title: Malaria treatment policy change in Uganda: what role did evidence play?
abstract: BACKGROUND
  Although increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. The present study explores the role of evidence, barriers, and factors facilitating the uptake of evidence in the change in malaria treatment policy in Uganda, building on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitatory factors for KT. Application of the MRT to a health policy case will contribute to refining it.
  
  
  METHODS
  Using a case study approach and mixed methods, perceptions of respondents on whether evidence was available, had been considered and barriers and facilitatory factors to the uptake of evidence were explored. In addition, the respondents' rating of the degree of consistency between the policy decision and available evidence was assessed. Data collection methods included key informant interviews and document review. Qualitative data were analysed using content thematic analysis, whereas quantitative data were analysed using Excel spreadsheets. The two data sets were eventually triangulated.
  
  
  RESULTS
  Evidence was used to change the malaria treatment policy, though the consistency between evidence and policy decisions varied along the policy development cycle. The availability of high-quality and contextualized evidence, including effective dissemination, Ministry of Health institutional capacity to lead the KT process, intervention of the WHO and a regional professional network, the existence of partnerships for KT with mutual trust and availability of funding, tools, and inputs to implement evidence, were the most important facilitatory factors that enhanced the uptake of evidence. Among the barriers that had to be overcome were resistance from implementers, the health system capacity to implement evidence, and financial sustainability.
  
  
  CONCLUSIONS
  The results agree with facilitatory factors identified in the earlier developed MRT, though additional factors emerged. These results refine the earlier MRT stating that high-quality and contextualized evidence will be taken up in policies, leading to evidence-informed policies when the MoH leads the KT process, partnerships are in place for KT, the WHO and regional professional bodies play a role, and funding, tools, and required inputs for implementing evidence are available.
authors.affiliation: WHO Regional Office for Africa, P,O Box 6, Brazzaville, Congo. julienabyonga@yahoo.com.
authors.forename: Juliet
authors.initials: J
authors.lastname: Nabyonga-Orem
authors.forename: Freddie
authors.initials: F
authors.lastname: Ssengooba
authors.forename: Jean
authors.initials: J
authors.lastname: Macq
authors.forename: Bart
authors.initials: B
authors.lastname: Criel
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D004358:Drug Therapy / Q000379:methods; D055317:Evidence-Based Practice; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000188:drug therapy*; D014454:Uganda
chemical_list: D000962:Antimalarials