对话卫生系统研究框架(DHSRF):促进卫生系统研究和政策研究中的自我批判、研究人员互动和知识管理的工具。

IF 2.5
PLOS global public health Pub Date : 2025-09-19 eCollection Date: 2025-01-01 DOI:10.1371/journal.pgph.0004209
Ritu Priya, Sayan Das, Liz M Kuriakose, Madhurima Shukla, Amitabha Sarkar, Neha Dumka, Erin Hannah, Nisha Basheer, Atul Kotwal
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引用次数: 0

摘要

过去二十年来,卫生系统研究(HSR)在理论、方法和实践方面取得了重大进展。卫生系统的复杂性为高铁提供了多种视角。然而,鉴于高铁不同领域之间缺乏对话,这一领域的多样性(或许是其最大的优势)正成为一项相当大的挑战。如果没有一种共同的语言,使研究人员能够相互交流,并对该领域进行批判性的检查,多样性很容易变成一种嘈杂。为了克服这种困惑,基于证据的政策制定需要能够评估为设计与期望的价值观和原则相一致的系统而产生的各种证据的工具。因此,我们需要一个共同的高铁研究框架,来理解、描述和解释系统的结构和功能,包括观察到的和预测的变化过程。它应该能够理解高铁的制定,允许不同的研究范式在高铁中占有适当的位置,并使它们相互交流而不是相互对立。本文介绍了对话卫生系统研究框架(DHSRF),该框架是通过基于理论、迭代和反思性的多方法方法开发的,涉及最初的系统叙述审查和后来的国家专家咨询以获得反馈和验证。DHSRF将自己置于公共卫生学科框架内,并借鉴综合初级卫生保健原则和复杂性视角。这导致对卫生系统采取全面的社会文化方法,将其正式和非正式组成部分结合起来,根据流行病学、历史分析、知识多元化和自下而上的方法,处理技术-管理和社会-经济-政治-文化方面的问题,使框架对环境敏感,对不同的观点开放,适应不同的环境,价值批判和对话。它可能有助于知识管理:a)允许在提案和设计阶段对高铁进行全面审查,以确保“非常适合目的”,以及b)评估高铁结果与研究目的和目标相关的强度。通过揭示高铁的内部运作,该框架可以激发对话和辩论,丰富该领域,并促进将其成果用于政策、规划和实施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The Dialogic Health Systems Research Framework (DHSRF): A tool for facilitating self-criticality, researcher interactions and knowledge management in Health Systems Research & Policy Studies.

The Dialogic Health Systems Research Framework (DHSRF): A tool for facilitating self-criticality, researcher interactions and knowledge management in Health Systems Research & Policy Studies.

The Dialogic Health Systems Research Framework (DHSRF): A tool for facilitating self-criticality, researcher interactions and knowledge management in Health Systems Research & Policy Studies.

The Dialogic Health Systems Research Framework (DHSRF): A tool for facilitating self-criticality, researcher interactions and knowledge management in Health Systems Research & Policy Studies.

Health Systems Research (HSR) has witnessed significant progress in theory, methodology and practice over the last two decades. The complexity of health systems has allowed for diverse lenses for HSR. However, given the absence of dialogue between the different streams of HSR, the diversity of this field, perhaps its greatest strength, is turning out to be quite the challenge. Without a common language that enables researcher interaction and critical examination of the field, diversity can easily turn into a din. To overcome this confusion, evidence-based policy making requires tools that can assess the diverse evidence generated for designing systems coherent with the desired values and principles. Hence, we need a common research framework for HSR, to understand, describe and explain the systems' structure and functioning, including observed and projected processes of change, across streams. It should be able to make sense of the formulation of HSR, allowing diverse research paradigms their appropriate place in HSR, and make them talk to each other rather than against each other. This paper presents the Dialogic Health Systems Research Framework (DHSRF), developed through a multi-method approach which was theory-based, iterative and reflexive involving an initial systematic narrative review and a later national expert consultation for feedback and validation. The DHSRF locates itself within a public health disciplinary frame and draws upon the comprehensive primary health care principles and a complexity lens. This led to adopting a comprehensive socio-cultural approach to health systems, incorporating their formal and informal components, addressing the techno-managerial and social-economic-political-cultural aspects with understandings drawn from epidemiology, historical analysis, knowledge pluralism and a bottom-up approach, making the framework context-sensitive, open to diverse perspectives, adaptable to different settings, value-critical and dialogic. It potentially contributes to knowledge management by a) allowing for a comprehensive review of HSR at the proposal and design stage to ensure a 'good fit for purpose', and b) assessing the strength of the outcomes of HSR in relation to the purpose and objective(s) of the research. By surfacing the inner workings of HSR, the framework can galvanise dialogue and debate to enrich the field and facilitate utilisation of its outcomes for policy, planning and implementation.

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