Decision-maker led implementation research on immunization: learning from low- and middle-income countries

Abstract

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. The past decade has witnessed a significantly increased interest in implementation research, a field of health policy and systems research (HPSR) defined as the “scientific inquiry into questions concerning implementation—the act of carrying an intention into effect, which in health research can be policies, programmes, or individual practices (collectively called interventions)” [1]. Among other factors, this was spurred by a growing realization that the ineffective implementation and scale-up of proven interventions hindered the achievement of the healthrelated Millennium Development Goals in many countries, a reality that persists in the Sustainable Development Goals era [2]. Immunization is an exemplar of such a proven, highly cost-effective intervention that averts up to three million deaths annually and is responsible for a reduction of more than 80% in measles incidence since the year 2000 [3, 4]. Despite this, in 2018, nearly 20 million infants did not receive the third dose of the diphtheria, pertussis and tetanus vaccine, a widely used marker for effective vaccination coverage. Sixty percent of these infants resided in 10 lowand middle-income countries (LMICs) [5]. Given the focus of implementation research on enhancing the implementation of interventions (including programmes, policies and individual practices), the extent and process of engagement of stakeholders beyond researchers in implementation research has emerged as a critical focus over time. Implementers have moved from more traditionally conceptualized roles as passive “knowledge users” to being active coproducers with researchers in the identification of research questions and generation of new scientific insights and knowledge products [6, 7]. The involvement of these decision-makers in identifying and developing research questions is thought to increase the likelihood that what is being researched will address their concerns and be of relevance and use to the health system [7, 8]. This collaboration may also then facilitate the uptake of research findings, including through their integration into decision-making processes. In addition, decision-maker engagement in the research process can facilitate access to “insider” perspectives and knowledge including tacit knowledge, allow for greater research ownership and acceptability, and create safe spaces to discuss difficult findings, with a focus on improvement [9]. All of these factors are essential to bring about the embedding of research into policy and decision-making, a situation “where researchers and decision-makers are linked through a system in which the need for evidence to inform policy is understood by decision-makers” [10]. Empowering decision-makers to play a central role in the research process is intrinsic to bringing about the embedding of research described above [8, 9]. One strategy towards bringing about the needed power shift is to engage decision-makers as principal investigators of Open Access