Integrative review; identifying the evidence base for policymaking and analysis in health care.

Abstract

Aim: To identify and synthesise the evidence underpinning the health policymaking process to inform the development of a health related policy analysis framework. Design: A mixed methods review using ‘Best Fit’ Framework synthesis. Data sources: PUBMED and CINAHL+ databases for English language papers published between March 2013 and March 2017. Review Methods: Titles were screened, data abstracted and analysed by two authors at each stage. Findings from included studies were coded against six a priori categories which had been constructed through a preliminary literature review, consultation and consensus. Results: 68 papers were included. There exists empirical support for six key domains which require to be addressed in the policymaking and analysis process: 1) Context 2) Process 3) Content 4) Stakeholder Consultation 5) Implementation 6) Evaluation. Failure to contextualise and integrate these six domains in problem identification, policy analysis, strategy and policy development, policy enactment and policy implementation is problematic. Conclusion: There is a need to test and refine the constructs linked to the policymaking cycle taking cognisance of the context in which these are developed, implemented and evaluated. Impact: This review makes a novel contribution to the synthesis of evidence to inform the policymaking and analysis process. Findings illuminate the complexity of policymaking, the competing pressures involved and the importance of the local, national and international context. These findings have international relevance and provide empirical support for key criteria to guide those involved in context specific policymaking and/or the analysis of existing policy.