How a problem is framed or described can determine the kinds of options considered to address the problem, as well as stakeholders’ perceptions of its importance. Thinking about how a problem has been framed means viewing the problem from different perspectives and identifying ways in which the problem could be packaged. A problem with chronic care, for example, might be framed in a number of different ways: as one of coordination and communication between primary and secondary care providers; as a problem with inadequate primary care; as a quality–of-care problem (poor adherence to clinical practice guidelines); as a problem of rising costs; or as a problem of long waiting times or lack of access to care. Each of these would lead to different perceptions and different sets of solutions. It is important to ensure that a problem is framed in a way that resonates with stakeholders and leads to the identification of appropriate options for addressing the problem. Therefore to facilitate this, consideration should be given to the different ways to frame the problem in light of how it originally came to attention, the available indicators and comparisons, and an analysis of its cause.
Interviews or discussions with key stakeholders about how a problem has been framed (or could be framed) can lead to the identification of alternative framing ideas and information about their advantages and disadvantages. Discussions can also provide a better sense of which framing approach is likely to resonate most with stakeholders and result in the identification of appropriate options. Studies of the perceptions and attitudes of stakeholders may also help to clarify how best to frame a problem. A worksheet for clarifying a problem is provided in the ‘Additional resources’ section of this guide, as well as example of completed worksheets (in Uganda and in Zambia). Further guidance can be found in the SUPPORT tool on using evidence to clarify the problem. Workshop materials and a presentation on clarifying the problem are also provided in the ‘Additional resources’ section. Click here to listen to a member of the Zambian EVIPNet team describing the clarification of the problem for a policy brief on integrating mental health care into primary care. Box 3.1 shows an example of a clarifying the problem exercise.
Box 3.1 Example of a clarifying the problem exercise |
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A useful way to consider whether a problem has been framed appropriately might be to create a table such as Table 3.1, and to add rows iteratively.
A detailed analysis of different ways to frame a problem is unlikely to be helpful to stakeholders or decision makers. However, when relevant, the policy brief should include a description of the different ways of framing the problem, the reason for framing the problem in a particular way, and the consequences of doing so. This information can be provided in the background section, in a separate section after it, or at the end of the problem description. Providing this information could help to reassure stakeholders that alternative ways of framing the problem have been considered, and that the problem has been framed appropriately. It can also form the basis for a more informed discussion of the problem.
An example of how a problem can be better clarified through a consideration of different ways to frame it is provided in the ‘Additional resources’ section of this guide.