Health policy-makers’ perceptions of their use of evidence: a systematic review

Simon Innvær,
Gunn Vist,
Mari Trommald,
Andrew Oxman

Health Services Research Unit, National Institute of Public Health, Oslo, Norway;
Health Services Research Unit, National Institute of Public Health, Oslo, Norway;
Health Services Research Unit, National Institute of Public Health, Oslo, Norway;
Health Services Research Unit, National Institute of Public Health, Oslo, Norway

Objectives: The empirical basis for theories and common wisdom regarding how to improve appropriate use of research evidence in policy decisions is unclear. One source of empirical evidence is interview studies with policy-makers. The aim of this systematic review was to summarise the evidence from interview studies of facilitators of, and barriers to, the use of research evidence by health policy-makers.

Methods: We searched multiple databases, including Medline,Embase, Sociofile, PsychLit, PAIS, IBSS, IPSA and HealthStarin June 2000, hand-searched key journals and personally contactedinvestigators. We included interview studies with health policy-makersthat covered their perceptions of the use of research evidencein health policy decisions at a national, regional or organisationallevel. Two reviewers independently assessed the relevance ofretrieved articles, described the methods of included studiesand extracted data that were summarised in tables and analysedqualitatively.

Results: We identified 24 studies that met our inclusion criteria.These studies included a total of 2041 interviews with healthpolicy-makers. Assessments of the use of evidence were largelydescriptive and qualitative, focusing on hypothetical scenariosor retrospective perceptions of the use of evidence in relationto specific cases. Perceived facilitators of, and barriers to,the use of evidence varied. The most commonly reported facilitatorswere personal contact (13/24), timely relevance (13/24), andthe inclusion of summaries with policy recommendations (11/24).The most commonly reported barriers were absence of personalcontact (11/24), lack of timeliness or relevance of research(9/24), mutual mistrust (8/24) and power and budget struggles(7/24).

Conclusions: Interview studies with health policy-makers provideonly limited support for commonly held beliefs about facilitatorsof, and barriers to, their use of evidence, and raise questionsabout commonsense proposals for improving the use of researchfor policy decisions. Two-way personal communication, the mostcommon suggestion, may improve the appropriate use of researchevidence, but it might also promote selective (inappropriate)use of research evidence.

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