Knowledge translation and exchange (KTE) is integral to the formation of evidence-informed policy. Prior to the work presented in this dissertation, a significant body of literature existed in the healthcare field regarding research-to-policy KTE; however, little was known about KTE between researchers and policymakers in the Canadian food safety system or the context-specific barriers that influence KTE. A mixed-methods approach was used, grounded in concepts from the healthcare literature, to explore Canadian food safety researchers’ KTE awareness and activities with policymakers, the barriers hindering KTE engagement and success, and timing and informational disparities between research and policy needs that may hinder KTE success. Canadian food safety researcher awareness of and engagement in KTE activities with policymakers was high. However engagement in activities identified as having the greatest potential for KTE success—i.e., collaboration with policymakers at all stages of the research process, provision of syntheses such as systematic reviews, and provision of a searchable database of research findings—was low relative to end-of-research dissemination of findings to policymakers. Several barriers were identified that limited KTE engagement and success from the researcher’s perspective, including an inability to identify relevant policymakers, high policymaker turnover, a lack of resources and support in the research organization, a perceived lack of KTE skills on the part of researchers, and an inability to break free from traditional publish-or-perish research roles. Apparent informational disconnects (i.e., research output not meeting policymakers’ apparent informational needs) were identified that may further hinder KTE and evidence-informed policymaking. While new methodologies, such as systematic review, have been adapted for food safety research, boosting researchers’ potential ability to produce policy-relevant evidence, a cultural shift must occur in research and policymaking organizations, if sustained KTE is to be successful. As well, significant future investment must be made on the part of research organizations and policymakers, if KTE barriers are to be mitigated. Future research should evaluate KTE tools (e.g., sustained linkages between researchers and policymakers, provision of syntheses, provision of access to a database of research findings) to identify specific methods that may facilitate research use in food safety policymaking. / Blake Graham Fellowship, Canadian Institutes of Health Research, Public Health Agency of Canada

Evidence-informed health policy making contributes to improved health outcomes by strengthening health systems. In addition, health policy decisions should take into consideration the needs and priorities of users of healthcare services. However, little research has been done to find best ways to facilitate evidence-informed and participatory health policymaking, particularly in low- and middle-income countries. This thesis is written based on three studies done in Ethiopia to fill this knowledge gap. In the first study, we examined whether, how and under what conditions evidence was used and service-users participated during the agenda-setting and policy formulation phases of selected policies in the ‘prevention of mother-to-child transmission of HIV’ program in Ethiopia using a multiple-case study design. In the second study, we identified strategies to facilitate evidence-informed health policy making using an online survey. In the third study, we identified strategies to facilitate participatory health policy making using a combined paper-based and Internet-based Delphi approach. The thesis does not have direct theoretical contribution. However, it will draw on two theoretical frameworks, namely Kingdon’s framework and the 3I+E framework. and use them in a setting from where they were originally developed. This thesis has two substantive and three methodological contributions. Substantively, the first study provides empirical evidence about the current practice of evidence-informed and participatory health policy making in a low-income, ‘revolutionary’ democratic country (Ethiopia). In addition, the studies have identified strategies to concretize the constitutional and policy provisions for evidence-informed and participatory health policy making in Ethiopia. The thesis has the following three methodological contributions. First, the studies explored the use of Kingdon’s multiple-streams framework and the 3I+E framework in predicting factors influencing agenda-setting and policy formulation phases, respectively, and in explaining the use of research evidence in informing these two phases in a ‘revolutionary’ democratic country where they have not previously been used. Second, the thesis has shown that paper-based and Internet-based Delphi could be combined in contexts with limited resources. Third, the thesis has demonstrated the possibility of training service-users as ‘peer’ researchers to collect and analyze data to inform their participation and maximize their contribution in surveys, forming a pyramid of participation. / Thesis / Doctor of Philosophy (PhD) / Evidence-informed health policy making can contribute to improved health outcomes by strengthening health systems. In addition, health policy decisions ultimately affect users of healthcare services. Thus, such decisions should take into consideration their needs and priorities. However, little research has been done to find best ways to facilitate evidence-informed and participatory health policymaking, particularly in low- and middle-income countries. This thesis is written based on three studies done in Ethiopia. In the first study, we examined whether, how and under what conditions evidence was used and service-users participated in the ‘prevention of mother-to-child transmission of HIV’ program in Ethiopia. In the second and third studies, we identified strategies to facilitate evidence-informed and participatory health policy making. In addition, we explored the possibility of combining Internet- and paper-based methods for consensus-building among policymakers, program managers, researchers, healthcare providers and service-users in settings with limited resources.