Publications
151 results found
Jimenez G, Harris M, 2017, Published evidence about bias against research from lower income countries: can we do something about it?, Revista Chileana de Dermatologia, Vol: 33, Pages: 6-7, ISSN: 0719-9406
We have always suspected it. Many colleagues, doctor friends and researchers from Latin American countries keep mentioning how di cult it is for them to publish articles in international journals, especially in high im- pact factor ones. Was this because their research came from lower-income countries (LICs)? Maybe. Is it ea- sier for research coming from higher-income countries (HICs) to be accepted in journals? Probably. We never knew for sure whether this was true but nally there is research demonstrating that there is indeed bias aga- inst research from lower-income countries.
Prime M, Bhatti Y, Harris M, et al., 2017, Frugal innovations for healthcare: a toolkit for innovators, Academy of Management conference, Publisher: Academy of Management, ISSN: 2151-6561
Global health systems face significant challenges over the coming years to meet the increasing demands of ageing populations, the growing burden of chronic disease and the exponential cost of healthcare delivery. In response innovators from around the world are beginning to develop solutions that focus on reducing the cost of care; widen access to care; and challenge the dogma that more is better. So-called frugal innovations are defined as “means or ends, to do more with less, for the many” (Bhatti, 2014). This paper seeks to ask, “How can we identify frugal innovations for healthcare and how are they achieving frugality?” with the specific objective of developing a frugal innovation toolkit for healthcare. An emergent, embedded, mixed-methods research strategy was employed. A pilot study was used to develop the Frugal Innovation for Healthcare - Identification Tool (FIH-ID tool). A larger study was undertaken to identify a cohort of frugal innovations, evaluate the application of the FIH-ID tool, and assess the processes and strategies employed by frugal innovators. 56 semi-structured interviews were undertaken with 90 representatives of 28 healthcare innovations exhibiting at the World Innovation Summit for Health (WISH) 2015. 15 frugal innovations for healthcare were identified. Inter-observer agreement for application of the FIH-ID tool demonstrated a high proportion of agreement (Po = 0.714), and a “fair” Cohen’s Kappa score (K = 0.499). A thematic analysis identified key strategies applied by individuals or organizations to produce frugal innovations. These include: the application of new information & communication technologies; harnessing existing networks; simplification; changing the location of care; and task-shifting. This paper presents a toolkit of strategies for identifying and creating frugal innovations for healthcare. This research suggests that the FIH-ID tool is a reliable means of identifying exampl
Harris M, Bhatti Y, Prime M, et al., 2017, Low-cost innovation in healthcare: what you find depends on where you look, Journal of the Royal Society of Medicine, Vol: 111, Pages: 47-50, ISSN: 1758-1095
Harris MJ, macinko J, jimenez G, et al., 2017, Measuring the bias against low-income country research: an Implicit Association Test, Globalization and Health, Vol: 13, ISSN: 1744-8603
BackgroundWith an increasing array of innovations and research emerging from low-income countries there is a growing recognition that even high-income countries could learn from these contexts. It is well known that the source of a product influences perception of that product, but little research has examined whether this applies also in evidence-based medicine and decision-making. In order to examine likely barriers to learning from low-income countries, this study uses established methods in cognitive psychology to explore whether healthcare professionals and researchers implicitly associate good research with rich countries more so than with poor countries.MethodsComputer-based Implicit Association Test (IAT) distributed to healthcare professionals and researchers. Stimuli representing Rich Countries were chosen from OECD members in the top ten (>$36,000 per capita) World Bank rankings and Poor Countries were chosen from the bottom thirty (<$1000 per capita) countries by GDP per capita, in both cases giving attention to regional representation. Stimuli representing Research were descriptors of the motivation (objective/biased), value (useful/worthless), clarity (precise/vague), process (transparent/dishonest), and trustworthiness (credible/unreliable) of research. IAT results are presented as a Cohen’s d statistic. Quantile regression was used to assess the contribution of covariates (e.g. age, sex, country of origin) to different values of IAT responses that correspond to different levels of implicit bias. Poisson regression was used to model dichotomized responses to the explicit bias item.ResultsThree hundred twenty one tests were completed in a four-week period between March and April 2015. The mean Implicit Association Test result (a standardized mean relative latency between congruent and non-congruent categories) for the sample was 0.57 (95% CI 0.52 to 0.61) indicating that on average our sample exhibited moderately strong implicit association
bhatti Y, taylor A, harris M, et al., 2017, Global Lessons In Frugal Innovation To Improve Health Care Delivery In The United States, Health Affairs, Vol: 36, Pages: 1912-1919, ISSN: 0278-2715
In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.
Bhatti Y, Prime M, Harris M, et al., 2017, The search for the Holy Grail -- frugal innovation in healthcare from developing countries for reverse innovation to developed countries, BMJ Innovations, Vol: 3, Pages: 212-220, ISSN: 2055-642X
The healthcare sector stands to benefit most from frugal innovation, the idea that more can be done for less for many more people, globally. As a first step for health systems to leverage new approaches to offset escalating health expenditures and to improve health outcomes, the most relevant frugal innovations have to be found. The Institute of Global Health Innovation was commissioned by the US-based Commonwealth Fund to identify frugal innovations from around the world that could, if transferred to the USA, offer approaches for expanding access to care and dramatically lower costs. Our global scan was motivated by the need to extend the list of frugal innovations in healthcare beyond the impressive but oft-repeated examples such as GE’s MAC 400, a US$800 portable ECG machine, Narayana’s US$1500 cardiac surgery and Aravind’s US$30 cataract surgery. Our search involved (1) scanning innovation databases, (2) refining frameworks to identify frugal innovations and evaluate their reverse potential and (3) developing in-depth case studies. From 520 possible innovations, we shortlisted 16 frugal innovations that we considered as frugal and with potential for reverse diffusion into high-income country health systems. Our global search was narrowed down to three care delivery models for case analysis: The Brazilian Family Health Strategy around community health workers; Singapore-based GeriCare@North use of telemedicine and Brazil’s Saude Crianca community involvement and citizenship programme. We share core features of the three frugal innovations and outline lessons for practitioners, scholars and policymakers seeking to lower healthcare costs while increasing access and quality.
Harris MJ, Marti J, Watt H, et al., 2017, Explicit Bias Toward High-Income Country Research: A Randomized, Blinded, Crossover Experiment Of English Clinicians, Health Affairs, Vol: 36, Pages: 1997-2004, ISSN: 0278-2715
Unconscious bias may interfere with the interpretation of research from some settings, particularly from lower-income countries. Most studies of this phenomenon have relied on indirect outcomes such as article citation counts and publication rates; few have addressed or proven the effect of unconscious bias in evidence interpretation. In this randomized, blinded crossover experiment in a sample of 347 English clinicians, we demonstrate that changing the source of a research abstract from a low- to a high-income country significantly improves how it is viewed, all else being equal. Using fixed-effects models, we measured differences in ratings for strength of evidence, relevance, and likelihood of referral to a peer. Having a high-income-country source had a significant overall impact on respondents’ ratings of relevance and recommendation to a peer. Unconscious bias can have far-reaching implications for the diffusion of knowledge and innovations from low-income countries.
Cowling TE, Laverty AA, Harris MJ, et al., 2017, Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey, Journal of the Royal Society of Medicine, Vol: 110, Pages: 440-451, ISSN: 1758-1095
Objective: To examine associations between the contractand ownership type of general practices and patient experiencein England.Design: Multilevel linear regression analysis of a nationalcross-sectional patient survey (General Practice PatientSurvey).Setting: All general practices in England in 2013–2014(n ¼ 8017).Participants: 903,357 survey respondents aged 18 years orover and registered with a general practice for six monthsor more (34.3% of 2,631,209 questionnaires sent).Main outcome measures: Patient reports of experienceacross five measures: frequency of consulting a preferreddoctor; ability to get a convenient appointment; rating ofdoctor communication skills; ease of contacting the practiceby telephone; and overall experience (measured onfour- or five-level interval scales from 0 to 100). Modelsadjusted for demographic and socioeconomic characteristicsof respondents and general practice populations and arandom intercept for each general practice.Results: Most practices had a centrally negotiated contractwith the UK government (‘General Medical Services’54.6%; 4337/7949). Few practices were limited companieswith locally negotiated ‘Alternative Provider MedicalServices’ contracts (1.2%; 98/7949); these practices providedworse overall experiences than General MedicalServices practices (adjusted mean difference 3.04, 95%CI 4.15 to 1.94). Associations were consistent in directionacross outcomes and largest in magnitude for frequencyof consulting a preferred doctor (12.78, 95% CI15.17 to 10.39). Results were similar for practicesowned by large organisations (defined as having 20 practices)which were uncommon (2.2%; 176/7949).Conclusions: Patients registered to general practicesowned by limited companies, including large organisations,reported worse experiences of their care than otherpatients in 2013–2014.
van Schalkwyk MC, Harris M, 2017, Translational health policy: towards an integration of academia and policy., Journal of the Royal Society of Medicine, Vol: 111, Pages: 15-17, ISSN: 1758-1095
Woringer M, Jones Nielsen J, Zibarras L, et al., 2017, Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme, BMJ Open, Vol: 7, ISSN: 2044-6055
BackgroundThe National Health Service (NHS) Health Check is a CVD risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There is no tool to assess the effectiveness of the programme in communicating CVD risk to patients. AimsThe aim of this paper was to develop a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme. MethodsWe developed an 85 item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were added. The resulting 65 item questionnaire with satisfactory content validity (content validity indices >=0.80) and face validity was tested on 110 NHS Health Check attendees in primary care in a cross sectional study between May 21 and July 28, 2014. ResultsFollowing analyses of data, we reduced the questionnaire from 65 to 26 items. The 26 item questionnaire constitutes 4 scales: Knowledge of CVD Risk and Prevention, Perceived Risk of Heart Attack/Stroke, Perceived Benefits and Intention to Change Behaviour and Healthy Eating Intentions. Perceived Risk (Cronbach’s α = 0.85) and Perceived Benefits and Intention to Change Behaviour (Cronbach’s α = 0.82) have satisfactory reliability (Cronbach’s α >=0.70). Healthy Eating Intentions (Cronbach’s α = 0.56) is below minimum threshold for reliability but acceptable for a three item scale. ConclusionsThe resulting questionnaire, with satisfactory reliability and validity, may be used in assessing patients’ awareness of CVD risk among NHS Health Check attendees.
Issa H, Kulasabanathan K, Darzi A, et al., 2017, Shared learning in an interconnected world: the role of international health partnerships., Journal of the Royal Society of Medicine, Vol: 110, Pages: 316-319, ISSN: 0141-0768
Kulasabanathan K, Issa H, Bhatti Y, et al., 2017, Do international health partnerships contribute to reverse innovation? A mixed methods study of THET-supported partnerships in the UK, Globalization and Health, Vol: 13, ISSN: 1744-8603
BackgroundInternational health partnerships (IHPs) are changing, with an increased emphasis on mutual accountability and joint agenda setting for both the high- and the low- or middle-income country (LMIC) partners. There is now an important focus on the bi-directionality of learning however for the UK partners, this typically focuses on learning at the individual level, through personal and professional development. We sought to evaluate whether this learning also takes the shape of ‘Reverse Innovation’ –when an idea conceived in a low-income country is subsequently adopted in a higher-income country.MethodsThis mixed methods study used an initial scoping survey of all the UK-leads of the Tropical Health Education Trust (THET)-supported International Health Partnerships (n = 114) to ascertain the extent to which the IHPs are or have been vehicles for Reverse Innovation. The survey formed the sampling frame for further deep-dive interviews to focus on volunteers’ experiences and attitudes to learning from LMICs. Interviews of IHP leads (n = 12) were audio-recorded and transcribed verbatim. Survey data was analysed descriptively. Interview transcripts were coded thematically, using an inductive approach.ResultsSurvey response rate was 27% (n = 34). The majority (70%) strongly agreed that supporting LMIC partners best described the mission of the partnership but only 13% of respondents strongly agreed that learning about new innovations and models was a primary mission of their partnership. Although more than half of respondents reported having observed innovative practice in the LMIC, only one IHP respondent indicated that this has led to Reverse Innovation. Interviews with a sample of survey respondents revealed themes primarily around how learning is conceptualised, but also a central power imbalance between the UK and LMIC partners. Paternalistic notions of knowledge could be traced to partnership p
Macinko J, Harris M, Rocha M, 2017, Introduction to the special edition on the Brazilian National Program to Improve Primary Care Access and Quality (PMAQ), Journal of Ambulatory Care Management, Vol: 40, Pages: S1-S3, ISSN: 1550-3267
Macinko J, Harris MJ, Rocha MG, 2017, Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) Fulfilling the Potential of the World's Largest Payment for Performance System in Primary Care, Journal of Ambulatory Care Management, Vol: 40, Pages: S4-S11, ISSN: 0148-9917
Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil.
Harris MJ, Bhatti Y, Prime M, et al., 2016, Global Diffusion of Healthcare Innovation: Making the Connections. Report for the World Innovation Summit for Health, World Innovation Summit for Health 2016, Publisher: World Innovation Summit for Health
04GDHIEXECUTIVE SUMMARYThis research is part of the ongoing study of GDHI. The diffusion or spread of innova-tions over time through a specific population or social system is important to unlock the potential benefits of an innovation. There has been much study of how to encour-age the uptake of innovations so that they become part of everyday practice and ben-efit many, rather than a few. In this research, we explore this from the demand side. We explore how FHWs and leaders find solutions to their everyday challenges, and which sources are the most influential. We consider how these groups are sourcing solutions to their problems in six countries and how healthcare organizations can source innovations more effectively to meet the needs of FHWs and leaders. The study also explores the role that ‘curator organizations’ – a specialized set of organ-izations that source innovations from around the world – are playing in helping to diffuse innovations into clinical practice. We consider what role these organizations could play in future to ensure that they are relevant to frontline needs. The study builds on previous findings from 2013 GDHI research that showed how cer-tain system characteristics, enablers and frontline behaviors are critical to diffusion.1It follows on from the 2015 GDHI study that assessed the importance and prevalence of these elements in eight case studies of rapid, successfully scaled innovations.2This year, our study focuses on how FHWs and organization leaders source innova-tion in the first place. Our research draws on quantitative surveys of more than 1,350 FHWs in major urban centers of six countries (England, the United States (US), Qatar, Brazil, India and Tanzania). We conducted more than 90 personal interviews with healthcare leaders in these locations and in-depth conversations with the managers of 10 curator organizations.
Harris MJ, Bhatti Y, Prime M, et al., 2016, Global Diffusion of Healthcare Innovation: Making the Connections, Global Diffusion of Healthcare Innovation: Making the Connections, Publisher: Qatar Foundation
Harris M, 2016, Mais Médicos (More Doctors) Program - a view from England, Ciência & Saúde Coletiva, Vol: 21, Pages: 2919-2923, ISSN: 1413-8123
The Programa Mais Medicos (PMM) is a national strategy to increase the numbers of Brazilian trained doctors entering primary care and is possibly the most significant human resource intervention in Latin America in recent years. From an English perspective, there are clearly opportunities to learn the PMM. First, PAHO's role in the PMM provides an exemplar for an overarching human resource migration and recruitment role throughout the EU. The role of the WHO in influencing and overseeing the recruitment of doctors throughout the EU could be an opportunity for improved distribution, avoiding a reliance on market forces. Secondly, a centrally-coordinated and governed process following well-established criteria and guidance laid out in law has helped to ensure that doctors are allocated to regions of the greatest need. Finally, the deployment of primary care doctors to ensure that the needs of the whole population are met, including in hard-to-reach areas. However, Brazil should not fall into the trap of doing much, and evaluating little. Brazil is in an exciting position to conduct robust before-after studies regarding the improvement in access, outcomes and equity that the ESF has already been credited with. Evaluation must include the impact of the PMM on Cuba.
Attaelmanan I, Bhatti YA, Harris M, et al., 2016, The development and diffusion of surgical frugal innovations – lessons for the NHS, LSE International Health Policy Conference 2017
Prime M, Bhatti Y, Harris M, 2016, Frugal and Reverse Innovations in Surgery, Global Surgery: The Essentials, Editors: Park, Price
Prime M, Bhatti Y, Harris M, 2016, African healthcare innovation: an untapped resource?, World Hospitals and Health Services Journal
Vamos EP, Pape UJ, Curcin V, et al., 2016, Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes., Canadian Medical Association Journal, ISSN: 0008-4409
BACKGROUND: The health burden caused by seasonal influenza is substantial. We sought to examine the effectiveness of influenza vaccination against admission to hospital for acute cardiovascular and respiratory conditions and all-cause death in people with type 2 diabetes. METHODS: We conducted a retrospective cohort study using primary and secondary care data from the Clinical Practice Research Datalink in England, over a 7-year period between 2003/04 and 2009/10. We enrolled 124 503 adults with type 2 diabetes. Outcome measures included admission to hospital for acute myocardial infarction (MI), stroke, heart failure or pneumonia/influenza, and death. We fitted Poisson regression models for influenza and off-season periods to estimate incidence rate ratios (IRR) for cohorts who had and had not received the vaccine. We used estimates for the summer, when influenza activity is low, to adjust for residual confounding. RESULTS: Study participants contributed to 623 591 person-years of observation during the 7-year study period. Vaccine recipients were older and had more comorbid conditions compared with nonrecipients. After we adjusted for covariates and residual confounding, vaccination was associated with significantly lower admission rates for stroke (IRR 0.70, 95% confidence interval [CI] 0.53-0.91), heart failure (IRR 0.78, 95% CI 0.65-0.92) and pneumonia or influenza (IRR 0.85, 95% CI 0.74-0.99), as well as all-cause death (IRR 0.76, 95% CI 0.65-0.83), and a nonsignificant change for acute MI (IRR 0.81, 95% CI 0.62-1.04) during the influenza seasons. INTERPRETATION: In this cohort of patients with type 2 diabetes, influenza vaccination was associated with reductions in rates of admission to hospital for specific cardiovascular events. Efforts should be focused on improvements in vaccine uptake in this important target group as part of comprehensive secondary prevention.
Harris MJ, Weisberger E, Silver D, et al., 2016, That’s not how the learning works - the paradox of Reverse Innovation: a qualitative study, Globalization and Health, Vol: 12, ISSN: 1744-8603
BackgroundThere are significant differences in the meaning and use of the term ‘Reverse Innovation’ between industry circles, where the term originated, and health policy circles where the term has gained traction. It is often conflated with other popularized terms such as Frugal Innovation, Co-development and Trickle-up Innovation. Compared to its use in the industrial sector, this conceptualization of Reverse Innovation describes a more complex, fragmented process, and one with no particular institution in charge. It follows that the way in which the term ‘Reverse Innovation’, specifically, is understood and used in the healthcare space is worthy of examination.MethodsBetween September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in the Reverse Innovation space in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also informants' experience and understanding of the term Reverse Innovation. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison.ResultsWe describe three main themes derived from the interviews. First, ‘Reverse Innovation,’ the term, has marketing currency to convince policy-makers that may be wary of learning from or adopting innovations from unexpected sources, in this case Low-Income Countries. Second, the term can have the opposite effect - by connoting frugality, or innovation arising from necessity as opposed to good leadership, the proposed innovation may be associated with poor quality, undermining potential translation into other contexts. Finally, the term ‘Reverse Innovation’ is a paradox – it breaks down preconceptions of the directionality of knowledge and learning
Cowling T, Harris M, Majeed F, 2016, Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey, BMJ Quality & Safety, Vol: 26, Pages: 360-371, ISSN: 2044-5423
Background The UK government plans to extend the opening hours of general practices in England. The ‘extended hours access scheme’ pays practices for providing appointments outside core times (08:00 to 18.30, Monday to Friday) for at least 30 min per 1000 registered patients each week.Objective To determine the association between extended hours access scheme participation and patient experience.Methods Retrospective analysis of a national cross-sectional survey completed by questionnaire (General Practice Patient Survey 2013–2014); 903 357 survey respondents aged ≥18 years old and registered to 8005 general practices formed the study population. Outcome measures were satisfaction with opening hours, experience of making an appointment and overall experience (on five-level interval scales from 0 to 100). Mean differences between scheme participation groups were estimated using multilevel random-effects regression, propensity score matching and instrumental variable analysis.Results Most patients were very (37.2%) or fairly satisfied (42.7%) with the opening hours of their general practices; results were similar for experience of making an appointment and overall experience. Most general practices participated in the extended hours access scheme (73.9%). Mean differences in outcome measures between scheme participants and non-participants were positive but small across estimation methods (mean differences ≤1.79). For example, scheme participation was associated with a 1.25 (95% CI 0.96 to 1.55) increase in satisfaction with opening hours using multilevel regression; this association was slightly greater when patients could not take time off work to see a general practitioner (2.08, 95% CI 1.53 to 2.63).Conclusions Participation in the extended hours access scheme has a limited association with three patient experience measures. This questions expected impacts of current plans to extend opening hours on patient experience.
Majeed F, Hansell A, Saxena S, et al., 2016, How would a decision to leave the European Union affect medical research and health in the United Kingdom?, Journal of the Royal Society of Medicine, Vol: 109, Pages: 216-218, ISSN: 1758-1095
Harris M, Bhatti Y, Darzi A, 2016, Does the Country of Origin Matter in Health Care Innovation Diffusion?, Journal of the American Medical Association, Vol: 315, Pages: 1103-1104, ISSN: 0002-9955
Harris M, Macinko J, Jimenez G, et al., 2016, Does a research article's country of origin affect perception of its quality and relevance? A national trial of US public health researchers (vol 5, e008993, 2015), BMJ OPEN, Vol: 6, ISSN: 2044-6055
Harris MJ, Macinko J, Jimenez G, et al., 2015, Does a research article’s country of origin affect perception of its quality and relevance? A national trial of US public health researchers., BMJ Open, Vol: 5, ISSN: 2044-6055
Objectives The source of research may influence one's interpretation of it in either negative or positive ways, however, there are no robust experiments to determine how source impacts on one's judgment of the research article. We determine the impact of source on respondents’ assessment of the quality and relevance of selected research abstracts.Design Web-based survey design using four healthcare research abstracts previously published and included in Cochrane Reviews.Setting All Council on the Education of Public Health-accredited Schools and Programmes of Public Health in the USA.Participants 899 core faculty members (full, associate and assistant professors)Intervention Each of the four abstracts appeared with a high-income source half of the time, and low-income source half of the time. Participants each reviewed the same four abstracts, but were randomly allocated to receive two abstracts with high-income source, and two abstracts with low-income source, allowing for within-abstract comparison of quality and relevancePrimary outcome measures Within-abstract comparison of participants’ rating scores on two measures—strength of the evidence, and likelihood of referral to a peer (1–10 rating scale). OR was calculated using a generalised ordered logit model adjusting for sociodemographic covariates.Results Participants who received high income country source abstracts were equal in all known characteristics to the participants who received the abstracts with low income country sources. For one of the four abstracts (a randomised, controlled trial of a pharmaceutical intervention), likelihood of referral to a peer was greater if the source was a high income country (OR 1.28, 1.02 to 1.62, p<0.05).Conclusions All things being equal, in one of the four abstracts, the respondents were influenced by a high-income source in their rating of research abstracts. More research may be needed to explore how the origin of a research article may lead
Cowling TE, Richards EC, Gunning E, et al., 2015, Online data on opening hours of general practices in England: a comparison with telephone survey data, British Journal of General Practice, ISSN: 1478-5242
Harris MJ, Weisberger E, Silver D, et al., 2015, ‘They hear “Africa” and they think that there can’t be any good services’ – perceived context in cross-national learning: a qualitative study of the barriers to Reverse Innovation., Globalization and Health, Vol: 11, ISSN: 1744-8603
BackgroundCountry-of-origin of a product can negatively influence its rating, particularly if the product is from a low-income country. It follows that how non-traditional sources of innovation, such as low-income countries, are perceived is likely to be an important part of a diffusion process, particularly given the strong social and cognitive boundaries associated with the healthcare professions.MethodsBetween September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in Reverse Innovation in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also to understand whether, in their experience translating or attempting to translate innovations from low-income contexts into the US, the source of the innovation matters in the adopter context. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison.ResultsOur findings show that innovations from low-income countries tend to be discounted early on because of prior assumptions about the potential for these contexts to offer solutions to healthcare problems in the US. Judgments are made about the similarity of low-income contexts with the US, even though this is based oftentimes on flimsy perceptions only. Mixing levels of analysis, local and national, leads to country-level stereotyping and missed opportunities to learn from low-income countries.ConclusionsOur research highlights that prior expectations, invoked by the Low-income country cue, are interfering with a transparent and objective learning process. There may be merit in adopting some techniques from the cognitive psychology and marketing literatures to understand better the relative importance of source in healthcare research and innovation diffusi
Laverty AA, Cowling TE, Harris MJ, et al., 2015, Variation in patient experience between general practice contract types: multilevel analysis of a national cross-sectional survey, LANCET, Vol: 386, Pages: S14-S14, ISSN: 0140-6736
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