The Contextualizing Guidance Workbook can help you consider factors from the broader health system and political system so you make the most appropriate policy recommendations and decisions. Find out how this tool can help you apply recommendations from a guidance document to address the issue/problem in your local context: View our summary of this resource here: http://www.nccmt.ca/resources/search/238 NCCMT is one of six NCCs for Public Healthh in Canada More on the NCCs at www.nccph.ca Production of this webinar has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

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Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The
views expressed here do not necessarily reflect the views of the Public Health Agency of Canada..
Contextualizing Guidelines Workbook
Presenter:
Elizabeth Alvarez
MD, MPH, CCFP, ABFM, PhD(c)
March 9, 2016 1:00 – 2:30 PM ET

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Contextualizing Guidelines
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http://www.nccmt.ca/resources/search/238
Episode 23
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Elizabeth Alvarez, MD,
MPH, CCFP, ABFM, PhD(c)
Family Medicine
Public Health, Administration
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Studies
Vanier Canada Graduate
Scholar
Presenter
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12. CONTEXTUALIZING GUIDANCE
WORKBOOK
NCCMT WEBINAR
MARCH 9, 2016
ELIZABETH ALVAREZ, MD, MPH, PHD(C)
JOHN LAVIS, MD, MSC, PHD

13. KNOWLEDGE TRANSLATION
• Many terms – knowledge transfer,
knowledge exchange, knowledge brokering
• “Knowledge transfer and exchange (KTE) is
an interactive process involving the
interchange of knowledge between
research users and researcher producers”
(Mitton et al, 2007)

14. BACKGROUND
• Fragmented and overburdened public health
systems
• Unused / underutilized effective public health
interventions
• Global, evidence-based guidance can be used to
strengthen public health systems (Bosch-Capblanch et al,
2012)

15. BACKGROUND
• Need to contextualize global guidance with national or
local evidence and health system and political system
assessments (Lavis et al, 2012)
• Clear direction from countries for need to have more
support in implementing global guidance
recommendations
• Countries requesting such support from WHO
• International forum on evidence-informed health policymaking in low and
middle-income countries, Addis Ababa, Ethiopia, Aug 2012

16. CONTEXTUALIZING GUIDANCE WORKBOOK
A systematic, transparent, and
user-friendly tool - a workbook to help
develop national or subnational policy
recommendations or policy decisions
Meshes global guidance and
national or local evidence
Includes broader health system and
broader political system factors
http://optimizemnh.org/Annexes/Annex_8_Contextualizing_Workbook.pdf

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Poll Question #4
How familiar are you with the
Contextualizing Guidelines Workbook?
A. I am not familiar with the Workbook.
B. I have heard of the Workbook.
C. I have used the Workbook.
17

18. Health systems guidance contextualization framework
STEP 1
•Clarify the problem
STEP 2
•Frame the options
STEP 3
•Identify implementation considerations
STEP 4
•Consider the broader health system context
STEP 5
•Consider the broader political system context
STEP 6
•Refine the statement of the problem, options and implementation considerations in light of health
system and political system factors
STEP 7
•Anticipate monitoring and evaluation needs
STEP 8
•Make policy recommendations or decisions

19. STEP 1 – CLARIFY THE PROBLEM
1) What is the problem?
a) a risk factor, disease or condition; b) the programmes, services or drugs
currently being used to address a risk factor, disease, or condition; c)
current health system arrangements, including delivery, financial and
governance arrangements; or d) the current degree of implementation of an
agreed upon course of action;
2) How did the problem come to attention, and has this process influenced
the prospect of it being addressed, in addition to the guidance?;
3) What indicators can be used or collected to establish the magnitude of the
problem and to measure progress in addressing it?;
4) What comparisons can be made to establish the magnitude of the problem
and to measure progress in addressing it?;
5) How can the problem be framed (or described) in a way that will motivate
different groups?

20. STEP 2 – FRAME THE OPTIONS
1) Has an appropriate set of options been identified to address the problem?;
2) What benefits are important to those who will be affected and which
benefits are likely to be achieved with each option?;
3) What harms are important to those who will be affected, which harms are
likely to arise with each option and how can these harms be mitigated?
4) What are the local costs of each option, and is there local evidence about
their cost-effectiveness?;
5) What adaptations might be made to any given option and how might they
alter its benefits, harms and costs?
6) Which stakeholder’s views and experiences might influence the
acceptability of each option and its benefits, harms and costs?

21. STEP 3 – IDENTIFY IMPLEMENTATION
CONSIDERATIONS
1) What are the potential barriers to the successful
implementation of each option?;
2) What strategies should be considered in order to facilitate the
necessary behavioural changes among healthcare
recipients/citizens?;
3) What strategies should be considered in order to facilitate the
necessary behavioural changes among healthcare
professionals?;
4) What strategies should be considered in order to facilitate the
necessary organizational changes?;
5) What strategies should be considered in order to facilitate the
necessary system changes?

22. STEP 4 – CONSIDER THE BROADER HEALTH
SYSTEM CONTEXT
1) How do delivery arrangements influence the
possibility of each option being adopted and
implemented successfully?;
2) How do financial arrangements influence the
possibility of each option being adopted and
implemented successfully?;
3) How do governance arrangements influence the
possibility of each option being adopted and
implemented successfully?

23. STEP 5 – CONSIDER THE
BROADER POLITICAL
SYSTEM CONTEXT
1) Would current political institutions allow for or hinder each
policy change?;
2) Which politically active group(s) might have an interest in
(face concentrated or diffuse costs or benefits) and mobilize
for or against each option?;
3) Does each option resonate with the beliefs and values of the
government and the public? Is there any local research
evidence on stakeholder’s views and experiences?;
4) Are there external factors which may press the issue forward
or draw attention away from each option?

24. STEP 6 - REFINE THE STATEMENT OF THE
PROBLEM, OPTIONS AND IMPLEMENTATION
CONSIDERATIONS IN LIGHT OF HEALTH SYSTEM
AND POLITICAL SYSTEM FACTORS

25. STEP 7 – ANTICIPATE MONITORING AND
EVALUATION NEEDS
1) Is monitoring necessary?;
Is monitoring already in place or are new systems necessary?
What are the costs of establishing a new system?
Are findings going to be useful for change? What actions would
occur if monitoring reveals things are not going as planned?
2) What should be measured?;
3) Should an impact evaluation be conducted?;
4) How should the impact evaluation be done?

26. STEP 8 – MAKE POLICY
RECOMMENDATIONS OR DECISIONS
1) If applicable, has the public been engaged in the
policymaking process?
2) Is a policy brief being developed to collate all of the
analyses captured in the workbook?
3) Is a policy dialogue being planned to support
evidence-informed policymaking

27. EVALUATION OF THE WORKBOOK
• The process of using the workbook was studied in Peru and Uganda
• Overall, the findings reflect 3 changes in the process of developing
evidence briefs:
1) A workbook, which was specific to contextualizing the
OptimizeMNH guidance, was provided.
2) Two authors from Canada provided support throughout the
process.
3) Each relevant recommendation from the OptimizeMNH guidance
was worked through systematically for developing policy options for the
evidence briefs, which according to country experts, is not how guidelines
are typically used, and are instead used more generally as a reference.

28. + Participants in both countries plan on using or are already using the workbook for other,
unrelated, work.
+ The workbook, which was specific for contextualizing the OptimizeMNH guidance, made the
process faster and easier when compared with prior processes.
+ The workbook was systematic, logical, and user-friendly. It served as a tool for developing
evidence briefs but also as a checklist for evaluating the work. There was a concern raised,
however, that because it is so systematic, it could also limit peoples’ thinking about the
problem or how to address it.
+ Examples in the workbook were seen as helpful, however, there was disagreement over
whether there was a need for more examples to help those in areas with limited data or those
who were not trained in health policy and systems.
+ Country experts were helpful for both content and methods (i.e., evidence briefs).
+ Outside support was helpful for building capacity and focusing attention on the work.
+ The process of using the workbook helped find gaps in knowledge and in practice.
+ The process of using the workbook helped evaluate the OptimizeMNH guidance and
standardize thinking globally.
Even though some of the comments made by participants reflected a sense of what the
guidance and the workbook should be able to do, it is important to address the expectations of
this work, as neither the guidance nor the workbook could address the specific contexts of
each country or region (although consideration could be given to having WHO regional offices
and country offices support the development of regional or national guidance) nor direct how
the country should or could make necessary changes (e.g., ensure a law is passed to support
the changes) nor replace the tacit knowledge of people at the country level.
ADVANTAGES OF USING THE WORKBOOK

29. CHALLENGES OF USING THE WORKBOOK
- The workbook was too long and complex.
In general, everyone reviewing the workbook stated that it is too dense or tedious
because of the amount of sections and questions asked in the workbook. However,
when asked which sections could be left out to make it shorter, there were no specific
areas mentioned.
- The workbook had areas of redundancy and overlap
- The workbook had missing components: glossary of medical terms, advocacy
Also, although costs are addressed in the workbook they may need to come out more
explicitly in the evidence brief since policymakers are very interested in cost.
- The language used in the workbook could be difficult for those without training in
health policy and systems to understand. Also, English terms could be difficult for
some to understand. This was not the case for those involved in these processes in
Peru and Uganda because they had the appropriate training, but they felt others may
have difficulty with the language. On the other hand, several interviewees felt the
workbook was easy to understand and that the terms were described well.

30. NEXT STEPS
Revise the workbook based on findings from
evaluating the process of using the workbook in
Peru and Uganda and from a critical interpretive
synthesis of the literature to better define
contextualization and contextual factors
affecting policy development and
implementation

31. REFERENCES
• Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, Røttingen J-A, Dröschel D, et al.
Guidance for Evidence-Informed Policies about Health Systems: Rationale for
and Challenges of Guidance Development. PLoS Med. 2012 2012/03/06;9(3).
• Lavis JN, Røttingen J-A, Bosch-Capblanch X, Atun R, El-Jardali F, Gilson L, et al.
Guidance for Evidence-Informed Policies about Health Systems: Linking
Guidance Development to Policy Development. PLoS Med. 2012
2012/03/13;9(3).
• Mitton C, Adair C, McKenzie E, Patten S and Wayperry, B. Knowledge Transfer
and Exchange: Review and Synthesis of the Literature. Milbank Quarterly 2007,
85(4): 729-768.

32. THANK YOU!!
Questions??

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37. Poll Question #5
What are your next steps? I plan to …
A. access the Contextualizing Guidelines
Workbook.
B. read the NCCMT summary of the
Contextualizing Guidelines Workbook.
C. consider using the Contextualizing
Guidelines Workbook.
D. tell a colleague about the Contextualizing
Guidelines Workbook.
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38. Join us for our next webinar
A Tool for Sharing Best Practices
March 30th from 1:00 – 2:30pm EST
The INFO Project with the United States Agency for
International Development, has developed a method for
sharing best practices within organizations. Join us to
learn more about how this method could be applicable to
your organization.
Register at: https://health-evidence.webex.com
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