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      Health research prioritization in Somalia: setting the agenda for context specific knowledge to advance universal health coverage

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          Abstract

          Introduction

          Despite recognition that health research is an imperative to progress toward universal health coverage, resources for health research are limited. Yet, especially in sub-Saharan Africa, more than 85% of the resources available for health research are spent on answering less relevant research questions. This misalignment is partially due to absence of locally determined health research priorities. In this study, we identified health research priorities which, if implemented, can inform local interventions required to accelerate progress toward universal health coverage in Somalia.

          Methods

          We adapted the child health and nutrition research initiative method for research priority setting and applied it in 4 major phases: (1) establishment of an exercise management team, (2) a web-based survey among 84 respondents to identify health research questions; (3) categorization of identified health research questions; and (4) a workshop with 42 participants to score and rank the identified health research questions. Ethical approval was received from ethics review committee of the London School of Hygiene and Tropical Medicine (Ref:26524) and the Somali Research and Development Institute (Ref: EA0143).

          Results

          Two hundred and thirty-one unique health research questions were identified and categorized under health systems, services and social determinants (77), communicable diseases (54), non-communicable diseases (41) and reproductive, maternal, new-born, child, adolescent health and nutrition (59). A priority score ranging from 1 to 9 was assigned to each of the questions. For each category, a list of 10 questions with the highest priority scores was developed. Across the four categories, an overall list of 10 questions with the highest priority scores was also developed. These related to bottlenecks to accessing essential health services, use of evidence in decision making, antimicrobial resistance, distribution and risk factors for non-communicable diseases, post-traumatic stress disorder and factors associated with low antenatal care attendance among others.

          Conclusion and recommendations

          The developed priority research questions can be used to focus health research and to inform appropriation of health research resources to questions that contribute to generation of local health system knowledge which is required to accelerate progress toward universal health coverage in Somalia. The Somalia national institute of health should set up a consortium for provision of technical and financial support for research addressing the identified priority research questions, establish a mechanism to continuously monitor the extent to which new health interventions in Somalia are informed by knowledge generated through conducting prioritized health research and prioritize interventions aimed at strengthening the broader national health research system for Somalia.

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          Most cited references34

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          Saturation in qualitative research: exploring its conceptualization and operationalization

          Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation—as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
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            Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research.

            Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
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              Avoidable waste in the production and reporting of research evidence.

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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                09 November 2023
                2023
                : 11
                : 1202034
                Affiliations
                [1] 1World Health Organization Country Office , Mogadishu, Somalia
                [2] 2Save the Children International , Mogadishu, Somalia
                [3] 3Somali Research and Development Institute , Mogadishu, Somalia
                [4] 4National Institute of Health , Mogadishu, Somalia
                [5] 5Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London, United Kingdom
                Author notes

                Edited by: Mekdes Gebremariam, University of Oslo, Norway

                Reviewed by: Naima Said Sheikh, Norwegian University of Life Sciences, Norway; Aladeen Alloubani, King Hussein Cancer Center, Jordan

                *Correspondence: Steven Ssendagire, sssendagire@ 123456musph.ac.ug
                Article
                10.3389/fpubh.2023.1202034
                10680366
                38026320
                8087bb7c-300e-4330-8652-9111f21c4fbf
                Copyright © 2023 Ssendagire, Mohamoud, Bashir, Jamal, Bulale, Azad, Warsame, Hassan, Omar, Dalmar, Karanja, Nyagah, Warsame, Diriye and Malik.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 07 April 2023
                : 20 October 2023
                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 34, Pages: 11, Words: 7244
                Funding
                Funded by: UK Research and Innovation as part of the Global Challenges Research Fund
                Award ID: ES/P010873
                The prioritization exercise from which data for this study was derived was funded by the UK Research and Innovation as part of the Global Challenges Research Fund, grant number ES/P010873 and by the office of the country representative, WHO Country office, Mogadishu, Somalia.
                Categories
                Public Health
                Original Research
                Custom metadata
                Disaster and Emergency Medicine

                somalia,health,research,prioritization,universal health coverage

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