✪ How integrated knowledge translation worked to reduce federal policy barriers to the implementation of medication abortion in Canada: a realist evaluation

Abstract:

Background

Initial Canadian federal regulations for the abortion pill, mifepristone, had the potential to impede safe and equitable access to this medication. To catalyze evidence-based regulatory change, we engaged health policy, health system, and health services decision makers, and health professional organizations in integrated knowledge translation (iKT), a research approach that engages the users of research as equal partners.

Methods

We conducted a realist evaluation of what iKT strategies worked, for whom, and in what context to impact federal mifepristone regulations. We constructed initial program theories (if–then statements about how iKT worked). We tested the initial program theories using interviews with researchers and knowledge partners and triangulated with analysis of research programme documents. We configured the evidence in relation to the initial program theories, and refined program theories into causal explanatory configurations.

Results

We analyzed 38 interviews with researchers, health professional leaders, advocacy group leaders, and administrative government policy makers, as well as 49 program documents. Our results indicated that researcher partnerships with stakeholders had a meaningful impact on the removal of restrictions. We found key components of the causal explanatory configurations included: researcher motivation to move evidence into action, trusted reputations as credible sources of evidence, strategic partnerships, understanding of health policy processes, and researcher roles as a trusted convenor between key groups and decision makers.

Conclusions

Our study identifies several practical and transferable approaches to impactful iKT. The findings may be of relevance to researchers focused on public health topics subject to stigma.

Contributions to the literature

• The effect of integrated knowledge translation (iKT) on public health policy is ambiguous, especially for issues that may be stigmatized, like abortion.
• To bridge this knowledge gap, we evaluated the iKT used to support Canadian federal drug regulatory decisions to remove restrictions for the medication abortion pill, mifepristone.
• Our realist evaluation identified several practical and transferable approaches to impactful iKT in complex policy systems that comprise an ‘iKT mindset’.
• Key approaches for researchers include acting on motivations to move evidence into policy, building trusted reputations as credible sources of evidence, understanding and targeting policy levers, acting as a source of strategic evidence, and acting as a trusted convenor between key groups and decision makers.
• Our use of realist methodology contributes to theoretical and empirical understandings of iKT with policy makers and has relevance for other stigmatized topics including opioid safe supply, vaccination, and climate change.

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