappropriateness of Data
At times, researchers present data in a very technical manner; consequently it is sometimes difficult for stakeholders to understand and utilise the data for their own benefit.
> Bad Communication of Results
The packaging and communication of results to all stakeholders is crucial if research is to benefit the intended beneficiaries. Researchers tend to communicate results in a technical manner rather than in a simple and clear manner.
> Inappropriate Links
The institutional framework linking researcher and stakeholders is essential, but in practice institutional frameworks only exist at national level and in some provinces in South Africa. Without such an institutional framework, communication is non-existent or ad hoc.
Institutional frameworks, such as the ENHR Committee, facilitate the involvement of stakeholders in the research processes.
> Researcher's View
Researchers usually view their role as purely investigative and neglect the broader role of consultation with other stakeholders in the communication and facilitation of research results.
All the above-mentioned impediments to the use of research are applicable to the eThekwini Municipality Health Unit situation. The officials, councillors and researchers need to be aware of them and also deal with them collectively. These issues also need to be considered when the health research policy framework is developed.
2.8 SOURCES OF POTENTIAL CONFLICT BETWEEN RESEARHERS