Identifying factors for promoting evidence-based policymaking in Japan with the perspective of policymakers, researchers and knowledge brokers: a semistructured interview

Abstract

Background

The promotion of evidence-based policymaking (EBPM) is increasingly recognized globally for its potential to maximize health outcomes by efficiently utilizing finite resources and focusing on evidence. Although previous literature has identified some facilitators and barriers to promoting EBPM, these are mainly produced in Western countries, with no comparable research conducted yet in Japan. In recent years, knowledge brokers (KBs) have been focusing on the potential to facilitate EBPM. However, previous studies have targeted policymakers and researchers. This study explores the factors promoting EBPM in Japan by integrating the perspectives of policymakers, researchers and KBs.

Methods

Semistructured interviews were conducted with 15 informants, 5 from each stakeholder, including policymakers, researchers and KBs. The data were analysed using an inductive thematic approach. Since this study aimed to identify factors considered necessary by multiple individuals for promoting EBPM rather than extracting atypical opinions, subcategories were defined as those with at least two speakers.

Results

A total of 15 interviewees (5 from each of the three stakeholders) participated. We identified five categories and 25 subcategories. The identified categories included cooperative engagement between government and external organizations, policy methods and mechanisms, governmental structure and environment, academic environment and development structure of KBs. The extracted subcategories were generating flexible evidence by researchers meeting the policy needs and creating platforms for active exchange of opinions and relationship-building across organizational boundaries.

Conclusions

Most factors identified in previous studies were observed in the Japanese context. Thus, we recommend that Japan implement interventions already established abroad, as they can significantly contribute to the advancement of EBPM. In addition, by incorporating the perspectives of KBs alongside policymakers and researchers, this study identified factors not addressed in prior research. To further support EBPM advancement, future studies should identify the competencies required for KBs and explore effective strategies for their development.

Background

The importance of promoting evidence-based policymaking (EBPM) is being increasingly recognized globally for its potential to maximize health outcomes by efficiently utilizing finite resources and focusing on evidence [1]. However, various challenges remain in effectively linking the evidence to policymaking. These include the reality that evidence alone does not automatically translate into effective policies, the inherent complexity of the policymaking process and the complicated political dynamics at play [2–4].

While EBPM has advanced in Western countries, statistical data and evidence have not been sufficiently utilized in policy formulation in Japan [5]. In 2015, discussions on statistical reform were held by an advisory council. In 2016, a recommendation emphasized the importance of EBPM in making rational policy decisions on the basis of evidence to maximize policy effectiveness within limited budgets and resources. In 2017, the Statistical Reform Promotion Council was established, leading to the creation of the EBPM Promotion Committee. The process continued in 2018 with the formulation of the “Basic Guidelines on the Provision of Statistical and Other Data and the Policy on Securing and Developing Human Resources”. Since 2015, these processes have raised awareness of EBPM within the Japanese government and have driven efforts to advance its implementation [5, 6].

To overcome the challenges of promoting EBPM, several reviews have identified factors that either facilitate or hinder the efficient integration of research evidence into policymaking [7, 8]. These findings highlight the importance of establishing and strengthening personal connections, building mutual trust between researchers and policymakers, fostering collaboration between researchers and policymakers, producing relevant research, ensuring timely research dissemination, maintaining an appropriate balance of power and budget allocations, improving policymakers’ skills and providing managerial support as key contributors to enhancing research use in policymaking.

In addition, recent individual studies have identified new facilitators for integrating evidence into policies. These include developing government structures that support novel research findings, generating evidence through multiinstitutional collaboration and leveraging situation-orientated evidence. However, undervalued policy research in the academic environment [9, 10], limited time for research dissemination [9], lack of transparency in the policymaking process [11], excess government reorganizations [12], external pressures that supersede research evidence [9, 11] and the absence of practical and actionable research findings [12, 13] could potentially inhibit the EBPM promotion. Although several studies have identified various facilitators and barriers, these studies have mainly been conducted in North America and Europe, with limited studies in Asian countries. In particular, no comparable research has been conducted in Japan [7, 8]. It remains unclear whether the existing evidence is specific to other countries or whether similar trends can be observed in Japan.

In recent years, knowledge brokers (KBs) have gained attention as one of the facilitators of EBPM [14], and their effectiveness has been observed in various fields, including healthcare [15], education [16] and policymaking [17]. KBs are often described as human agents facilitating knowledge transfer, enabling the movement of information from one location or group to another [18]. Specifically in the health policy context, KBs have the function of bridging the gap between research evidence and policymaking to promote EBPM [15, 19]. Oldham and McLean [20] and Ward et al. [21] proposed three main functions for KBs: (1) knowledge management by compiling and evaluating evidence on specific policies; (2) intermediation by facilitating connections between policymakers and researchers and (3) capacity building by providing education to policymakers on research. Among these, KBs are considered particularly effective when acting as intermediaries to link research evidence and policymaking. Because studies in this area are more likely to focus on either researchers or policymakers, none have considered researchers, policymakers or KBs equally. The populations examined in the most recent review were predominantly policymakers, policy advisors, healthcare managers and researchers [8].

Thus, this study aimed to identify the factors that promote EBPM in Japan by integrating the perspectives of policymakers, researchers and KBs. By focusing on Japan’s unique context, it seeks to generate actionable insights that address local challenges and contribute globally. Furthermore, examining the factors influencing EBPM among these stakeholders can enhance awareness of evidence utilization and generation while improving coordination mechanisms for evidence supply and demand. KBs are included as research subjects because previous studies have identified their utilization as a factor promoting EBPM. Given their significant role in Japan, this study aimed to identify specific contributing factors by incorporating their perspectives.

Methods

Study design and study setting

This qualitative study uses one-on-one semistructured interviews to explore the factors that promote EBPM in Japan. The Standards for Reporting Qualitative Research (SRQR) checklist was adopted [22].

Recruitment and data collection

Semistructured interviews were conducted using an interview guide from February to September 2023 (see Appendix 1). In total, 15 participants were interviewed, 5 from each stakeholder: policymakers, researchers and KBs. Although the sample was not limited to specific areas of health, we targeted individuals with experience in health policy development, implementation, research or advisory roles. The inclusion criteria of study participants in this study were as follows.

• 1. Study participants could be policymakers employed by governmental authorities with director-level positions or analysis officers with at least 10 years of experience. They typically rotate between departments every 2–3 years. During these rotations, they are responsible for setting policy issues, identifying policy needs and formulating and evaluating policies.

• 2. Study participants could be researchers who have served as principal investigators or subinvestigators of large-scale research projects funded by government research grants, with experience in advisory roles. They are responsible for generating evidence through commissioned research projects, such as those funded by the Ministry of Health, Labour and Welfare. Additionally, some researchers are invited as external experts to national councils and advisory committees for specific policies to provide academic insights. However, such opportunities are not widely available to most researchers.

• 3. Study participants could be KBs with research or clinical backgrounds who were involved in the policymaking process for more than 2 years in government authorities. Japan has a system in which the private and healthcare sectors, including hospitals, assign personnel to ministries, research institutes and clinical fields. These personnel are expected to serve as KBs, playing an important role in the relationship between health policy, various fields (for example, local governments and clinical fields) and scientific evidence. A 2-year secondment is typical in Japan but may be extended.

The study participants were recruited using snowball sampling. A researcher (S.S.) recruited potential participants from her network and asked the interviewees to refer to other potential participants who met the study criteria. No participants declined participation or withdrew from the study.

Y.A. and S.S. conducted semistructured interviews. S.K., H.M. and H.U. also participated in the interviews. One of the interviewers (S.S.) was a paediatrician with substantial experience in policymaking as a technical officer in the Ministry of Health, Labour and Welfare. To mitigate researcher bias, the following measures were implemented: (1) during the interviews, a structured interview guide was used to ensure consistency across participants. The questions were designed to follow the sequence of the EBPM cycle, systematically eliciting relevant factors. Additionally, a neutral stance was maintained throughout the interviews to minimize bias; (2) during the analysis, the researcher did not serve as the primary analyst. Instead, two researchers conducted independent coding, and any discrepancies in categorization were resolved through discussion. A third researcher participated as a reviewer when consensus could not be reached between the two coders.

The interview guide was developed on the basis of a literature review and pilot interviews [23–25]. The interview was structured around the following policymaking process: identifying the current situation, setting the agenda, policymaking, building consensus, policy implementation and evaluation [5, 24]. The informants were first asked about their recognition of each policymaking process, the factors that promote or hinder these steps, and potential solutions to address the inhibiting factors. Each interview was audio recorded and transcribed to a Word file. Electronic data (recordings and text) did not contain any respondent identifiers. Each researcher (Y.A., S.K., H.M., H.U. and S.S.) shared data on a protected internal system, which cannot be accessed externally. Theoretical saturation was achieved when no new themes emerged [26].

Data analysis

The data was analysed with the following processes:

• 1. Y.A. read all interview transcripts multiple times and segmented the texts into meaningful units. Subsequently, S.K., H.M. and H.U. independently reviewed the units.

• 2. Coding was conducted in pairs using an inductive thematic analysis approach. Each pair included one researcher (Y.A.) to ensure consistency across the analysis, working alongside other researchers (S.K., H.M., or H.U.).

• 3. The pairs compared their coding results. When discrepancies occurred among researchers (Y.A., S.K., H.M. or H.U.), additional researchers (K.T. and S.S.) participated in discussions to reach a consensus.

• 4. Subsequently, the pairs independently re-examined the texts to refine the context and coding, repeating this cycle until all results were consistent.

• 5. Since this study aimed to identify factors considered necessary by multiple individuals for promoting EBPM rather than extracting atypical opinions, subcategories were defined as those with at least two speakers. Consequently, codes with only one speaker were treated as extraneous codes. These codes were defined as follows: codes that did not fit into any existing subcategory and, even when combined with other extraneous codes, did not justify the creation of a new subcategory. These classifications were determined through researcher consensus.

• 6. Y.A. translated the data.

Results

In total, 15 interviewees (5 from each of the three stakeholders) participated. Table 1 describes the interviewees’ characteristics. All of the policymakers were affiliated with the government. Researchers were employed in either universities or research institutes. KBs were primarily affiliated with universities, research institutes and hospitals. All recruited participants participated in the interviews. We identified five categories and 25 subcategories. The identified categories were cooperative engagement between government and external organizations, policy methods and mechanisms, governmental structure and environment, academic environment and development structures of KBs. Each category, subcategory and illustrative quote is provided in Table 2. The following paragraphs present detailed explanations and narratives for this subcategory.

Table 1 Demographics of the study participants

Table 2 Categories and subcategories related to EBPM promotion, with illustrative quotes from each stakeholder

Cooperative engagement between government and external organizations

This category encompassed five subcategories related to building relationships between policymakers and researchers and sharing interorganizational skills: (1) generating flexible evidence by researchers meeting policy needs and establishing administrative mechanisms to leverage them; (2) creating platforms for active exchanges of opinions and relationship-building across organizational boundaries; (3) promoting shared interorganizational awareness throughout the entire EBPM and at each stage; (4) continuing involvement in policymaking from external organizations with specialized knowledge and field expertise and (5) establishing and utilizing think tanks to provide scientifically reliable information. Stakeholders expressed similar views on (2), (3) and (4), emphasizing the importance of cross-organizational platforms, shared awareness and continuous involvement of specialized external organizations. They highlighted the need to bridge gaps in EBPM understanding and terminology. In contrast, (1) and (5) revealed differing opinions; policymakers noted a lack of research aligned with policy needs, while researchers cited insufficient communication of these needs by policymakers.

Policy methods and mechanisms

This category comprised six subcategories related to organizing leverageable data and improving individual EBPM skills: (1) setting agendas from a comprehensive perspective; (2) organizing and disseminating leverageable evidence and data; (3) evaluating the current situation on the basis of accurate data and qualitatively collected field insights; (4) enhancing the knowledge and skills of policymakers and researchers in policymaking processes, EBPM and research; (5) citizen participatory policy formation and (6) ensuring the thorough dissemination of policies and information to local governments and policy beneficiaries. Stakeholders shared concerns regarding (1), (2), (3) and (6), citing unsystematic policy prioritization, overemphasis on vocal groups, insufficient individual EBPM skills and the need for thorough policy dissemination. Differing views were observed in (4) and (5), where policymakers criticized the complexity of data access, researchers highlighted data unavailability and KBs stressed the lack of scientific inclusion of beneficiaries’ voices.

Governmental structure and environment

The following eight subcategories were identified under the theme of governmental structure and environment: (1) increasing awareness and establishing evaluation systems for policies within the government; (2) introducing schemes to strengthen implementation capabilities at the local government level; (3) ensuring appropriate allocation of budgetary, personnel and time resources within the government; (4) establishing systems that could fairly reference evidence and expert opinions; (5) implementing administrative procedures that reflected not only central government ministries and agencies but also external organizational perspectives in policy evaluation and effectively utilized the outcomes; (6) instituting personnel systems that enabled long-term engagement in policies; (7) developing flexible frameworks for adjusting policy trajectories and (8) establishing personnel evaluation systems that considered the policy implementation performance of policymakers and policy evaluations.

Among these, subcategories (1) and (2) related to policy evaluation and strengthening implementation capabilities at the local government level revealed differing opinions among stakeholders. The former policymakers often expressed uncertainty regarding subsequent actions after evaluations owing to the absence of clearly defined next steps, while researchers and KB stated that evaluations were not conducted within the administration. The latter, policymakers and researchers, frequently mentioned the importance of sharing successful case studies among local governments, whereas KB highlighted the need for detailed policy guidelines from the central government to facilitate implementation by local governments.

Conversely, stakeholders demonstrated similar views on several subcategories, including (3) appropriate allocation of resources, (4) fair referencing of evidence, (5) flexible policy frameworks and (6) long-term personnel systems. All stakeholders emphasized the necessity of creating a list of experts whom policymakers could consult. Additionally, KB expressed concern about the insufficient infrastructure within the government for early and mid-level bureaucrats, who are responsible for policymaking, to access academic journals. Stakeholders also highlighted the challenges posed by (7) the 2- to 3-year personnel rotation system, which made long-term planning difficult and (8) inadequate handovers among policymakers, hindering collaboration with external organizations.

Academic environment

An academic environment comprises two subcategories: (1) developing personnel evaluation systems that reflect policy impact in academia and (2) improving the research environment to foster policy-related studies. Personal evaluation should not be limited to the number of publications but should also consider researchers’ contributions to and impact on policies. Improving the research environment requires measures such as government support for health policy researchers. Stakeholders expressed similar opinions on (1), emphasizing the importance of including policy impact in personnel evaluations in addition to research output. However, opinions differed on (2), with researchers highlighting that data obtained from government-funded research could not always be used for individual research purposes and KBs stressing the need for greater support from the government for researchers.

Development structures of KBs

The development structures of KBs category comprised the following four subcategories related to the development of KBs: (1) generating personnel exchange participants by providing lectures and hands-on experience and establishing human resource development systems; (2) introducing career opportunities for personnel exchange participants after their exchange programmes; (3) creating support systems to provide technical and psychological assistance to personnel exchange participants; and (4) providing organizational support to utilize the experiences of personnel exchange participants. Stakeholders emphasized the importance of (3) providing sufficient support due to the significant differences between the research or clinical field and the administrative environment as well as (4) the necessity of establishing support systems within the home organizations of personnel exchange participants to enable them to share their experiences and serve as a bridge to policy-making processes.

Discussion

Through semistructured interviews, this study provided valuable insights for identifying five categories and 25 subcategories to promote EBPM among policymakers, researchers and KBs in Japan. Of these five categories, four were consistent with the most well-recognized and recent review article [8]. These were cooperative engagements between government and external organizations, policy methods and mechanisms, governmental structure and environment and the academic environment. However, one new category concerning the development of KBs has been identified. This was the first study in Japan to examine factors that promote EBPM by integrating the perspectives of policymakers, researchers and KBs. The subsequent paragraph compares the study’s findings with previous literature.

At the subcategory level, both similarities and differences with studies conducted in other countries have been observed. For instance, similarities include the importance of generating evidence that meets policy needs, a key factor in various countries, including the United States, the United Kingdom, the Netherlands, Iran and India [7, 27–29]. Other factors include the establishment of systems that allow policymakers to consult experts, as observed in Australia [12]; the enhancement of individual skills related to EBPM and the creation of platforms for collaboration between policymakers and researchers in Iran, India and Pakistan [7, 27, 28, 30]. Furthermore, securing human resources and budgets is consistently highlighted as an essential administrative task in numerous countries [7, 8, 31]. Because these factors have been extracted from previous studies, it is assumed that they are commonly important factors for EBPM promotion, regardless of country specificity or political system. These findings imply that adopting initiatives similar to those implemented in other countries, such as the National Institute for Health and Care Excellence (NICE) and What Works Centre (WWC) in the United Kingdom [32], could further advance EBPM in Japan.

Additionally, differences were also observed, primarily related to local government and policy evaluation. These differences can be attributed to variations in national political structures and cultural contexts. The following sections discuss the key findings in more detail.

For example, regarding citizen participatory policy formation, Japan does not sufficiently incorporate the voices of stakeholders into policy development compared with Western countries. For instance, in the United Kingdom, the systematic collection of policy beneficiaries’ opinions is integral to the policymaking process, fostering a participatory decision-making framework [33, 34]. However, in recent years, Japan has increasingly sought to incorporate the voices of policy beneficiaries into policymaking, particularly in specific fields such as cancer care and dementia. For example, in dementia policy, a guideline for improving dementia-related policies has been developed in collaboration with patients, promoting initiatives that reflect the perspectives of policy beneficiaries. However, in practice, only approximately 20% of initiatives aimed at gathering the voices of affected individuals have been implemented, highlighting the need for further efforts in this area [35]. Given this context, it is likely that this subcategory was identified in this study.

Another example of policy dissemination to local governments and policy beneficiaries is that the Japanese government provides opportunities to explain newly formulated policies to local governments, which serve as the implementing bodies. However, inadequate information sharing remains a significant challenge [36]. A survey conducted by the Ministry of Internal Affairs and Communications found that approximately 30% of local governments faced difficulties in immediately applying national policies to their operations. The survey emphasized the need for more tailored and detailed explanations that align with local contexts [36]. This finding highlights the importance of effective communication in policy implementation, which emerged as a critical factor in this study.

Another example is policy evaluation that incorporates the perspectives of external organizations. Compared with Western countries, Japan has not established a well-developed system for conducting policy evaluations in collaboration with external organizations. In Japanese ministries, policy evaluation primarily occurs within the government. Although researchers may participate in national councils and advisory committees as external experts, an independent system in which researchers conduct evaluations separately and their findings are directly reflected in policymaking remains underdeveloped [37]. By contrast, the United Kingdom established the Evaluation Task Force in 2020, assigning dedicated personnel to policy evaluation, thereby strengthening collaboration with external organizations [38]. Similarly, in the United States, the Foundations for EBPM Act of 2018 (Evidence Act) promotes policy evaluation in cooperation with external organizations and introduces mechanisms to facilitate its implementation [39]. Given this context, this study identified the importance of establishing a system in Japan that enables policy evaluation in collaboration with external organizations.

A key difference between the categories identified in this study and those highlighted in the latest review is the inclusion of factors related to KB development. This distinction likely arises from the participation of KBs, who themselves recognize the importance of establishing a structured system for KB development. On the basis of this, we examined the identified subcategories in relation to the current state of KBs in other countries. For instance, regarding the subcategory generating personnel exchange participants by providing lectures and hands-on experience and establishing human resource development systems, Japan’s personnel exchange system frequently allows professionals to transition from the clinical field to government ministries. However, policymakers rarely use this system to gain research experience outside government institutions. Furthermore, compared with the United States, where administrative personnel are often completely replaced following a change in administration [40], Japan has had a long-standing Liberal Democratic Party (LDP)–Komeito coalition government. Consequently, Japanese policymakers do not automatically gain opportunities to acquire experience from external organizations. In the United States, this turnover has naturally fostered a system in which policymakers and think tanks frequently interact, leading many policymakers to assume the role of KBs. This contextual difference may explain why this subcategory was not identified in previous studies but emerged in this study.

Another notable issue is the absence of a structured system within Japanese ministries for acquiring specialized knowledge while remaining in government service. Japanese policymakers typically rotate between departments every 2–3 years, prioritizing the development of generalists. Consequently, Japan has not established dedicated positions for specialists in data analysis and statistics independent of personnel rotations. By contrast, the United Kingdom employs a substantial number of analysts within the government, who serve as key intermediaries between evidence and policy through cross-government networks such as the Government Analysis Function and the Cross-Government Evaluation Group [38]. In Japan, this role is primarily fulfilled by KBs, who may have contributed to the identification of this subcategory in this study. Given these circumstances, it is essential to develop a system that facilitates personnel exchange between the government and external organizations while simultaneously strengthening the internal capacity of the government for specialized expertise in policymaking.

Strengths and limitations

This study has several limitations. One limitation is the sample’s low representativeness, as this study included 15 highly experienced people, with most of them having 10–15 years of experience. Another limitation is the low external validity of other countries. A few categories related to government structure and environment contain aspects specific to Japan, making them less applicable to other countries. Furthermore, regarding the saturation criteria, this study determined the saturation threshold at 15 participants. However, this number reflects the total across all stakeholders, and saturation was not confirmed within each stakeholder group. To examine differences between stakeholder groups more rigorously, it may be more reliable to ensure that the saturation criteria are met within each group. A potential concern also lies in sampling bias. The study recruited participants through the researcher’s (S.S.) existing network in the maternal and child health field. This may have limited the diversity of perspectives, potentially reducing the external validity for other health fields.

Despite these limitations, one of the strengths of this study is that it is the first to identify factors that promote EBPM in Japan. The second advantage is the novelty of the study participants. Unlike previous studies, which primarily focused on policymakers and researchers, this study also included KBs. This inclusion allows for the identification of additional factors related to the development of KBs, expanding upon the factors identified in earlier research. This study contributes to the global promotion of EBPM by offering new perspectives, particularly by strengthening the development of KBs, who play a crucial role in integrating evidence into policymaking, thereby fostering a more robust and systematic advancement of EBPM.

Conclusions

In total, five categories and 25 subcategories were identified that promote EBPM. Most of the factors identified in previous studies were observed in the Japanese context. Thus, we recommend that Japan implement interventions already established abroad, as they can significantly contribute to the advancement of EBPM. In addition, by incorporating the perspective of KBs alongside those of policymakers and researchers, this study identified factors that previous research has not uncovered. Thus, the development of KBs should be enhanced globally to advance EBPM significantly. To further support this advancement, future studies should identify the competencies required for KBs and explore effective strategies for their development.