Typically, policy development and implementation to achieve impact starts off with identifying and framing a problem that needs attention. Ideally, this step should be preceded by, or accompanied with, a formal priority-setting process [25]. The framing of the problem generally includes a clear/concise problem statement, a description of the magnitude of the problem, the consequences of the problem, the factors underlying the problem, and the equity considerations related to the problem [25]. The understanding of the problem should be informed by research evidence, the context for the decision, equity considerations, and discussion with key stakeholders (e.g. decision-makers, researchers, research commissioners) [5],[25][83].
When identifying a high-priority issue, it is fundamental to consider the local context. For this, local evidence will be needed. Local evidence is evidence that is available from the specific setting(s) in which a decision or action will be implemented [28]. The word “local” can refer to municipality, state or national levels, depending on the intervention or policy issue being considered. The kind of evidence needed includes information on the characteristics of an area and those who live or work in it; the prevalence or baseline risk of the health issue;
Examples of alternative framing of a scenario relating to antimicrobial resistance (AMR) include [25]:
• “unavailability of laws that regulate the use of antibiotics in agriculture and animals” may resonate with NGOs and activists;
• “a rise in the AMR” may resonate with public health professionals;
• “no efforts to educate students on AMR and reasonable antibiotic use in a regular manner” may resonate with parents and stakeholders in the education system;
• comparing the country with other countries may resonate with politicians.
services available; views and experiences of local stakeholders; costs; political traditions; institutional capacity; and the availability of resources such as staff and equipment [28].
Ideally, a stakeholder mapping and analysis should take place early on in the process to identify the user organization(s), change agents and target audiences, and to allow for an early involvement of the relevant stakeholders into the evidence application process [25]. Stakeholders can include decision-makers and policy-makers, national and international organizations, researchers in the f ield, civil society groups and other influencers (Fig.2.3).
It is important that the way the problem is framed resonates with the main stakeholder groups/audiences. This does not mean distorting research findings, but presenting the problem in ways that will convince key stakeholders to back change [84]. The problem-framing should, for example, avoid so-called “trigger” words and phrases, which could make the issue politically challenging for stakeholders [84]. Similarly, some groups will respond better to a positively framed problem (e.g. “Our country will, within five years, achieve the national health goals related to infant mortality.”) than one that is framed negatively (e.g. “Our country has the highest infant mortality rate in the region”), or to a focus on a specific risk factor rather than a disease [83].
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