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Agricultural Policy Analysis pp 179–193 Cite as

Qualitative Methods for Policy Analysis: Case Study Research Strategy

  • Sarath S. Kodithuwakku 3  
  • First Online: 10 April 2022

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Many policy researchers are predisposed to use either quantitative or qualitative research methods regardless of the research questions at hand, leading to varying degrees of gaps in their findings and policy recommendations. Qualitative approaches effectively address why and how types of research questions to complement the answers for who , what , where , how many , and how much research questions, obtained using quantitative research methods, enabling researchers to make policy outcomes meaningful and contextually relevant. This chapter introduces the case study as an appropriate research strategy for accommodating qualitative and quantitative methods, followed by a brief account of qualitative research methods.

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  • Case study approach

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Miles MB, Huberman M, Saldaña J (2020) Qualitative data analysis: a methods sourcebook, 4th edn. Sage, London

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Kodithuwakku, S.S. (2022). Qualitative Methods for Policy Analysis: Case Study Research Strategy. In: Weerahewa, J., Jacque, A. (eds) Agricultural Policy Analysis. Springer, Singapore. https://doi.org/10.1007/978-981-16-3284-6_7

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Article Contents

1 introduction, 2 the evolution and purpose of ‘evidence-based’ policy, 3 capabilities and conditions required for ebp, 4 forms of knowledge and evidence, 5 criticisms, reservations and challenges, 6 enhanced impact through knowledge transfer and interaction, 7 conclusions: ebp in transition, 8 papers in this symposium, acknowledgements, reconsidering evidence-based policy: key issues and challenges.

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Brian W Head, Reconsidering evidence-based policy: Key issues and challenges, Policy and Society , Volume 29, Issue 2, May 2010, Pages 77–94, https://doi.org/10.1016/j.polsoc.2010.03.001

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The evidence-based policy (EBP) movement has sought to promote rigorous analysis of service programs and policy options in order to improve the quality of decision-making. Rigorous research findings are seen as useful and necessary inputs for policy-makers in their ongoing consideration of policy development and program review. This article provides a critical overview of the research literature on evidence-based policy in the context of government policy-making and program improvement. Particular attention is given to the rational expectation that improved policy analysis will flow from a better evidence base, with consequent improvements in the service delivery and problem-solving capacities of government agencies. This expectation is contrasted with the practical limitations on rational processes typical in the real world of political decision-making, which is characterised by bargaining, entrenched commitments, and the interplay of diverse stakeholder values and interests. Key issues for consideration include the forms of evidence that are of greatest relevance or utility for decision-makers, and the most productive forms of interaction between the producers and the users of research and evaluation findings.

This symposium brings together a range of contemporary analyses which illustrate the scope of recent work exploring and assessing ‘evidence-based policy’ (EBP). The EBP movement represents both an important set of professional practices and aspirations; and also a political rhetoric seeking to legitimate forms of decision-making that are alternatives to ideological or faith-based policy-making. A summary of the papers included in this special issue is provided in the final section of this article. The authors in this symposium consider a range of examples of EBP-in-action, drawn from OECD countries—the USA, the United Kingdom, Ireland, Canada, Australia, and beyond. Although the range of examples is broad, and the wider research literature is growing rapidly, it is not yet possible to make systematic comparisons and generalisations about the role of EBP across different kinds of political systems and across different policy domains.

The symposium does not attempt to cover all areas of policy-relevant research, where the tools of rigorous analysis and evaluation are sometimes brought to bear on controversial or innovative policy development, e.g. debates about the evidence base for national security and foreign policy, bio-technology policy issues, and regional economic innovation policy. The strength of the EBP movement has been evident mainly in the human services policy domains (such as health, social services, education and criminal justice). The adoption of EBP approaches has proceeded more strongly in those advanced democratic nations which have invested in policy-relevant research and in performance information systems. It is possible that the EBP movement will remain largely confined for some time to these countries, but it is noteworthy that some of the analytical techniques typical of EBP are already being applied in technical and managerial aspects of policy-making in several of the rapidly developing nations.

This article comprises the following sections. Firstly we consider the origins and purposes underlying the rise of the evidence-based policy movement. Secondly, we consider the conditions and capabilities required for EBP to flourish in a practical political context. Thirdly, we consider the debates over forms of knowledge and evidence, and note the methodological issues concerning what counts as reliable and relevant evidence. Fourthly, we consider several sources of challenge and critique concerning the ambitions and efficacy of EBP, the limitations of knowledge for decision-making and political learning, and limitations arising in policy design and program implementation. Fifthly we consider the research literature on how to increase the positive impacts of research through promoting better interaction and knowledge transfer between the research and policy communities. Finally, we briefly outline the papers included in this symposium and note their significance for these debates.

The general proposition that reliable knowledge is a powerful instrument for advising decision-makers and for achieving political success is a very old doctrine, linked to the exercise of effective statecraft and efficient governance in early modern Europe. In later periods, the distinctively modern foundation of the knowledge/power relationship has been closely associated with the rise of the empirical social sciences – sociology, economics, political science, social psychology, etc. – which emerged in the 19th century and expanded very rapidly in the 20th century. Historically, the underlying sense of purpose in the social sciences – their values base – has always involved the enlightenment ethos of human improvement arising from greater understanding and therefore greater control ( Abrams, 1968 ; Head, 1982 ; McDonald, 1993 ; Heilbron, Magnusson, & Wittrock, 1998 ). In advanced Western nations the social sciences developed rapidly in the postwar era of the 1940s and 1950s, exemplified by Keynesian economics and by welfare-oriented social and educational planning. In the USA the ‘policy sciences’ championed by Lasswell and his colleagues were clearly linked to the value bases of democracy and social well-being (e.g. Lerner & Lasswell, 1951 ). Social scientists became deeply involved in the grand programs of social welfare, educational reform and urban renewal in North America, Europe and Australia over several decades through to the 1960s and 1970s (e.g. Aaron, 1978 ; Innes, 2002 ; Meltsner, 1976 ; Nathan, 1988 ; Wilson, 1981 ; Wagner, Weiss, Wittrock, & Wollmann, 1991 ; Solesbury, 2002 ).

However, the results were often disappointing, and some of the blame fell on the inadequacies of social research, as well as the poor implementation and coordination capacities of government agencies (e.g. Pressman & Wildavsky, 1973 ). For example, in the field of prisons and corrections policy, Martinson (1974) concluded that ‘nothing works’ and that the research base was too thin to suggest reliable approaches. How could the social sciences become more precise and reliable? By the 1960s a doctrine championing rigorous behavioural methodologies had emerged, insisting that the social sciences should raise their ‘scientific’ standards. The use of quantitative data and experimental methods was strongly advocated as a means of providing more precise and reliable evidence for decision-makers (e.g. Campbell, 1969 ). Thus in these decades there emerged a focus on the potential benefits of greater rigour and greater use of analytical methods. Many of the recent debates within the social sciences about the prospects for EBP stem from the controversy about the centrality of rigorous quantitative methodologies, as noted in a later section below.

In considering the evolution of the evidence-based policy movement, it is useful to note the operation of both demand and supply factors. The demand for rigorous social and economic research stems largely from government agencies and legislative bodies which may be seeking information to report on performance and meet the needs of decision-makers. Government-funded research has become, directly and indirectly, the most important source of social science input to government. The perceived preferences of government bodies for certain types of research have a large impact on how research is conducted. On the supply side, social and economic researchers have developed research capacities that enable them to provide research findings on topics of interest to government. The topics and formats are usually influenced by funders’ priorities. These research capacities have been consolidated over time in substantial research centres. There are several organizational types in the research sector including universities, consultancy firms, private sector think-tanks ( Stone & Denham, 2004 ), and not-for-profit social welfare bodies (e.g. Joseph Rowntree Foundation, 2000 ). Government agencies draw on these diverse external bodies for information and advice; but they also maintain substantial units inside the public sector for gathering and processing social and economic information as inputs to the policy process. In federal countries (such as Canada, Germany, Australia and the USA), these public sector capabilities for information analysis and policy advice are replicated at national and sub-national levels, leading to some challenging problems of coordination and even competition in some policy areas.

Evidence-based policy has become a catch-cry in recent decades in those countries which take seriously the quality of policy analysis and the evaluation of program effectiveness. The EBP approach under discussion arguably has two fundamental foundations in those countries. Firstly, a favourable political culture can allow substantial elements of transparency and rationality in the policy process. This in turn may facilitate a preference by decision-makers for increased utilization of policy-relevant knowledge. Secondly, the associated research culture will encourage and foster an analytical commitment to rigorous methodologies for generating a range of policy-relevant evidence. Evidence-based policy has been a growth area in policy research because of these demand and supply factors: the ‘needs’ of government decision-makers for certain types of information about problems, programs and the effectiveness of options; and the increased array of tools and techniques for analysis and evaluation of policy options that emerged over recent years. EBP is attractive to professionals concerned with building robust information bases and improving the techniques for analysis and evaluation.

The UK central government, under incoming Prime Minister Blair from 1997, attempted to develop a more coherent approach to policy development, championing evidence-based policy as a major element in developing fresh thinking and increased policy capability as required by a reformist government ( UK Cabinet Office, 1999a , 1999b ). This approach became institutionalised through new public service units and cross-departmental teams working on complex issues. It also was reflected in new skills and training initiatives. Importantly, the UK Economic and Social Research Council committed substantial funds to a broad long-term research programs on evidence-based policy and practice, thereby linking the spheres of policy-making, evaluation research, and improved professional practice in health and social care. Issues targeted by the ESRC included the barriers and facilitators to research utilisation, and programs to build capacities for evidence-based policy and professional practice. The diverse findings of these research programs have played a crucial role in legitimating and institutionalising EBP approaches to applied research (see Bochel & Duncan, 2007 ; Nutley, Walter, & Davies, 2007 ). To their credit, the researchers have managed to avoid creating new orthodoxies, by carefully exploring the nuanced complexities of EBP and maintaining the need to incorporate a wide range of methodologies and forms of knowledge.

Thus the debate has moved along. It began many years ago in relation to the uptake of more rigorous approaches to the systematic gathering of evidence and its rigorous use as a foundation for decision-making in the public sector. The debate has now broadened as a result of a large body of case-study material which allows greater sophistication in teasing out the contextual factors which help to explain the conditions influencing program effectiveness, and for which clients. These case studies also draw attention to some of the factors that may facilitate or hinder research utilization by policy-makers and program professionals. Even more ambitiously, it is possible this rich material will ultimately throw more light on the conditions for institutional learning.

…adopting and utilizing an evidence-based innovation in clinical practice fundamentally depends on a set of social processes such as sensing and interpreting new evidence; integrating it with existing evidence, including tacit evidence; its reinforcement or marginalization by professional networks and communities of practice; relating the new evidence to the needs of the local context; discussing and debating the evidence with local stakeholders; taking joint decisions about its enactment; and changing practice. Successful ‘adoption’ of an evidence-based practice depends on all these supportive social processes operating in the background. ( Ferlie, 2005 :183)

The reputation of clinical medicine in pioneering ‘evidence-based’ approaches remains so powerful that much of the broader ‘evidence-based’ social evaluation literature begins by asking whether these rigorous health-based approaches are applicable to other areas of policy, such as social welfare, schooling, juvenile justice, community-health and natural resource management. It is argued that the uptake of EBP approaches is facilitated by several factors, outlined in the section below, but that significant variations across policy domains remain important in relation to the dynamics of policy change and program implementation.

This Government's declaration that ‘what counts is what works’ is the basis for the present heightened interest in the part played by evidence in policy making..….. policy decisions should be based on sound evidence. The raw ingredient of evidence is information. Good quality policy making depends on high-quality information, derived from a variety of sources—expert knowledge; existing domestic and international research; existing statistics; stakeholder consultation; evaluation of previous policies; new research, if appropriate; or secondary sources, including the internet. ( UK Cabinet Office, 1999b : ch. 7)

The need for good information is one of the foundations for good policy and review processes ( Shaxson, 2005 ). However, the dynamics of policy-making are deeply affected by institutional, professional and cultural factors, which will differ across policy domains and issues. Evidence-based interventions associated with the EBP approach have been most carefully pursued in areas such as education (e.g. Mosteller & Boruch, 2002 ; Zigler & Styfco, 2004 ), social welfare (e.g. Cannon & Kilburn, 2003 ; Roberts, 2005 ), criminology (e.g. France & Homel, 2007 ; Sherman, Farrington, Welsh, & MacKenzie, 2006 ; Welsh, Farrington, & Sherman, 2001 ), healthcare (e.g. Lemieux-Charles & Champagne, 2004 ; Lin & Gibson, 2003 ; Cochrane Collaboration, 2010 ), and environment/natural resource management.

The evidence-based policy (EBP) movement has sought to promote rigorous analysis of service programs and policy options, thereby providing useful inputs for policy-makers in their ongoing consideration of policy development and program improvement. However, it is now clear that the early hopes of large and rapid improvements in policies and programs, as a result of closer integration with rigorous research, have not materialised as readily as anticipated. The new ‘realism’ emerging from recent research suggests that while evidence-based improvements are both desirable and possible, we cannot expect to construct a policy system that is fuelled primarily by objective research findings. Creating more systematic linkages between rigorous research and the processes of policy-making would require long and complex effort at many levels. This reconsideration concludes that varieties of evidence can inform policy rather than constitute a systematic foundation for the policy process.

There are several reasons for this. Firstly, a strong research base, with rigorous research findings on key issues, is simply not yet available in many areas for informing policy and program managers. Moreover there is a growing recognition of the paradox that the more we discover about social issues the more we are likely to become aware of the gaps and limitations of our knowledge. Thus the repeated call by social advocacy groups to move from a focus on ‘knowledge’ (understanding the problem) to ‘action’ (doing what needs to be done) may be premature in some areas.

Secondly, policy managers and political leaders are often motivated and influenced by many factors besides research evidence, as discussed in the following sections. The mere availability of reliable research does not ensure its subsequent influence and impact. Political leaders are often preoccupied with maintaining support among allies, responding to media commentary, polishing leadership credentials, and managing risks. Policy managers are as much motivated by perceptions about external support (stakeholders and partner organisations) as by the depth of their systematic evidence base for decision-making.

Thirdly, even where reliable evidence has been documented, there is often a poor ‘fit’ between how this information has been assembled by researchers (e.g. scientific reports) and the practical needs of policy and program managers. Researchers themselves are not often adept at packaging and communicating their findings, and many prefer to remain distant from direct engagement with public debates around key issues.

Fourthly, the value of professional knowledge, as distinct from experimental research-based knowledge, is increasingly being recognised as crucial. This is especially so in social care domains where robust and wide-ranging experimental knowledge is unlikely to emerge. How should policy-makers and service providers weigh the relative merits of relying on the precise findings of systematic/scientific research and relying on the practical experience of professional service providers? The latter are able to gain valuable insights through grappling with complex problems in field situations; and they are well positioned to understand local nuances, including the practical need for adjusting general objectives and procedures for local conditions.

Fifthly, EBP seems to have less standing and relevance in those areas where the issues are turbulent or subject to rapid change. EBP seems to ‘work’ best where it is possible to identify an agreed and persuasive body of research evidence and to position it at the centre of decision-making. However, evidence is deployed under different conditions in turbulent policy fields, marked by value-conflict, rapid change and high risk. Here, evidence-based arguments are likely to become politicized, and evidence will be used for partisan purposes. In complex value-laden areas – such as bio-technology applications in healthcare (e.g. Mintrom & Bollard, 2009 ), or policy responses to climate change – rational and reasonable deliberative processes can become side-tracked by heated controversy. To the extent that research findings are widely used as weapons in strongly emotive debates, it may be only a short step to accusations that most research on these matters is biased and lacks objectivity.

Taking these concerns into account, it appears there are four crucial enabling factors which both underpin modern conceptions of evidence-based policy and which need to be promoted as a basis for constructing a more robust evidence-based (or at least evidence-informed) system of decision-making:

High-quality information bases on relevant topic areas.

Governments have been the main investors in the collection and dissemination of systematic data on major economic, social and environmental trends and issues. For example, among the more advanced nations in the OECD, a commitment to providing good information and undertaking rigorous analysis of trends and issues has been seen as inherent in good governance and democratic accountability. Moreover the endorsement of international agreements is often predicated on undertakings to comply with sophisticated reporting on performance. In advanced nations, the principle of transparency reinforces the need for investing in high-quality and accessible information. But building information bases and investing in capability can be expensive.

Cohorts of professionals with skills in data analysis and policy evaluation.

Data needs to be converted into useful information about causal patterns, trends over time, and understanding the likely effects of various policy instruments. Within the government sector, this requirement raises serious challenges concerning the recruitment, training and retention of skilled analytical staff ( Meltsner, 1976 ). There have been internal debates within government agencies about which skills are most vital for policy work, and about the appropriate balance between ‘in-house’ skills and reliance on external advice from policy-oriented consultancy firms and independent think-tanks outside the public sector, whose proliferation has sharpened the ongoing debates about the quality and timeliness of advice. There has been surprisingly little research about how policy staff actually do their jobs (but see the recent work of Colebatch, 2006b ; Dobuzinskis, Howlett, & Laycock, 2007 ; Hoppe & Jeliazkova, 2006 ; Page & Jenkins, 2005 ; Radin, 2000 ). The very nature of policy work is disputed by some researchers, some of whom argue that policy analysis is a professional craft with a broad skills base (e.g. Parsons, 2002 , 2004 ), while others give precedence to statistical analytical tools such as cost-benefit analysis (e.g. Argyrous, 2009 ) or the use of systematic reviews of evidence (e.g. Petticrew & Roberts, 2005 ).

Political and organisational incentives for utilising evidence-based analysis and advice.

a robust, evidence-based policy making process. Policy design and policy evaluation should be driven by analysis of all the available options, and not by ideology….. In fostering a culture of policy innovation, we should trial new approaches and policy options through small-scale pilot studies….. Policy innovation and evidence-based policy making is at the heart of being a reformist government. ( Rudd, 2008 )

The operational implications of such general statements are seldom clear and remain to be tested. One such test might be the extent to which government organisations invest in research and evaluation functions over a period of time. This would provide an indication of whether organisational culture supports the systematic evaluation of initiatives and interventions. Incentives and protections are perhaps also necessary to counter the risk-averse behaviour of civil servants and other advisors who may be wary that the balance of evidence may be critical of cherished policies and thus the messages arising from EBP will sometimes be unwelcome. Rigorous evaluation of program initiatives can be politically risky. Governments do not relish being exposed to strong public criticism when program outcomes are disappointing or when pilot schemes produce very weak results. Building a culture of evaluation is crucial, especially if this is understood as a culture of learning; and therefore ideally should be institutionalised as good practice with bipartisan support across the political divide.

Substantial mutual understanding between the roles of policy professionals, researchers and decision-makers.

Research about EBP considers both the ‘supply side’ (the work of researchers or analysts) and the ‘demand side’ (the behaviour of policy and program managers in using information). All these groupings need to adapt their activities and priorities if research utilisation is to be improved. Researchers need to work on important issues, ask the right questions, and provide relevant findings in a well written and accessible way. Additionally, where possible, the implications of the research for policy and practice might be noted. On the other side of the ledger, policy managers need to become more aware of the value of relevant research, become more adept at accessing and using such research, understand both the strengths and limitations of the evidence base, and know how to balance the competing perspectives of research, politics and management ( Nutley et al., 2007 : ch. 8).

The quest for evidence-based policy is premised on the use of rigorous research and the incorporation of these findings into governmental processes for policy and program review and more broadly into public policy debates. Seeking rigorous and reliable knowledge, and promoting its utilisation within the policy process, are core features of the EBP approach. The primary goal is to improve the reliability of advice concerning the efficiency and effectiveness of policy settings and possible alternatives. The quest for rigour is central, and there is a large literature providing guidance on methodological questions of data validity, reliability and objectivity. Specialists in the design of information collection and statistical analysis have a special interest in data quality for use in applied research on specific problems or programs. But other voices in the EBP debates, noted below, argue that the circle of relevant evidence needs to be broadened to reflect other important types of knowledge and information.

One key issue is the significance of ‘qualitative’ evidence, e.g. evidence concerning the values, attitudes and perceptions of stakeholders and decision-makers. The importance assigned to qualitative evidence differs across the disciplinary traditions of the social sciences. Some disciplines (e.g. social anthropology, history) generally centre upon the ‘experience’ of participants – meanings, motives, contexts – rather than seeking behavioural generalisations (which are more typical of quantitative approaches relying on economic and social statistics). Program evaluation professionals tend to use mixed methods as appropriate, and bridges are being built across the qualitative/quantitative divide. Mixed methods are increasingly championed by analysts and evaluators who are attempting to explain complex problems and assess complex interventions (e.g. Woolcock, 2009 ).

The most fiercely debated notion in EBP is the claim, drawn from the medical research literature, that there is an ‘evidence-hierarchy’, i.e. forms of evidence should be ranked in terms of the methodological rigour underlying project design, data collection and causal analysis. Scientific experts may reasonably disagree about methods and instruments. The fundamental question is the degree of trust in the reliability of research findings. Whereas standards of proof and rules on the admissibility of testimony in courts of law are often linked to standards of fairness, the standards for EBP are derived from scientific methods for establishing data validity and testing explanatory rigour. Fifty years ago, debate on how to use ‘empiricist’ methods centred on whether the big issues were being either ignored or trivialised through a narrow focus on ‘researchable’ issues (e.g. Mills (1959) pointed to the dangers of fragmented and abstracted empiricism). In more recent decades the argument for rigour was strongly advanced by those who claim that randomised controlled trials (RCTs), first pioneered in medical research to appraise clinical interventions, can and should be applied in the social sciences ( Boruch & Rui, 2008 ; Campbell, 1969 ; Leigh, 2009 ; see also Coalition for Evidence-Based Policy, 2006 , and the Campbell Collaboration, 2010 ). A softer variant is the claim that single-study case findings are misleading, and that a better understanding of causes and consequences emerges from ‘systematic reviews’ of all available research, after taking into account the rigour of the methods followed in each study ( Petticrew, 2007 ; Petticrew & Roberts, 2005 ). Government agencies have generally been wary of prescribing a single preferred methodology, and UK government agencies have softened their apparent initial preference for randomised controlled trials. However, the largest concentrations of professional expertise in program assessment and policy analysis are in the USA, where generations of analysts have refined the methodologies for evidence-based assessment of programs and policy options. The mandating of particular forms of program appraisal as a condition of program funding has proceeded further in the USA than most other nations ( Boruch & Rui, 2008 ; Haskins, 2006 ), although the practical conduct of evaluations remain diverse and somewhat fragmented across agencies and levels of government.

The counter-arguments against the primacy given to RCTs are ethical, practical and methodological. They turn on (1) the difficulty of implementing RCTs in sensitive areas of social policy; (2) the difficulty of transplanting quasi-experimental results to the complex interactive world of large-scale program applications ( Deaton, 2009 ); and (3) the tendency for RCTs to downplay the experience of professionals with field experience who have contextual knowledge of what works under what conditions ( Pawson, Boaz, Grayson, Long, & Barnes, 2003 ; Pawson, 2006 ; Schorr, 2003 ; Schorr & Auspos, 2003 ). It is also probable that politicians, policy managers, scientists, and service users have very different perspectives on what kinds of evidence are regarded as most trustworthy (e.g. Glasby & Beresford, 2006 ). A key challenge is therefore how best to utilise the practical knowledge of professional service delivery managers and the experience of service users.

Instead of reaching ‘solutions’ that can be judged by standards of rationality, policy making reaches settlements, reconciliations, adjustments and agreements that one can evaluate only inconclusively by such standards as fairness, acceptability, openness to reconsideration and responsiveness to a variety of interests. And analysis in large part is transformed from an evaluative technique into a method of exerting influence, control and power which we call partisan analysis. ( Lindblom, 1980 : 122)

Lindblom perhaps goes too far towards discounting the EBP vision of science seeking to inform (if not shape) the exercise of political power. But Lindblom is certainly correct in asserting that the policy process comprises many activities in which scientific rigour rubs up against power, interests and values. In many advanced countries, systematic research (scientific knowledge) does provide an important contribution to policy-making. Such research and analysis is undertaken in many institutional contexts—including academia, think-tanks, consultancy firms, and large units within the government agencies themselves. In particular, the role of rigorous evaluation has gradually become more substantial in the policy and review process of many countries, in conjunction with the increased capability of evaluation practitioners to assess the effectiveness of complex interventions.

But rigorous scientific analysis in this sense constitutes only one set of voices in the larger world of policy and program debate. Several other types of knowledge and expertise have legitimate voices in a democratic society. It has been argued that these other ‘lenses’ ( Head, 2008a ) or knowledge cultures ( Shonkoff, 2000 ) may include the following:

The political knowledge, strategies, tactics and agenda-setting of political leaders and their organisations set the ‘big picture’ of priorities and approaches. The logic of political debate is often seen as inimical to the reasoned use of objective policy-relevant evidence. Ideas, arguments and values are instead mobilised to support political objectives and to build coalitions of support; ‘spin’ may become more important than objective tests of effectiveness and accountability.

The professional knowledge of service delivery practitioners and the technical knowledge of program managers and coordinators is vital for advising on feasibility and effectiveness. They have crucial experience in service delivery roles, and field experience in implementing and monitoring client services across social care, education, healthcare, environmental standards, etc. They wrestle with everyday problems of effectiveness and implementation, and develop practical understandings of what works (and under what conditions), and sometimes improvise to meet local challenges ( Lipsky, 1980 ; Mashaw, 1983 ; Schon, 1983 ). The practical details of how programs are implemented in a variety of specific settings are essential components for a realistic understanding of policy effectiveness ( Durlak & DuPre, 2008 ; Hill & Hupe, 2002 ; Nutley & Homel, 2006 ).

In addition to these institutional sources of expertise, the experiential knowledge of service users and stakeholders is vital for ‘client-focused’ service delivery. Ordinary citizens may have different perspectives from those of service providers and program designers; their views are increasingly seen as important for program evaluation in order to ensure that services are appropriately responsive to clients’ needs and choices or that standards are set realistically ( Coote, Allen, & Woodhead, 2004 ).

Thus, rigorous analysis can often make an important contribution but is only part of the story. A related issue is to consider where are the most accessible points in the policy development and evaluation process for ‘EBP rigour’ to be influential. The initial assumption might be that policy-relevant research on ‘what works under what conditions’ would be linked into the evaluation phase of the policy cycle (e.g. Roberts, 2005 ). However, the notion of a rational and cyclical process of policy development, implementation and review does not correspond closely with political realities ( Colebatch, 2006a ). A more realistic model would allow for reiteration of steps with continual processes of consultation, gathering evidence, and assessing options. Case studies of policy change and review, including international studies, do not provide general answers but illustrate the diverse contexts for policy analysis both inside and outside the public bureaucracies (e.g. Edwards, 2001 ).

Rigorous evidence could therefore be relevant at several points in the development and review processes. But not all matters are genuinely open to rethinking by decision-makers at a given point in time. Some areas of policy are tightly defined by government priorities, electoral promises, and ideological preferences. Here, the scope for revised approaches may be strictly limited even when there is major new evidence about ‘what works’. On the other hand, some program areas achieve more settled character over a period of time ( Mulgan, 2005 ). Evidence-based arguments about ‘fine-tuning’, based on careful research about effectiveness, might be more likely to gain traction in those areas that are away from the political heat. By contrast, on matters of deep controversy, research findings are more likely to be mobilised as arrows in the battle of ideas, and sometimes in ways that the original authors may find distasteful.

The rationalist and optimistic view of EBP aims at achieving cumulative knowledge, as a basis for iterative policy learning in a democratic policy-making process which takes close account of research and evaluation findings ( Lerner & Lasswell, 1951 ). However, there are few contemporary analysts who now adopt such a rationalist position. The recent trajectory of EBP in the United Kingdom illustrates some of the current ambiguities. With the demise of a long-serving conservative government in 1997 and the launching of reformist policy frameworks foreshadowing evidence-based policy-making ( UK Cabinet Office, 1999a , 1999b ), the increased respect for research and evaluation was generally welcomed by policy researchers (e.g. Davies, Nutley, & Smith, 2000 ; Walker, 2001 ). But some commentators came to see the new approach as ‘technocratic’ ( Clarence, 2002 ), owing to its implicit preference for quantitative precision and technical expertise over other forms of professional knowledge, and its tacit opposition to inclusive deliberation as a basis for reform (e.g. Parsons, 2002 , 2004 ). Moreover, the EBP approach was seen as operating within a particular paradigm (e.g. new public management notions of efficiency) as defined by government rather than encouraging new thinking and operating through broad and open debate ( Marston & Watts, 2003 ).

Within the policy bureaucracies the early champions of a rigorous quantitative approach to EBP quickly found it necessary to broaden their view to accommodate the plural forms of knowledge that are relevant to policy analysis (e.g. Davies, 2004 ), and there has been a degree of rapprochement on methodological issues. Thus the UK central agencies have recognised the importance of qualitative studies, if conducted with appropriate methodological rigour ( UK Cabinet Office, 2003 , 2008 ; UK Treasury, 2007 ). Large- N qualitative studies are increasingly seen as open to the rigorous techniques of quantitative analysis. Longitudinal panel studies have also become an increasingly rich source of several types of evidence. Understanding complex issues and associated interventions will require mixed methods that go beyond computer-generated data models.

A second area of concern has centred on the importance of long-term or durable governmental commitments both to program implementation and to evaluation processes. Ideally, EBP is not about quick fixes for simple tactical issues, but centres on more complex issues where research and evaluation findings can enhance understanding of patterns, trends and causes. A recent report found that up to 60% of the research budget of UK government departments is devoted to ‘short-term’ projects to meet current political and administrative demands ( British Academy, 2008 : 26). Political leaders often insist that measurable results be available in a short time-frame, leading to greater focus on visible activities rather building the foundations for sustainable benefits. Moreover, governments have a propensity to change a program before outcomes have been assessed, so that any evaluation would thus be measuring moving targets with variable criteria of success.

In a complex policy intervention, clear program outcomes may not emerge for several years. As Brooks-Gunn (2003) reminds us, there are no silver bullets or magical solutions in the hard business of social policy, and persistence over time using a wide range of expertise is usually required. Fortunately there are recent examples of solid commitment to program stability and to long-term evaluation. In the UK, for example, a complex program targeting early childhood development in disadvantaged communities underwent structural changes to improve coordination but the associated evaluation project has managed to provide an impressive series of assessments over several years ( Percy-Smith, 2005 ; Belsky, Barnes, & Melhuish, 2007 ; Melhuish, Belsky, & Barnes, 2009 ). One of the positive trends in some countries has been more comprehensive investment in policy-relevant research and stronger commitment to evaluation, including making better use of the products of rigorous independent evaluations. When these evaluations have an educative and learning purpose ( Edelenbos & Van Buuren, 2005 ; Head, 2008b ), rather than simply a performance auditing role, the contribution to EBP approaches is likely to be much enhanced.

The third challenge is how EBP can deal with large and complex problems. In relatively simple issues where all the variables can be specified and controlled, methodological rigour is likely to be tight, with some confidence that causal factors can be clarified. But in programs with multiple objectives, or where the clients/stakeholders are subjected to many sources of influence beyond the scope of the program, the challenge of accurate understanding is compounded. Thus, the way in which a problem is framed has implications both for scientific validity and for political management. The scales or units of analysis (e.g. individuals, households, organisations and suburbs) and the degree of issue-complexity (one problem or a nested series of related issues) strongly influences how policy problems are framed, debated and researched. This poses diverse challenges for evidence, analysis and recommendation. The political requirement for solutions will sometimes encourage rapid generic responses, rather than the hard road of detailed field research with careful evaluation of program trials and possible larger-scale implementation in due course.

Some of these large problems have been termed ‘wicked’ owing to their resistance to clear and agreed solutions. These systemic and complex problems are marked by value divergence, knowledge gaps and uncertainties, and involve complex relationships to other problems ( APSC, 2007 ; Head, 2008c ). Traditional bureaucratic structures, even when energised by the sophisticated managerial approaches of outcome-focused governments, cannot successfully tackle these intractable problems through standard performance management approaches. This is partly because complex problems are unlikely to be ‘solvable’ through a single policy instrument or ‘magic bullet’. Policy-makers might be wise to adopt multi-layered approaches which may look ‘clumsy’ rather than elegant ( Verweij & Thompson, 2006 ). Moreover, a key feature of complex social problems is that there are underlying clashes of values, which are often not well identified and need to be addressed ( Schon & Rein, 1994 ). Policy analysts confronted by complex problems have tended to drift into one of three camps, centred on what we can describe as incentives, conflict resolution, and increased coordination.

The first approach to complexity relies on identifying levers or instruments ( APSC, 2009a ) which can influence behaviour at arm's length, through changing the patterns of incentives and constraints. Examples include the so-called ‘new paternalism’ or conditional welfare (e.g. Mead, 1997 ), whereby disadvantaged clients are required to take available job and training opportunities as a condition of social security payments. Behavioural analysis based on incentive theory (e.g. Thaler & Sunstein, 2008 ) argues that judicious ‘nudging’ of citizens through incentives and penalties can potentially produce positive outcomes, with less need for intensive long-term case-management or other expensive oversight and compliance mechanisms. Behavioural change arises indirectly from the ‘choice architecture’ embedded in the program design.

Responsive policy-making for large-scale complex policy issues such as ILM requires both sophisticated policy analysis as well as an institutional structure which allows problems to be addressed on a multilevel and multi-sectoral basis.

Thus, each of these three approaches to tackling complexity may pose major challenges for understanding causal patterns and for assessing related program interventions, which are themselves the fundamental basis for EBP.

Evidence-based policy requires that research and evaluation findings are effectively communicated and available to be utilised by policy and program managers ( Huberman, 1994 ; Radaelli, 1995 ). There is an extensive literature suggesting that even where the quality of research is high, the apparent overall level of impact or utilisation by decision-makers is problematic or disappointing ( Amara, Ouimet, & Landry, 2004 ; Commission on the Social Sciences, 2003 ; Landry, Amara, & Lamari, 2001 ; Landry, Lamari, & Amara, 2003 ; Nelson, Roberts, Maederer, Wertheimer, & Johnson, 1987 ; Nutley et al., 2007 ; Rich & Oh, 2000 ; Shulock, 1999 ). To test the significance of these claims we need to clarify the conception of ‘influence’ that is being deployed, and whether the anticipated ‘flow’ of influence from research into policy is realistic. It is convenient to follow the typology suggested by Weiss (1978 , 1979 , 1980 ), who distinguished between direct (instrumental) uses or impacts of research, which may involve the direct adoption/utilisation of findings (especially when research has been tailored to address a specific issue identified by decision-makers); and indirect forms of influence via research contributions toward enhanced understanding of social processes or through new frameworks for re-conceptualising processes, problems or solutions. Weiss also drew attention to the political or symbolic uses of research findings, when they are taken up as weapons in partisan debate. Most impacts are indirect in the above sense. Recent literature reviews ( Boaz, Fitzpatrick, & Shaw, 2008 ; Walter, Nutley, & Davies, 2003 ; Walter, Nutley, & Davies, 2005 ;) have confirmed this general pattern, and added useful detail about practical strategies for improving the interaction between the research, policy and professional practice sectors.

A report commissioned by the British Academy collected evidence on perceptions about the research/ policy interface. Based on interviews with researchers, policy-makers and others, the following lengthy list of possible contributions by researchers to social policy were noted:

acting as special government advisers;

leading or contributing to major national enquiries, or to the work of various standing commissions;

raising public awareness of key problems and issues;

providing the answers to specific questions through, for example, modelling or evaluations;

providing objective analysis of what works and what does not;

monitoring and analysing social trends;

providing independent scrutiny of government initiatives and developments;

offering solutions to help improve and refine current policy initiatives;

enhancing the effective delivery of public services;

challenging current paradigms, helping to identify new approaches, concepts and principles. ( British Academy, 2008 : 20).

Researchers who seek engagement with the policy process generally desire substantive influence, and this can be attempted in a variety of roles as experts, consultants and advisors ( Jackson, 2007 ; Pollitt, 2006 ). But many academics are disappointed to find that policy-makers are highly constrained and that they do not appreciate research which is contentious or inconsistent with current orthodoxies ( British Academy, 2008 : 3). For those researchers who engage closely with policy bureaucrats, perhaps through some form of contract research, there are possible dangers of dependency and policy ‘capture’, i.e. tacit politicisation in the conduct and scope of research projects. However, given the cultural context of academic independence, many researchers prefer to avoid co-option and close engagement. These researchers include both radical critics of government policy who cherish their freedom to question fundamentals ( Horowitz, 1975 ), as well as conservatives and sceptics who query the capacity and wisdom of governments to ‘solve’ social problems. According to Smith (2009) , in an ideal world academics would be well funded by public agencies to conduct independent research, subject to rigorous peer review, concerning ‘the success of existing programs’. But, he notes, in the real world this is very unlikely.

The value-proposition for EBP is that policy settings can be improved on the basis of high-quality evidence. But how does reliable knowledge actually flow between producers and users? How strong are the channels and relationships that improve these flows? Considerable research on such matters has been undertaken across a range of applied social policy areas (e.g., see France & Homel, 2007 ; Ferlie, 2005 ; Jones & Seelig, 2005 ; Lin & Gibson, 2003 ; Mosteller & Boruch, 2002 ; Saunders & Walter, 2005 ). The issues involved in creating useful forms of mutual interaction and influence between the policy and research sectors have been well surveyed by Nutley et al (2007: ch. 7) and Davies, Nutley, and Walter (2008) . Detailed studies suggest that the metaphor of knowledge ‘transfer’ or knowledge ‘transmission’ is too linear and simplistic. The challenge is to consider how to construct better ‘learning’ processes, together with establishing new channels and forums for mutual understanding and influence ( Meagher, Lyall, & Nutley, 2008 ; Tsui, 2006 ).

However, the most useful ways to enhance interaction need to be carefully considered in the light of the known systemic obstacles to the wider impact of EBP approaches. These include:

The politicised context of governmental commitments and decision-making.

As noted above, political leaders and program managers are unlikely to fund, or even notice, research projects whose findings ‘encourage policy-makers to jettison dearly held but failing policies in the face of overwhelming evidence’. The realities of research funding and the realities of political institutions point towards a preference for research that ‘reinforces desired policies’ ( Smith, 2009 : 96–7). One of the criteria implicitly used by policy analysts is the ‘political feasibility’ of specific options as well as their technical and economic feasibility ( Meltsner, 1972 ). Thus, in many cases where rigorous research can be undertaken on contentious issues, the ‘lessons’ will be seen as unwelcome in the eyes of some political leaders. For example, political leaders campaigning on law-and-order issues have chosen to ignore systematic reviews ( Petrosino, Petrosino, & Buehler, 2003 ) which demonstrate that young at-risk offenders are not ‘scared straight’ by being required to visit corrections facilities.

Public officials often have a low awareness of research and evaluation findings.

It is clear that key personnel have to be aware of research findings if the EBP process can be robust and energised. It is important to recognise the substantial role of ‘in-house’ research and evaluation activities inside public agencies, as well as highlighting the findings of ‘external’ researchers in academic and independent bodies. A number of ‘bridging’ strategies have been developed in recent years to ensure that both the researchers and policy-makers learn more about each other's business as a basis for better utilisation of policy-relevant research by government agencies (see Boaz, Fitzpatrick, et al., 2008 ; Bochel & Duncan, 2007 ; Bowen & Zwi, 2005 ; Lavis et al., 2002 ; Lavis, Robertson, Woodside, McLeod, & Abelson, 2003 ; Lomas, 1990 ; Lomas, 2000 ; Nutley et al., 2007 ).

The research sector lacks an appreciation of decision-makers’ needs for well targeted and well communicated findings.

In the 1970s, Scott and Shore (1979) concluded that a great deal of social analysis undertaken by applied researchers tended to exhibit two basic weaknesses. Either the research was fragmented and lacked ‘discernible policy implications’; or alternatively, where recommendations were suggested, these were not well calibrated to the practical and political needs of decision-makers (1979: ch. 1). These problems are not new and the possible solutions are still not clear. A report by the British Academy (2008) noted a report that listed reasons given by policy-makers as to why they avoided or ignored certain types of external research. These included the perception that:

research was not highly valued or well communicated within their organisation;

internally conducted or commissioned research was more likely to be seen as relevant;

research was not timely or relevant to users’ needs;

research was less likely to be used when findings were controversial or upset the status quo;

policy-makers might prefer to rely on other sources of information. ( British Academy, 2008 : 27).

Thus the channels through which rigorous evidence might influence policymaking are somewhat fragile, and are readily disrupted by political and organisational pressures. Hence, the knowledge/ communication channels need specific care and attention both to understand their characteristics and to improve their outcomes ( Lavis et al., 2003 ; Lewig, Arney, & Scott, 2006 ; Nutley et al., 2007 ; Ouimet, Landry, Ziam, & Bedard, 2009 ). Supply-side provision of good research about ‘what works’ is not enough. Potential users of research findings will pay close attention only if they are more familiar with these potential inputs, understand the advantages and limits of the information, and are in a position to make use of the findings either directly or indirectly ( Edwards, 2004 ; Nutley et al., 2007 ). The social and institutional foundations for EBP do not emerge spontaneously from the policy process or from the information systems. Capabilities and understandings need to be built within and across organisations. If the research community and the policy community are mutually ignorant or indifferent, there is little prospect of evidence-based policy becoming more robust. This situation arises not primarily from a deficiency in technical knowledge, but more from deficiencies in relationships, communication and mutual interest.

Thus, after some decades of experience, both the supply of policy-relevant research and the policy analysis capacities of governmental and other organisations have increased in many countries. There has been a gradual incorporation of rigorous research evidence into public policy debates and internal public sector processes for policy evaluation and program improvement ( Adams, 2004 ; Banks, 2009 ; Boaz, Grayson, Levitt, & Solebury, 2008 ; Maynard, 2006 ). This trend has been supported by the research efforts of international organisations such as the OECD. Arguably there have been numerous improvements in policy and practice flowing from closer integration with rigorous research. If the primary goal of the EBP movement is to improve the reliability of advice concerning the efficiency and effectiveness of policy settings and possible alternatives, this approach can be very attractive to pragmatic leaders and decision-makers, who want to know what works under what conditions. But despite wide support for the goals of better information and better analysis, the substantial uptake of research findings remains problematic.

Some decades of academic research about policy change, reinforced by media commentary, strongly suggest that policy and program changes are seldom generated primarily by research. Political judgements are generally decisive. Nevertheless, decision-makers are often reliant on advice from officials who may be well informed about research findings, evaluation reports, and their implications. There are potential roles for research findings in helping to clarify trends and opportunities; moreover, opportunities for new thinking and policy adjustment can emerge in unexpected ways in response to incidents, crises and conflicts. But overall, the policy process is best understood as a patchwork quilt of arguments and persuasion ( Fischer, 2003 ; Majone, 1989 ) in which various forms of evidence are deployed as part of political debate. The professional crafts of policy and program development will continue to require ‘weaving’ together the implications of case-studies with the big picture, and to reconcile the strands of scientific information with the underlying value-driven approaches of the political system ( Head, 2008a ; Parsons, 2004 ; Sabatier, 2007 ).

The relationship between policy processes and research production has become more closely institutionalised in some countries and in some policy domains ( Jones & Seelig, 2005 ; Nutley, Walter, & Davies, 2009 ; Saunders & Walter, 2005 ), thus providing positive opportunities for fruitful influence and interaction. The conditions for further embedding EBP approaches in different countries will be widely divergent, and different models are likely to prevail. Among these differences, issues will arise in relation to the four key areas of investment in data and research-based evaluation, professional skills, political and organisational support for independent analysis, and constructive working relations across the divide between policy, research and practice networks.

Further research is needed to ‘connect the dots’ between policy, research and evaluation processes, and to document the transfer of research insights into the practice of service professionals (evidence-based practice). The role of research and policy analysis within the government agencies (e.g. Hoppe & Jeliazkova, 2006 ; Page & Jenkins, 2005 ), and their role in commissioning external research, seems to be crucial. It is quite possible that the research-informed analysis provided by policy bureaucrats will be found to be more influential in policy-making than the numerous academic studies undertaken for professional/scientific audiences. These institutional patterns are likely to be country-specific and policy-specific, but insufficient research has yet been undertaken to allow systematic comparisons. Some useful comparative studies have been initiated on themes such as policy capacity (e.g. Bakvis, 2000 ; Painter & Pierre, 2005 ; Peters, 1996 ) and in areas of health research (e.g. Council on Health Research, 2000 ). Some detailed single-country studies are beginning to emerge (e.g. Dobuzinskis et al., 2007 , on Canada) which may become an important foundation for comparative analyses.

The politics of decision-making inherently involves a mixing of science, value preferences, and practical judgements about the feasibility and legitimacy of policy choices. Outside the scientific community the realms of knowledge and evidence are diverse and contested. Competing sets of evidence and testimony inform and influence policy. Rigorous and systematic policy research seeks a voice in a competitive struggle for clarity and attention, jostled by many powerful players in the wider context of public debate and media commentary. To the extent that rigour is valued, it needs to be protected by strong institutions and robust professional practices. It remains to be seen whether the stated commitment to EBP in some countries will lead to measurably greater investment in policy research and evaluation over the coming years. In many countries the overall level of investment in policy-relevant research, program evaluation and policy skills training remains disappointing. EBP will continue to inspire efforts for better performance in the policy sciences, but will always be constrained by the realities of community values, political authority and stakeholder interests.

This symposium considers a range of examples of EBP-in-action, drawing primarily on the experience of OECD countries—the United Kingdom, Ireland, Canada, the USA, Australia, and beyond. The papers consider the roles and knowledge not only of government agency managers – whose contributions to EBP involve developing, implementing or evaluating public policy programs – but also of research professionals and independent evaluators who provide policy-relevant analysis and review. The symposium thus makes a significant contribution to ongoing debates concerning the contributions and limitations of the evidence-based policy movement.

Whereas the present overview article has surveyed a number of the major issues concerning EBP, the following eight papers provide case studies analysing several of the key challenges, and exploring the roles of knowledge producers, stakeholders, analysts and decision-makers across a range of policy issues and institutional contexts. These eight papers were originally prepared for the Panel on Evidence-based Policy at the International Research Symposium on Public Management held in Copenhagen in April 2009. The first three of these papers tackle various aspects of the supply and demand for policy-relevant knowledge including how knowledge is actually used in specific institutional settings.

Iestyn Williams and Jon Glasby provide an analysis of how different forms of knowledge are produced and used for UK health and social care decision-making. Decision-makers in UK health and social care are routinely expected to draw on evidence of ‘what works’ when designing services and changing practices. However, this paper argues that too much focus has been placed on a narrow definition of what constitutes valid ‘evidence’ (and one that privileges particular approaches and voices over others). As a result, policy and practice have too often been dominated by medical and quantitative ways of ‘knowing the world’. In contrast, Williams and Glasby call for a more inclusive notion of ‘knowledge-based practice’, which draws on different types of research, including the tacit knowledge of front-line practitioners and the lived experience of people using the services. This approach, they argue, will lead to a more nuanced approach to ‘the evidence’ and – ultimately – to better and more integrated decisions. Against this background, the paper outlines a suggested research agenda for those seeking to develop decision-making within these areas.

In a related paper drawing on examples from the UK health and social care sector, Kieran Walshe and Huw Davies examine how research findings have made a difference in the behaviour of healthcare organisations. New organisations have been created to bring research evidence to bear directly on healthcare management decision-making, and to encourage both the production of well-focussed research and the better communication and mobilisation of knowledge. Walshe and Davies discuss attempts to promote linkage and exchange between the research and practitioner communities and to build awareness, receptiveness and capacity in research use among healthcare managers. However, the barriers or constraints on research use are still deeply embedded in cultures, incentives, structures and organisational arrangements. They therefore propose new approaches for commissioning research which would give greater weight to the potential impact and influence of research, with more attention to implementation issues. Such new priorities might help to change the longer term and more deep-seated characteristics of both the academic and healthcare systems.

Looking beyond the context of health and social care, Peter Carroll asks whether the evidence that is regularly produced for improving the quality of regulatory regimes – regulatory impact assessment – is being translated into better policy outcomes. Regulatory impact assessment systems are supposed to generate evidence relevant to improving the quality or efficacy of new or modified regulations. Such review systems have become mandatory in many OECD countries. Regulatory proposals put forward by government agencies thus should have a firm evidence base that clearly supports the new or modified regulations, but Carroll suggests that regulatory proposals continue to offer little in the way of a rigorous and convincing evidence base. Carroll explores the reasons for this poor performance including the varying levels of ministerial and executive commitment, poor integration of impact assessment with policy development processes, variable capacity for rigorous policy analysis in departments, and a lack of data on which evidence-based policy can be developed. These factors would clearly have resonance in a wide range of policy examples.

Turning from cases focusing mainly on how evidence is generated to the question of how information and research knowledge are actually used by government analysts and decision-makers, the remaining five papers in the symposium address various aspects of this question. Two papers examine what types of information and skills are deployed by policy and program staff within government agencies. Among federal countries, most of the previous research has focused on the national level, but much of the policy and program activity remains at the sub-national level (states or provinces). Michael Howlett and Joshua Newman report on the first thorough survey of the work of policy analysts at the sub-national level in Canada. Their paper reports on the findings of a 2008–2009 survey aimed specifically at examining the background and training of provincial policy analysts in Canada, the types of techniques they employ in their jobs, and what they do in their work on a day-by-day basis. The resulting profile of sub-national policy analysts reveals several substantial differences between analysts working for national government and their sub-national counterparts. This may have important implications for policy training and practice, and for the ability of Canada and other countries to improve their policy advice systems in order to better accomplish their long-term policy goals.

Jeremy Hall and Edward Jennings also consider the sub-national level of evidence-based policy, reporting results from a 2008 survey of U.S. State agency administrators across all 50 states and across 12 different agency types. Agency managers were asked to disclose the extent to which they relied on information from diverse information sources and to weight the value of information from each source. Hall and Jennings are especially interested in ascertaining the importance of formal scientific evidence, and its influence on agency decisions relative to other potential sources of information. Hall and Jennings present their findings by agency type with significant differences across substantive policy areas noted.

Mary Lee Rhodes and Simon Brooke analyse the role of evaluation studies in contributing to the development of services for the homeless in Ireland. They show how the processes of evaluation interact with the complex issues of policy and implementation. There are many complexities in determining ‘what works’ in the cycle of policy development, implementation and evaluation. This paper examines how these three activities unfolded over two decades since 1988, when ‘homelessness’ was defined first in Irish legislation. They explain the complex and significant changes in policy, changes in implementation approaches, and the positive impact of a series of evaluations over this period.

Tracey Wond and Michael Macaulay investigate the evaluation of a UK local economic development program which raises key questions about the disparity between central guidance and local implementation, and the use of evaluation data as an evidence base for public policy. Based on observational and interview data, they highlight a number of issues. Firstly, uncertainty and ambiguity of policy direction can lead to barriers in establishing clear evaluation goals. Secondly, differences emerge between the generic strategies developed by central policy-makers in response to broad problems (which they term ‘problem-inspired’ policy), and the local ‘problem-solving’ interpretations by implementers responding to local challenges. This discontinuity can be compounded where central decision-makers overlook the significance of local variations in terms of cultures, geographies or historical contexts. In responding to these problems, Wond and Macaulay argue that regardless of where policy control and decision-making occurs, the experiences of implementers at a local level are crucial for success because they better understand the nuances of context and capability.

Finally, Brian Head presents a case study in water policy in order to explore the implications for evidence-based policy of the distinction between relatively stable and relatively turbulent policy issues. In stable policy domains it is more likely that rigorous analysis will be able to enhance policy-makers’ consideration of improvement options. However, EBP has taken different turns in policy fields marked by value-conflict, rapid change, high risk or radical uncertainty. One such area in recent years has been water policy, in the context of water scarcity. There have been urgent new challenges for water policy, planning and delivery in many cities and regions around the world. This paper examines an Australian case study, the urban water crisis in Southeast Queensland (SEQ). The sub-national government became increasingly alarmed by evidence of a deteriorating water-supply outlook, and undertook a number of policy changes including substantial re-structuring of urban water governance. The paper raises issues about the evidence base for decision-making, and for policy learning, where policy is shaped under conditions of uncertainty and crisis.

Work for this project on EBP was partly funded by Australian Research Council grant LP100100380. The author also thanks numerous colleagues who have helped to shape these ideas over many years including Meredith Edwards, Sandra Nutley, and several of the contributors to this symposium.

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Cases in Public Policy Analysis

Third Edition

George M. Guess and Paul G. Farnham

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Combining the insights of an economist and a political scientist, this new third edition of Cases in Public Policy Analysis offers real world cases to provide students with the institutional and political dimensions of policy problems as well as easily understood principles and methods for analyzing public policies. Guess and Farnham clearly explain such basic tools as problem-identification, forecasting alternatives, cost-effectiveness analysis, and cost-benefit analysis and show how to apply these tools to specific cases. The new edition offers a revised framework for policy analysis, practical guidelines for institutional assessment, and five new action-forcing cases. Up-to-date materials involving complex policy issues, such as education reform, cigarette smoking regulation, air pollution control, public transit capital planning, HIV/AIDS prevention strategies, and prison overcrowding are also included. Bridging the gap between methods and their application in real life, Cases in Public Policy Analysis will be of interest to professors involved with upper-division and graduate-level policy courses, as well as an excellent sourcebook in applied policy training for government practitioners and consultants.

Preface 1. The Policymaking Process: Between Technical Rationality and Politics 2. Problem Identification and Structuring Case Study: Fighting Crime: The Case for Emptier Prisons 3. Forecasting Institutional Impacts on Public Policy Performance Case Study: Washington, DC, School Reform 4. Forecasting Policy Options Case Study: Transit Options for Metro's Purple Line 5. Pricing and Public Policy: The Case of Cigarette Taxes Case Study: Cigarette Tax Clouds Boosts among States 6. Cost-Effectiveness Analysis: The Case of HIV Prevention Programs Case Study: Fighting HIV, a Community at a Time 7. Cost-Benefit Analysis: The Case of Environmental Air Quality Standards Case Study: The Debate over Ambient Air Quality Standards for Fine Particulate Matter 8. Summary and Conclusions Glossary Index

"In this excellent book, Guess and Farnham provide the field's clearest explanation of the balance between democratic values, practical politics, and sound analysis. The techniques and tools described in this book will stimulate and inform real-world decision making. This is an excellent book for any policy analysis or policy process course."— Thomas Birkland , Kretzer Professor of Public Policy, North Carolina State University "The third edition of Cases in Public Policy Analysis continues to provide a solid overview of the essential elements of policy analysis. The real world cases will challenge students as they build their analytic repertoire so that they may bring clarity to 'messy' problems. Guess and Farnham, you did it again!"— Jeffrey D. Straussman , Dean, Rockefeller College of Public Affairs and Policy, University at Albany, SUNY

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About the author.

George M. Guess is a scholar-in-residence in public administration and policy at American University. Paul G. Farnham is an associate professor emeritus in the Department of Economics at the Andrew Young School of Policy Studies at Georgia State University.

Hardcover 408 pp., 6 x 9 12 figures, 26 tables ISBN: May 2011 World

Paperback 408 pp., 6 x 9 12 figures, 26 tables ISBN: 978-1-58901-734-4 May 2011 World

Ebook 408 pp. 12 figures, 26 tables ISBN: 978-1-58901-749-8 May 2011 World

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Between the 6-week modules in each term, students spend two weeks on Policy Case Studies, taught by practitioners. The case study classes are small and highly interactive between students and instructors. Each case study spans five half-days, developing the complete storyline and multi-dimensional complexity of an actual policy, including:

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The Policy Case Studies for 2023-2024 are drawn from:

A School Food Program for Canada: A Case Study of a Successful Social Movement for Policy Change

Policy change often comes after years of cultural change and its more visible expression in the development of grassroots engagement, organizing and mobilizing. This course will examine the decades-long work of the school food movement in creating a successful campaign for “A School Food Program for Canada”. Focusing on this process, Debbie Field and David Kraft will reference the experiences of other movements for change, to provide a conceptual framework and a practical approach that is relevant to understanding, analyzing and participating in the development of any social movement for policy change.

Instructor: Debbie Field & David Kraft

Ontario’s Green Energy & Green Economy Act

This is a case study in public policy examines a decade-long, politically driven effort from 2008-2018 by an industrialized jurisdiction of about 13 million people to design and implement a set of changes in the electric power system -- Ontario's Green Energy and Green Economy Act (GEA). The generating mix at the time of the policy’s launch was based on nuclear, hydroelectric, and coal.  The mix of policy objectives included (i) ending coal-fired generation to reduce atmospheric emissions (both smog and greenhouse gases), and (ii) developing technology and manufacturing industries in non-hydro renewable energy (wind and solar). Participants are responsible for ensuring they have a basic understanding of how a modern electricity system works, major types of environmental impact, and how various energy sources produce those impacts. This is essential for undertaking the case study (and, as will be seen, is also essential for making public policy in the energy sector). The case study emphasizes the importance of subject matter expertise in policymaking, and the need for nonpartisanship (or cross-partisanship) in long-term planning exercises.

Instructor: John Stewart

Alberta’s Climate Change Plan

With its 2015 climate change leadership plan, Alberta joined a very select group of petroleum producers (Norway, Holland and the UK) who have reached for a global leadership role in addressing climate change. In this policy case study, Brian Topp, Alberta Premier Rachel Notley’s chief of staff in 2015 and 2016 and one of that plan’s architects, will outline his perspective on its background, genesis, and fate – a case study in economic and political strategic governance.

Instructor: Brian Topp

Preventing Violence Against Women and Children in Kenya

This case study is about a ground-breaking initiative aimed at combating sexual violence. It started with public interest litigation in Kenya following multiple cases of sexual assault against young girls in central/eastern Kenya. The case involves not only issues of criminal law, but also policy issues that were the product of indifferent governments, inadequate policing, and community inertia. A group of girls ranging from 3 to 17 years of age, working through an NGO, sued the Kenyan government for the damage they had experienced, not only physically, but all in terms of lack of access to personal security, to education, and to life opportunities. They secured a landmark victory in 2013. But that victory turned out to be just the beginning. In this case study, students will have the opportunity to examine how public policy can be reformed and official attitudes changed starting with civil society organizations and the courts, and ending with a police training, political and policy changes, and engagement through the arts and sports to improve awareness. Concepts such as instrument choice and the policy cycle will be reviewed, as well as legal tools to analyze concepts of gender equality. Students will also review leading cases on violence against women in national and international jurisdictions. This course will be of particular interest for students who would like additional background in preparing for the Law, Human Rights and Public Policy course. Please note that this course addresses difficult and sensitive topics and may be disturbing or triggering for some students.

Instructor: Pearl Eliadis

Women’s Equality Rights in India

Across the globe, pluralist democracies grapple with the issue of balancing gender equality with religious freedom and group rights. This seminar will examine how the Indian Supreme Court mediates the tension between these competing interests and the extent to which it affirms women’s rights through the lens of its ruling in Shayara Bano v. Union of India.  Shayara Bano is a good example of the steps involved in the formulation of public policy, starting from civil society action, leading to constitutional litigation and finally culminating in law reform. This course is designed to provide students with a framework for analyzing the debates that shape public policy, focusing on constitutional rights in the areas of legal pluralism, minority rights, religious freedom and women’s rights within the family. Through the course, students will evaluate the emancipatory potential of constitutional law to develop understandings of justice that can improve the lives of women and move them further towards equality.   

Instructor: Vrinda Narain

Seeking to convince Russia to eliminate a Non-Tariff Barrier: Stakeholder Management by a Multinational Corp

This case study provides an insider’s view of Stakeholder engagement an influencing in a high-stakes business environment.   At its core is Russia’s steadfast refusal to provide airworthiness certification to Canadian- and Brazilian-made Regional Jets and their US-made Aero-engines.  This refusal was a blatant attempt to preserve the Russian market for an indigenous RJ in development (the Sukhoi SuperJet). Important context for the case study includes Russia’s ongoing but as-yet incomplete accession to the WTO and Sukhoi’s own attempts to market and sell its aircraft internationally.  We will explore how a group of MNCs from Canada and other countries devised and managed a sophisticated stakeholder engagement campaign at the highest international levels, seeking to change this Russian policy.  

Instructor: Michael McAdoo

How to Reduce Poverty in a Big City: a Community Approach

Municipalities are often described as the level of government closest to the population but are traditionally viewed as having a limited role in reducing poverty. Despite its national and provincial aspects, poverty reduction should also be a major preoccupation for municipal leaders. This case study will examine a bottom-up local policy initiative on poverty reduction in the Borough of Côte-des-Neiges-Notre-Dame-de-Grâce (CDN-NDG), the City of Montréal’s most populous and diverse neighbourhood. It will examine how and why this initiative was launched and the challenges associated with such community driven policy development, risk taking, and innovation.

Instructor: Russell Copeman

Participatory Canada: Prototyping & Scaling Social Infrastructure that Centers Truth & Reconciliation

This course provides public policy students with an introduction to social infrastructure generally, and an in-depth look at the case of Participatory Canada, prototyped in 2020-2021 in Montreal, Toronto, and Halifax. Focus is on an approach that is Indigenous-(co)led by the Mi’kmaw Native Friendship Centre and that embeds Truth & Reconciliation at the heart. We’ll discuss policy issues that can be addressed by this social infrastructure and study the ‘participatory city approach’ and how it was adapted to distinct local contexts. Students will learn about: social R&D in a policy context, outcomes of prototyping social infrastructure during the pandemic, emerging strategy, what it means to center Truth & Reconciliation in community work that is inclusive and aims to decolonize, and longer-term financing and policy challenges and innovations that could support social infrastructure needed for rapidly changing futures.

Instructor: Jayne Engle

From Canada to Timbuktu: Peacekeeping in the Quicksand of Mali

In 2015, the Trudeau government committed to restoring Canada’s historic leadership in peacekeeping as part of Canada’s foreign policy renewal and campaign for a UN Security Council seat. Following extensive consultations across the government, with the UN in parallel with allies, the government opted for a one-year Air Task Force in Mali as the centerpiece of its effort. What factors led to this decision? At the time, Mali hosted the deadliest UN peacekeeping mission, struggling to protect itself. Mali’s peace process had stalled in the years since French and partner military forces wrested the country from a combination of terrorist and rebel groups. Can Canada help bring peace to Mali? How did the military mission complement other Canadian and international tools to build peace, such as diplomacy, policing, security sector reform, stabilization programs and development assistance?

Instructor:  Andrew Ng

Transitional Justice and Reconciliation in Rwanda

In post-conflict nations, who is held responsible for mass atrocities and what processes should be used? How do governments manage difficult political and social transitions while attempting to reconcile torn societies? States must achieve a fine balance between political stability and social peace on the one hand and demands for justice and accountability on the other. This case study examines how the Rwandan government, donors and the ‘international community’ sought to resolve those tensions in the years following the 1994 genocide in a decimated nation with an obliterated justice system and a traumatized population. The seminar will focus on how institutional policy instruments were created and implemented in the late 1990s and early 2000s to provide students with a framework to analyze difficult public policy choices in contexts where none of the usual policy prescriptions apply.

Instructor:  Pearl Eliadis

Canada, Quebec, and Immigration 

Successfully adopting comprehensive immigration policy continues to present a major challenge for Western democracies. In the United States, polarizing contentious debates surrounding border control and a pathway to citizenship for undocumented immigrants have been ongoing for years with no consensus in sight. In Europe, a failure to deliver a comprehensive and effective immigration framework has resulted in some member states refusing to take in a significant number of migrants. Despite the many challenges to building, adopting or reforming immigration policy, Canada’s point-based immigration system is generally well regarded by both Canadian citizens and the international community. This course will allow the participant to gain a better understanding of the challenges to finding consensus on immigration reform, with a special emphasis on the Quebec perspective. The Canada-Quebec Accord of 1991 takes into account the province’s distinct francophone identity, and gives Quebec complete jurisdiction over economic immigration. This makes Quebec the only province in the country to control the selection of over seventy percent of its immigrant population. In the midst of the contentious reasonable accommodation debate on the rights of religious minorities (2007), the Quebec government moved to adopt an immigration plan that increased immigration levels over the next 3 years. Though the 2008-2010 immigration plan was adopted, the provincial government’s plan was met with sustained opposition throughout the consultation process. Participants will explore questions including: How does one advance policy under contentious circumstances? How are stakeholders identified and how can they be persuaded? Should the government have pulled back and changed course in spite of the data confirming the advantages of the policy? Participants will also explore the often-invisible work that supports the development of an immigration plan and its ultimate adoption. Discussion will address the importance of consulting different constituencies and stakeholders, consensus building, and the importance of communicating a vision. Through this case study, participants will explore the inherent challenges of framing a policy response in the world of identity politics, the media’s influence on debate and the relevance of setting up performance indicators to test the policy strengths and weaknesses.

Instructor: Yolande James

Managing Principled Trade-offs in International Public Policy: Lessons from International Peace, Security and Humanitarian Interventions

International public policy makers continually manage trade-offs among often-competing principles in complex and highly politicized environments. United Nations officials working in situations of violent conflict around the world are faced with daily decisions on how to balance political vs. humanitarian priorities, short- vs. long-term objectives, and expedient vs. principled solutions. Each decision has life and death implications for those affected by conflict, for the effectiveness of the United Nations, and for the viability and legitimacy of multilateral approaches to managing violence and alleviating suffering. This seminar examines the competing principles at play in international complex emergencies, and the processes by which international public policymakers manage decision making in delicate and dynamic political and humanitarian environments. Looking across a series of historical and ongoing violent conflicts around the world, the course will examine how universal principles come into contact with real-world situations and imperatives. For example, the course will analyse how public policy makers balance trade-offs between the universality of human rights versus sovereignty, and humanity versus neutrality. The course will delve into the management of institutional interests and reputation as a consideration in public policy making and address innate tensions between the universal principle of state sovereignty and the mandate of many international organizations, including the United Nations, to pursue specific normative objectives. Using a participatory approach, participants in the seminar will actively engage with the processes for managing these trade-offs, including stakeholder management and consultation, transparency and public engagement, moral and ethical reasoning, and internal debate and decision-making. In so going, the seminar aims to equip participants with an understanding of nuance and complexity in international public policy making; the skills to manage complex operational, ethical, and political questions in highly charged and morally laden situations; and practical expertise applying these skills to a broad variety of real-world scenarios of international public policy, including international aid and development, trade and economic assistance, and international diplomacy and negotiation.

Instructor:  Dirk Druet

Domestic vs. International Politics: Canada-United States-Mexico Trade Agreement – Is Any Deal Better Than No Deal?

The negotiations to replace the North America Free Trade Agreement (NAFTA) were fraught with tensions and political gamesmanship. The resulting agreement, the Canada-United States Mexico Agreement (CUSMA) was, in many respects, weaker than the original. These events offer important considerations for policy analysis, including the interplay of domestic and international factors that underpin a decision to pursue a major external policy goal, negotiation strategies under conditions of asymmetry, and the trade-offs between political and economic objectives in the pursuit of policy goals. This policy case study utilizes negotiation simulations, guest speakers from the trade teams of the three countries, and academic analysts. The CUSMA case will be augmented by discussions of trade dynamics in Europe and Asia to create a more complete understanding of contemporary economic integration and fragmentation.

Instructor:  Laura Dawson

Human Trafficking

The purpose of this case study is to explore the international and national legal frameworks governing human trafficking; identify the indicators of human trafficking; foster an understanding of the complexities of human trafficking in a discussion/seminar format; unpack different conceptions of human trafficking and their influence on public policy and law; reflect on the structural factors that facilitate exploitative and coercive conditions and practices, including legal and policy conditions.

Instructor: Olivia Smith

Preventing Homelessness in Quebec 

This case study is about a novel policy initiative designed to address homelessness “upstream” through prevention strategies that protect access to adequate and affordable housing. Inadequate housing is a pervasive and persistent policy problem with no single cause or entry point for solving it. Canada occupies the lowest position among G7 countries in terms of housing units per 1,000 residents, while municipal authorities bluntly warn of a “humanitarian crisis. Quebec alone has almost 6,000 visibly unhoused people, most of whom are in Montreal, and thousands more are living in hidden homelessness or other unstable housing situations. The Quebec Homelessness Prevention Policy Collaborative is a multi-disciplinary and multi-sectoral policy collaborative launched in 2021 by Montreal’s Old Brewery Mission and McGill University. It examines policy options for Québec and catalyzes law reform through rights-based, people-centered approaches. The case study will give students real-time insights into building and sustaining a multi-sectoral policy initiative: topics include the initial conceptualization and design of the collaborative, the creation of partnerships and research streams, knowledge co-creation, communications, and outreach strategies. During the week, students will hear from key members of the Collaborative, including practitioners, academics, and civil society leaders.

Responding to the Freedom Convoy

A series of highly disruptive protests and blockades began in Ottawa in January 2022 that attracted attention around the world. The initial movement focused on opposing vaccine mandates for crossing the US border but evolved over time into protests against COVID-19 mandates and government writ large. Downtown Ottawa was effectively brought to a standstill, and several offshoot protests stopped traffic across the Canada-US border. After several weeks of growing tensions, the federal Government invoked the Emergencies Act on 14 February 2022 for the first time since its creation in 1988. A week later, the convoy protests were over. A Public Order Emergency Commission (the Rouleau Commission) looking into the invocation of the Emergencies Act produced its final report in February 2023. This policy lab will explore the origins of the so-called Freedom Convoy protests across Canada during the winter of 2022, as well as the response of government at various levels. What prompted such near-fanatical protests? Was it just COVID-19 or part of a broader statement against the role of government in society and the lives of individual Canadians? How effective were the protests in achieving their aims? How effective was the government response? Was there adequate coordination between federal, provincial and municipal levels? Did the various police forces involved perform adequately? The intelligence community? Did it evolve into a national security crisis as the government claimed, and if so, when? Was the invocation of the Emergencies Act warranted? Were the conclusions and recommendations of the Rouleau Commission helpful? What lessons were learned for future such events?

Instructor: Vincent Rigby

Horizontal Review of Canada's Business Innovation and Clean Technology Programs

This case study delves into the policy complexities around the Government of Canada's $1.7billion in programs that support business innovation and clean technology. It follows the design and dynamics of the horizontal review of these programs by the Treasury Board Secretariat of Canada and over 20 departments and agencies. It explores the strategies used by the review team, as well as their findings. The case study aims to equip students with a better understanding of the skills and methodologies required to undertake an effective horizontal review in a complex domain. This is particularly relevant as governments consider ways to contain expenditures and consolidate programs while preserving and enhancing their effectiveness.

Instructor: Neil Bouwer

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What the Case Study Method Really Teaches

  • Nitin Nohria

case study policy options

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

  • Nitin Nohria is the George F. Baker Jr. Professor at Harvard Business School and the former dean of HBS.

Partner Center

  • Open access
  • Published: 08 December 2015

Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden

  • H. Strehlenert 1 ,
  • L. Richter-Sundberg 1 , 2 ,
  • M. E. Nyström 1 , 2 &
  • H. Hasson 1 , 3  

Implementation Science volume  10 , Article number:  169 ( 2015 ) Cite this article

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Evidence has come to play a central role in health policymaking. However, policymakers tend to use other types of information besides research evidence. Most prior studies on evidence-informed policy have focused on the policy formulation phase without a systematic analysis of its implementation. It has been suggested that in order to fully understand the policy process, the analysis should include both policy formulation and implementation. The purpose of the study was to explore and compare two policies aiming to improve health and social care in Sweden and to empirically test a new conceptual model for evidence-informed policy formulation and implementation.

Two concurrent national policies were studied during the entire policy process using a longitudinal, comparative case study approach. Data was collected through interviews, observations, and documents. A Conceptual Model for Evidence-Informed Policy Formulation and Implementation was developed based on prior frameworks for evidence-informed policymaking and policy dissemination and implementation. The conceptual model was used to organize and analyze the data.

The policies differed regarding the use of evidence in the policy formulation and the extent to which the policy formulation and implementation phases overlapped. Similarities between the cases were an emphasis on capacity assessment, modified activities based on the assessment, and a highly active implementation approach relying on networks of stakeholders. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was empirically useful to organize the data.

Conclusions

The policy actors’ roles and functions were found to have a great influence on the choices of strategies and collaborators in all policy phases. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be useful. However, it provided insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies, and overlapping policy phases. A revised version of the model that includes these aspects is suggested.

Peer Review reports

Evidence has come to play a central role not only in evidence-based medicine but also within health policy [ 1 , 2 ]. Research on evidence-based policy has often started with the assumption that the use of more research would lead to a better policy [ 2 , 3 ]. Recently, a call was made for studies aiming to understand the complex processes behind policy change [ 2 ]. Several authors have suggested that an unprejudiced and more explorative approach would be useful [ 2 , 4 – 6 ]. This would imply more focus on understanding the processes behind using evidence and taking into consideration the contextual factors.

Policymakers tend to interpret evidence in a broad sense and to use other types and sources of information besides research evidence [ 7 ]. Non-research evidence has been defined as the views of local stakeholders, including expert and professional opinions, values and traditions, lobbyists and pressure groups, and the particular pragmatics and contingencies of the policy situation [ 8 ]. The term “evidence-informed policy” has been suggested to reflect this variety of sources [ 4 ]. Oxman et al. defined evidence-informed policymaking as an approach that aims to ensure that decision-making is informed by the best available research evidence in a systematic and transparent way [ 9 ].

It has been argued that in order to fully understand the policy process, the analysis should also include policy implementation [ 2 ]. Most prior studies within the area of evidence-based policy (with some exceptions, e.g., [ 10 ]), have not conducted systematic analysis of implementation. Several authors have suggested that using literature from both implementation science and policy implementation research could be beneficial for understanding policy implementation processes [ 11 , 12 ]. Scholars within political science have focused on governance and inter-organizational relationships [ 13 ]. Governance deals with creating conditions for collective actions. This kind of governance (as opposed to legislative governance) is synonymous with the term “soft law” [ 14 ]. The Advocacy Coalition Framework (ACF) proposes that multiple actors who are motivated by their beliefs form advocacy coalitions and attempt to influence policy by using multiple resources, strategies, and institutional arenas [ 15 ]. Categories of resources that can be employed by coalitions include access to legal authority, public opinion, information, mobilizable troops, financial resources, and skillful leadership [ 16 ].

Conceptual model for evidence-informed policy formulation and implementation

In the current study, a conceptual model for analyzing evidence-informed policy formulation and implementation was developed. We combined central features of a framework for evidence-informed policymaking [ 4 ] and a framework for policy dissemination and implementation [ 17 ] in order to cover the whole policy process (Fig.  1 ). The model mirrors the classical illustration of the policy process consisting of the following phases: agenda setting, policy formulation, policy implementation, and evaluation [ 18 ].

Conceptual Model for Evidence-Informed Policy Formulation and Implementation. Developed from the frameworks by Bowen & Zwi [ 1 ] and Dodson et al. [ 23 ]

Bowen and Zwi [ 4 ] proposed that the use of evidence involves active interpretation and balancing of scientific knowledge in relation to other types of knowledge. Target audiences’ capacity to implement deals with target individuals’, organizations’, and systems’ capacity to carry out the policy objectives. Dodson et al. [ 17 ] suggested that policymaking agencies need to make decisions on how to disseminate and implement the policy. Two basic alternatives exist: a passive strategy implying mere dissemination and a more active approach with outreaching strategies to influence awareness, adoption, implementation, and maintenance of the policy. Adoption includes the target audiences’ decision to implement the policy [ 17 ]. The implementation stage involves activities to improve knowledge and skills, and facilitation of the change process. Maintenance focuses on ensuring the continued use of the policy as part of organizational operations. The policy outcomes involve monitoring of whether the policy is being implemented as planned, as well as impact evaluation aiming to establish a causal relationship between the policy and changes in outcomes [ 19 ]. Bowen and Zwi [ 4 ] also suggested that the context influences the policymaking process and that evidence needs to be contextualized for effective policymaking. They define context as the setting in which the policy is developed and implemented, consisting of political, social, historical, and economic elements, as well as the healthcare system and service context.

The purpose of this study was to explore and compare two policies aiming to improve health and social care in Sweden and to empirically test the Conceptual Model for Evidence-Informed Policy Formulation and Implementation.

Study design

This study draws on two empirical projects. A longitudinal, comparative case study approach was applied. Case study 1 focused on the development and implementation of national guidelines for methods of preventing disease that took place between 2007 and 2014 [ 20 ]. Case study 2 explored the development and implementation of a national policy aiming to improve the quality and coordination of care for the most ill older people, between 2009 and 2014 [ 21 ] (for descriptions of the cases, see Additional file 1 and for description of the healthcare system and actors, see Additional file 2 ). These policies share some key characteristics: (1) focus on health and social care, (2) emphasis on prevention, (3) broad scope, and (4) multidisciplinary target audiences, including all regional and local authorities and multiple professional groups. The cases differed mainly regarding what actors were involved.

Data collection

For both cases, data covering the whole policy period was collected (Case 1 2007–2014; Case 2 2009–2014). Public and non-public documents were collected for all policy phases (Case 1 n  = 18; Case 2 n  = 70). Semi-structured interviews were conducted with a purposive sample of 22 key stakeholders between 2009–2014 (Case 1 n  = 10) and 2012–2014 (Case 2 n  = 12). The interviews focused on how the policy was formulated, what strategies and activities were used, and the actors involved. The interviews (lasting between 45 and 90 min) were recorded and then transcribed. The informants were seen as proxies for their respective organizations at an institutional level. Forty-seven observations of meetings, seminars, and conferences were conducted between 2009–2014 (Case 1 n  = 9) and 2012–2014 (Case 2 n  = 38). The main purpose was to gain familiarity with the process and actors. In both cases, the observations were made by two researchers (Case 1 LRS and MN; Case 2 HS and MN). A structured protocol indicating time and the meeting’s pre-set agenda were used. Observational data contained aspects of the content (e.g., what was verbalized by whom in speech or writing) and the process (e.g., types of activities and procedures). Most observations were non-participatory, but a few observations also included feedback and discussions about preliminary results. The participatory observations enabled the researchers to ask follow-up questions based on previous observations and to validate results.

Data analysis

The transcribed interviews were entered into software for qualitative analysis (Open Code 4.02, NVivo 10) and analyzed using a directed content analysis approach [ 22 ]. Data that could not be coded into the categories of the conceptual model formed new categories reflecting relevant aspects of the policy process. Information about key stakeholders, events and relevant process, and contextual factors were identified in the documents and observation protocols, compiled in chronological matrix for each case, and then coded using the stages in the conceptual model. The next step involved a synthesis to prepare a case record for each policy. Case description consistency was cross-checked between interviews and documents to ensure internal validity. Finally, key similarities and differences were discussed and identified. Ethical applications were sent to the Regional Ethics Committee in Umeå (Case 1, ref no. 2011-64-31M), which approved the study, and the Regional Ethics Committee in Stockholm (Case 2, ref no. 2011/5:11), which judged that the study had no ethical aspects to be considered.

Agenda setting

The initiative to develop the preventive services was raised as a political issue. There was a general positive development within public health, though there were some worrying trends concerning obesity and use of alcohol. National surveys indicated that there were large variations in preventive practices between the regions. In 2007, the National Board of Health and Welfare (NBHW) started to develop national guidelines with a disease-preventive scope that aimed to provide recommendations about treatments and methods, financial and organizational consequences of adhering to the guidelines, and indicators for assessment.

Policy formulation

Sourcing evidence.

A structured process was used, regulated by NBHW’s steering documents, which standardize the process of searching, assessing, and prioritizing evidence. Expert groups consisting of researchers with expertise in each of the target areas conducted systematic literature searches. Relevant conditions (e.g., daily smoking) and interventions (e.g., advanced counseling) were identified and paired, and then the quality of evidence was assessed using the GRADE system.

Using evidence

High quality research evidence played a key part in the process. Based on the literature searches, the expert groups summarized effect sizes, methodological considerations, and generalizability of findings. This resulted in a selection of studies that were included in the remaining process. The prioritization group, consisting of 25 health professionals, was given the evidence, compiled and assessed by the expert groups. The prioritization group then formulated the policy recommendations based on group discussions and consensus decisions. Three criteria were used: the strength of the scientific evidence, cost-effectiveness, and ethical considerations.

Strategy for dissemination and implementation

The guidelines were launched in 2011. Though NBHW is not by default responsible for supporting guideline implementation, the government decided to employ an active strategy and gave NBHW an assignment and funding to support the implementation during 2011–2014. The main tasks were to organize the dissemination to the regional and local levels and to develop an interactive web-based platform on disease prevention.

Capacity to implement

During the last guideline development phase, NBHW arranged regional seminars to allow representatives of the target audiences to discuss guideline implications. Implementation challenges were identified, mainly because the guidelines were comprehensive and would affect all parts of the healthcare system. The policy implied a paradigm shift in emphasizing the preventive aspects of healthcare. The policy had organizational implications regarding steering documents, staff training, relocation, and coordination of resources and actors. A decision-maker at NBHW described this:

Most clinical guidelines focus only on a limited part of the healthcare services, but in this case we are talking about the entire healthcare system. […] We realized that this was going to be a challenge – to change the attitudes and ways of working among such a vast array of recipients and contexts. It was obvious that the need of support to succeed with the implementation was bigger than for other guidelines.

NBHW established regional networks, consisting of managers and healthcare developers, to share experiences and analyze implementation barriers and facilitators. The regular network meetings allowed NBHW to monitor the regional capacity and adapt the implementation support.

  • Implementation

The process was described as a complex interplay of top-down and bottom-up processes between the government agency and the regional healthcare organizations. The guideline model implies an active strategy for raising awareness by involving stakeholders during the development of the guidelines. This was done through involvement of health professional organizations and via dialogue with healthcare decision-makers. By using the professional organizations’ existing infrastructures for communication, the implementation activities could start without delay. The aim was to gain support from healthcare professional actors and thereby increase the chances for positive reception among target audiences. A decision-maker at NBHW described this:

We are working through the health professional organizations. […] There were indications that we would have to change the attitudes among the target audiences, […] and in order to reach out it would be better if the health professional organizations acted as senders, rather than NBHW.

NBHW offered funding to seven health professional organizations to launch implementation projects and to researchers, aiming to increase knowledge of how the guidelines could be adopted. The uptake of the policy was described as complex and slow, but as a potentially promising process. Barriers to adoption were inflexibility of the documentation systems and negative attitudes among parts of the health professional groups. No national performance-based grants were disbursed; instead, the regional authorities developed their own financial incentives.

A core management group at the NBHW coordinated the implementation. They analyzed information to identify the support needed. Possible solutions were sought and developed together with stakeholders and actors in healthcare. NBHW also formed a reference group with representatives from national stakeholders (e.g., the Swedish Association of Local Authorities and Regions (SALAR), the Swedish Society of Medicine, and the National Food Agency). NBHW’s four key strategies were to (1) engage the health professional organizations, (2) support the managers and healthcare developers with knowledge to facilitate the change process, (3) create an arena for exchanging experiences (i.e., network meetings hosted by NBHW), and (4) support research on the implementation of disease prevention methods.

Maintenance

NBHW’s strategy was to place the responsibility for continued enforcement of the policy on the health professional organizations and the regional and local authorities. This was based on the idea that the professions and the healthcare decision-makers are best suited to judge the needs for and barriers to implementing the guidelines. NBHW is responsible for updating the guidelines every 3 to 5 years, repeating the development and dissemination procedure. Quality indicators for the guidelines were implemented in the patient record systems, and the aim was to connect these indicators to the annual national quality measurements and a national quality registry in the future.

The guidelines include a model to measure policy and implementation outcomes. The outcome measurement will show the proportion of patients who received a specific recommendation and the results. Nine indicators will be reported from patients’ medical records to NBHW. The results will be public and openly compared. However, the reporting of indicators encountered barriers in the medical record systems, and there were still ongoing development in June 2014.

The need to improve care for older people was well acknowledged among all stakeholders, along with an awareness that evidence-based practices were not being applied systematically. Previous improvement initiatives had been difficult to evaluate, and there were large local variations in the quality and coordination of care for older people. Several related policies in health and social care including performance-based grants were being implemented by the government and SALAR. A policy resonating these interests was developed in 2010 in negotiations between the government and SALAR. The main goals, content, and actors were established at the start, but the annual renegotiations 2010–2014 enabled the parties to take the past year’s evaluation into account before making decisions for the next year. A member of the project management team at SALAR described this:

Initially, we [SALAR] did not like the conditional requirement about documentation of a management system for systematic quality work. […] But we yielded on that point, and the support to our members [to meet the requirement] has helped them. Now they are more aware of their decision-making structures, what regulations apply and what templates they should use… So I guess there have been some positive effects.

The ambition was to formulate a coherent policy comprising a few important improvement areas and to stick to these for the whole period while successively increasing the requirements for the performance-based grants.

This did not follow a structured or pre-defined process. In the first two agreements, both parties used their own experiences as well as their political and social values to negotiate the content. An expert at NBHW described this:

The choice of improvement areas eligible for performance-based grants was made through some kind of consensus procedure, by a small group of experts from the organizations involved. We tried to identify the main problems from a more value-based point of view and then we had to narrow down the list due to availability of data. There were important areas that needed improvement where we couldn’t find any suitable indicators or data.

SALAR, which was responsible for the administration of national quality registries, identified relevant registries (e.g., within palliative care) and suggested using them in the policy as a means for improving the older people care. National quality registries contain patient-level data regarding diagnoses, treatments, and outcomes. The use of the registries involved systematic assessments with validated instruments, evidence-based interventions, and follow-ups. In 2011, the government introduced a more structured strategy for sourcing information. A national coordinator for older people care was appointed to coordinate the government’s work, including the current policy. A problem investigation was conducted to serve as a basis for a more comprehensive agreement in the 2012 negotiations. Information was gathered through study visits, hearings, and interviews with stakeholders. A broad literature search was also conducted, mainly involving reports from national agencies.

Synthesized information from several sources was used. A pragmatic approach was used in the negotiations about the areas eligible for performance-based grants (preventive care, palliative care, dementia care, pharmacological treatment, and coordination of care). Knowledge and arguments were assessed regarding the perceived significance for improving care, scientific evidence, and the availability of suitable indicators.

Several actors were engaged, primarily SALAR, the national quality registries and the government, acting through the national coordinator at the Ministry of Health and Social Affairs (MHSA). SALAR was the main actor, responsible for engaging regional and local authorities, coordinating and supporting the implementation by organizing activities, and compiling and reporting on the results. The strategy also included capacity-building and establishing regional support structures (i.e., improvement coaches and higher-level managerial support).

Assessment of the capacity was based on the government’s and SALAR’s previous knowledge, and the hearings with experts and representatives of regions and local authorities and the professional organizations. The assessment resulted in specific capacity-building strategies, such as funding for support structures and conditional requirements for obtaining performance-based grants. The annual renegotiation of the agreement allowed for the successive development of the target audiences’ capacity to influence the content, performance levels, and implementation support.

SALAR had the formal responsibility to increase awareness, and strategic communication was given high priority. Initially, great emphasis was put on reaching out quickly with information. SALAR invited regional and local stakeholders to conferences and also used their established networks to disseminate the policy. The government and SALAR collaborated to raise awareness among target audiences and other groups, such as retiree organizations, for instance by conducting joint visits to all regions.

The national performance-based grants provided a strong incentive for political and higher management levels to adopt the policy. SALAR’s direct contacts and ability to influence regional and local managers, as well as peer pressure among managers, were also important. A member of the project management team at SALAR described this:

No other organization in Sweden can reach out like SALAR, via our member networks. […] We can talk to [representatives from the regional and local authorities] behind closed doors and do whatever is needed to persuade them. No governmental authority can do that.

Benefits of evidence-based practices were used as arguments to spur on adoption among professionals. The core value of the policy, i.e., benefits for the individual patient, was emphasized. This was described as a strategic choice, since the need to improve older people care was the feature that all stakeholders strongly agreed upon.

SALAR’s combined role as a partner in the agreement and as an interest organization for the target audiences enabled them to create pressure to implement the policy. Facilitative strategies were used extensively, with the focus on establishing regional support structures for the policy. Improvement coaches were hired in each region and SALAR supported the coaches via regular network meetings and a web-based interactive platform for sharing experiences and information. Collaborative teams of managers were formed in each region to drive the implementation from a managerial point of view. A program was initiated to inspire the teams to put action plans into practice. SALAR created arenas for education and sharing experiences for the management teams. SALAR also organized support to increase the regions’ capacity to analyze data. A web-based portal presenting indicators was developed, which made it possible to openly and continuously monitor the development. SALAR emphasized strategic communication in the implementation phase, stressing the value of every individual’s right to personalized, safe care. A large amount of information materials and a web-based tool for measuring older people’s experiences of care were developed. Numerous educational events were organized, and efforts were made to coordinate the activities with other ongoing policies to streamline the implementation. SALAR also participated in local and regional activities across the country. The quality registry actors played an important role. They provided support to the improvement coaches and users at the local level.

After the implementation, the disbursement of performance-based grants stopped, the project team at SALAR dissolved, and responsibility for continued implementation rested with the regional and local authorities. However, in the last agreement, the regional and local authorities were asked to present their plans for maintenance of the policy in order to qualify for the final year’s performance-based grants. SALAR arranged for the maintenance of the web-based tools, and the quality registries continue to support their users. Measurement of some of the indicators continues as parts of the annual national quality measurements.

Monitoring and feedback were central aspects of the policy. Indicators and target levels for performance-based grants were developed and refined over time for each improvement area. Initially, the monitoring focused on activities, but measures concerning outputs and outcomes were introduced successively. The web portal for outcome data enabled stakeholders to continuously view and compare results and to use the information for planning and systematic improvement work.

Similarities and differences between the cases

In both cases, policymakers gathered information through their networks to assess the capacity to implement. Assessments showed that the target groups lacked the capacity to act on the policy without support and thus actions were taken to strengthen the capacity. The implementation strategies in the cases were also similar: dissemination through existing channels, interactive educational activities, and creating arenas for support and sharing experiences between regional and local implementers. As for policy outcomes, indicators were identified for monitoring, feedback, and comparison of results in both cases. The cases differed regarding how the actors were involved in developing the policy, the extent to which the phases in the process overlapped and the rigor of methods for searching and assessing evidence. There were also differences in core values, which influenced the choices regarding dissemination and implementation strategies (for more information about the similarities and differences, see Additional file 3 ).

The two policies differed greatly regarding how evidence was used, how the policies were formulated, and the extent to which the policy phases overlapped. Similarities were an emphasis on capacity assessment and modification of activities based on the assessment and a highly active implementation approach relying on networks of stakeholders. We found that the Conceptual Model for Evidence-Informed Policy Formulation and Implementation (Fig.  1 ) was a useful tool for organizing the data. We also suggest some further development to the model based on new categories that emerged in the analysis (Fig.  2 ). These findings are discussed below, and implications for practice and research are suggested.

Revised Conceptual Model for Evidence-Informed Policy Formulation and Implementation

One of the main findings concerned how evidence was used in the formulation of the policies. What was regarded as evidence and how this knowledge was used depended heavily on the nature of the policy. The guidelines in Case 1 share the characteristics of a practice policy as presented by Black [ 23 ]. Practice policies are described as rather linear and rationalist processes for sourcing and using scientific evidence. The nature of the policy in Case 2 represents a combination of service and governance policies, implying a weaker relation between scientific evidence and the policy [ 23 ].

Other reasons behind differences in the use of evidence concerned policy actors’ beliefs and the coalitions that were formed (as described in the Advocacy Coalition Framework [ 15 ]). In Case 1, there was a central policy core belief shared by the principal actors that high-quality scientific evidence is the key to creating value for the patients. This case can be seen as an optimal model for developing evidence-based policy, in terms of using a systematic and transparent decision-making process using the best available research evidence [ 24 , 25 ]. In Case 2, a central policy core belief was that knowledge that has been proven to work in practical settings is necessary in order to create value for the patients. A broad definition of evidence, including both scientific and practical knowledge such as expert opinions, values, and traditions [ 8 ] were used. The use of evidence in Case 2 is in line with prior studies suggesting that policymakers tend to interpret and use evidence in a broad sense [ 7 ]. The goal was to use a scientifically sound evidence base, even though this was done indirectly and in rather non-systematic ways. Thus, the policy in Case 2 was characterized by a pragmatic approach with regard to the policy content rather than strictly scientific as in Case 1. Case 2 is an example of a highly complex and political process of policy negotiation. These processes often consist of trade-offs between competing interests and values [ 26 ], which was also the case in this study. The two cases can be said to represent different positions, not only regarding the use of different sources of evidence but also in the contextualization of the policy. This has to do with the main actors’ values and credibility; NBHW cannot make policies if there is not enough high quality evidence, while SALAR cannot participate in policymaking that would violate the interests of its members, i.e., the regional and local authorities [ 27 ]. These results highlight the importance of analyzing coalitions’ sub-system actors and the roles, functions, and possible relationships between these actors.

The Advocacy Coalition Framework assumes that coalitions utilize resources to influence the policy process [ 16 ]. An important resource for the coalition in Case 1 was the supervisory authority of the government agency, even though it was not formally exercised in this case. Other resources were related to information and the involvement of researchers and clinical experts, which increased the scientific value of the guidelines. The support of key healthcare professional actors was mobilized through the health professional organizations. The main resources used in Case 2 were related to credibility and the ability to mobilize support from line managers and staff at local level trough higher-level managers. Moreover, the coalition had strong financial resources that were used for extensive implementation support and economic incentives. Resources related to formal authority were also used, since the politically governed interest organization had a formal agreement with the government about the policy.

Our findings also offer insight into the policymakers’ process of analyzing target audiences’ capacity to implement a policy and the actions taken based on this knowledge. In both cases, policymakers conducted analyses of capacity, concluded that the target groups lacked the capacity to act on the policy without support and thus initiated activities to strengthen the capacity. In Case 1, the government commissioned NBHW to organize implementation support, and in Case 2, substantial resources were allocated to national coordination of the implementation and to the establishment of support structures to facilitate regional and local implementation. We suggest the addition of a new element describing capacity-building to the Conceptual Model for Evidence-Informed Policy Formulation and Implementation.

In both cases, a highly active implementation approach was used, relying on collaboration between actors. In Case 1, NBHW took as its starting point that healthcare is highly professionalized and that influence and learning between health professionals would be effective for inducing change. In Case 2, SALAR’s aim was to strengthen the provider systems, structures for collaboration and work practices, thus seeking partnerships with regional and local managers. The partnership approach illustrates typical examples of soft law governance dealing with creating conditions for collective actions [ 14 ].

We found that the process in Case 1 followed the phases illustrated in the Conceptual Model for Evidence-Informed Policy Formulation and Implementation (Fig.  1 ). This implied a sequential process, starting with the development of the policy content, followed by the assessment of the capacity to implement and then the implementation activities. However, NBHW sought to address implementation determinants during policy formulation, for example by involving stakeholders. In Case 2, the policy formulation and implementation were integrated, implying that the content of the policy was developed iteratively while the policy was being implemented on a large scale. The policy outcomes were also continuously monitored and evaluated. One important feature of this policy process was the yearly renegotiation between the government and SALAR, where assessment of the past year’s policy outcomes and the implementation experiences provided input to the negotiation for the next agreement. This illustrates the emergent character of the policy and its implementation, a process that required flexibility and enabled corrective actions based on gathered knowledge. This process exemplifies both contextualizing of the policy content and governance. We suggest revisions to the Conceptual Model for Evidence-Informed Policy Formulation and Implementation that enables description and analysis of overlapping policy phases and iterative qualities of the process (dotted arrows in Fig.  2 ).

Methodological considerations

A strength of the study is the use of two concurrent, empirical cases within the same country. Although the two cases are distinct, they help to highlight a spectrum of actors and resources involved in the formulation and implementation of evidence-informed health policy. The cases provided variation, which was important for drawing conclusions about the usefulness of the conceptual model. The longitudinal design and the use of multiple data collection methods increased the credibility of the findings. Another strength was to combine deductive and inductive approaches in the analysis by using a theoretical framework to organize the data, but still allowing new relevant categories to emerge. The national context limits the possibility to generalize to other nations, while the use of the conceptual model makes theoretical generalizations possible. Another potential limitation was the difference between the cases regarding the economic resources, which in some aspects presented a challenge to the comparison. In addition, we focused on sub-system actors at an institutional level rather than individual actors, and by doing so, we may not have captured influences by specific individuals. We were not able to study the policy outcomes and thus cannot draw any conclusions about the success of the policies.

The policy actors’ roles and functions were found to have a great influence on the choices of strategies and collaborators in all policy phases. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be a useful tool for organizing and analyzing the data. However, it provided insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies, and overlapping policy phases. A revised version of the model that includes these aspects is suggested.

Abbreviations

Ministry of Health and Social Affairs

National Board of Health and Welfare

Swedish Association of Local Authorities and Regions

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Acknowledgements

This work was supported by the Vinnvård Research Program [grant number A2008-025] and the Swedish Association for Local Authorities and Regions (SALAR) with no restrictions impending the research content. Additional contributions were received from the Swedish Research Council for Health, Working Life and Welfare (FORTE) [grant number 2012-1688], Umeå Centre for Global Health Research and the Department of Clinical Sciences, and Unit of Child and Adolescent Psychiatry at Umeå University (LRS). The last author (HH) was funded by ERA-AGE2, Future Leaders of Aging Research in Europe (FLARE)/FORTE.

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HS, MN, LRS, and HH designed the study. HS, LRS, and MN collected the data. HS, LRS, and HH conducted the analyses. HS, LRS, and HH drafted the manuscript. All authors contributed to, read, and approved the final manuscript.

Additional files

Additional file 1:.

Case descriptions. Description of the problems, aims, content and the agencies involved in the two policy cases. (DOCX 133 kb)

Additional file 2:

Description of the study setting—Swedish health and social care. Description of the setting for evidence-informed policymaking in Swedish health and social care. (DOCX 127 kb)

Additional file 3:

Key similarities and differences between the policy processes in the cases. Table summarizing the key similarities and differences between the policy processes in the two cases. (DOCX 105 kb)

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Strehlenert, H., Richter-Sundberg, L., Nyström, M.E. et al. Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden. Implementation Sci 10 , 169 (2015). https://doi.org/10.1186/s13012-015-0359-1

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  • What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

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When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

  • Provide new or unexpected insights into the subject
  • Challenge or complicate existing assumptions and theories
  • Propose practical courses of action to resolve a problem
  • Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

  • Exemplify a theory by showing how it explains the case under investigation
  • Expand on a theory by uncovering new concepts and ideas that need to be incorporated
  • Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

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Moore v. United States: A Supreme Court case that could upend the tax code

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The definition of income —what it is and how it’s taxed—is a core issue of a Supreme Court case that could have far-reaching effects for taxpayers.

Moore v. United States, argued before the court in December, concerns the taxation of unrealized income. A finding on whether the plaintiffs, Charles and Kathleen Moore, must pay taxes on their profits as partial owners of a multinational corporation, could lead future courts to strike down other parts of the U.S. tax code. A ruling is expected this spring or summer.

Sloan Speck , associate professor of law specializing in taxation and tax policy, offers his take on the potential repercussions of the Moore v. U.S. ruling.

Sloan Speck

Associate Professor Sloan Speck

What’s at stake in this case?

First is a structural threat to the entire income tax system as we know it. Moore is setting a stage for future litigation that may have concrete stakes for ordinary taxpayers.

Second, Congress historically has defined income by statute. Congress generally taxes only realized income—where something has happened, such as a sale, to fix and identify that income. This statutory realization requirement has had a simplifying effect on how the income tax system has operated.

In Moore, the question is whether there is a realization requirement under the U.S. Constitution. If the court says there is a constitutional realization requirement or leaves that question open, which I think is extraordinarily likely, that raises a question about how the realization requirement actually operates. Is it a clear rule, or is it more like a legal standard—something that is fuzzy, hard to apply, and requires being resolved after the fact through litigation?

I think it’s a standard, and one that would, to some extent, flip income tax on its head by giving certain taxpayers a new weapon they could use to invalidate different provisions of the income tax law. And the narrow facts in Moore really give no sense of how far taxpayers could take a constitutional realization requirement.

The final stakes for Moore are with respect to wealth taxes. It's well-known that the Biden administration proposed a billionaire tax early on that has not gone anywhere, but it would have explicitly taxed unrealized gains each year and imposed a 20% minimum tax for all people with a net worth in excess of $100 million. Moore is a proxy fight about whether that provision works, and it's an effort to foreclose billionaire taxes before they are enacted and prevent future litigation over those instruments.

What are realized gains?

Realization hasn't ever been clearly defined, but it's fairly intuitive. So the basic case is: I own a piece of property that I sell to another person and get cash back. I can pay the tax that's due on that sale, and I recognize that income as the difference between the cash I have in my pocket and what I paid for the asset to begin with. It works for shares of stock and personal-use property like automobiles and your home.

But there are lots of harder questions about realization. The Moores are taxpayers who own a significant stake in a foreign corporation that's incorporated in India, and the U.S. doesn't tax foreign corporations. While the Moores owned the company, it earned money. Like a lot of corporations, it reinvested that money back into the business and never paid out any of its earnings in dividends. The Moores never got cash in their pockets with respect to their stock, but they’re better off—they’ve made money—because they own part of a successful company.

Their argument is that there was never realization. And that’s the question we're concerned with: Has there been realization because the corporation earned money, or do the Moores actually have to receive those earnings as cash in their pockets?

What would a winning verdict for the Moores mean?

It could undermine big chunks of the Internal Revenue Code. The best example that came up in Supreme Court oral arguments are the partnership tax rules. A lot of people, from high earners down, are partners in a partnership. A lot of small businesses and real estate ventures are partnerships. And the way the partnership tax rules work today is that, if the partnership earns income, the partners pay tax on that income whether they get cash or not.

And for many partners, they don’t get cash. Instead, these partners reinvest their earnings back into the business. That’s the business deal. If there is a constitutional realization requirement, then it could be unclear what rules apply to these very common business arrangements. There would be a lot of uncertainty about how to file taxes for a bunch of small businesses.

In Moore, the government essentially argues that none of this partnership income would be taxable, which is hard on federal revenues but easier on small businesses. Another possibility, however, is that these partnerships could become taxable like corporations, where there would be two levels of tax paid by the partnership and then the partners. 

That would be really bad for all of these businesses. It would dislocate the entire sector because everybody's made their business deals on the assumption you can plow your earnings back in and your partners pay the tax. If suddenly the partnership is paying tax, that's going to materially change what partnership businesses look like, and it will be extremely hard on those business operators and owners.

Finally, there are a bunch of other provisions that are effectively anti-abuse rules that operate on non-realization principles. If those anti-abuse rules were to fall, high earners would be able to avoid paying taxes even more so than they already do. And if the government needs revenue, it will need to look to middle earners. That could cause a shift and who pays what and how much.

What is the most likely ruling?

It doesn't really matter whether the Moores win or lose —that's not the important thing to watch. The outcome of this case is much less significant than the rationale the court provides and the language of the opinions, which is going to shape what happens going forward.

Like the overwhelming majority of Supreme Court decisions, this decision is likely to be bipartisan. So we should expect the opinion to be a heavy compromise between what the liberal and conservative justices want.

It’s been clear for a while that there would be litigation supported by conservative advocacy groups that would target different aspects of income tax. And the Moores were chosen. They stepped forward as a vehicle for advancing questions that have been raised among conservative commentators and advocacy groups for more than a decade.

This is not a surprising case, and its outcome is just one point on a larger arc. It’s the first step and what will probably be a long and difficult path for the government in defending current income tax law.

Even if the decision itself is not destabilizing, it will affect what Congress and the Treasury Department do because they know they will need to defend rules on this basis going forward. And that will shape the income tax law, probably in a way that shifts the burden of the income tax toward middle-income households and away from higher earners.

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College of Nursing

Driving change: a case study of a dnp leader in residence program in a gerontological center of excellence.

View as pdf A later version of this article appeared in Nurse Leader , Volume 21, Issue 6 , December 2023 . 

The American Association of Colleges of Nursing (AACN) published the Essentials of Doctoral Education for Advanced Practice Nursing in 2004 identifying the essential curriculum needed for preparing advanced practice nurse leaders to effectively assess organizations, identify systemic issues, and facilitate organizational changes. 1 In 2021, AACN updated the curriculum by issuing The Essentials: Core Competencies for Professional Nursing Education to guide the development of competency-based education for nursing students. 1 In addition to AACN’s competency-based approach to curriculum, in 2015 the American Organization of Nurse Leaders (AONL) released Nurse Leader Core Competencies (updated in 2023) to help provide a competency based model to follow in developing nurse leaders. 2

Despite AACN and AONL competency-based curriculum and model, it is still common for nurse leaders to be promoted to management positions based solely on their work experience or exceptional clinical skills, rather than demonstration of management and leadership competencies. 3 The importance of identifying, training, and assessing executive leaders through formal leadership development programs, within supportive organizational cultures has been discussed by national leaders. As well as the need for nurturing emerging leaders through fostering interprofessional collaboration, mentorship, and continuous development of leadership skills has been identified. 4 As Doctor of Nursing Practice (DNP) nurse leaders assume executive roles within healthcare organizations, they play a vital role within complex systems. Demonstration of leadership competence and participation in formal leadership development programs has become imperative for their success. However, models of competency-based executive leadership development programs can be hard to find, particularly programs outside of health care systems.

The implementation of a DNP Leader in Residence program, such as the one designed for The Barbara and Richard Csomay Center for Gerontological Excellence, addresses many of the challenges facing new DNP leaders and ensures mastery of executive leadership competencies and readiness to practice through exposure to varied experiences and close mentoring. The Csomay Center , based at The University of Iowa, was established in 2000 as one of the five original Hartford Centers of Geriatric Nursing Excellence in the country. Later funding by the Csomay family established an endowment that supports the Center's ongoing work. The current Csomay Center strategic plan and mission aims to develop future healthcare leaders while promoting optimal aging and quality of life for older adults. The Csomay Center Director created the innovative DNP Leader in Residence program to foster the growth of future nurse leaders in non-healthcare systems. The purpose of this paper is to present a case study of the development and implementation of the Leader in Residence program, followed by suggested evaluation strategies, and discussion of future innovation of leadership opportunities in non-traditional health care settings.

Development of the DNP Leader in Residence Program

The Plan-Do-Study-Act (PDSA) cycle has garnered substantial recognition as a valuable tool for fostering development and driving improvement initiatives. 5 The PDSA cycle can function as an independent methodology and as an integral component of broader quality enhancement approaches with notable efficacy in its ability to facilitate the rapid creation, testing, and evaluation of transformative interventions within healthcare. 6 Consequently, the PDSA cycle model was deemed fitting to guide the development and implementation of the DNP Leader in Residence Program at the Csomay Center.

PDSA Cycle: Plan

Existing resources. The DNP Health Systems: Administration/Executive Leadership Program offered by the University of Iowa is comprised of comprehensive nursing administration and leadership curriculum, led by distinguished faculty composed of national leaders in the realms of innovation, health policy, leadership, clinical education, and evidence-based practice. The curriculum is designed to cultivate the next generation of nursing executive leaders, with emphasis on personalized career planning and tailored practicum placements. The DNP Health Systems: Administration/Executive Leadership curriculum includes a range of courses focused on leadership and management with diverse topics such as policy an law, infrastructure and informatics, finance and economics, marketing and communication, quality and safety, evidence-based practice, and social determinants of health. The curriculum is complemented by an extensive practicum component and culminates in a DNP project with additional hours of practicum.

New program. The DNP Leader in Residence program at the Csomay Center is designed to encompass communication and relationship building, systems thinking, change management, transformation and innovation, knowledge of clinical principles in the community, professionalism, and business skills including financial, strategic, and human resource management. The program fully immerses students in the objectives of the DNP Health Systems: Administration/Executive Leadership curriculum and enables them to progressively demonstrate competencies outlined by AONL. The Leader in Residence program also includes career development coaching, reflective practice, and personal and professional accountability. The program is integrated throughout the entire duration of the Leader in Residence’s coursework, fulfilling the required practicum hours for both the DNP coursework and DNP project.

The DNP Leader in Residence program begins with the first semester of practicum being focused on completing an onboarding process to the Center including understanding the center's strategic plan, mission, vision, and history. Onboarding for the Leader in Residence provides access to all relevant Center information and resources and integration into the leadership team, community partnerships, and other University of Iowa College of Nursing Centers associated with the Csomay Center. During this first semester, observation and identification of the Csomay Center Director's various roles including being a leader, manager, innovator, socializer, and mentor is facilitated. In collaboration with the Center Director (a faculty position) and Center Coordinator (a staff position), specific competencies to be measured and mastered along with learning opportunities desired throughout the program are established to ensure a well-planned and thorough immersion experience.

Following the initial semester of practicum, the Leader in Residence has weekly check-ins with the Center Director and Center Coordinator to continue to identify learning opportunities and progression through executive leadership competencies to enrich the experience. The Leader in Residence also undertakes an administrative project for the Center this semester, while concurrently continuing observations of the Center Director's activities in local, regional, and national executive leadership settings. The student has ongoing participation and advancement in executive leadership roles and activities throughout the practicum, creating a well-prepared future nurse executive leader.

After completing practicum hours related to the Health Systems: Administration/Executive Leadership coursework, the Leader in Residence engages in dedicated residency hours to continue to experience domains within nursing leadership competencies like communication, professionalism, and relationship building. During residency hours, time is spent with the completion of a small quality improvement project for the Csomay Center, along with any other administrative projects identified by the Center Director and Center Coordinator. The Leader in Residence is fully integrated into the Csomay Center's Leadership Team during this phase, assisting the Center Coordinator in creating agendas and leading meetings. Additional participation includes active involvement in community engagement activities and presenting at or attending a national conference as a representative of the Csomay Center. The Leader in Residence must mentor a master’s in nursing student during the final year of the DNP Residency.

Implementation of the DNP Leader in Residence Program

PDSA Cycle: Do

Immersive experience. In this case study, the DNP Leader in Residence was fully immersed in a wide range of center activities, providing valuable opportunities to engage in administrative projects and observe executive leadership roles and skills during practicum hours spent at the Csomay Center. Throughout the program, the Leader in Residence observed and learned from multidisciplinary leaders at the national, regional, and university levels who engaged with the Center. By shadowing the Csomay Center Director, the Leader in Residence had the opportunity to observe executive leadership objectives such as fostering innovation, facilitating multidisciplinary collaboration, and nurturing meaningful relationships. The immersive experience within the center’s activities also allowed the Leader in Residence to gain a deep understanding of crucial facets such as philanthropy and community engagement. Active involvement in administrative processes such as strategic planning, budgeting, human resources management, and the development of standard operating procedures provided valuable exposure to strategies that are needed to be an effective nurse leader in the future.

Active participation. The DNP Leader in Residence also played a key role in advancing specific actions outlined in the center's strategic plan during the program including: 1) the creation of a membership structure for the Csomay Center and 2) successfully completing a state Board of Regents application for official recognition as a distinguished center. The Csomay Center sponsored membership for the Leader in Residence in the Midwest Nurse Research Society (MNRS), which opened doors to attend the annual MNRS conference and engage with regional nursing leadership, while fostering socialization, promotion of the Csomay Center and Leader in Residence program, and observation of current nursing research. Furthermore, the Leader in Residence participated in the strategic planning committee and engagement subcommittee for MNRS, collaborating directly with the MNRS president. Additional active participation by the Leader in Residence included attendance in planning sessions and completion of the annual report for GeriatricPain.org , an initiative falling under the umbrella of the Csomay Center. Finally, the Leader in Residence was involved in archiving research and curriculum for distinguished nursing leader and researcher, Dr. Kitty Buckwalter, for the Benjamin Rose Institute on Aging, the University of Pennsylvania Barbara Bates Center for the Study of the History of Nursing, and the University of Iowa library archives.

Suggested Evaluation Strategies of the DNP Leader in Residence Program

PDSA Cycle: Study

Assessment and benchmarking. To effectively assess the outcomes and success of the DNP Leader in Residence Program, a comprehensive evaluation framework should be used throughout the program. Key measures should include the collection and review of executive leadership opportunities experienced, leadership roles observed, and competencies mastered. The Leader in Residence is responsible for maintaining detailed logs of their participation in center activities and initiatives on a semester basis. These logs serve to track the progression of mastery of AONL competencies by benchmarking activities and identifying areas for future growth for the Leader in Residence.

Evaluation. In addition to assessment and benchmarking, evaluations need to be completed by Csomay Center stakeholders (leadership, staff, and community partners involved) and the individual Leader in Residence both during and upon completion of the program. Feedback from stakeholders will identify the contributions made by the Leader in Residence and provide valuable insights into their growth. Self-reflection on experiences by the individual Leader in Residence throughout the program will serve as an important measure of personal successes and identify gaps in the program. Factors such as career advancement during the program, application of curriculum objectives in the workplace, and prospects for future career progression for the Leader in Residence should be considered as additional indicators of the success of the program.

The evaluation should also encompass a thorough review of the opportunities experienced during the residency, with the aim of identifying areas for potential expansion and enrichment of the DNP Leader in Residence program. By carefully examining the logs, reflecting on the acquired executive leadership competencies, and studying stakeholder evaluations, additional experiences and opportunities can be identified to further enhance the program's efficacy. The evaluation process should be utilized to identify specific executive leadership competencies that require further immersion and exploration throughout the program.

Future Innovation of DNP Leader in Residence Programs in Non-traditional Healthcare Settings

PDSA Cycle: Act

As subsequent residents complete the program and their experiences are thoroughly evaluated, it is essential to identify new opportunities for DNP Leader in Residence programs to be implemented in other non-health care system settings. When feasible, expansion into clinical healthcare settings, including long-term care and acute care environments, should be pursued. By leveraging the insights gained from previous Leaders in Residence and their respective experiences, the program can be refined to better align with desired outcomes and competencies. These expansions will broaden the scope and impact of the program and provide a wider array of experiences and challenges for future Leaders in Residency to navigate, enriching their development as dynamic nurse executive leaders within diverse healthcare landscapes.

This case study presented a comprehensive overview of the development and implementation of the DNP Leader in Residence program developed by the Barbara and Richard Csomay Center for Gerontological Excellence. The Leader in Residence program provided a transformative experience by integrating key curriculum objectives, competency-based learning, and mentorship by esteemed nursing leaders and researchers through successful integration into the Center. With ongoing innovation and application of the PDSA cycle, the DNP Leader in Residence program presented in this case study holds immense potential to help better prepare 21 st century nurse leaders capable of driving positive change within complex healthcare systems.

Acknowledgements

         The author would like to express gratitude to the Barbara and Richard Csomay Center for Gerontological Excellence for the fostering environment to provide an immersion experience and the ongoing support for development of the DNP Leader in Residence program. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  • American Association of Colleges of Nursing. The essentials: core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf . Accessed June 26, 2023.
  • American Organization for Nursing Leadership. Nurse leader core competencies. https://www.aonl.org/resources/nurse-leader-competencies . Accessed July 10, 2023.
  • Warshawsky, N, Cramer, E. Describing nurse manager role preparation and competency: findings from a national study. J Nurs Adm . 2019;49(5):249-255. DOI:  10.1097/NNA.0000000000000746
  • Van Diggel, C, Burgess, A, Roberts, C, Mellis, C. Leadership in healthcare education. BMC Med. Educ . 2020;20(465). doi: 10.1186/s12909-020-02288-x
  • Institute for Healthcare Improvement. Plan-do-study-act (PDSA) worksheet. https://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWorksheet.aspx . Accessed July 4, 2023.
  • Taylor, M, McNicolas, C, Nicolay, C, Darzi, A, Bell, D, Reed, J. Systemic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety. 2014:23:290-298. doi: 10.1136/bmjqs-2013-002703

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A man speaks outside court

How will Donald Trump pay the $438m he owes in penalties from civil trials?

Two giant penalties handed down in a matter of weeks will cost him millions – and that’s only part of what he could owe

  • Full report: Trump ordered to pay over $350m in New York fraud case
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In a matter of weeks, Donald Trump was hit with two giant penalties from two civil trials in New York – $83m for defamation against the writer E Jean Carroll and $354.9m plus pre-judgment interest for inflating the value of his assets on government financial statements.

The verdicts combined will cost him some $438m, and that’s only part of what Trump could owe across numerous lawsuits. The payments will probably create a sizable dent in his wallet. Bloomberg’s billionaires’ list estimated that Trump’s net worth in 2021 was about $2.3bn, meaning these two rulings alone could take out almost a fifth of Trump’s net worth.

Trump’s finances have been notoriously opaque, not least because the Trump Organization is a private business, meaning it does not have to file public financial reports. But here’s what we know about what Trump has to pay and how it will affect his finances.

It all depends on the appeals

Trump is likely to appeal both cases, the outcomes of which could affect how much he ends up owing. It is unclear how long the appeals will take. For reference, an appeals court has yet to rule on a May 2023 ruling for a separate Carroll case that found Trump guilty of sexual abuse and defamation. Trump was ordered to pay $5m in damages in that case.

Also, the appeals court is technically considering two appeals coming out of Trump’s fraud trial. The first appeal came after a September pre-trial ruling found Trump guilty of fraud, ordering the removal of his business licenses. The second appeal is about the penalty the New York judge Arthur Engoron ordered Trump to pay after the months-long trial. It is unclear whether the appeals court will decide on the two appeals together or separately, but it will probably be at least a few months before any decision is announced.

Bankruptcy for Trump is unlikely

While $438m is no small sum, Trump is wealthy. Trump ally Rudy Giuliani declared bankruptcy after a jury ordered him to pay $148m to two Georgia election workers; the former New York mayor has declared he owes between $100m and $500m and has assets of between $1m and $10m.

To declare bankruptcy, Trump would have to prove that the verdict outweighs his assets, something that is highly unlikely.

During a deposition with prosecutors for the fraud trial in April 2023, Trump said that he had more than $400m in cash. However, last year, Forbes reported that Trump had since invested the bulk of his cash in bonds and treasuries, with a small portion kept in stocks and mutual funds. After his guilty verdicts, Trump will probably have to sell a good chunk of those investments.

A big question is whether Trump will have to touch anything in his real estate portfolio. Trump has gotten a cash boost from selling his properties before: he sold his golf club in the Bronx last year, and in 2022, he completed the sale of the Old Post Office building in Washington DC, which was converted into a hotel. Court documents showed that the sale of the Old Post Office netted $131.4m before taxes, according to the New York Times .

It will be a tough decision for a man who, just several years ago, claimed he was worth $10bn. This pride in his wealth has recently been used against him. In closing arguments in Carroll’s January trial, her lawyers told the jury that they should punish Trump with higher damages precisely because he claims he is so wealthy.

“A billionaire like Donald Trump could pay a million dollars a day for 10 years and still have money left in the bank,” Carroll attorney’s Roberta Kaplan told the jury on 26 January. “It will take an unusually high punitive damages award to have any hope of stopping Donald Trump.”

Trump will still have to pay the court, even as appeals go through

Even though Trump is waiting on multiple appeals decisions, he will have to give the court the money to hold on to. If Trump wins any of his appeals, he can get his money back.

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Trump has a few options in paying the court. He could pay up everything that he owes now in cash. Or he could try to get an appeal bond, meaning he wouldn’t have to pay all the cash up front in exchange for a premium and putting up collateral.

In his May 2023 Carroll case, Trump set aside the $5m he owed in cash, saving him about $55,500 in what would have been bond premiums. Though Trump may prefer to pay out the verdicts in cash, it is unclear whether he has enough on hand to avoid a bond this time.

Trump is rich with campaign money, but spending it on personal legal expenses will be complicated

Trump has been zealously fundraising off his legal troubles, probably because he has sizable legal fees for his two civil trials and four criminal trials.

What Trump can pay for using his campaign money is unclear. A federal law bans candidates from using campaign funds for personal use, making it unlikely that Trump can use campaign funds to help pay off some of the Carroll award and fraud penalty.

But Trump has not shied away from using campaign funds for some of his trials. The Associated Press reported in October that Trump’s Save America political action committee (Pac) had paid $37m in legal fees, more than half of the Pac’s total spending.

And the money keeps flowing in. Trump was the Republican candidate who received the most donations last fall, raising $45.5m in the third quarter. Ron DeSantis, who dropped out of the race in January, raised the second most, taking in about $30m.

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Community Perspective on Policy Options for Resettlement Management: A Case Study of Risk Reduction in Bududa, Eastern Uganda

Stella neema.

College of Humanities, Makerere University, Kampala, Uganda

Grace Mongo Bua

School of Public Health-Resilient Africa Network, College of Health Sciences, Makerere University, Kampala, Uganda

Doreen Tuhebwe

Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

Julius Ssentongo

Nathan tumuhamye.

Department of Epidemiology and Biostatistics, School of Public Health-Resilient Africa Network, College of Health Sciences, Makerere University, Kampala, Uganda

Roy William Mayega

Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

James Fishkin

Stanford University Center for Deliberative Democracy, ResilientAfrica Network

Lynn M Atuyambe

Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

William Bazeyo

Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

Introduction: Despite existing policy actions on Disaster Risk Reduction (DRR), many community members in Bududa still continue to settle in high-risk areas re-zoned for nonsettlement. There seems to be an apparent information asymmetry on expectations between the community and Government. The challenge then is ‘ how to consult communities and seek their opinion in an adequately representative unbiased way ’. This paper sets out to explore policy options on resettlement management as a DRR approach and how engaging with communities in a public discourse using the Deliberative Polling (DP) approach; to obtain their opinions and insights on these policy issues, revealed underlying challenges to policy implementation.

Methods: A qualitative study was conducted in Bududa in eastern Uganda with fourteen group discussions; comprising 12-15 randomly assigned participants of mixed socio-economic variables. Trained research assistants and moderators collected data. All discussions were audio taped, transcribed verbatim before analysis. Data were analyzed using latent content analysis by identifying codes from which sub-themes were generated and grouped into main themes on policy options for resettlement management.

Results and Discussion: We used Deliberative Polling, an innovative approach to public policy consultation and found that although the community is in agreement with most government policy options under resettlement management, they lacked an understanding of the rationale underlying these policy options leading to challenges in implementation. The community members seemed uncertain and had mistrust in government’s ability to implement the policies especially on issues of compensation for land lost.

Key Words: Policy, Deliberative Polling, Climate change, risk-reduction, landslides, Uganda

Introduction

Disaster incidents are on the increase globally in frequency, intensity and duration especially in the advent of climate change/variability manifested as floods, landslides, drought and glacial runoffs among others 1 . This has been worsened by the unpredictable nature of these events. Climate variability is attributed directly or indirectly to human activity that alters the composition of the global atmosphere 2 .

In Uganda, landslides are one of the devastating effects that have been faced due to climate variability. Landslides usually occur in hilly terrain and are triggered by persistent rainfall 3 , 4 . Bududa district of Uganda has a history of landslides, attributed to the hilly terrain of Mt Elgon. Bududa receives an average precipitation of above 1, 500 millimeters (mm) per year (meaning it basically rains every day) triggering landslide occurrence 3 . This is worsened by the ever-increasing population which puts much pressure on the land 3 . The current population is about 227,400 inhabitants with a population density of 906.7 persons per square kilometre, four (04) times higher than the National average, making it the most densely populated region in Uganda 6 . The occupants exploit the slopes of Mt Elgon for settlement and agriculture often causing land degradation 7 , 5.

The most devastating landslide in Uganda occurred on 1st March 2010 in Bududa District 8 , 9 , 10 , 11 .The landslide was triggered by heavy rains that lasted over three months. The landslide buried three villages in Bududa, killing over 400 and displacing an estimated 5,000 people. The landslide led to an immediate breakdown of water and sanitation systems predisposing affected people to disease outbreaks such as cholera 8 , 11 .

Following the landslide, several policy recommendations and options were issued in the Uganda National Policy for Disaster Preparedness and Management (2010) 12 . The options included resettlement of affected people, re-zoning of the high risk areas for no settlement, compensation of victims, voluntary relocation and establishment of early warning systems many of which were enforced by the relevant authorities 12

In Bududa, resettlement was applied as a long-term risk reduction solution. It involved resettlement of people away from high-risk areas 12 , 13 . Resettlement of affected persons from Bududa was implemented by the Government of Uganda 12 . Affected communities were relocated to Kiryandongo district, in western Uganda majorly because of the availability of vast lands 10 . This also included the displaced persons who were temporarily taking refuge in Internally Displaced Peoples (IDP) camps at Bulucheke sub-County headquarters in Bududa district 10 . However, despite the availability of vast land, It is important to appreciate the significant contextual backgrounds and differences between these two districts; socially, culturally and economically 22 . Communities in Bududa are used to settling in the highlands as compared to those in Kiryandongo who are used to settling in low lands. The cultural practices of these two peoples are also different; in Bududa the annual male circumcision''Imbalu'', a rite of passage signifying transition of the young boys to manhood is celebrated and held to such high esteem because it constructs the Bagisu identity, while those in Kiryandongo do not practice these cultural practices, making it difficult for the Bagisu to fit in 22 . Economically, the people from Bududa are farmers owing mainly to the highly fertile volcanic soils while Kiryandongo has less fertile soils and are mainly mixed farmers but predominantly herdsmen 22 .

Currently, after years of implementing the policy on resettlement of people in Bududa, this policy has not yielded the required outputs. Many Bududa community members still continue to settle in high-risk areas rezoned for non-settlement and many previously relocated to Kiryandongo have returned to the same affected landslide stricken area 14 .This poses the question: why has the resettlement policy failed in this vulnerable community?

One of the reasons for the failure of this policy could be the ineffective consultation of the affected communities prior to the implementation of the policy. The Uganda National Policy for Disaster Preparedness and Management was developed by the government through a process of conducting consultations at all levels using local leaders at community level, through the district leaders to stakeholders at national level 12 . However, it seems that there is information asymmetry between the local community and government expectations regarding resettlement as a risk reduction policy. This has contributed to an apparent complacency about the proposed policy measures in these communities.

In many countries, public consultation during the policy making process does not adequately involve the communities right from the initial stages 15 . Governments often use subjective assessments of situations to craft policies for risk reduction. Although the bottom-up approach may seem effective in policy formulation, only a selected few in leadership positions are consulted upon 16

In the bottom-up approach currently being used in Uganda, the community members do not have the opportunity to carefully think through the issues, be educated upon and make an informed decision hence the community members lack the right information on issues affecting them. There is a need to bridge this gap in information asymmetry by devising better ways of public consultation.

The challenge then is ‘how to consult the communities and seek their opinion in an adequately representative unbiased way’ . In order to counteract this challenge, we used a Deliberative PollingÒ (DP) approach. DP offers an innovative tool in which a representative sample of the community can be consulted in depth on key issues. It provides representative and informed opinion data, both quantitative and qualitative, about the views of the public once they have really considered the issues 16

Deliberative PollingÒ(DP) in essence assesses the representative opinions of a population 17 . The premise of Deliberative Polling is that when policy options are important for a community, then public consultations about them should be representative of the population and thoughtfully based on the best information available 16 , 18 .

The first ever successful DP in Africa was conducted in Bududa district in the Mt Elgon region on 7th-8th July 2014. In this paper we examine why there are unsuccessful efforts by the government to effectively communicate the rationale underlying the current policy on resettlement. The reasons were derived from consultation with the community using the DP approach.

Ò Deliberative Polling® is a registered trade mark of James S. Fishkin. The trade mark is for quality control and benefits the Stanford Center for Deliberative Democracy.

Methodology

Study Location

This paper focuses on the DP proceedings from Bududa district. Bududa district is located in Eastern Uganda, bordering Kenya to the east, Manafwa district to the south, Mbale to the West and Sironko the north. The district is mostly mountainous with an average altitude of 5,900 ft above sea level. The area has been prone to landslides that have been catastrophic . The population is mainly Lumasaba speaking 19 .

Study Design

The entire design of the DP process involved both Quantitative and Qualitative methods. The Qualitative methods assessed whether there was a policy change in attitudes regarding the policy options both before and after the plenary sessions while the Quantitative methods (handled in a separate research paper) assessed to what extent and their levels of significance. This paper focuses on the discussion before the plenary session . The group discussions were conducted on the 7th and 8th July 2014 in Bududa District. The plenary session is a session where all participants convene and pose questions from the group discussions to a group of experts and policy makers. It provides a platform for transparency, accountability, knowledge dissemination and learning.

For this paper, the study design was a case study. According to Thomas (2011), "Case studies are analyses of persons, events, decisions, periods, projects, policies, institutions, or other systems that are studied holistically by one or more methods 20 . In this instance, the case is the Bududa participants who came for the DP and we put them into group discussions. This is because it is from these group discussions that participants’ opinions regarding the various policy options were captured.

Participants and sampling

Participants for this study were recruited by random selection of households and random selection of those within the households 18. The DP participants were originally selected through a three-stage sampling technique. During the first stage, 7 sub-Counties from Bududa district were randomly selected: three sub-Counties from the high-risk areas, two from moderate risk and one from low-risk areas. The sub-Counties were simple randomly selected. In the second selection stage, three parishes from each sub-County were selected using simple random sampling technique and the sample size for the district was then allocated to the 21 parishes proportionate to their population sizes. In the third and final stage, participants aged 18-75 years were randomly selected from the parishes. A list of the households, and their adult occupants in each of the selected parishes was compiled by community scouts identified in the respective parishes and guided participant selection. The selection of the sub-Counties was guided by Bududa District Disaster Management Plan 2013, which stipulates that ten sub-Counties are high risk, five are medium risk and one Sub -County; low risk of landslides. One sub-County of low risk was automatically selected and the remaining fifteen sub-Counties were subjected to a ratio of 1:2 hence two sub-Counties for moderate risk and five sub counties for high risk sub-Counties respectively.

The total sample size for this study was 208 participants. In conducting the Deliberative Poll, the random sample first completed a baseline survey in order to collect information about community perception and ranking of importance on the specific policy proposals from stakeholders. The survey respondents were then invited to participate in a DP meeting to deliberate face to face on their understanding and concerns regarding proposed policy options. Originally, the participants of the group discussions were sampled using simple random sampling at household level in the different communities for a quantitative survey. It is from the DP meeting that we purposively selected participants for the group discussions. A total of 14 group discussions of 12-15 participants each were conducted. Figure 1 shows the schematic illustration of the DP process in Bududa.

Fig 1-Schematic illustration of the DP process in Bududa (Source
                            Authors  own)-Revised_001

Data collection methods and procedures

During the deliberations, participants focused on the pros and cons of the policy proposals and arrived at key questions they wished to pose in the plenary session of experts.

The guide used to moderate the discussion focused on the pros and cons of the policy proposals and arrived at key questions they wished to pose in the plenary session of experts. The guide used to moderate the discussion focused on the policy options around: resettlement management, as an option that can be taken to reduce the damage of landslides. Under resettlement management, the proposals of discussion included re-zoning high risk areas for no settlement, compensation for relocation, resettlement in newly built peri-urban centers, temporary resettlement after a disaster, building an early warning system, supporting local disaster management committees, use of sirens in the early warning system and use of text messages in the early warning system.

Selection and training of Moderators

Fifteen research assistants were recruited and trained to facilitate group discussions. The selected research assistants had a minimum of a bachelor’s degree and prior experience in research specifically qualitative research-interview skills. They were knowledgeable in Lumasaba the local language commonly spoken in the district. They were equipped with digital audio recorders to record the group discussions. The training of moderators was jointly conducted by experts from the ResilientAfrica Network, Stanford University and a faculty member from Makerere University School of Public Health.

Data analysis

Data collected through the group discussions were transcribed verbatim and those in the local languages translated without altering the meaning. A content analysis approach was used as described by Graneheim and Lundman (2004) 21 . Analysis was done in two stages, first, the manifest content analysis (what the text says, deals with the content aspect and describes the visible, obvious components) and then the latent content analysis (what the text talks about, deals with relationship aspects and involves an interpretation of the underlying meaning of the text). The transcripts were read and re-read by the authors who then assigned codes and came up with a coding structure (Open coding). Data meaning units were then aligned under their respective codes. This was followed by axial and selective coding to develop higher codes and categories. Categories were reviewed further to develop overarching themes.

Ethical considerations

Ethical approval was obtained from the Makerere University School of Public Health Higher Degrees, Research and Ethics Committee and approval from the Uganda National Council of Science and Technology (UNCST) [study number SS 3532]. Permission to carry out the research was further sought from Bududa District Administration. Verbal consents were obtained from the participants and a request was made to audio-record the discussions. Study objectives, benefits and risks were explained to our respondents. In addition, respondents had the opportunity to ask questions or clarification before consent for the discussion to proceed. All information obtained during the study was treated as confidential.

In this section we describe the thematic structure of our analysis, showing the main themes and sub-themes regarding policy options for resettlement management. Our key themes were relocation from high to low risk areas, relocation to relatives, compensation for resettlement and risk communication.

Participants

We conducted fourteen group discussions where participants were assigned randomly to groups comprising 12-15 participants of mixed gender (58.7% male and 41.3% female); 90% were married,57.7% primary education,10.4% had no education;86.6% were farmers, and the average number of children per woman was 6.3 as shown in Table 1.

Table 1: Demographic characteristics of study participants

The analysis identified within the three policy options for resettlement management as: (i) resettlement with support for livelihood and in the same community, (ii) Modalities of compensation; (iii) risk communication as early warning favourable to save life. These themes are described in detail in the next section of the article. Figure 2 shows the thematic structure of the research findings based on Gioia (2013) 23 .

Fig 2-Thematic structure of the research findings (Gioia ,Corley
                            et al 2013)-Revised_001

Relocation from high to low risk areas

The first main theme was resettlement from high to low-risk areas. Low-risk areas would involve being relocated from the high risk mountainous areas characterized by cliffs, steep colluvial deposits and scars due to previous landslides to low risk areas which are low lying, receive less rain to trigger landslides and relatively safer. These low risk areas mainly have trading centres and are inhabited mainly by relatives. In all the group discussions held, the issue of relocation created mixed feelings. They discussed whether relocation would be temporary or permanent. Participants seemed to weigh the risks of staying in the risky areas and the benefits of relocation.

In general relocation of people who live in hilly risky areas to lower less risky areas was acceptable. This would help them go back to check on their gardens and do some farm work. This was mostly on condition that they would access their gardens or be relocated in areas where they can do farming,''

I also say that people like us from Bukalasi, say that, when it rains a lot of our lives are always in danger and always leave us very worried. Therefore, I suggest that you people should fight for us a lot. That government should help us to take us in places like this one so that we can avoid being worried all the time when it rains,'' (group 3).

Saving life and property outweighed clinging to their land. They reported of the many landslides in that area where many people including their relatives lost their lives as illustrated by the quote below:

“ As I talk, in 2010 there was a heavy down pour in the morning and the mudslide covered up my brother’s house and killed five children on spot. It’s good for people to be resettled to other parts of the district, “(Group 6) .

Participants were affirmative and wanted relocation due to the situation they were in especially those who were in very high risk places such as Buwilimbi parish, Bukibokolo sub-County where they would lose their lives in case of landslides. They noted that preventive relocation would save the government in spending more money to manage disasters. Hence landslide risk significantly affects people’s willingness to resettle. People living in the riskiest areas such as Bukibokolo sub-County in Bududa had a strong willingness to resettle.

That said, most participants were in favour of relocation so long as the government was willing to support them. An assurance of compensation would facilitate their acceptance of relocation. Thus relocation was tagged to compensation of some kind.

“ I think it helps, because if problems befall you, at least you have a starting point, and if the government gives you this assistance, relocation becomes easier. So I'm in support of the idea of relocation, ” (Group 5) .

The participants often highlighted that the reasons as to why people resist relocations is because in most cases, they are promised assistance but in the end they get nothing. They were not sure what the funds promised for relocations were used for. Referring to the past experience of those who were relocated in 2011 to Kiryandongo District, people suffered more and some of their land was sold.

“ Now like for us people from Nametsi, we are in area where there were landslides but they carried people and took them to Kiryandongo but for us we refused to go. Now they are yearning to come back and yet some of them have sold off all their land. Where will they start from? Because the conditions are not favourable where they were taken” (group 4)

The destination for resettlement was discussed extensively and this influences the willingness to be relocated. Most groups preferred to be resettled anywhere in greater Masabaland where they share the same language and culture. They were not in favour of being resettled elsewhere. Social cohesion would be fostered better and they would be able to perform their cultural rituals especially the male circumcision ''Imbalu'' which is a rite of passage to adulthood for this particular ethnic group. Hence, such opinions indicate that an individual’s sense of identity and belonging profoundly discourages people from relocating.

“ For me, I was saying that relocating in Masaba land, within Mbale is better than relocating out (of Masaba land). Because we shall understand lugisu (the local language), we speak, work together and perform our cultural rituals together. And if a problem has befallen us like I may be in Bubulo, I can just walk and come even if I do not have money I can come home,” (Group 4)

However,a few people, were specific and mentioned that the relocation should be in Bududa low lying areas such as Busanza, Manjiya and Namatyale. They alluded to the fact that Bududa has very fertile soils compared to other districts in greater Mbale.

“ On the issue of being relocated is good but we the people of Bududa, we want to be relocated within, they should not take us to another sub-county or other district because there is a lot of land Bududa like in the low lands of Nalwanza”(Group 1)

Group participants had many questions related to the type of support provided by the government and how long it would last. Concerns about the ownership of their land in the high risky areas when they leave were raised. They were not sure whether they would still remain with their land after relocation.

“My question is like this, Government thinks of relocating people who are in risky areas, to remove them and take them to other places; if they take them away, who will have authority over the places they have left behind,” (Group 4)

Relocations to trading centres: Most participants felt that relocation from risky areas to trading centers was a good idea because trading centers are spacious, safe and accessible to social amenities than rural areas (e.g. clinics, shops). They noted that the services from government and NGOs would reach relocated community better and faster, and all would benefit.

“ I support it because, it will bring development in the trading centres and besides, when government sends assistance, it will be easily accessed by many since they will be in one place,”(Group 5)

A few of the participants disagreed to be relocated to trading centres because they were of the view that trading centres would be crowded and easily breed diseases such as Cholera that were typical of where they camped during the landslide disasters. Negative influences and behaviours would be acquired from the different people put together especially if there is scarcity of food and other needs.

“ Government should be able to meet our demands but not just making us crowd in one area .Now like the way we are here, the first thing is theft and secondly diseases.So it is better for government provide us with a place where we can temporarily be in case a disaster is about to happen so that we do not crowd in centres and get diseases, “(Group 1)

Related to the above was the fear of the concentration of so many people from different areas with different behaviours and habits such as those who abuse substances like alcohol and drugs. Such would breed quarrels, conflicts and insecurity. These examples given were a reflection of what happened in the previous landslides when they were relocated to some trading centres.

“ There is something burning in my heart, we were here in 2010-2011 but we suffered due to the crowding of people in one area. There were many diseases and the people whom we left behind who were in good places started stealing our things that we left at our homes. If we are to be relocated it has to be within Bukalasi because there are places that are safe it will be easy for us to go and check on our gardens,” (Group 8)

Most of the participants, being subsistence farmers, felt that in trading centres they would not have land to graze their cows and goats and to do farming. However those who supported being relocated to trading centres were putting their lives by relocating to a relatively safe area and only using the risky area to farm. Trading centres were preferred because they would be near their ancestral homes than relocation outside the greater Mbale region.

“ I think that if the trading centres are near our original homes, we shall be going to farm and come back to the centres,so that even if the landslides occur, only the food can be affected but not life,” (Group 5).

Relocation to relatives

Although extended families are common, most participants did not favour the idea of relocating to relatives. They felt that they would temporarily stay with their relatives but not for long. They noted that the social support systems have weakened and the hospitality would be abused given the high number household members they have including their domestic animals and other property. They felt they would be a burden to their relatives.

“I also concur with the last member’s idea even if it is a brother’s home you shared the same breast or even share the same mother, if you go there with your children it reaches a time and he chases you away,” (Group 1).

Relocating to relatives or friends with their families is something that they were not comfortable with. Most felt they could only stay for a short time until the situation stabilizes. Anticipated family conflicts were some of the inhibiting factors in relocation to relatives and friends. Others mentioned that some of their relatives are poorer than they are and so may not be of much help. A few mentioned that since it would be for a short time to relocate to relatives and friends, they can endure that instead of losing life and property due to landslides.

“ It is good to shift to the relative’s even if you are to quarrel than losing all your entire life and family , it’s good to go and endure and after the disaster you can easily come back home, “(Group 6 )

A few reported they would be itinerant migrants whereby during the rainy season they migrate to a safe place and go back to their homes during the dry season.

“ So for me, I was suggesting in times of dry seasons, those people should remain there and cultivate their crops but in rainy seasons they should get small rooms for their shelter elsewhere, when rainy season stopped, they go back, that is my opinion, I don’t know whether it helps,” (Group 3).

Compensation for resettlement

Another theme on policy options for resettlement was compensation. In several group discussions participants seemed relatively uncertain regarding compensation by government after relocation from high to low risk areas. The land was valued highly valued and thus compensation was seen as not a feasible option. This led to negative attitude towards compensation for resettlement. They were unclear about the modalities of pay off and this resulted into a prolonged discussions. In fact, they had more questions than answers “ As we were asking, when you compensate people and leave the hilly areas, does that place remain for the government or for the local people? They were not sure about ownership of the land the moment they are paid off. They preferred to be compensated with the same amount of land they had before the resettlement.

“ Here we need to agree, but let me ask; when I am being paid, am I paid to leave that place permanently[my land] and it remains free? And the money I am paid, am I allowed to buy a place of my choice or what is it”? (Group 2)

That said, they were positive that it was a good idea if the government paid for their land they left behind in the risky areas. But they were cautious and preferred to get a place to be relocated before they are compensated.

One particular issue that emerged from most groups was the inequitable compensation by government to affected persons which in a way influenced relocation negatively.

'' I may have my coffee and I am earning much from it and when I equate it and see that what they are giving in a year is not equal to what government is giving me, I can refuse to relocate. We also have bananas, yams and many others. These help us a lot in our homes,'' (Group 2)

Thus, government commitment in compensation was considered crucial for people to accept relocation. Moreover, they articulated the perceived benefits of relocation such as being alive and safe, with less difficulties than staying in the risky areas prone to landslides. However, they noted other negative consequences on people’s lives such loosing cultural and social ties which may not be cost during compensation.

Risk communication

An early warning system is a response to an assessment of the risk and it involves monitoring, forecasting, warning, dissemination and communication of warning using a range of media and communication channels. Communities and other key actors should know how to respond promptly to avoid loss of life and adverse effects on livelihoods. Group participants were asked about the systems that can be instituted to warn the residents early enough before landslides strike.

In several group discussions, instituting early warning system was desired by participants. They felt it was a good measure to put in place so that people are aware when a problem is about to happen instead of being caught up by the disaster leading to loss of lives and property

“ For me I support it because it will have helped us so much because you may be in the house and maybe not aware that at this moment a landslide is taking place. But if it (early warning system) sounds like an alarm, or when it (early warning system) sounds like an ambulance, you just know that we have got a problem and we start moving away from that area and relocate to another area,” (Group 9)

The participants however, reported that traditionally warning systems were in place such as the traditional drum beats that were used to alert people in case of danger, community work or even for festive events as illustrated by the quote below.

“ These things were in place like long ago if somebody died they could easily drum,there was a particular drumming which showed that it is circumcision and there was also a particular drumming which could also alert people to come for drinking. When it drummed, someone could easily tell that there is local brew (alcohol) at this person’s place. So when those things are put in place, one knows if there is a particular kind of drumming, it signifies landslide. People shall always be aware,” (Group 3).

Drawing on such experiences of community warning systems helps inform and lay the groundwork for the future early warning systems because the early warning systems are able to use both indigenous knowledge and modern knowledge. The community noted that those with their indigenous knowledge know when the risky months are; usually May, September and October when there is a lot of rains.

“ So we know all these periods in our heads but we still suddenly find when it has slid, so it doesn’t help us much especially if you are near such risky areas”. The participants who were from the high-risk areas prone to landslides gave their real life experience with landslides and so supported the establishment of early warning systems.

“ I support it because for us who live on the hills, now like for me I sleep in between escarpments, there is a hill on this side and one on the other side. There is a time when a landslide occurred across there, we stood on that hill to look at the people at the other end and we were listening as people were shouting, it was dark, what we saw were only torches and we also continued to make alarms so much and the people from the other end continued running and yet this alarming of ours does not help so much. That is why I was saying that if that early warning system is put in place, it will have helped us,” (Group 14)

The bells and sirens were desired by most groups and that they could be instituted in areas that are risky. The bells and sirens were thought to be good because they were audible enough. However some participants were not sure how these early warning systems could work given that disasters such as floods or landslides happen suddenly. Moreover, they needed to understand the type of sound of the bell that would signify danger.

“ It’s true these early warning systems are good , but we don’t know the devil's plans or those of God. Because when these disasters are going to happen, they don’t inform people, now how will they inform people that a disaster in form of a landslide is going to happen?”(Group 7)

A few were skeptical about the bells and sirens as the landslide might occur at night when people are asleep and so they may not hear the alarm. Some of the houses are iron roofed and when there is a storm the sound of the siren may not be heard. Or if it is heard people may be in disarray and end up running to where the danger is. They alluded to the fact that the way landslides occur is a process; that it does not happen during the heavy downpour rather it is when the rain is slowing down that the mud slides begin to move down as a mass. So, they felt that the bells and sirens may warn when the landslide is forming and this may be too late as some people would be swallowed on the way to safety. Hence the risk communication system may not be dependable or may not be effectively communicated especially to the most vulnerable populations. In one of the landslide affected area of Nametsi they reported the landslide happened at night.

“ When a landslide is happening, it doesn’t do so during a heavy downpour. It times when the rain is slowing down then the mud slides down. The early warning systems may warn when it happening and when you run out it can find you on the way. For me I support the issue of relocation to safer places than depending on the warning systems,”(group 5)

“ I have a doubt with regard to that issue because these landslides may occur in the night and usually it happens during heavy stormy rains when the clouds are very heavy and dark in iron sheet roofed houses which are very nosy. For example, in Nametsi the landslide occurred in the night when people were sleeping and even those who moved in the low land, the landslides buried them as well. So our thoughts are really troubled,” (Group 11)

The participants wanted to know more about the early warning system that would be established in order to act responsibly. They categorically indicated that alarms with no guidance on where to run to will not save the situation in such emergencies.

One of the options mentioned by a few group discussions was the use of short phone messages popularly known as ‘SMS’. This option was found only feasible to a few community members that owned mobile telephone sets. While this communication system had potential to reach out to many people at the same time, a number of issues were raised that rendered it ineffective. Participants raised the problem of low literacy (ability to read and write) as most know only how to receive and make a call by pressing some familiar iconic buttons; phone ownership density where only few people especially men owned mobile phones; low network coverage as well as low battery. At night, most of the phones are switched off for charging rendering SMS unreliable for disaster response.

‘’... the idea of sending messages on phone is good for like me who have a phone. Once the message is sent and received; that message on phone, you can go to your brother who is in the neighbor hood and inform them about what is bound to happen. It is a very good idea,’’ (Group 1)

‘’.. the massages sent by phone are good but the problem is not all people have phones and another problem is that some of us may have phones but do not know how to read so even if a message is sent I will not be able to read it.....They just told us that you press here like this, (illustrates), (laughter), and you put on the ear,’’ (Group 1).

‘’ the way me I see, not all of us have cell phones, and me I really see the best option of reminding us of any problem is the siren but not text messages since we have no phones’’(Group 3) .

Discussions

The results show that while the community is in agreement with most of the policy options proposed by the government such as relocation from high to low risk areas including trading centres and to relatives and risk communication including early warning systems, others were in disagreement with the above policy options for the reasons highlighted in the results section. Still,others were uncertain about the proposed policy options e.g compensation for resettlement. The community members also still have mistrust in the ability of the government to fulfill the promises. Moreover, the community members do not understand the rationale underlying some of the policy options proposed by government let alone an understanding of the proposed policy itself.

Regarding the policy on resettlement, most participants were in favour of relocation as long as the government was willing to support the affected persons through the process. This is in line with Bankoff who noted that communities that are affected by hazards tend to respond by way of helping one another, by providing shelter, food and other necessities with those who have lost their livelihood 24 .

Although in principal, mobility is often understood as a potentially beneficial strategy for vulnerable households, to cope with and reduce exposure to hazards, the exacerbated climatic shocks that have resulted from climate change have rendered resettlement as a core risk reduction strategy as is in the case of Bududa 3 . In Uganda, resettlement was done as part of the risk reduction strategy for Bududa District 12 .

For its success, the benefits of resettlement have to be clarified to the affected community. Much as some institutions define resettlement as a physical movement , in this community of Bududa, resettlement has not been defined well,hence the question from the community on whether resettlement was permanent or temporary. This speaks to the need for better communication about risk reduction programs. Other questions still unanswered were whether the community members would still own the land in the area where they have been resettled from.

Benefits such as the intention to lessen site-specific vulnerabilities for example in areas like Bududa that are prone to recurrent landslides must be re-laid to the community as was the case in 2008, when a landslide severely affected 85 households in a densely populated and low-income community of Cochabamba city,Bolivia 37 . The proposed solution was the relocation of the affected communities from the high risk zone areas 25 . Resettlement has also been implemented in areas of civil stiff to reduce risk faced by persons during wars 26

Resettlement as a coping strategy can contribute to income diversification enhancing capacity of households and communities to cope with the adverse effects of environmental and climate change stresses. It also can be a long-term adaptation strategy. The intention is that resettled people will be better off over time as a result of resettlement – according to their own assessment and external expert review 27

In the case study of Vietnam, the outcomes of relocation and resettlement were mixed and it was demonstrated that resettlement programs have the potential to increase resilience and security of vulnerable households 28 . However, the question sometimes remains, what do the affected communities perceive as benefits for resettlement? In the case of Bududa district in Uganda, it is unlikely the community perceives the benefits of resettlement such as improved access to public services; protection of the community from environmental shocks and stresses and improved living conditions. This was negated by previous resettlement experiences of 2011 to Kiryandongo. All the groups reported more perceived risks than benefits.

While the resettlement processes have many benefits, resettlement has also been shown to have challenges such as the increased distances thus people need more time to travel to their agricultural fields 28 . This has an implication on the consultations that must take place between the state agencies and communities to identify and address the several factors that contribute to the failure of resettlement efforts.

In Bududa community the issue of the type and place of relocation/resettlement came out strongly with some communities preferring to be relocated in the trading centre. This speaks to the adequacy of the relocation site as has been documented elsewhere 29 . Officials have to consider the adequacy of relocation site during their planning since the choice of the relocation site could either enable or hinder the resettlement efforts.

In Bududa, the community members preferred to be relocated anywhere in Masabaland in greater Mbale District where they share the same language and culture. Social cohesion would be fostered better and they would be able to perform their cultural rituals especially male circumcision which is a rite of passage to adulthood. This highlights the complexities and enormous challenge in finding suitable sites for relocating disaster-affected communities.That said, with unchecked population growth in the Mt Elgon region intra resettlement may carry a short term relief which is unsustainable in the long run if the livelihood source remains signifcantly agro and eco-system based.

Policy makers need to be aware that unsuitable new sites can lead to lost livelihoods, lost sense of community and social capital, cultural alienation, poverty, and people abandoning the new sites and returning to the location of their original community 8 , 11 , 37 . The economic, social, and environmental costs of relocation should be carefully assessed before the decision to relocate and where is finalized.

In the case of Bududa district in Uganda, following the March 2010 catastrophic landslide, residents were temporarily resettled in IDP camps that led to challenges of poor sanitation, overcrowding and environmental degradation 8 . Wisner and colleagues note that choosing inappropriate land for resettlement i.e. if it’s not close to sources of employment, distancing the new site from vital resources etc can lead to the failure of the resettlement efforts 13 .

According to Putro (2012), following a large scale mudflow that happened in Sidaorja, Indonesia in 2006, the villagers’ decision-making process on where to resettle was guided by job patterns: 1) workers tended to choose locations near the city center; 2) farmers preferred to move as a group, maintaining their social network with other community members; and 3) traders, self-employed workers, and others lost their jobs and were forced to live in severe hardship because of the relocation 27 . This is in line with our study findings in Bududa where the community members preferred to be resettled in areas that were close to their farmland so that they can continue with livelihood activities. Representative community consultations would have brought out these concerns and possibly aided the success of the resettlement policy in Bududa 30

An assurance of compensation is one of the ways that would facilitate community acceptance of relocation. In Bududa, the state agencies have never come out to clearly communicate the compensation terms for relocation of the affected victims. Compensation has been noted to be a major factor in relocation plans by the International Finance Corporation (IFC) 31 Lack of adequate information on compensation and terms of resettlement compromised the trust in the government policies. In times of compensation during resettlement, it is the right of the community to have fair and transparent compensation process.

IFC recommends that the compensation provided should be equal to or above what is required by law and in agreement with host communities on the methodology for calculating compensation. Although compensating for the loss of social capital can be challenging, IFC considers it a key aspect of compensation. Where possible, compensation is provided in forms other than cash so that long-term goals and livelihood improvements can be achieved 31 . Given that in Bududa, resettlement meant that the community members had to incur some losses, compensation has to be taken seriously and consulted on.

Another issue that policy makers had to be aware of during this policy implementation in Bududa was the fact that resettlement could lead to some social disruptions such as men losing their social status and or political positions in cases where populations had to be dispersed 32 . Such fears that were not identified prior might have contributed to the failure of the policy.

Added to this, most victims, having lost most of their assets in the landslide are literally left with nothing and therefore cannot be in a position to support them to relocate. They will need to be provided with some relief items- beddings, soap, cooking oil, sugar 33 . This implies that relocation may be an expensive venture to a victim and this is worth considering by technical persons and policy makers who enforce these policies.

It has also been noted that resettlement is more likely to be successful when communities fully participate in well-planned adequately financed programmes that include elements such as land-for-land compensation, livelihood generation, food security. In other words there is increased chance of success when resettlement is conceived as a sustainable development programme that includes Disaster Risk Reduction (DRR) 13

As we note that resettlement must be part of a holistic risk reduction plan, in highly vulnerable communities, there is need for effective early warning systems that can generate and disseminate timely and meaningful warning information to enable individuals, communities and organizations threatened by a hazard to prepare and to act appropriately and in sufficient time to reduce the possibility of harm or loss 34 .

Interestingly, majority of the participants did not trust use of text messaging for early warning because they did not think the mobile phone system was sufficiently reliable. In fact, majority of the members in the group discussions resisted it because of the various reasons as mentioned in the results section. However, use of Short Messaging Service (SMS) for early warning can be a potentially feasible option when the challenges associated with its use are overcome.

It was noted that sirens as an early warning system technology was desired by the people and it means that this acceptability can be leveraged to initiate and scale up the Early Warning Systems (EWS). It is important for the implementing agencies to adhere to standards of cultural sensitivity, acceptability and suitability of the EWS in order to assure sustainability in building EWS. Choosing a warning communication technology is dependent on considering who the recipients are, their location, their activity, the systems they rely on to receive local news and information, any special needs they may have and how they understand and respond to warnings 35

Rogers and Tsirkunov (2010) noted that one critical step is the willingness to act on a warning and take appropriate individual and collective measures to protect lives and poverty 36 . So it’s important to have effective warning systems that can engage its expected beneficiaries by raising awareness and knowledge of risks and ensuring that the actions taken are realistic 36 . In line with this our study demonstrated that collective traditional warning systems were noted such as drum beats that were used to alert people in case of danger, community work or for festive events.

Methodological discussion

The credibility of this study lies in the fact that we used group discussions and a stratified random sampling strategy. It is rare for qualitative work to be conducted with random samples and almost unprecedented for qualitative work to be done where the number of group discussions together is enough to add up to a credible representative sample of the population. We ought to note, however, that while participants from the group discussions were obtained from the 3 zones (low, medium and high risk zones to landslides), participants were heterogeneously composed. Therefore, it was not possible to conduct analysis by the 3 zones. Non-the-less this form composition generated rich and diverse discussion about policy options for resettlement management.

Conclusions

From the consultations using the deliberative poll method with the community, it can be generally agreed that resettlement is a highly complex issue. Policy makers have to be aware that resettlement and economic displacement of people can have significant adverse impacts on their future life, social fabric and livelihoods. If consultations are not adequately conducted, success determining issues are swept under the carpet. Ineffective consultations can leave the affected community feeling aggravated,hence do not adhere to the “agreed” position because some facts are only known to the technical people at the district level and policy makers in the District.

We recommend that for disaster risk reduction policies, in order to increase community acceptability and successful implementation of the proposed policies there is a need to increase community engagement during the policy formulation process. Deliberative polling presents a new and inclusive community consultation process of obtaining community perspectives for successful policy implementation.

Data Availabilty

The supplementary raw and analyzed data that support the findings of this study are available in figshare with the identifier data DOI: 10.6084/m9.figshare.5501326 https://doi.org/10.6084/m9.figshare.5501326

Conflict of Interest

The authors declare that no conflicts of interest exist.

This work was supported by the United States Agency for International Development under Makerere University School of Public Health's Resilient Africa Network (RAN) project. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of USAID. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Corresponding Authors

Grace Mongo Bua ([email protected]; [email protected]; [email protected])

Biographies

Dr Stella Neema is a Senior Lecturer at Makerere University Institute of Social Sciences,Kampala Uganda. She has expertise in Medical Anthropology and Cultural Anthropology.

Grace M Bua holds a Master’s Degree in Public Health (MPH) from Makerere University. She is currently a Community Liaison Officer, ResilientAfrica Network, a project at Makerere University School of Public Health, where she is responsible for planning and managing all community engagements RAN innovators have with RAN’s target communities across Africa to enable them develop, pilot, test and scale their resilience innovations to the actual beneficiaries at the grassroots communities.. She has expertise in Ethnography, Innovations pilot and scaling, field epidemiology, research methods, M&E, management, resilience, disaster risk management and development programming.

I hold a Master’s Degree in Public Health (MPH), currently a field coordinator for the Master of Public Health training program at the Department of Health Policy Planning & Management and an Instructional Materials Designer and trainer at Makerere University School of Public Health (MakSPH). I have expertise in field epidemiology, research methods, disaster risk management, management and development programming.

Dr. Julius Ssentongo is a Public Health Specialist working as a research fellow at Makerere University's School of Public Health. Julius holds a Masters of Public Health obtained in 2014 from Makerere University. His undergraduate training is a Bachelor’s Degree in Medicine and Surgery obtained from Makerere University in 2009. Julius has over 6 years experience in working with the public health care system and research. His current area of research focuses on resilience programming in the face of climate change and chronic conflict.

Nathan Tumuhamye is a research fellow at Makerere University School of Public Health. He holds a Bachelor’s Degree in Community Psychology and a Master’s Degree in Health Services Research. He is currently a Director Eastern Africa Resilience Innovation Lab at Makerere University School of Public Health

Lecturer Department of Epidemiology and Biostatistics, Makerere University School of Public Health. Holds a degree in Medicine/Surgery and a Master's Degree in Public Health from Makerere University, as well as a PhD in Medical Science. Key research interests in Non Communicable Diseases as well as Disaster Management

James Fishkin holds the Janet M. Peck Chair in International Communication at Stanford University where he is Professor of Communication and Professor of Political Science (by courtesy) and Director of the Center for Deliberative Democracy

Dr. Lynn M. Atuyambe has a Ph.D. in Public Health Sciences (International Health) from Karolinska Institutet in Stockholm, Sweden. His Thesis was on adolescent health; teenage pregnancies and coping mechanisms in Uganda. He is an Associate Professor at the Makerere University School of Public Health (MakSPH) with close to 20 years of research experience especially in reproductive health. He teaches both undergraduate and postgraduate students. He supervises post graduate (MPH, HSR, MPHN, OBS/GYNAE) and Doctoral students at the College of Health Sciences. He is the coordinator for the course Advanced Qualitative Research Methods for Health Sciences. He runs the course Adolescent Sexual and Reproductive Health as well as Health Promotion, Health Education, Behavior Change Communication for the Post graduates at the MakSPH. Most of the research therefore has focused on health social and behaviors matters related to reproductive health. Specifically, tasks related to family planning, fertility and adolescent health and development including youth friendly services have been undertaken. Besides, he has participated in both qualitative and quantitative research projects in various capacities over the years. He is a trainer in Qualitative research methods, data collection techniques and analysis. His recent publications take a qualitative approach. He is very experienced in surveys in Uganda and the region. He has collaborated on research in Ethiopia, Ghana, Tanzania and Zambia. He has also served on evaluation teams for reproductive health programs as principal and co-investigator. Amongst baseline surveys conducted, topics have ranged from HIV/AIDS needs assessments for the community as well as persons living with AIDS (PLWAs) to HIV/AIDS evaluation programs. He has extensively worked in the domain of STI, Sexual maturation and health, Adolescent sexual and reproductive health. In HIV/AIDS specific topics have been on Adolescent reproductive health, child sexual abuse, STIs in the army in relation to migration and troop movements, Access to and patient selection for enhanced ART, AIDS District Assessment. Dr. Atuyambe’s recent publications have focused on adolescent reproductive health, Coping theories among pregnant adolescents, HIV/AIDS, ART access and fairness, Stigma and discrimination and HIV disclosure outcomes. Dr. Atuyambe has over 50 publications in peer reviewed journals http:http://www.ncbi.nlm.nih.gov/pubmed/?term=Atuyambe+L.

William Bazeyo is a Ugandan physician, academician and Occupational Health specialist. He is currently a professor of occupational medicine at Makerere University college of Health Sciences' School of Public Health where he is the Dean of the school.

Contributor Information

Stella Neema, College of Humanities, Makerere University, Kampala, Uganda.

Grace Mongo Bua, School of Public Health-Resilient Africa Network, College of Health Sciences, Makerere University, Kampala, Uganda.

Doreen Tuhebwe, Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Julius Ssentongo, School of Public Health-Resilient Africa Network, College of Health Sciences, Makerere University, Kampala, Uganda.

Nathan Tumuhamye, Department of Epidemiology and Biostatistics, School of Public Health-Resilient Africa Network, College of Health Sciences, Makerere University, Kampala, Uganda.

Roy William Mayega, Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

James Fishkin, Stanford University Center for Deliberative Democracy, ResilientAfrica Network.

Lynn M Atuyambe, Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

William Bazeyo, Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

A Gen Zer set out to make $100 a day for 100 days through side hustles. Here are the gigs and passive income streams she recommends.

  • Jackie Mitchell said in a TikTok video that she made nearly $11,000 outside her job in 100 days.
  • Her goal for these 100 days was to make money to help with an eventual down payment.
  • She talked to Business Insider about side-hustle options and setting earning goals.

Insider Today

Jackie Mitchell says she was able to save up for a down payment to buy her first home with her husband in part by making money through side hustles and passive income .

To get to what she would be comfortable with for a down payment, Mitchell, 26, set a goal to earn an extra $100 daily for 100 days. She started in September, and the couple closed on a home a few months later.

"We moved pretty quickly once we got the funds and kind of found a house we loved right away," she said, adding that the side hustles and extra money "enabled us to apply for that home that would otherwise not be on the market by the time we could otherwise finish saving up."

She said in a TikTok video recapping the 100th day of the challenge in late December that she made nearly $11,000, roughly meeting that $100-a-day goal. Over the past few months, she posted videos highlighting the money she made from passive income or side hustles .

"I just posted it to see if I could get anyone to hold me accountable because I am very competitive with myself, but I'm even more so when people are watching," Mitchell said. "I think I've always made side hustles kind of a game of some sort for myself in order to bring in extra money."

Business Insider talked to Mitchell about some of the side hustles that worked for her over the 100-day challenge, what people should know about making an earnings goal, and whether others should pick up side-hustle work.

Setting an earnings goal

"I'm not saying everyone has to do a side hustle, but I do think in this economy it's helpful," Mitchell said.

While there are many options , Mitchell recommended easy-to-start side hustles that fit into your schedule. She also suggested setting simple and realistic goals and putting in consistent work.

"The race is always the name of the game, especially in earning, and you'll never regret just taking it low and slow," she said. "It'll be easier on you. And then if you want to amp it up, that's fine."

You should celebrate the money you end up making, Mitchell said, because it's money you wouldn't have otherwise.

"What I want to encourage people to do, and what I'm hoping to encourage people to do during my series this year , is to remind people that little steps in the right direction, if they're consistent, really add up," she said.

Finding side hustles and passive income streams that fit your needs

Mitchell said she would recommend side hustles or making passive income if you're willing to make the time commitment. That includes the process of researching opportunities.

"It's almost less about do you have two hours in your day as much as it is do you have two hours in your day that you are willing to give up?" she said.

Side hustles and passive income have been helpful for Mitchell outside her job at a church.

"Obviously, it's a job that I love and I'm very passionate about, but it is a nonprofit so it doesn't pay a lot," she said. "So that was part of my passion behind making extra money — being able to do a job I love and care about while still being able to hit some financial goals."

Completing surveys or being a study participant could bring in some money

For animal lovers, pet sitting may be a good side hustle. Others may be more interested in doing surveys for some extra scratch.

Prolific , a site where you can be a research participant or do surveys, could be one option. Mitchell thinks it's worth trying because of the "pay ratio to what you need to get started," she said. She has found the pay is quite good and some surveys are quick.

She made at least £650, or about $818, on Prolific, which Business Insider verified with documentation. According to the site, the minimum pay is £6 an hour, though there could be instances of underpaying that Prolific tries to flag, and it recommends people get at least £9 an hour.

Mitchell added that there could be a waitlist and she was on one for months.

"We have to be able to selectively invite participants in controlled numbers to ensure our participant pool meets the ever-changing needs of our researchers," Prolific's site says , adding that invites off the waitlist can vary from a few hours to months.

"Part of that waiting game is just to see when researchers are looking for more people of your demographic," Mitchell said.

Focus groups are another good option

Another way to make some extra cash that Mitchell recommends is through focus groups that pay.

Mitchell said she tried Focus Group for this. She found it was more consumer-focused than Prolific.

"These are things like in-home product testing," she said. "So maybe a brand wants to send you a makeup product — they send it kind of without any packaging on it."

She added that this could then involve giving your opinion about that product.

Mitchell has found that while there are frequent opportunities on Prolific, that hasn't been the case for Focus Group. Its frequently asked questions section says people won't qualify for all surveys.

"Of course, you can get on more sites and sign up for several different focus-groups sites," Mitchell said.

The FAQ section on Focus Group says people get "an incentive in the form of reward points," which can be redeemed at various retailers, for participating but should note this could be taxable.

Brand deals or partnerships and user-generated content

Mitchell found brand deals or partnerships could be fun side hustles that pay well.

"It's hard for me to say everyone should do brand deals because, of course, they pay really well, but really that's not accessible to most people," she said.

Mitchell added that "there's a lot of great creators specifically in the UGC realm on TikTok." She said in one of her TikTok videos that she thought she was contacted for user-generated-content work because of the traction she got from the 100-day challenge.

While there are different kinds of user-generated content, it might be hard to stand apart from others.

"I do think the UGC market is becoming somewhat saturated now," Mitchell said. "I feel like that's a very popular side hustle, so it may be harder to crack into."

For those who do work with brands or make content for them, Mitchell told BI that "really what brands are paying for is access to your specific audience," which is why she said it's important that you review and evaluate the companies first.

Earning through TikTok posts

For those who enjoy making TikTok content, it could be a side hustle. Mitchell has done the Creativity Program Beta , which she said could be a fun option.

This passive-income method might not be an available side hustle for all; TikTok requires participating accounts to be US-based. Beyond location and an age requirement of being at least 18, people need 10,000 or more followers and "at least 100,000 video views in the last 30 days," TikTok's webpage on the program says.

Mitchell has made over $10,000 in rewards from participating in this TikTok program. She said a lot of that came after the 100-day challenge, with the bulk coming from a few viral posts. One of these videos after the challenge translated to over $5,000. The dollar amounts were verified with documentation sent to Business Insider.

"I think the rate is pretty consistent and you just kind of get to see per day on your dashboard how much you made," she said. "Sometimes that's huge. Other weeks, that's a couple bucks a day."

She added: "It really just depends on the virality of your content at any given time and how many people are interacting with your content."

Have you made money from side hustles? Reach out to this reporter to share your experience at [email protected] .

case study policy options

Watch: 8 great ways to earn passive income

case study policy options

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