Insights on the contribution of doctoral research findings from a school in a South African University towards policy formulation

The paper addresses the persistent gap between health research and policymaking in sub-Saharan Africa, where research evidence is underutilized in policy formulation. It focuses on doctoral research from the University of KwaZulu-Natal (UKZN) School of Nursing and Public Health (SNPH) and its potential contribution to KwaZulu-Natal Department of Health (KZN-DOH) policies. The study aims to determine whether doctoral research findings from SNPH (2014–2021) contributed to existing DOH policies or influenced guideline and policy formulation, and to analyze factors that promote or hinder knowledge uptake by policymakers. The specific research questions were: (1) How have PhD theses produced in SNPH, UKZN between 2014 and 2021 contributed to existing policies or influenced policy formulation? (2) What factors contribute to utilization of doctoral research findings in SNPH, UKZN by policymakers? (3) What factors influence utilization of doctoral research findings by DOH? Contextually, WHO and global literature emphasize the importance of translating research into policy and practice to improve health systems, yet evidence uptake remains slow and limited. The KZN Provincial Health Research and Ethics Committee publishes provincial research priorities, providing an avenue for alignment between doctoral research and policy needs.

Background literature highlights a global recognition that translating health research into policy and practice is crucial for improving health systems and outcomes, yet research findings are often underutilized and slow to influence policy. Studies have shown much postgraduate research remains on shelves and is not translated. Effective knowledge translation can be supported by appropriate dissemination methods (e.g., policy briefs, media, seminars, workshops) and early engagement of policymakers and stakeholders in identifying research priorities. WHO stresses closer collaboration between researchers and policymakers to align evidence generation with policy needs. In the provincial context, KZN-PHREC provides priority research questions to guide researchers, but evidence on the specific contribution of SNPH doctoral research to policy in South Africa had not been examined. Prior work from Africa underscores barriers such as limited engagement with policymakers, inadequate packaging of findings for policy audiences, poor demand for evidence, and capacity or resource constraints among policymakers to access and interpret research evidence.

Setting and participants: The study was conducted in KwaZulu-Natal (KZN), South Africa, focusing on the University of KwaZulu-Natal (UKZN), College of Health Sciences, School of Nursing and Public Health (SNPH), which enrolls ~44 PhD students per year, graduates ~32 annually, and has ~54 PhD supervisors across nine disciplines. SNPH collaborates with KZN-DOH. Design: A convergent mixed methods case study was used. Qualitative and quantitative data were collected concurrently, analyzed separately, and integrated at interpretation, with equal priority to both strands. Sampling and inclusion criteria: Non-probability purposive sampling targeted items/participants able to provide relevant data. Inclusion: PhD theses (2014–2021) based on research conducted in South Africa; PhD graduates (2014–2021); PhD final-year students (in data collection/analysis, write-up, submission, awaiting results); PhD supervisors who had supervised PhDs to completion; and provincial DOH research committee members. Exclusion: Non–South Africa-based theses, PhDs before 2014, final-year students at proposal stage, supervisors without PhD completions, and non-committee DOH personnel. Sample: Targeted: 81 theses, 81 graduates, 48 final-year students, 48 supervisors. Accessible theses: 51, of which 29 met criteria (23 thesis-by-publication; 6 traditional). Participants: 47 graduates (58% of 81), 11 final-year students (23% of 48), 21 supervisors (44% of 48), and 4 policymakers (DOH committee members). Overall response rate: 45%. Data collection: Three tools: (1) Content analysis of 29 theses using a data extraction form capturing discipline, research question identification process, dissemination methods, and development of frameworks/guidelines/policy briefs and policy contributions. When thesis text did not detail research question formulation, the student questionnaire responses were used. (2) In-depth interviews with four provincial DOH research committee members using a structured, open-ended guide on expectations, barriers, and facilitators of utilization. Interviews lasted ~40 minutes (three via Zoom, one face-to-face), were recorded with consent, and notes were taken. (3) Structured questionnaires via KoboCollect: one for 47 graduates and 11 final-year students (50 items), and one for 21 supervisors (30 items). Data were entered into Excel and cleaned. Analysis: Qualitative content analysis of theses; interview transcripts were verbatim, coded and thematically analyzed in NVivo 12 (open coding, development of categories and themes). Quantitative data were analyzed in IBM SPSS v27 and summarized as percentages. Mixed methods integration occurred at interpretation, assessing convergence, complementarity, and dissonance. Rigor and ethics: Triangulation across methods improved validity. Pilot testing of interview guides and questionnaires was done with non-participating DOH personnel, graduates, final-year students, and supervisors, with revisions for clarity and reliability. Ethical approval: BREC/00001384/2020 and KZ-202008-030; informed consent obtained; procedures adhered to institutional ethical standards.

- Sample and participation: 29 PhD theses analyzed (23 thesis-by-publication; 6 traditional). Quantitative respondents included 47 graduates, 11 final-year students, 21 supervisors, and 4 policymakers (total data sources n=112). - Supervisors’ reports of policy consideration: 11 of 21 supervisors (52%) reported that findings from 22 PhD-related studies (2014–2021) were being considered for policy development/adoption. Some resulted in policy-relevant guidelines and frameworks. These spanned areas including traditional circumcision care, HIV prevention in traditional settings, WISN staffing frameworks, patient information documentation frameworks, praziquantel dosing for schistosomiasis (recommendation to continue 40 mg/kg), nurse training guidelines for students with disabilities, nutrition and parasite control inputs, air quality standards, child-friendly HIV care spaces, malaria elimination strategies, community mental health tools adoption, and frameworks for traditional health practitioners, among others. - Involvement of DOH in research question formulation: 16 (28%) PhD respondents involved DOH; 42 (72%) did not involve DOH in formulating research questions. - Dissemination to DOH: Only 22 (38%) students reported sending findings to DOH upon completion; 36 (62%) did not, despite gatekeeper permission conditions. Supervisors reported varied frequencies of feeding back results to DOH: Never 14.3%, Rarely 9.5%, Sometimes 38.1%, Often 19%, Always 19%. - Dissemination channels used (student questionnaire, n=48 total responses across options): Conference presentations 27%; research reports 19%; copies of theses 21%; journal articles 13%; presentations at DOH annual research day 8%; policy briefs 4%; dissemination to stakeholders 4%; National Health Research Database 2%; media 2%. Additionally, 53% attended the KZN-DOH annual research day; 40% presented there; 47% attended to listen. - Production of policy briefs: Only two students (≈3%) produced policy briefs (three briefs total). One supervisor (5%) reported their students produced policy briefs. - Policymaker awareness: Interviewed DOH personnel reported unawareness of specific SNPH PhD studies influencing policy/guidelines during 2014–2021. They cited monitoring challenges due to high project volumes and lack of a system to ensure feedback. - Barriers to translation: Limited DOH involvement in setting research questions; inappropriate packaging (few policy briefs); DOH/policymaker unawareness of available findings; limited dissemination to DOH; poor demand for research evidence by policymakers; non-commissioning of research by DOH due to funding constraints; preference for academic dissemination venues less frequented by policymakers. - Facilitators noted: Where supervisors perceived policy relevance, they engaged DOH and other agencies directly, embedded students’ work within larger projects, and used learning collaboratives within KZN-DOH to facilitate evidence-based learning.

The study identifies a persistent gap between doctoral research and health policy/practice in South Africa, consistent with broader LMIC contexts. While 52% of supervisors indicated 22 studies were under consideration for policy, provincial DOH interviewees were unaware of doctoral research influencing policy, suggesting a disconnect between dissemination at district/municipal levels and awareness at provincial level, as well as deficiencies in upward reporting systems. Limited engagement with DOH during research question formulation (72% did not involve DOH) reduces alignment with policy priorities and visibility of findings. Dissemination predominantly through academic journals and conferences, where policymakers are less present, further constrains research uptake. Few policy briefs were produced, and feedback to DOH was inconsistent, despite gatekeeper requirements. Structural barriers include DOH’s lack of commissioning due to funding, poor demand for research evidence, and absence of automated systems to track and capture completed research outputs. The KZN-DOH annual research day provides a potentially valuable knowledge translation platform but is underutilized (limited presentation slots, poor attendance by decision-makers). Strengthening early engagement with policymakers, improving packaging of findings (e.g., policy briefs), enhancing DOH systems for monitoring and accessing research outputs (e.g., journal clubs, scheduled presentations), and expanding policy-facing dissemination venues could improve translation and uptake of doctoral research into policy.

The study demonstrates that some SNPH doctoral studies (2014–2021) are being considered for policy development and have yielded guidelines and frameworks supportive of policy formulation. However, overall utilization remains suboptimal due to limited policymaker engagement during research question formulation, dissemination formats oriented to academic audiences, and weak systems for ensuring DOH awareness and feedback. The work led to the development of a framework to guide students and policymakers on processes to promote consideration of doctoral findings in policy formulation. Future research should further explore policymakers’ perspectives on facilitators and barriers to utilizing PhD work and assess concrete contributions of doctoral findings to policy, particularly given limited policymaker data during COVID-19 restrictions.

- Limited access to theses: Institutional repository coverage was incomplete (only 13 accessible initially), necessitating direct collection from graduates and the postgraduate office; some graduates declined sharing, risking missing relevant information. - Single-case scope: Conducted in one school within UKZN; findings may not generalize to other schools or colleges. - Recency of theses: Some theses were too recent for findings to have been utilized in policy. - Participant recruitment constraints: Several supervisors could not participate; requirement for supervisors to have supervised to completion reduced pool. COVID-19 restrictions constrained recruitment to email and online questionnaires, contributing to a low overall response rate (45%). - Policymaker data: Only four DOH personnel (provincial level) were interviewed; limited perspectives and potential unawareness of district/municipal-level dissemination may have affected conclusions on utilization.