Identifying implementation science research and policy priorities to advance universal health coverage: a multi-country modified Delphi study

Despite efforts to advance universal health coverage (UHC) in different contexts, evidence gaps remain, and implementation science has been underused to address these gaps and determine 'what works'. The study aimed to establish a research agenda that could guide future research by identifying implementation science research priorities to advance UHC. A three-round modified Delphi study design with a multi-country panel was employed. Initial implementation science research gaps were identified from two scoping reviews conducted by our team, supplemented by 10 papers that we identified through a search of Medline and CINAHL databases. We generated 64 research gaps that were shared with 272 participants in Round I. Round I responses were analysed using descriptive statistics and a cut-off of 75% to move to Round II. Round I qualitative analysis resulted in an additional 15 research gaps and one new topic area. Based on Round I findings, an improved set of research gaps was shared in Round II. Quantitative data in Round II were analysed using the same approach as Round I, using an 85% cut-off point. Open-ended responses were analysed thematically. Round II research gaps were then presented in a virtual workshop. Results from the workshop were analysed using weighted ranking analysis. Round I response rate was 34.9% with 43 research gaps across 12 topic areas. Round II response rate was 77.9% with 42 gaps across 13 topic areas that passed to the virtual workshop. The workshop response rate was 39%. Through this process, the top 10 ranked implementation science research gaps were identified. Identified research gaps are focused on assessing equity in the delivery of health services and financial risk protection interventions. Future research will further contextualise this research agenda with country-level actors.