The translation of health research into policy is crucial for improving health systems, particularly in sub-Saharan Africa where research evidence is often underutilized. This study focuses on doctoral health research from the SNPH at the University of KwaZulu-Natal (UKZN) and its contribution to policy formulation within the KwaZulu-Natal Department of Health (KZN-DOH). The KZN-DOH actively publishes research priority questions, aiming to align research with provincial needs. However, the extent to which doctoral research from UKZN's SNPH influences policy remains unclear. This study aims to determine if SNPH doctoral research has contributed to existing DOH policies or guidelines and to identify factors promoting or hindering knowledge uptake by policymakers. The study's significance lies in its potential to bridge the gap between research and policy, ensuring that valuable doctoral research is effectively utilized to improve health outcomes in KwaZulu-Natal.

Existing literature highlights the global importance of translating health research findings into policy and practice to enhance health systems and improve health outcomes. However, research shows underutilization of research findings, often due to delays in translation into policy. Studies documenting the pathways of students' research indicate that a substantial portion remains underutilized. Several strategies to facilitate this translation are identified, including diverse dissemination methods (e.g., policy briefs, media engagement, workshops) and early stakeholder (policymaker) involvement in research question formulation. The KwaZulu-Natal Provincial Health Research and Ethics Committee (KZN-PHREC) in South Africa sets research priorities, shared with academic institutions, but existing research on the specific contribution of UKZN's SNPH doctoral research to policy remains absent. This gap highlights the need for the current study.

This study employed a convergent mixed-methods approach, combining qualitative and quantitative data collection and analysis concurrently. The SNPH at UKZN was treated as the case study. Qualitative data was gathered through content analysis of 29 PhD theses (2014-2021), focusing on research question formulation, dissemination methods, and policy contributions. Four in-depth interviews were conducted with KZN-DOH personnel involved in research approvals. Quantitative data was obtained from structured questionnaires administered to 47 PhD graduates, 11 final-year PhD students, and 21 PhD supervisors. The questionnaires explored involvement of the DOH in research question formulation and dissemination methods used. Data analysis involved thematic analysis for qualitative data and quantitative analysis (percentages) for questionnaire data. Triangulation was used to enhance validity, combining data from theses, interviews, and questionnaires. Ethical considerations included approval by the Biomedical Research Ethics Committee and the KZN-DOH, with informed consent obtained from all participants. The sample size for the quantitative aspect was calculated using the Cochran formula.

The study revealed that while 52% of PhD supervisors reported that findings from 22 studies were considered for policy development, a significant proportion of studies (72%) did not involve the DOH in research question formulation. Only 38% of students shared their findings with the DOH. The study identified two key themes: 1) Involvement of the DOH in Research Question Formulation: Only 28% of PhD respondents involved the DOH in formulating research questions, highlighting a disconnect between research priorities and policy needs. While the DOH publishes priority research questions, students frequently did not engage with them, often conducting studies related to their supervisors' larger projects, and 2) Research Findings Dissemination: A majority of students (62%) did not share research findings with the DOH despite approval stipulations. Dissemination methods varied, with journal articles and conference presentations being more prevalent than policy briefs or direct engagement with policymakers. Only two students produced policy briefs. Policymakers expressed limited awareness of relevant doctoral research produced in SNPH.

The findings reveal a significant gap between doctoral research generated at UKZN's SNPH and its utilization in KZN-DOH policy formulation. While some research is considered, the underutilization stems from several factors: lack of DOH involvement in research question development, inadequate dissemination methods that prioritize academic channels over policy-relevant formats, and insufficient awareness among policymakers of existing relevant research. The limited production of policy briefs further hinders knowledge translation. The discrepancy between supervisors' and policymakers' perspectives on research utilization suggests challenges in communication and information flow within the system. The study underscores the need for improved strategies to align research priorities with policy needs and for more effective communication and collaboration between researchers and policymakers.

This study highlights the underutilization of doctoral research findings from the SNPH, UKZN in health policy formulation within the KZN-DOH. Key barriers include a lack of early DOH involvement in research question formulation, insufficient dissemination of findings using policy-relevant formats, and limited awareness among policymakers of available research. Future research should explore policymakers' perspectives on doctoral research utilization, investigate the long-term impact of those studies that were considered for policy, and develop effective strategies to enhance collaboration and knowledge translation between researchers and policymakers. The development of a framework that guides both students and policymakers in the processes necessary for considering doctoral research findings in policy formulation is a crucial outcome of this study.

Limitations include limited access to PhD theses due to an incomplete institutional repository and difficulties in obtaining data from some participants. The study's focus on a single school within UKZN limits the generalizability of findings to the entire university. The time lag between thesis completion and data collection for some theses may affect the assessment of policy impact. The low response rate for the online questionnaire and limited interviews with policymakers may also influence the results. COVID-19 restrictions impacted data collection and access to some participants.