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      Setting health research priorities using the CHNRI method: VII. A review of the first 50 applications of the CHNRI method

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          Abstract

          Background

          Several recent reviews of the methods used to set research priorities have identified the CHNRI method (acronym derived from the “Child Health and Nutrition Research Initiative”) as an approach that clearly became popular and widely used over the past decade. In this paper we review the first 50 examples of application of the CHNRI method, published between 2007 and 2016, and summarize the most important messages that emerged from those experiences.

          Methods

          We conducted a literature review to identify the first 50 examples of application of the CHNRI method in chronological order. We searched Google Scholar, PubMed and so–called grey literature.

          Results

          Initially, between 2007 and 2011, the CHNRI method was mainly used for setting research priorities to address global child health issues, although the first cases of application outside this field (eg, mental health, disabilities and zoonoses) were also recorded. Since 2012 the CHNRI method was used more widely, expanding into the topics such as adolescent health, dementia, national health policy and education. The majority of the exercises were focused on issues that were only relevant to low– and middle–income countries, and national–level applications are on the rise. The first CHNRI–based articles adhered to the five recommended priority–setting criteria, but by 2016 more than two–thirds of all conducted exercises departed from recommendations, modifying the CHNRI method to suit each particular exercise. This was done not only by changing the number of criteria used, but also by introducing some entirely new criteria (eg, “low cost”, “sustainability”, “acceptability”, “feasibility”, “relevance” and others).

          Conclusions

          The popularity of the CHNRI method in setting health research priorities can be attributed to several key conceptual advances that have addressed common concerns. The method is systematic in nature, offering an acceptable framework for handling many research questions. It is also transparent and replicable, because it clearly defines the context and priority–setting criteria. It is democratic, as it relies on “crowd–sourcing”. It is inclusive, fostering “ownership” of the results by ensuring that various groups invest in the process. It is very flexible and adjustable to many different contexts and needs. Finally, it is simple and relatively inexpensive to conduct, which we believe is one of the main reasons for its uptake by many groups globally, particularly those in low– and middle–income countries.

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          Most cited references14

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          Research priorities to reduce the global burden of dementia by 2025.

          At the First WHO Ministerial Conference on Global Action Against Dementia in March, 2015, 160 delegates, including representatives from 80 WHO Member States and four UN agencies, agreed on a call for action to reduce the global burden of dementia by fostering a collective effort to advance research. To drive this effort, we completed a globally representative research prioritisation exercise using an adapted version of the Child Health and Nutrition Research Initiative method. We elicited 863 research questions from 201 participants and consolidated these questions into 59 thematic research avenues, which were scored anonymously by 162 researchers and stakeholders from 39 countries according to five criteria. Six of the top ten research priorities were focused on prevention, identification, and reduction of dementia risk, and on delivery and quality of care for people with dementia and their carers. Other priorities related to diagnosis, biomarkers, treatment development, basic research into disease mechanisms, and public awareness and understanding of dementia. Research priorities identified by this systematic international process should be mapped onto the global dementia research landscape to identify crucial gaps and inform and motivate policy makers, funders, and researchers to support and conduct research to reduce the global burden of dementia. Efforts are needed by all stakeholders, including WHO, WHO Member States, and civil society, to continuously monitor research investments and progress, through international platforms such as a Global Dementia Observatory. With established research priorities, an opportunity now exists to translate the call for action into a global dementia action plan to reduce the global burden of dementia.
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            Setting priorities in global child health research investments: guidelines for implementation of CHNRI method.

            This article provides detailed guidelines for the implementation of systematic method for setting priorities in health research investments that was recently developed by Child Health and Nutrition Research Initiative (CHNRI). The target audience for the proposed method are international agencies, large research funding donors, and national governments and policy-makers. The process has the following steps: (i) selecting the managers of the process; (ii) specifying the context and risk management preferences; (iii) discussing criteria for setting health research priorities; (iv) choosing a limited set of the most useful and important criteria; (v) developing means to assess the likelihood that proposed health research options will satisfy the selected criteria; (vi) systematic listing of a large number of proposed health research options; (vii) pre-scoring check of all competing health research options; (viii) scoring of health research options using the chosen set of criteria; (ix) calculating intermediate scores for each health research option; (x) obtaining further input from the stakeholders; (xi) adjusting intermediate scores taking into account the values of stakeholders; (xii) calculating overall priority scores and assigning ranks; (xiii) performing an analysis of agreement between the scorers; (xiv) linking computed research priority scores with investment decisions; (xv) feedback and revision. The CHNRI method is a flexible process that enables prioritizing health research investments at any level: institutional, regional, national, international, or global.
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              Approaches, tools and methods used for setting priorities in health research in the 21st century

              Background Health research is difficult to prioritize, because the number of possible competing ideas for research is large, the outcome of research is inherently uncertain, and the impact of research is difficult to predict and measure. A systematic and transparent process to assist policy makers and research funding agencies in making investment decisions is a permanent need. Methods To obtain a better understanding of the landscape of approaches, tools and methods used to prioritize health research, I conducted a methodical review using the PubMed database for the period 2001–2014. Results A total of 165 relevant studies were identified, in which health research prioritization was conducted. They most frequently used the CHNRI method (26%), followed by the Delphi method (24%), James Lind Alliance method (8%), the Combined Approach Matrix (CAM) method (2%) and the Essential National Health Research method (<1%). About 3% of studies reported no clear process and provided very little information on how priorities were set. A further 19% used a combination of expert panel interview and focus group discussion (“consultation process”) but provided few details, while a further 2% used approaches that were clearly described, but not established as a replicable method. Online surveys that were not accompanied by face–to–face meetings were used in 8% of studies, while 9% used a combination of literature review and questionnaire to scrutinise the research options for prioritization among the participating experts. Conclusion The number of priority setting exercises in health research published in PubMed–indexed journals is increasing, especially since 2010. These exercises are being conducted at a variety of levels, ranging from the global level to the level of an individual hospital. With the development of new tools and methods which have a well–defined structure – such as the CHNRI method, James Lind Alliance Method and Combined Approach Matrix – it is likely that the Delphi method and non–replicable consultation processes will gradually be replaced by these emerging tools, which offer more transparency and replicability. It is too early to say whether any single method can address the needs of most exercises conducted at different levels, or if better results may perhaps be achieved through combination of components of several methods.
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                Author and article information

                Journal
                J Glob Health
                J Glob Health
                JGH
                Journal of Global Health
                Edinburgh University Global Health Society
                2047-2978
                2047-2986
                June 2017
                18 June 2017
                : 7
                : 1
                : 011004
                Affiliations
                [1 ]Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Scotland, UK
                [2 ]Department for Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
                [3 ]Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
                [4 ]Centre for Medical Informatics, The Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Scotland, UK
                [5 ]NRF Centre of Excellence in Human Development, DVC Research Office, University of Witwatersrand, Johannesburg, South Africa
                [6 ]Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
                [7 ]Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
                [8 ]Centre for Global Child Health, the Hospital for Sick Children, Toronto, Canada
                [9 ]Centre of Excellence in Women and Child Health, the Aga Khan University Karachi, Pakistan
                [10 ]The World Bank, Washington, DC, USA
                [11 ]Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
                [12 ]International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
                [13 ]Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
                [14 ]Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
                Author notes
                Correspondence to:
Professor Igor Rudan
Centre for Global Health Research
The Usher Institute for Population Health Sciences and Informatics
The University of Edinburgh
Teviot Place
Edinburgh EH8 9AG
Scotland, UK
 igor.rudan@ 123456ed.ac.uk
                Article
                jogh-07-011004
                10.7189/jogh.07.011004
                5481891
                28685049
                71e0f9d2-3b27-4a1b-937d-0d4ad3053ab0
                Copyright © 2017 by the Journal of Global Health. All rights reserved.

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 15, Pages: 7
                Categories
                Research Theme 6: Global Health Research Priorities

                Public health
                Public health

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