title: Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden.
abstract: BACKGROUND
  Evidence has come to play a central role in health policymaking. However, policymakers tend to use other types of information besides research evidence. Most prior studies on evidence-informed policy have focused on the policy formulation phase without a systematic analysis of its implementation. It has been suggested that in order to fully understand the policy process, the analysis should include both policy formulation and implementation. The purpose of the study was to explore and compare two policies aiming to improve health and social care in Sweden and to empirically test a new conceptual model for evidence-informed policy formulation and implementation.
  
  
  METHODS
  Two concurrent national policies were studied during the entire policy process using a longitudinal, comparative case study approach. Data was collected through interviews, observations, and documents. A Conceptual Model for Evidence-Informed Policy Formulation and Implementation was developed based on prior frameworks for evidence-informed policymaking and policy dissemination and implementation. The conceptual model was used to organize and analyze the data.
  
  
  RESULTS
  The policies differed regarding the use of evidence in the policy formulation and the extent to which the policy formulation and implementation phases overlapped. Similarities between the cases were an emphasis on capacity assessment, modified activities based on the assessment, and a highly active implementation approach relying on networks of stakeholders. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was empirically useful to organize the data.
  
  
  CONCLUSIONS
  The policy actors' roles and functions were found to have a great influence on the choices of strategies and collaborators in all policy phases. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be useful. However, it provided insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies, and overlapping policy phases. A revised version of the model that includes these aspects is suggested.
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden. helena.strehlenert@ki.se.
authors.forename: H
authors.initials: H
authors.lastname: Strehlenert
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden. linda.sundberg@ki.se.|Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden. linda.sundberg@ki.se.
authors.forename: L
authors.initials: L
authors.lastname: Richter-Sundberg
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden. monica.nystrom@ki.se.|Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden. monica.nystrom@ki.se.
authors.forename: M E
authors.initials: ME
authors.lastname: Nyström
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden. henna.hasson@ki.se.|Center for Epidemiology and Community Medicine, Stockholm County Council, SE 171 29, Stockholm, Sweden. henna.hasson@ki.se.
authors.forename: H
authors.initials: H
authors.lastname: Hasson
mesh_terms: D016022:Case-Control Studies; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D019317:Evidence-Based Medicine; D006291:Health Policy; D006801:Humans; D033181:Information Dissemination; D008137:Longitudinal Studies; D011050:Policy Making; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*; D012947:Social Work / Q000458:organization & administration* / Q000592:standards; D013548:Sweden