A Retrospective Document Analysis of Health Priority Alignment in Research Projects at an

<title>Abstract</title> <p>Background Research prioritization is essential for directing limited resources toward the most pressing health needs. Despite numerous exercises in Iran to set priorities, little evidence exists on whether completed projects align with these agendas or generate meaningful impacts. Methods: This cross-sectional pilot study analyzed documents from 96 randomly sampled research projects completed at Shahid Beheshti University of Medical Sciences between 2013 and 2023. Projects were randomly sampled from the university’s schools, research centers, and clinical research units. Data were extracted from final reports and publications using a validated 12-item questionnaire assessing project characteristics, strategic alignment, health and economic impacts, and research outputs. Data were summarized using descriptive statistics, including frequencies and percentages, to illustrate project characteristics, alignment with priorities, impacts, and outputs. Results: Most projects (95.8%) were consistent with institutional priorities; however, only 60.4% addressed conditions included in Iran’s top 25 causes of disability-adjusted life years (DALYs). The portfolio was dominated by basic-applied (42.7%) and observational (40.6%) studies. Reported impacts were primarily on health status and service delivery (63.5%), particularly through identification of high-risk groups and improved patient management. Economic impacts were rare (2.1%). Nearly all projects (94.8%) resulted in journal publications, mostly in international venues, though only a few produced decision-support documents such as guidelines or policy briefs. Conclusion: Strong alignment with institutional priorities did not guarantee relevance to national disease burden. The research portfolio, dominated by basic-applied and observational studies, yielded few policy or economic outcomes. These findings suggest that rigorous priority-setting processes must be coupled with robust governance, dedicated funding for health systems research, and incentive structures that value translation, to better align research with urgent population health needs.</p>