Introduction: Moving Research into Practice

FHI initiative seeks to bridge the gap between findings and their use.

Network: 2003, Vol. 23, No. 1

By Matthew Tiedemann, MA
FHI Senior Program Manager
Tiedemann manages FHI's Research to Practice Initiative.

Public health research is not an end in itself; rather, it is intended to generate knowledge that can be used to improve service delivery, policies, and practices. Many research findings are available to inform health services, yet a gap exists between research results and the desired outcome of putting them into practice.¹ This is of particular concern in the developing world, where the challenges of providing quality health services to a growing population are enormous.

Bridging the research to practice gap, however, is rarely straightforward. Efforts to promote use of research findings must address the complexities of both the research and policy-making processes, as well as the difficulties of effecting organizational and behavioral change.

Recently, the international health community has begun paying greater attention to research utilization. The World Health Organization (WHO), which has long considered this issue a priority, convened a technical consultation on utilization earlier this year. A meeting report that describes utilization case studies, some of which are featured in this issue of Network, is available (contact Dr. Michael Mbizvo). WHO, together with FHI, the Population Council's Frontiers in Reproductive Health Program, the United Nations Population Fund (UNFPA), the U.S. Agency for International Development (USAID), and other partners, is also developing a "toolkit" that includes some of these case studies, defines levels of utilization, and explains research utilization pathways.

Growing international interest in this topic is also illustrated by the fact that donor organizations are focusing more on the impact of their investments in research.² Service delivery organizations are increasingly expected to demonstrate that their interventions and services are efficient, effective, and based on the best evidence available. In addition, research ethics require that study participants and their communities benefit from research more directly than has been typical in the past.³

Those individuals attempting to enhance research utilization often speak of conditions that can facilitate or hinder utilization. A few conditions are, in fact, necessary for use to occur. For instance, potential users of research results must appreciate the relevance of particular findings and commit to using them. Such commitment can be encouraged by involving potential users in the research process; for example, they can help identify questions and interpret findings.

While no specific set of conditions is sufficient to ensure that results will be used, understanding which conditions will likely influence their use, and which conditions can be altered, is fundamental to utilization efforts. Determining what can be done to create these conditions in a given setting is the primary challenge facing those promoting research utilization. Some evidence and logic suggest that comprehensive efforts addressing multiple factors are more likely to achieve the goal of sustained use of findings.⁴ Yet, such comprehensive approaches require substantial time, effort, and financial resources.

Especially challenging is the task of advancing findings from global-level research — that is, research to address broad questions that are relevant in a range of settings. (An example of such a question was the suspected link between vasectomy and prostate cancer. A recent study conducted in five countries found no evidence to support this link.⁵) These types of questions can most effectively be answered via multisite trials that satisfy sample size and infrastructure requirements and can produce generalizable knowledge. Such research is intended to inform policies and practice globally; however, the nature of the study design limits local stakeholder involvement (beyond that at study sites), and research findings may not directly address service delivery issues in other settings. As a result, certain necessary and facilitating conditions for research utilization may be absent and must be established if the global findings are to be used. That means that the active participation of those who know and understand the local environment is critical for translating such results into practice.⁶

Recognizing the myriad challenges of bringing research to practice and seeking to maximize use of its own research findings, FHI launched a Research to Practice Initiative in 2001. This initiative takes a strategic approach to creating conditions that influence research utilization and to improving the channels from research to practice and from practice to research. We invite readers to learn more about this initiative by clicking here. We also encourage readers to write to us at network@fhi.org to share how they are putting research into practice.

References

1. Rosenberg R. Translating biomedical research to the bedside: a national crisis and a call to action. JAMA 2003;289(10):1305-6.
2. Askew I, Matthews Z, Partridge R. Going Beyond Research. New York, NY: Population Council, n.d.; Buxton M, Hanney S. How can payback from health services research be assessed? J Health Serv Res Policy 1996;1(1):35-43.
3. Council for International Organizations of Medical Sciences (CIOMS). International Ethical Guidelines for Biomedical Research Involving Human Subjects. Geneva, Switzerland: CIOMS, 2002.
4. Grimshaw J, Shirran L, Thomas R, et al. Changing provider behavior: an overview of systematic reviews of interventions to promote implementation of research findings by healthcare professionals. In Haines A, Donald A, eds. Getting Research Findings into Practice, Second Edition. (London, UK: BMJ Books, 2001)29-67; Haines A, Donald A. Making better use of research findings. BMJ 1998;317(7150):72-75.
5. Cox B, Sneyd MJ, Paul C, et al. Vasectomy and risk of prostate cancer. JAMA 2002;287(23):3110-15.
6. Ellerman D. Knowledge-based development assistance. Knowledge Technol Policy 2000;12(4):17-43.