BACKGROUND Progress towards universal health coverage requires health policies and systems that are informed by contextualised and actionable research. Many challenges impede the uptake of evidence to enhance health policy implementation and the coverage, quality, efficiency and equity of health systems. To address this need, we developed an innovative model of implementation research embedded in real-world policy and programme cycles and led directly by policy-makers and health systems decision-makers. The approach was tested in ten settings in Latin America and the Caribbean, supported under a common funding and capacity strengthening initiative. The present study aims to analyse ten embedded implementation research projects in order to identify barriers and facilitators to embedding research into policy and practice as well as to assess the programme, policy and systems improvements and the cross-cutting lessons in conducting research embedded in real-world policy and systems decision-making. METHODS The multi-country analysis is based on the triangulation of data collected via three methods, namely (1) document review, (2) an electronic questionnaire and (3) in-depth interviews with decision-makers. Data from the document review was charted and narratively synthesised. Data from the questionnaire was used to assess three characteristics of the decision-maker's participation in embedded research, namely (1) level of engagement in different stages of research; (2) extent to which their capacities to conduct and use research were developed; and (3) the level of confidence in undertaking implementation research activities. Interview data was analysed using a thematic approach. RESULTS The main barriers to effective delivery or scale-up of health interventions identified in the research projects were inadequate financing, fragmentation of healthcare services and information systems, limited capacity of health system stakeholders, insufficient time, cultural factors, and a lack of information. Decision-makers' experience in embedded research showed strong engagement in protocol development, moderate engagement in data collection and low engagement in data analysis. The in-depth interviews identified 17 facilitators and 8 barriers to embedding research into policy and systems. The principal facilitating factors were actionability of findings, relevance of research and engagement of decision-makers, whereas the main barriers were time and political processes. In Argentina, the research led to the development of new monitoring indicators to improve the implementation of the perinatal health policy, while in Chile, empirical findings supported the establishment of a training programme on reproductive rights, targeted to municipal health facilities. CONCLUSIONS This multi-country analysis contributes to the evidence base for the embedded research approach to support health policy and systems decisions-making. Embedding research into policy and practice stimulates the relevance and applicability of research, while promoting decision-makers' engagement and likelihood to use research evidence in policy-making and health systems strengthening.

中文翻译：

---

嵌入实施研究以增强卫生政策和体系：来自拉丁美洲和加勒比地区十个国家的多国分析。

背景技术在实现全民健康覆盖方面的进步需要健康的政策和系统，并要根据具体情况和切实可行的研究来提供信息。许多挑战阻碍了采用证据来加强卫生政策的实施以及卫生系统的覆盖范围，质量，效率和公平性。为了满足这一需求，我们开发了一种实施研究的创新模型，该模型嵌入到现实世界的政策和计划周期中，并由政策制定者和卫生系统决策者直接领导。在一项共同供资和能力加强举措的支持下，该方法在拉丁美洲和加勒比地区的十个环境中进行了测试。本研究旨在分析十个嵌入式实施研究项目，以找出将研究嵌入政策和实践中的障碍和促进者，并评估计划，政策和系统的改进以及在实际应用中嵌入研究的跨领域课程。世界政策和系统决策。方法多国分析基于通过三种方法收集的数据的三角测量，即（1）文档审阅，（2）电子问卷和（3）与决策者的深度访谈。来自文档审查的数据已绘制图表并进行了叙述性综合。问卷中的数据用于评估决策者参与嵌入式研究的三个特征，即：（1）不同研究阶段的参与程度；（2）在多大程度上发展了他们进行和使用研究的能力；（3）对实施研究活动的信心水平。访谈数据使用主题方法进行了分析。结果研究项目中确定的有效实施或扩大卫生干预措施的主要障碍是资金不足，卫生保健服务和信息系统分散，卫生系统利益相关者能力有限，时间不足，文化因素以及信息不足。决策者在嵌入式研究中的经验表明，他们对协议开发的参与度很高，对数据收集的参与度中等，而对数据分析的参与度较低。深入访谈确定了将研究纳入政策和体系的17个促进者和8个障碍。主要的促进因素是调查结果的可操作性，研究的相关性和决策者的参与，而主要障碍是时间和政治程序。在阿根廷，该研究导致制定新的监测指标，以改善围产期卫生政策的执行，而在智利，经验结果支持建立针对市政卫生设施的生殖权利培训计划。结论该多国分析为嵌入式研究方法的证据基础做出了贡献，以支持卫生政策和系统决策。将研究纳入政策和实践可以激发研究的相关性和适用性，同时促进决策者的参与。