The ExpertLens– Building bricks of evidence

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Original content from the Mapping Pathways blog team

Caroline Viola Fry

The ongoing InternationalAIDS Conference (AIDS 2012) in WashingtonD.C. is an opportunity for Mapping Pathways team members to disseminateinformation and findings on the project. 
In the second of this two-part post, Ohid Yaqub and Caroline Viola Fry from RAND Europe discuss the work involved for the ExpertLens, acornerstone of the Mapping Pathways project. Read part one here.

Ohid Yaqub

MP: How did younarrow down on the stakeholders or participants in the ExpertLens?
OY: We chose theparticipants from the U.S., South Africa and India, the three focus countriesof the Mapping Pathways project. We aimed to assemble an expert panel acrossmultiple stakeholder groups in each country. So we were looking for policymakers, academic researchers, clinical researchers and people from industry.
One more thing to note is that we weren’t targeting extremelytop-level policy makers who may not necessarily be familiar with the details ofthe situation on the ground and the context in which the proposed care strategymight be deployed. We were looking for people with the appropriate knowledgeand the time to think very carefully about their answers, think about them yet againin relation to the group, justify their answers to the group, discuss them andmaybe refine their answers afterwards over the course of three weeks in anonline forum. Our participants needed to be very engaged with the topic.
CVF: We wantedour participants to have some background knowledge and expertise in their areabut not necessarily be experts in everything there is to know about the HIVlandscape. The benchmark on which we were trying to look for people to engagewith was if they knew about the HPTN052 trial orabout Truvada.
MP: How much time andeffort went into drafting the questions for the ExpertLens?
OY: We draftedthe questions very carefully and lot of work went into giving questions theright tone so that we could generate useful discussions in the online forum.There were more than 20 versions of the question set. 
We were very aware when thinking about the questions that thesituation many decision-makers might face is not one where they can say yes toeverything but one where they may have to make choices from a limited pot ofresources. There may be a situation where they have to choose one over the otherand so that’s why some of those questions were ranking questions.
CVF: Thequestions ended up drawing out some of the more nuanced views on issues, whichhighlighted the fact that they were not straightforward questions and thatpolicy decisions are not black and white.
MP: What, in yourview, were some of the most palpable benefits of using the ExpertLens?
OY: Our initial impression was that we’d get quick-fire, reactionaryopinions being thrown around on this topic. The ExpertLens forced people to belittle more reflective, and take on board what other people were saying.
One thing everyone does agree on is that HIV is a veryinterdisciplinary problem where concerns of policymakers, researchers andclinicians need to taken into account since they are all stakeholders. Beingable to get different stakeholder groups to be able to talk to each other isvery important since some forms of media and discussion forums don’t allow that.A prime example is journals, where disciplines and professions talk to eachother in very considered, robust ways. But the issue there is that they talk totheir own disciplines and tend to talk to people who read the same journals. Sothe ExpertLens is a great way to have a different kind of conversation.
CVF: One of theuseful aspects of it being online on forums rather than being a conversation inperson is that one can track these discussions and analyse what contributed tosomeone changing mind if they did. We also looked at what may not have had aneffect and left people where they were. We went through comments very carefullyand stepped into some of these conversations as moderators to prompt some ofthe discussions and ask relevant questions.
MP: Is the ExpertLensan ongoing process? Is there a key finding that you could share?
OY: Theiterations have all been done and the ExpertLens has been closed. It ran forroughly about a week for each round. We then analysed the data and are in theprocess of writing up the findings, which will be published in an upcoming RANDbook on the Mapping Pathways project (forthcoming on www.randeurope.org).
CVF: The findingsare so complex that it’s impossible to sum up here. The key finding is thatthere’s very little information out there and very little consensus. It’s not abad thing because it’s still interesting to ask where the points of divergenceare and why do people disagree.
OY: Phase two plansto build on what we’ve assembled here in phase one. ExpertLens is one of thebricks of evidence we’re pulling together. We’ll be synthesising evidence fromliterature reviews, surveys, interviews and this ExpertLens to make up seriesof assumptions that can feed into better starting conditions on a model and wecan then try and model for behavior. 

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