title: The roles and influence of actors in the uptake of evidence: the case of malaria treatment policy change in Uganda.
abstract: BACKGROUND
  Uganda changed its malaria treatment policy in response to evidence of resistance to commonly used antimalarials. The use of evidence in policy development--also referred to as knowledge translation (KT)--is crucial, especially in resource-limited settings. However, KT processes occur amidst a complex web of stakeholder interactions. Stakeholder involvement in evidence generation and in KT activities is essential. In the present study, we explored how stakeholders impacted the uptake of evidence in the malaria treatment policy change in Uganda.
  
  
  METHODS
  We employed a qualitative case study methodology involving interviews with key informants and review of documents. A timeline of events was developed, which guided the purposive sampling of respondents and identification of relevant documents. Data were analysed using inductive content analysis techniques.
  
  
  RESULTS
  Stakeholders played multiple roles in evidence uptake in the malaria treatment policy change. Donors, the Ministry of Health (MoH), service providers, and researchers engaged in the role of evidence generation. The MoH, parliamentarians, and opinion leaders at the national and local levels engaged in dissemination of evidence. The donors, MoH, researchers, and service providers engaged in the uptake of evidence in policy development and implementation. Stakeholders exerted varying levels of support and influence for different reasons. It is noteworthy that all of the influential stakeholders were divided regarding the best antimalarial alternative to adopt.
  
  
  CONCLUSIONS
  Our results showed a diverse group of stakeholders who played multiple roles, with varying levels of support and influence on the uptake of evidence in the malaria treatment policy change. For a given KT processes, mapping the relevant stakeholders and devising mechanism for their engagement and for how to resolve conflicts of interest and disagreements a priori will enhance uptake of evidence in policy development.
authors.affiliation: WHO Regional Office for Africa, Brazzaville, Congo. julienabyonga@yahoo.com.
authors.forename: Juliet
authors.initials: J
authors.lastname: Nabyonga-Orem
authors.forename: Miriam
authors.initials: M
authors.lastname: Nanyunja
authors.forename: Bruno
authors.initials: B
authors.lastname: Marchal
authors.forename: Bart
authors.initials: B
authors.lastname: Criel
authors.forename: Freddie
authors.initials: F
authors.lastname: Ssengooba
mesh_terms: D000288:Administrative Personnel; D000962:Antimalarials / Q000627:therapeutic use; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000188:drug therapy*; D024382:Professional Role; D036301:Qualitative Research; D057170:Translational Research, Biomedical / Q000379:methods; D014454:Uganda / Q000453:epidemiology
chemical_list: D000962:Antimalarials