During the last decade, there has been growing international interest in generating new knowledge regarding understanding, developing and evaluating mechanisms that support the use of research evidence by policymakers as a strategy to strengthen health systems in low-and middle-income countries (LMICs). This thesis contributes to this knowledge through three original scientific contributions that employ a mixed methods approach, with the goal of supporting the use of research evidence in the Colombian health system. Specifically, in the chapters I present: 1) the development of an analytical schema that explains the conceptualization of the Colombian government, research funder and universities of an evidence-informed health system; 2) two case studies that explain whether and how political factors influenced the role of research evidence in the agenda-setting and policy-development stages of two past health policy decisions in Colombia; and 3) a protocol for a randomized controlled trial evaluating the effectiveness of a multifaceted intervention in increasing the utilization of an evidence service and the intention to use synthesized research evidence by policy advisors and analysts at the Colombian Ministry of Health. As a whole, the chapters presented in this thesis provide substantive, methodological and disciplinary contributions to the field of health systems research and particularly to the study of efforts that aim to support evidence-informed policy in LMICs. They also help to provide insights that can be utilized to support a more nuanced approach to the use of research evidence in LMICs that takes into account the many factors that can influence health system policymaking. Ideally, this will help those engaged in developing mechanisms to support the use of research evidence in the policy process, and contribute to stronger health systems across the world. / Thesis / Candidate in Philosophy

There have been an increasing number of calls emphasizing the need to use the best-available research evidence to inform health system policies and, in response, efforts have been made in many countries to develop and implement policy-support organizations (PSOs) to enhance the use of research in policymaking. However, there is a paucity of evidence regarding both the best approaches for the successful establishment of such organizations. Moreover, there are very few attempts to consider how approaches can be applied in particular contexts, and operationalized by policymakers and stakeholders in their efforts to support EIPM through the establishment of PSOs. This dissertation incorporates a mix of methodological approaches to address this gap. First, in chapter two, a critical interpretive synthesis was used to develop a conceptual framework that can guide the process of establishing a PSO or similar entities. The framework outlines the stages in the process of establishing a policy support organization and the contextual factors at the political-, research- and health-system level that influence this process. Second, in chapter three, the framework from the CIS was used to inform the design of a survey tool and interview guide used in a sequential mixed methods study to enrich the framework by soliciting insights from those with practical experience with developing and operationalizing PSOs in real-world contexts. Specifically, this study provides insights into the approaches and strategies for each stage in the establishment process for a PSO. Lastly, in chapter four, the findings from chapter two and three were used -- along with in-depth one-on-one semi-structured interviews with policymakers, researchers and stakeholders who are familiar with the Omani system -- to develop a model for an Omani knowledge translation department, which can be used in a future co-design process for activating the department. The dissertation chapters build on each other and make substantive, methodological, and theoretical contributions. Substantively this dissertation clarifies and defines key concepts that are essential to enable a rich understanding of the process of establishing a PSO. It highlights that the process of establishing such an organization is iterative and can be influenced by multiple contextual factors that affect the individual approach that has been used to support evidence-informed policymaking. Methodologically, this dissertation is the first study of PSOs that uses a mix of conceptual framework generation, insights from a wide range of fields such as organizational development, and empirical approaches that adopt mixed methods to derive fulsome answers to specific questions about establishing PSOs. Theoretically, this dissertation provides a conceptual framework that can be used to inform the process of establishing a PSO in different contexts. The theoretical constructs of this framework were verified and strengthened through direct application in subsequent studies in the dissertation. This dissertation has many implications for policy and research. Most importantly, for those interested in establishing a PSO, my findings provide a road map for identifying the most appropriate starting point and the factors that might influence the establishment process. In addition, leaders of existing PSOs can use my findings to expand or refine their scope of work. Given that this framework focuses only on PSOs in the health sector, an important next step for research will be to include other sectors and identify any additional insight that can enhance the framework I have developed. / Thesis / Doctor of Philosophy (PhD) / Health system policymaking is a challenging task because many factors need to be balanced in policy decisions (e.g., efficiency, equity, and politics). There have been an increasing number of calls emphasizing the need to use the best-available research evidence to inform health system policies and, in response, efforts have been made in many countries to develop and implement approaches to enhance the use of research in the policymaking process. In some instances, organizations have been given sole responsibility for supporting evidence-informed policy, but evidence is limited to inform the process of establishing these organizations. This dissertation addresses this gap in the literature by: I) developing a new conceptual framework for the process of establishing organizations that can support evidence-informed policymaking; ii) identifying approaches that can be used in this process; and iii) developing a model for a proposed Omani knowledge translation department using this framework.