Background: The challenges in the utilization of scientific findings in the fields of prevention and mental health are well documented. Scholars have found significant gaps between the knowledge available and the knowledge applied in healthcare. Studies have suggested that about half of the patients receive the recommended care for their medical condition. In order to address this gap, health systems at global, national, regional and local levels have made diverse efforts to facilitate the uptake of research for example through evidence-based health policy processes. In Sweden, government agencies and health policy actors such as the National Board of Health and Welfare support and control the health care system through evidence-based policies amongst other steering tools. The overall aim of this thesis is to explore evidence-based policy processes, and to further understand barriers to implementation of policies in the fields of preventive and mental health services. Methods: A multiple case study approach was used, and data were collected from several sources. Qualitative content analysis methodology was used. Case 1 comprises the development and early implementation of national guidelines for methods of preventing disease managed by the National Board of Health and Welfare during 2007–2014. Case 2 covers the effort to improve health care for the older population that was undertaken through an agreement between the Swedish government and the Swedish Association of Local Authorities and Regions during 2009–2014. Case 3 involves an effort to implement an adapted version of a systematic review from the Swedish agency for health technology assessment and assessment of social services on treatment of depression in primary health care. Data was collected between 2007 and 2010. In Paper 1, the policies from Case 1 and 2 were studied using a longitudinal, comparative case study approach. Data were collected through interviews, documents and observations. A conceptual model was developed based on prior frameworks. The model was used to organize and analyse the data. In Paper 2, the guideline development process (Case 1) was studied through interviews and the collection of documents. A prior framework on guideline quality was used in order to organize the data. Paper 3 investigated decision-making processes during guideline development using a longitudinal approach. Qualitative data were collected from questionnaires, documents and observations and analysed using conventional and summative content analysis. In Paper 4, the barriers to implementation were investigated through interviews and the collection of documents. Data were analysed using qualitative content analysis with a conceptual model to structure the analysis. Results: The sources and procedures for policy formulation differed in Case 1 and 2, as did the approaches to promote the implementation of the policies. The policy processes were cyclical, and phases overlapped to a large degree. The policy actors intended to promote implementation, both during and after the policy formulation process. The thesis shows variation in how the key policy actors defined and used research evidence in the policy processes. In addition, other types of knowledge (e.g. politics, context, experience) served as alternative or multiple sources to inform the health policies. The composition of sources that informed the policies changed over time in Cases 1 and B. During the policy formulation and implementation process, efforts to integrate research evidence with clinical experiences and values were associated with tension and recurrent dilemmas. On the local level (i.e. primary health care centres), barriers to implementation were found related to the innovation and among health professionals, patients, in social networks as well as in the organizational, economic and political contexts. Conclusion: The concept of evidence holds a key position in terms of goals and means for knowledge based policymaking in the Swedish health system. Broad definitions of evidence – including research and non-research evidence - were requested and to various extents utilized by the policy actors in the studied cases. An explicit terminology and systematic, transparent methodology to define, identify, and assess also non-research evidence in policy processes would potentially strengthen the clarity and validity of these processes and also enhance policy implementation. Particular determinants to implementation, such as the interventions characteristic, are to a considerable degree established early in the policy process, during agenda setting and policy formulation. This early phase offers unique opportunities to assess and build capacity, initiate and facilitate implementation. Early analysis and considerations of target populations and contexts and other implementation determinants related to the specific policy scope (e.g. disease preventive guidelines) could enhance the forth-coming implementation of the policy.

Introduction The main aim of the study was to explore the technical capacity of members of the 12 Sector Human Resource Development committees of the Human Resource Development Council in the management of evidence-based policymaking in the course of implementing the national and sector-specific Human Resource Development plans for all matters of national human resource development. The study set out to contribute to the urgency and growing importance of research evidence as the basis for making informed policy and practical decisions across the world. There is a significant research gap in understanding how members of the Human Resource Development committees, as policymakers in the context of this study, use research-based evidence in the course of developing Human Resource Development plans. There is limited understanding of the factors that may induce or constrain members of the committees to use research-based evidence in implementing the national and sector-specific Human Resource Development plans. Methodology The study adopted an exploratory, sequential, inductive mixed methods approach in addition to the deductive use of the Canadian Institutes of Health Research (CIHR) knowledge-to-action framework. The target participants for the study were the members of the 12 Sector Human Resource Development committees of the Human Resource Development Council who were asked to complete a questionnaire. The questionnaire elicited respondents’ perceptions about their capacity to adapt knowledge generated; identify inhibiting/ facilitating factors; assess and approve research evidence and sustainable use of research evidence. Qualitative data was collected through conducting interviews with the chairpersons of the committees. The scope of the in-depth interview questions covered respondents’ perceptions on the same key areas as in the questionnaire. This was to allow respondents to express their feelings during the in-depth discussions without any limitations. Findings The insights based on the perceptions of chairpersons and members of the committees in this current study have revealed the areas for possible improvement in managing evidence-based policies in the context of Botswana. Issues that emerged with respect to the perceptions of respondents to adaptation of research evidence included packaging and presenting research evidence; lengthy reports and use of complex language; lack of understanding of the policymaking context by researchers, and inversely, policymakers not understanding the research process; lack of collaboration and engagement between researchers and policymakers; and lack of implementation plans. Issues that related to the perceptions of respondents on factors that may inhibit or facilitate the use of research evidence entailed positive attitude towards evidence-based policies; development of policy briefs; difficulty in accessing research articles, databases and journals; building policymakers’ ability to search for relevant research evidence; insufficient time to read and evaluate research articles; lack of organisational support; and authority and decision-making power. Concerning respondents’ perceptions on assessing and approving research evidence, issues raised covered skills in interpreting the research evidence; policymakers being generalists; lack of appraisal criteria and guidelines; and training on appraising research evidence being more theoretical than practical. As for the strategic interventions suggested to sustain evidence-based policies, respondents highlighted the need for skills development for both researchers and policymakers; participation of policymakers in the research process; and provision of incentive schemes. Conclusions In conclusion, the findings of the current study show that all the sub-constructs of adaptation of research evidence, factors inhibiting or facilitating the use of research evidence, and assessing and approving the quality of research evidence are significantly and positively related to research evidence informing policy and practice. Overall, the insights emerging from this current study provide conceptual tools to use research evidence to inform policy and practice. The study sought to complement and advance the literature on the field of evidence-based policy management, essentially contributing to the research-policy interface in Botswana context. Botswana, as an emerging economy, is still grappling with understanding the dynamics of evidence-based policy management. There is still a need to initiate, develop and sustain evidence-based policy management through strategic interventions. The insights gained from the current study can be used as a basis for future research. / Educational Management and Leadership / Ph. D. (Educational Leadership and Management)

Zahlreiche Hoffnungen sind mit einer auf Pflanzen basierenden Wirtschaft, einer Bioökonomie, verbunden. Ob deren Weiterentwicklung den Zustand der Umwelt und die Wohlfahrt eines Landes verbessern kann, bleibt jedoch fraglich. Sich im Aufbau befindliche Bioökonomie-Monitoring-Systeme haben die Aufgabe, Informationen über Zielkonflikte zu liefern und somit eine erkenntnisgestützte Politikgestaltung zu ermöglichen. Das Ziel dieser Doktorarbeit ist es, Erkenntnisse für die Weiterentwicklung solcher Systeme zu gewinnen. Bisher entwickelte Bioökonomie-Indikatoren sind ungeeignet, den Übergang von einer fossil-basierten zu einer bio-basierten Wirtschaft korrekt abzubilden. In der vorliegenden Arbeit werden deshalb entsprechende Indikatoren entwickelt und am Beispiel der Biokunststoffproduktion in Deutschland gemessen. Damit leiste ich einen Beitrag zur systematischen Indikatorenentwicklung, zur Charakterisierung einer bestimmten Bioökonomie-Transformation und zur quantitativen Modellierung der Indikatoren. Zukünftige Bioökonomie-Monitoring-Systeme könnten davon profitieren, wenn die Indikatorenentwicklung noch stärker als Prozess verstanden wird, der eine Auseinandersetzung mit den Zielen und deren Messbarkeit umfasst, sich so lange wiederholt bis zufriedenstellende Indikatoren verfügbar sind und die wichtigsten Akteure einbezieht. Zudem ist ein stärkerer Fokus auf nachhaltige Bioökonomie-Transformationen erforderlich, die sich an einem kreislauf- und suffizienzbasierten Wirtschaften orientieren und den Substitutionsbegriff weiter fassen als bisher. Das hier entwickelte Biokunststoff-Modell könnte in Monitoring-Systeme integriert werden, wenn es um Kohlenstoffflüsse und Post-Produktionsprozesse ergänzt wird. Forschungsbedarf besteht beim Aufbau eines auf gesellschaftliche Bedürfnisse fokussierten Monitoring-Systems und bei der Wirksamkeit von Monitoring-Systemen in der politischen Entscheidungsfindung. / The relationship between bioeconomy transitions and sustainable development is not straightforward. For policymakers it is often difficult to keep track of bioeconomy developments and formulate appropriate bioeconomy-related policies that are also conducive towards sustainable development. Consequently, bioeconomy monitoring systems have recently been initiated to provide more reliable sources of information. There is a clear mismatch between the vision of a transition from fossil-based to bio-based economies and available indicators. I aim here to enhance current bioeconomy monitoring systems by developing and applying a set of appropriate indicators and providing insight into three key issues: 1) how indicators can be systematically developed, 2) what dimensions of an economy need to receive attention while monitoring transition from a fossil-based to a bio-based one, and 3) what kinds of quantitative models are suitable for this purpose. This study shows that it is possible to quantify the bioeconomy transition and measure it with systematically developed indicators, applied to plastics substitution. I conclude that, 1) developing bioeconomy indicators should be a process that is goal-oriented, iterative, and inclusive, 2) bioeconomy transition indicators need to exhibit advancement in the circular use of biomass and in sufficient consumption behavior, and 3) the model developed here can be integrated into bioeconomy monitoring systems but requires advances regarding carbon flows and post-production processes. Developers of bioeconomy monitoring systems should develop new indicators through stronger involvement of carefully selected stakeholders. Policymakers need to participate more actively in designing such systems and provide greater and more stable funding. Research could explore sectoral strategies to reduce environmental impacts while fulfilling societal needs, design related indicator sets, and assess their relevance for political decision-making.