Development of the Integrated Policy Analysis Framework (IPAF): A Multidimensional Approach to Health Policy Analysis

Introduction

The critical analysis of health policies and their development within and across jurisdictions is essential for understanding how policy decisions shape health systems and influence population health outcomes [1-3]. Health policy analysis functions as a learning system by enabling critical reflection, feedback, and adaptation, whereby evidence, implementation experience, and contextual knowledge inform policy refinement and future decision-making [4,5]. However, conducting rigorous health policy analysis remains challenging because existing frameworks often focus on specific dimensions of the policy process, such as agenda setting, formulation, implementation, governance, or evaluation, rather than providing an integrated approach capable of analysing policy development and implementation as a dynamic and interconnected process.

A recent systematic review shows numerous frameworks, theories and models have been developed to support health policy analysis, each contributing valuable insights into specific dimensions of policymaking, such as policy content, policy actors, institutions, implementation processes, and contextual influences [1]. While these frameworks have substantially advanced understanding of individual components of policymaking, relatively few provide a comprehensive and practical model capable of supportin transparent and systematic analysis across diverse health system contexts [2,6-8]. Consequently, students, researchers, and policy analysts continue to face challenges in accessing and applying consistent and transparent frameworks for analysing complex health policies across different settings [9].

A diverse range of complementary analytical approaches, including for example realist evaluation, economic approaches, Theory of Change, logic models, and PESTEL analyses (Political, Economic, Social, Technological, Environmental, Legal), provide valuable contributions to understanding interventions, causal pathways, and contextual influences for policymaking [10-13]. However, these approaches were primarily developed for programme planning, evaluation, and contextual assessment rather than comprehensive analysis of health policy processes and outcomes [12,14]. Theory of Change and logic models support articulation of causal assumptions, intervention mechanisms, and expected outcomes but provide less guidance for examining political processes, stakeholder interests, governance arrangements, power relations, and institutional influences shaping policy development and implementation [2,7]. Similarly, PESTEL approaches support assessment of macro-level contextual factors but do not capture how policies are formulated, negotiated, implemented, and adapted within complex health systems [8,15]. Therefore, while these approaches represent valuable analytical framings, they are not always a good fit to enable comprehensive, comparative, and context-sensitive health policy analysis.

Although existing frameworks, models and approaches have advanced understanding of specific dimensions of policymaking, there remains limited consensus on an integrated, operational framework capable of bringing these perspectives together to enable systematic comparison of health policies across diverse health system contexts [1]. To address this methodological gap, the Integrated Policy Analysis Framework (IPAF) was developed as a structured, multidimensional approach that synthesises concepts from comparative policy analysis, systems thinking, governance, health economics, implementation science and evidenceinformed policymaking into a standardised analytical model. IPAF builds upon established policy theories and integrates their complementary strengths to support systematic and comparative analysis of complex health policies across varied contexts.

This article describes the development, application, and refinement of IPAF. The framework is founded on the premise that effective health policy analysis requires consideration not only of policy content and intended objectives, but also of the dynamic processes through which policies are formulated, implemented, governed, monitored, and evaluated within wider political, economic, social, and health system environments. Accordingly, IPAF provides a structured approach for examining health policies across interconnected domains, including policy development, implementation, cost and value, outcomes, equity, and transferability. It recognises that policy effectiveness is shaped by the interaction between policy design and a range of contextual factors, including implementation processes, stakeholder engagement, governance arrangements, resource availability, system capacity, and broader contextual conditions. These factors influence not only policy outcomes but also the potential for policies to advance or constrain health equity [16-19].

A defining feature of IPAF is its explicit focus on multidimensional analysis and policy transferability. Rather than assuming that policies demonstrating success in one setting can be directly replicated elsewhere, IPAF supports critical assessment of contextual alignment, necessary adaptations, and the conditions required for effective implementation across different health systems. Through structured domains and guiding questions, IPAF facilitates systematic, transparent, and consistent examination of complex policies, providing a practical resource for health policy research, evaluation, education, and evidence-informed decisionmaking.

Framework Development Approach

The IPAF was developed through an iterative framework synthesis approach informed by a targeted review of the literature. Framework synthesis is an established methodological approach for developing analytical models by systematically identifying, integrating, and refining concepts from existing theories, frameworks, and empirical evidence [20-22]. This approach enables the development of a comprehensive and theoretically grounded framework while avoiding unnecessary methodological complexity and overly granular data collection during the initial development phase [23,24].

Framework development proceeded through four iterative and interconnected stages: 1) targeted literature review, 2) thematic synthesis, 3) framework design, and 4) refinement and validation. Each stage informed subsequent iterations, allowing key analytical domains, relationships between concepts, and practical applications of the framework to be progressively identified, structured, and refined.

Stage 1: Literature Review

Development of the Integrated Policy Analysis Framework (IPAF) began with a structured narrative review of established policy analysis frameworks and guidance used across public health, health systems, healthcare, and public policy disciplines internationally. The review aimed to identify the conceptual and methodological elements that underpin robust policy analysis and synthesise these into a practical framework for multidimensional health policy research. Rather than assessing the effectiveness of individual frameworks, the review focused on identifying recurring analytical domains, concepts and approaches that could be integrated into a coherent and comprehensive framework for health policy analysis. Given the objective of framework development, a structured narrative review approach was considered more appropriate than a systematic review, as it enabled synthesis of conceptual and theoretical perspectives from diverse disciplines rather than formal appraisal of intervention effectiveness or empirical outcomes.

Relevant literature was identified through searches of PubMed, MEDLINE, APA PsycInfo, CINAHL (via the EBSCOhost platform), and Web of Science electronic data-bases. The primary search strategy combined terms related to health policy analysis frameworks and health systems, including: (“policy analysis framework” OR “policy framework” OR “policy analysis model”) AND (“health”). Additional literature was identified through reference list screening, citation tracking, and targeted searches of influential frameworks relating to comparative policy analysis, governance, implementation, and health impact assessment.

The searches identified a large body of literature (over 4,000 articles); however, the analysis focused on identifying established policy analysis frameworks themselves, examining their conceptual foundations, components, and application across the literature, rather than systematically reviewing the individual policy studies or contexts in which they were used. The purpose was to identify key influential frameworks and guidance documents to collectively inform the development of IPAF. Using a constant comparison method of titles and abstracts, the key established frameworks identified in the literature included Kingdon’s Multiple Streams Framework (1984), Bardach’s Eightfold Path [25], Walt and Gilson’s Policy Triangle (1994) [8], the CDC Policy Process Framework (2014) [26], Consolidated Framework for Implementation Research (CFIR) [19], WHO guidance on health policy and systems research [2], Health Impact Assessment frameworks [27], and comparative public policy models [28,29]. These frameworks were selected for further analysis because they provide complementary perspectives across different stages and dimensions of the health policy process, including agenda setting, policy formulation, implementation, health systems analysis, impact assessment, and comparative policy learning.

Table 1 presents the eight selected frameworks according to their primary analytical contribution across the policy analysis continuum rather than chronological order of development, to illustrate how each contributed to the development of IPAF domains. Each framework was examined according to its primary purpose, analytical domains, methodological approach, strengths, limitations, and relevance to health policy analysis. Particular attention was given to the extent to which frameworks addressed key dimensions of policymaking, including policy context, drivers, stakeholders, governance, implementation, evaluation, health equity, policy outcomes, adaptation, and comparative analysis.

Table 1: Conceptual foundations of the Integrated Policy Analysis Framework (IPAF).

This table summarises key policy analysis frameworks and guidance including their primary purposes, analytical components, strengths, limitations, and contributions to the development of IPAF. The frameworks were selected to represent complementary analytical perspectives, including policy appraisal, policy processes, health systems analysis, health impact assessment, and comparative policy analysis. Together, these approaches informed the integration of multiple analytical levels within IPAF.

Figure 1 illustrates the disciplinary distribution of the 3,605 Web of Science publications, identified through the search strategy, for the eight selected policy analysis frameworks. This distribution analysis was conducted to explore the distribution and disciplinary reach of these selected frameworks within the health research literature, rather than to synthesise the literature. The findings demonstrate that the selected frameworks have been applied across a wide range of health research areas, with the highest representation in Health Care Sciences and Services (32%), Public, Environmental and Occupational Health (22%), and General Internal Medicine (10%). Smaller proportions were observed across nursing, psychology, medical informatics, pharmacy, rehabilitation, oncology, and other clinical and public health disciplines, highlighting the broad applicability of these policy analysis frameworks across health research.

Figure 1: Distribution of Web of Science health-related articles included in the review of selected policy analysis frameworks by research area (n = 3,605).

The pie chart shows the percentage of articles identified through the Web of Science data-base that examined or applied one of the policy analysis frameworks included in this review: Kingdon’s Multiple Streams Framework, Bardach’s Eightfold Path, Walt and Gilson’s Policy Triangle, the Centers for Disease Control and Prevention (CDC) Policy Process Framework, the Consolidated Framework for Implementation Research (CFIR), WHO Health Policy and Systems Research guidance, Health Impact Assessment (HIA) frameworks, and comparative public policy models. Articles were categorised according to their Web of Science research area. The largest proportion of publications were classified within Health Care Sciences and Services (32%), followed by Public, Environmental and Occupational Health (22%) and General Internal Medicine (10%), demonstrating the broad application of these policy analysis frameworks across health disciplines. Comparison of the selected frameworks demonstrated that, although each provides valuable insights into specific aspects of policymaking or policy implementation, no individual framework fully addresses the range of domains required for comprehensive health policy analysis, such as equity, economic and value perspectives. Across the reviewed literature, recurring analytical concepts included policy context and drivers, governance, stakeholder engagement, implementation processes, evaluation, health equity, policy outcomes, adaptation, and policy transfer. These concepts were mapped using a comparative synthesis and subsequently refined into the eight domains of IPAF (Table 2). The framework developed integrates complementary strengths from existing approaches into a flexible, multidimensional analytical structure designed to support systematic analysis of health policies across diverse contexts, including public health, health services, healthcare delivery, health systems reform, and broader social policy domains.

Table 2: Synthesis of literature themes and their alignment with the Integrated Policy Analysis Framework (IPAF) domains.

Table note: The identified literature themes represent recurring analytical dimensions across comparative health policy analysis, systems thinking, governance, health economics, implementation science and evidence-informed policymaking. These themes were synthesised to inform the structure and content of the IPAF domains, ensuring that the framework integrates complementary perspectives across the policy analysis continuum.

Stage 2: Thematic Synthesis

Key concepts identified during the literature review were subjected to thematic synthesis and framework development processes to identify recurring analytical dimensions. Related concepts were clustered, compared, and refined into broader domains representing the core components required for comprehensive health policy analysis [20,21,30]. The synthesis resulted in eight overarching analytical domains that form the conceptual foundation of IPAF (Table 2).

These eight themes and corresponding domains reflect the progression of health policy analysis as a continuous learning process, moving from understanding the policy environment and rationale through to assessing implementation, outcomes, comparative learning, and future improvement [4,5]. By integrating these domains, IPAF conceptualises policy analysis not as a linear assessment exercise, but as an iterative process that supports reflection, adaptation, and evidence-informed decision-making.

Stage 3: Framework Design

The design challenge was to develop a practical framework that balances comprehensiveness with usability by integrating multiple dimensions of policy analysis without creating excessive complexity. The framework needed to support both single-country and cross-country comparative analysis, remain applicable across diverse health and related policy areas (including emerging topics such as One Health), align with principles of evidence-informed policymaking, and provide a practical tool that researchers, educators, and students could readily apply and adapt to different analytical contexts.

Following thematic synthesis, the emerging domains were organised into a logical sequence to facilitate systematic policy comparison. Thus, the order of the framework begins by establishing the contextual factors influencing policy development before examining policy objectives and implementation processes. Subsequent domains focus on evaluating policy effectiveness, assessing equity considerations, determining transferability across settings, synthesising comparative insights, exploring cost and value, and identifying gaps to inform future policy development.

Each domain contains a series of guiding questions designed to support critical reflection while maintaining flexibility for application across diverse health policy topics and national contexts. IPAF is intended to function as an analytical guide rather than a scoring instrument, facilitating structured qualitative assessment and evidence-informed comparison. However, its broad conceptual structure also allows adaptation for quantitative analysis and mixed-methods approaches where appropriate.

Importantly, IPAF is designed to be methodologically flexible and can be applied using multiple approaches, including document analysis, qualitative inquiry, stakeholder engagement, and mixed methods. Document analysis provides an important means of examining policy content, governance arrangements, implementation mechanisms, and contextual influences within the IPAF domains. Structured approaches to document analysis, such as the READ framework, highlight the importance of systematic and transparent procedures when analysing health policy documents [31].

A one-page visualisation was designed to provide an accessible entry point into policy analysis by presenting key analytical domains and guiding questions in a clear and structured format. This approach supports a shared understanding of the policy analysis process and enables students, researchers, and policymakers to apply a consistent analytical approach without requiring extensive prior expertise. The framework design is intended as a foundational starting point rather than a substitute for more detailed policy evaluation methods. Where deeper analysis is required, individual domains can be expanded using additional evidence, theoretical perspectives, and context-specific methodologies.

Stage 4: Application and Refinement of IPAF Through Applied Policy Analyses

Following the development of the initial framework domains, IPAF was applied prospectively across a range of health policy topics to assess its practical utility, analytical validity, and adaptability across different policy contexts. These applications provided opportunities to test whether the framework could support systematic analysis of diverse policies, identify areas requiring further clarification, and refine the domains and guiding questions. The applied studies examined policies spanning professional regulation, palliative care, long-term care workforce, and home support, representing different health system settings, governance structures, policy challenges, and stages of policy maturity.

Application examples include:

• Language assessment policies in nurse regulation [32]: An early developmental version of IPAF was applied to examine how language assessment requirements influence international nurse regulation, workforce mobility, professional integration, and patient safety. The framework supported analysis beyond the policy objective of ensuring communication competence by examining the broader policy context, regulatory drivers, stakeholder perspectives, implementation processes, equity implications, and unintended consequences for internationally educated nurses. This application of IPAF highlighted the importance of incorporating workforce, migration, and equity considerations within policy analysis and contributed to refinement of IPAF’s Scope and Context, Governance and Implementation, and Equity and Inclusion domains.
• International comparison of palliative care policy [33]: IPAF was used to compare palliative care policies across two countries on one island (Republic of Ireland and Northern Ireland UK). The framework guided an analysis of differences in policy development, health system organisation, governance arrangements, implementation approaches, outcomes, and contextual influences. The framework supported structured comparison while recognising that policy effectiveness is dependent on local health system capacity, cultural factors, financing arrangements, and service delivery models. This analysis strengthened the Comparison and Policy Insights and Transferability and Adaptation domains by demonstrating the importance of assessing contextual compatibility rather than assuming direct policy transfer.
• Roles and responsibilities of healthcare assistants in longterm care [34]: IPAF informed analysis of healthcare assistant roles in long-term care by examining how workforce policies are shaped by demographic pressures, labour market conditions, regulatory environments, training requirements, and models of care delivery. Application of the framework in this context demonstrated the value of analysing policy implementation mechanisms, stakeholder responsibilities (e.g., private versus public employers), governance structures, and workforce implications, alongside formal health policy objectives. Findings from this study contributed to refinement of the Policy Approach and Design and Governance and Implementation domains by highlighting the importance of role clarity, accountability, and implementation capacity.
• International perspectives on home support policy [35]: IPAF was applied to examine international approaches to home support policy, including policy objectives, service models, governance arrangements, equity considerations, and approaches to sustainability. The framework enabled comparison of how different countries balance independence, informal caregiving, workforce availability, and resource constraints when designing community-based care policies. This application further refined IPAF’s emphasis on Equity and Inclusion, Transferability and Adaptation, and Gaps, Recommendations, and Future Directions by demonstrating the importance of considering social context and future system pressures.

The example in Box 1 illustrates how the application of IPAF in the fourth study, helps to provide a robust contextual analysis of the current policy for home support in the Republic of Ireland.

Box 1: Application of the Integrated Policy Analysis Framework (IPAF) to Home Support Policy in Ireland (adapted from Morrow et al., 2026 using IPAF).

To demonstrate the iterative refinement of the IPAF, the framework was applied across these four diverse health policy analyses. Figure 2 illustrates how each application contributed to strengthening specific IPAF domains, with contributions varying according to the policy context and analytical focus. Collectively, the applications enhanced all eight domains, with particularly strong refinements in Governance and Implementation, Equity and Inclusion, Comparison and Policy Insights, and Transferability and Adaptation. The summary diagram highlights the cumulative contribution of these applied studies, demonstrating how iterative testing across different policy settings improved the framework’s comprehensiveness, contextual sensitivity, and practical applicability.

Figure 2: Application and refinement of the Integrated Policy Analysis Framework.