title: The evidence does not speak for itself: The role of research evidence in shaping policy change for the implementation of publicly funded syringe exchange programs in three US cities.
abstract: BACKGROUND
  A breadth of literature exists that explores the utilization of research evidence in policy change processes. From this work, a number of studies suggest research evidence is applied to change processes by policy change stakeholders primarily through instrumental, conceptual, and/or symbolic applications, or is not used at all. Despite the expansiveness of research on policy change processes, a deficit exists in understanding the role of research evidence during change processes related to the implementation of structural interventions for HIV prevention among injection drug users (IDU). This study examined the role of research evidence in policy change processes for the implementation of publicly funded syringe exchange services in three US cities: Baltimore, MD, Philadelphia, PA, and Washington, DC.
  
  
  METHODS
  In-depth qualitative interviews were conducted with key stakeholders (n=29) from each of the study cities. Stakeholders were asked about the historical, social, political, and scientific contexts in their city during the policy change process. Interviews were transcribed and analyzed for common themes pertaining to applications of research evidence.
  
  
  RESULTS
  In Baltimore and Philadelphia, the typological approaches (instrumental and symbolic/conceptual, respectively) to the applications of research evidence used by harm reduction proponents contributed to the momentum for securing policy change for the implementation of syringe exchange services. Applications of research evidence were less successful in DC because policymakers had differing ideas about the implications of syringe exchange program implementation and because opponents of policy change used evidence incorrectly or not at all in policy change discussions.
  
  
  CONCLUSIONS
  Typological applications of research evidence are useful for understanding policy change processes, but their efficacy falls short when sociopolitical factors complicate legislative processes. Advocates for harm reduction may benefit from understanding how to effectively integrate research evidence into policy change processes in ways that confront the myriad of factors that influence policy change.
authors.affiliation: Department of Prevention & Community Health, Milken Institute School of Public Health at The George Washington University, 950 New Hampshire Avenue, Suite 300, Washington, DC 20052, USA. Electronic address: seanallen@gwu.edu.
authors.forename: Sean T
authors.initials: ST
authors.lastname: Allen
authors.affiliation: Department of Prevention & Community Health, Milken Institute School of Public Health at The George Washington University, 950 New Hampshire Avenue, Suite 300, Washington, DC 20052, USA.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Ruiz
authors.affiliation: Department of Prevention & Community Health, Milken Institute School of Public Health at The George Washington University, 950 New Hampshire Avenue, Suite 300, Washington, DC 20052, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: O'Rourke
mesh_terms: D015142:Baltimore; D003625:Data Collection; D004219:District of Columbia; D055030:Drug Users; D005260:Female; D005380:Financing, Government; D015658:HIV Infections / Q000517:prevention & control; D040261:Harm Reduction; D006291:Health Policy; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D015143:Philadelphia; D011050:Policy Making; D012106:Research / Q000458:organization & administration; D015819:Substance Abuse, Intravenous / Q000150:complications*
keywords: HIV; Injection drug use; Research evidence