Incorporating Complex Science into Decisions; Lived Experiences of using Genomics Data and Information in Decision-making Processes in Malawi.

Abstract Policy and decision-makers are increasingly interacting with complex science as the momentum for evidence-informed decision-making grows. Unfortunately, often, the decision-makers have not been equipped optimally for this interaction, and so may not understand, communicate, or use the data and information appropriately, or at all. This leads to missed opportunities for science to improve health and society outcomes, and in the worst case scenarios, may lead to risky decisions, if results are misinterpreted or miscommunicated. In this study, we explored decision-makers' lived experiences interacting with complex science at the mid and grass-roots levels in Malawi, using genomics as a case example of complex science. Decision-makers articulated points at which bottlenecks are present, and how. They identified challenges with knowledge of, interpretation, and application of genomics-related information, not knowing where to find it, the absence of translation of concepts to facilitate local dialogue, and poor evidence-intermediary structures and efforts, among others. They also identified interventions that could facilitate the process including the use of locally established and already-trusted structures for brokering knowledge. It is important that these challenges are addressed to improve the use of complex science in both high and local level decision-making, or it risks continuing to be seen as difficult and elitist and left out of crucial decisions.