Policy Makers

Methodological assumptions consider how researchers approach finding out what they believe can be known (Denzin & Lincoln, 2011 ), finding the best fit to the phenomena under investigation in a pragmatic manner. Within qualitative description, the outcome is to describe the phenomenon literally as a starting point and its methodological orientation may be drawn from a range of theorists, for example, Sandelowski (2000) (link). Qualitative description design then moves beyond the literal description of the data and attempts to interpret the findings without moving too far from that literal description. Stating one’s theoretical orientation will help readers understand how research methods are decided, for example, data collection, data analysis, interpretation, findings presentation, and rigor. Within the qualitative description approach, the phenomenon of interest is explored with participants in a particular situation and from a particular conceptual framework (Parse, 2001 ) with the research question related to the meaning of the experience. The participants are a purposive or purposeful sample who have the requisite knowledge and experience of the phenomena being researched. The interactions of a given social unit are investigated and the “participant group is selected from the population the researcher wishes to engage in the study” (Parse, 2001 , p. 59). The descriptions obtained from participants are then analyzed and synthesized from the perspective of the chosen framework. Researchers aiming to use a qualitative description approach need to address from the outset (as indeed do all researchers regardless of approach) their theoretical positioning, congruence between methodology and methods, strategies to establish rigor, and the analytic lens through which data analysis is conducted.
The goal of qualitative description research is not “discovery” as is the case in grounded theory, not to “explain” or “seeking to understand” as with ethnography, not to “explore a process” as is a case study or “describe the experiences” as is expected in phenomenology (Doody & Bailey, 2016 (link)). Qualitative description research seeks instead to provide a rich description of the experience depicted in easily understood language (Sullivan-Bolyai et al., 2005 (link)). The researcher seeks to discover and understand a phenomenon, a process, or the perspectives and worldviews of the people involved (Caelli et al., 2003 ). A qualitative description approach, therefore, offers the opportunity to gather rich descriptions about a phenomenon which little may be known about. Within the process, the researcher strives to stay close to the “surface of the data and events” (Sandelowski, 2000 (link), p. 336), where the experience is described from the viewpoint of the participants (Sullivan-Bolyai et al., 2005 (link)).
The goal of the researcher is to provide an account of the “experiences, events and process that most people (researchers and participants) would agree are accurate” (Sullivan-Bolyai et al., 2005 (link), p. 128). The focus on producing rich description about the phenomenon from those who have the experience offers a unique opportunity to gain inside or emic knowledge and learn how they see their world.
Two main elements constant with qualitative description studies in health care research are learning from the participants and their descriptions, and second, using this knowledge to influence interventions (Sullivan-Bolyai et al., 2005 (link)). Therefore, a fundamental qualitative description design is valuable in its own right. Qualitative description studies are typically directed toward discovering the who, what, where, and why of events or experiences (Neergaard et al., 2009 ). A qualitative descriptive approach does not require the researcher to move as far from the data and does not require a highly abstract rendering of data compared with other qualitative designs (Lambert & Lambert, 2012 ) but of course does result in some interpretation. The findings from these studies can often be of special relevance to practitioners and policy makers (Sandelowski, 2000 (link)).

Numerous interventions have been applied and tested to promote the use of research evidence in practice. Implementation of such interventions is often accompanied by complex strategies comprising support structures, resources and processes. While numerous systematic reviews have been conducted to determine the effectiveness of specific interventions [17 (link)-22 (link)], a systematic synthesis of the literature to examine the mechanisms by which such interventions work, and under what circumstances, has not been undertaken. Therefore the broad purpose of this review was to determine what interventions and strategies are effective in enabling evidence-informed healthcare. The specific purpose of the review was to establish what works, for whom, in what circumstances, and why with respect to interventions and strategies to enable evidence-informed healthcare. The purpose of the review was refined through stakeholder engagement at a knowledge utilisation colloquium meeting (http://www.uofaweb.ualberta.ca/kusp/KU0Xarchive.cfm). The stakeholders are a multi-disciplinary community of researchers, practitioners, and policy makers with expertise in knowledge translation. This community served as a stakeholder reference group that were consulted at key stages in the review process: questions formulation, tool development, and evidence synthesis, providing critique and challenge to the method and emerging findings.

We will use a range of research designs to answer our key questions, as shown in Table 2. In the Inception phase we conducted a situational analysis of the mental health system in the selected district in each country. Using these data, we engaged in formative research to refine the substance and delivery of the proposed mental health care plan. This formative work has included three aspects. (1) We conducted a series of “theory of change” consultative workshops [22] . Theory of change is a structured participatory approach to the design and evaluation of interventions that provides “a systematic and cumulative study of the links between activities, outcomes, and contexts of the initiative” ([22] , p. 16). In the theory of change workshops, local stakeholders were asked to work with the research team to map out the steps in the causal pathway that lead to the intended outcome of the mental health care plan. This provided an opportunity for the research team and local stakeholders to interrogate the assumptions in each step of the proposed system change, as well as identify key indicators needed to monitor that change. (2) We conducted individual semi-structured interviews and focus group discussions to gather information from local stakeholders on the acceptability and feasibility of the proposed intervention packages. A wide range of stakeholders were interviewed, including national policy makers, district health managers, mental health specialists, primary care practitioners, community health workers, people living with the priority mental disorders, and local NGOs. Interview schedules addressed a range of topics, including experience and understanding of mental health problems, and participants' views on the draft mental health plans, training needs of primary care practitioners, task shifting, barriers to care, and health system requirements for integrating mental health into primary health care. (3) We developed a costing tool to estimate the resources required to implement the mental health care plan in each district, informed by local data and consultations.
Once the final mental health care plan has been approved by all stakeholders, training materials will be developed, the proposed interventions will be piloted, and the intervention will then be implemented and evaluated in each district. The primary quantitative methodologies for this evaluation are influenced by recent innovations for evaluating complex interventions implemented at the level of health systems or populations. These include community-based surveys to assess changes in coverage and stigma, facility-based surveys to assess changes in case detection, case studies of district level mental health systems, and studies of cohorts of individuals treated by the mental health care plans, to assess changes in mental health, social, and economic outcomes [23] (link)–[26] (link). All data will be disaggregated by gender, residence (rural/urban), and economic status to monitor equity of access to services and outcomes.

In this study we employed a qualitative descriptive approach to understand the experiences of PROMs and PREMs users across different pediatric settings in a single Canadian province. Qualitative description studies offer a comprehensive summary of an event or phenomenon, which has a low degree of interpretation of the data and is good for applied research meant for practitioners and policy-makers [24 (link)].