Informing Policy and Practice to Improve Quality of Care for Malaria in Pregnancy in Uganda

“Adopting a strategic approach to research uptake increases the likelihood of research results being taken up by policy-makers and practitioners.”

This Learning Brief describes the activities that supported research uptake for an operational research study, which explored the barriers to achieving high coverage of intermittent preventive treatment for malaria in pregnancy (IPTp) in Uganda. The lessons learnt from implementing these activities can be useful for researchers who wish to increase the likelihood of their findings being taken up by policymakers and practitioners.

As explained in the brief, “[P]ublic health research is crucial in generating evidence of what works in different contexts. In order for research to have an impact, it must be understood by policy-makers and practitioners and used to influence their decision-making. Research uptake refers to the activities that facilitate the use of research to inform policy and practice. It comprises advocacy and communications elements and involves engaging with stakeholders throughout the research process to ensure that the research is relevant to the needs and priorities in the country where the research is being undertaken”.

The pilot study and resulting practice that the programme wanted to promote involved the use of text messages to reinforce learning from training received by health workers on IPTp. Formative research on barriers to IPTp uptake had shown that many of the missed opportunities for the provision of IPTp are due to inadequate health worker knowledge of the IPTp provision guidelines and poor service delivery practices.

In order to increase the potential for change in policy and practice with regard to IPTp provision, this study adopted a strategic approach to research uptake, which involved engaging with relevant stakeholders throughout the duration of the study. This was informed by the principles of the ‘embedded approach’, which is based on the assumption that operational research is best prioritised, designed, conducted, and replicated when it is embedded within Ministry of Health structures.

The brief explains the two key activities that were undertaken to support research uptake.  The first was the development of a research uptake strategy. This involved identifying key stakeholders and then developing an uptake strategy which outlined how stakeholders would be informed and involved throughout the study. Key messages, budgeted activities, and measurable targets were set for each stakeholder.

Secondly, to support research uptake, the brief explains how stakeholders were consulted in study design, implementation and interpretation of results through meetings where progress and results were shared verbally and through briefing materials tailored to non-academic audiences such as project and research briefs.  

The brief outlines how the research uptake activities successfully influenced policy and decision makers to use the study results to increase IPTp coverage in Uganda. For example, findings that emerged during the formative research process, such as the existence of stock outs, were taken into consideration by the Ministry of Health. In addition, the Ministry of Health committed to adopting the text messaging approach pilot tested in this study in its national malaria in pregnancy training strategy.

The brief also describes some of the challenges relating to research uptake on this study.  For example, there were reservations among some stakeholders on the use of a qualitative design in the formative research and the pilot study design to evaluate the mHealth intervention. These concerns were addressed by explaining to stakeholders the suitability of these approaches and by modifying the research design - for example, by including additional interviews in the formative research and a control group in the pilot study.

In conclusion, the brief states that, “[K]ey to the research uptake successes of this study were its strategic approach to research uptake and the close engagement with relevant stakeholders, in particular those from the Ministry of Health during all stages of the research project. Setting aside a budget for research uptake activities and continuing engagement with stakeholders beyond completion of the research were important factors of research uptake success.”