Received 2016-10-10
Revised 2016-11-16
Accepted 2016-12-06
Evidence- based Policy and Decision-Making among Health Managers: A Case of Shiraz University of Medical Sciences
Peivand Bastani 1, Zahra Kavosi 1, Somayeh Alipoori 2 , Mohammad Hasan Imani-Nasab 3
1 Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences,
Shiraz, Iran
2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Public Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Abstract Background: According to the importance of evidence-based policy-making in health scope, this study was conducted to investigate the present situation of decision-making among medical managers.Materials and Methods: This cross-sectional study carried out on all the managers worked in one of the hospitals, health centers, medical schools and central departments of Shiraz University of Medical Sciences in 2016. A questionnaire containing demographic data and 50 questions was applied to 5 sections: attitude (9), subjective norms (13), perceived controlled behavior (22), intention (3) and behavior (3). Choronbache α was between 0.73-0.91 emphasizing a good reliability, the questionnaire`s content and face validity were 0.83 and 0.67 respectively. Data was analyzed using Independent t-test, ANOVA, and Pearson correlation. Results: The greatest frequency of the respondents belongs to the men (77/85.1%), and the majority of the respondents were in an age range from 30 to 40 years. The highest mean score was related to the indirect attitude (8.17), and the lowest was obtained for the indirect perception (1.21). There was a statistical relationship between the mean score of direct and indirect controlled perceived behavior according to the participants’ educational level (P=0.03 and P=0.043, respectively). A significant relationship was also be observed between direct behavior and educational major (P=0.044). Pearson correlation indicates a significant positive relationship between the manager intention for evidence-based policy-making and all the other variables.Conclusion: It seems that the present situation of evidence-based decision-making is not appropriate for the university managers. In this regard, planning for the effective courses in knowledge translation, evidence-based policy-making and advanced searching along with monitoring the managers’ decision outcomes through an internal and external audit can have an effective role in improving decisions and enhancing evidence application. [GMJ.2017;6(1):30-38] Keywords: Evidence-based; Policy-making; Decision-Making; Intention; Behavior |
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Correspondence to: Somayeh Alipoori, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Telephone Number: +989171396212 Email Adress:salipoori@gmail.com
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Introduction
The use of global evidence has been increasingly considered as the essential part of the policy-making process and the policies adopted with the research evidence will be more likely to attain the health objectives [1].
The evidence indicates that the lower general public’s confidence in the governments during the recent years can be connected to the low quality of the decisions made by the states and this is why the governments have gained increasingly higher interests in taking advantage of the credible evidences in the policy-making process [2].
Evidence-based policy-making is an approach adopted in respect to the political decision-making which aims at assuring the decisions are adopted through acquiring sufficient awareness of the best evidences [3].Such an approach stands in contrast to the opinion-based policy making which is mostly laid the foundation for the selective use of the evidence for instance, single individual studies disregarding the quality thereof or the untested individual attitudes which are predominantly inspired by the ideological viewpoints, prejudgments or presuppositions [2].In the meantime, decision-making without sufficient attention to the evidences can lead to the following outcomes: decreasing access to health services, not enhancing health indicators and being incapable of reaching the millennium development goals, lack of effectiveness and injustice in health systems [3].
In this regard, a study in 2005 indicated that few organizations, at a global level, support taking advantage of the evidences gained through doing researches in making decisions related to health programs [4].
Evidence-based policy making, in developing countries, can have more significant effects such as contributing to saving the individuals’ lives; mitigating poverty and improving performance [5,6].
Where there are a limited availability and constrained resources, the policy-makers’ awareness of the research evidences finds more importance in ensuring the informed application of the limited resources [7].
Countries with low and intermediate income levels usually have fewer resources at discretion to face the problems arising in the health systems, and they are in need of high-quality evidence to make efficient use of scarce resources [8].
However, evidence-based decision-making is seemingly perpetually confronted with the bottleneck of the highest demand and the lowest capacity; developing countries apparently are discovered to have a lower capacity than the developed, for establishing such an approach [6].
In this regard, the relationship extant between the evidences signified that attitudes, subjective norm and perceived behavioral control could be highly influential on the individual’s intentions and behaviors [9-11]. Insofar as the systematic reviews have shown that such variables can account for about 39% of the variations in the individuals’intention and about 27% of their behavior [12]. The other studies exhibit that the behavior and the intention to make practical use of the survey evidences in line with supporting the evidence-based decision-making can be elaborated by the aforementioned variables similar to any other intention and behavior [13].
According to what has been expressed, the status quo of the evidence-based decision-making is going to be surveyed in the present study among all of the managers working in the area of health in the southern section of the country based on the predictor variables.
Material and Methods
Participants
This cross-sectional study was undertaken in 2016. The study population includes all of the lines and headquarter managers working in any of the hospitals, treatment and health networks, colleges and headquarters in central departments of Shiraz Medical Sciences University. All these 141 managers were taken as the study participants through the census.
Among the studied participants, 47 individuals were working as hygiene managers, 45 were headquartered managers, 18 were working as treatment managers, and 31 individuals were working in instructional and educational areas.
Data Collection