Research result to sustained change in practice and policy: a long and winding road

1. Research result to sustained change in practice and policy: a long and winding road

2. Disclosure of interests Director of Australasian Cochrane Centre Employee Monash University Funding from NHMRC, TAC and DoHA Physiotherapist in private practice

3. The problem: research – practice gap ‘There is a gap between today’s scientific advances and their application: between what we know and what is actually being done. Health work teaches us with great rigour that action without knowledge is wasted effort, just as knowledge without action is wasted resource’. LEE Jong-wook WHO Director General 2003-2006

4. “Bridging the know-do gap is one of the most important challenges for public health in this century”.

6. The environment: why we need a better way Over half doctors in US suffer burn out, significantly more that other fields, citing increasing bureaucracy and low sense of accomplishment Evidence based practice is in no way intended to increase bureaucracy or limit autonomy, rather to increase access to reliable knowledge, facilitate best practice and reduce research waste

8. Major strategic initiative to: “support more effective and accelerated translation of health and medical research into improved policy and practice in Australia” • Initial focus on identifying the most significant gaps between research evidence and health policy and practice in NHMRC’s Major Health Issues • Developing a compelling case for NHMRC on how to address those gaps, including advice to government about health policy

9. Research (knowledge) translation • Ensuring stakeholders are aware of and use research evidence to inform their health and healthcare decision-making 1 • Ensuring research is informed by current available evidence and the experiences and information needs of stakeholders • Stakeholders for knowledge translation include: • professionals (practitioners) • consumers (i.e.patients, family members, carers) • educators • policy makers • research funders 1Grimshaw. Implement Sci2012;7:50

10. Knowledge-to-Action Cycle Graham, J EvalClinPract2006, 26:13-24

11. Knowledge-to-Action Cycle Graham, J EvalClinPract2006, 26:13-24

12. ‘I have had the opportunity to consider from more than one perspective the mismatch between what clinical researchers do and what patients need.’

15. Knowledge-to-Action Cycle Graham, J EvalClinPract2006, 26:13-24

16. Translating bodies of knowledge: syntheses of research • The results of individual studies need to be interpreted and translated alongside the totality of evidence • Individual studies rarely by themselves provide sufficient evidence for policy or practice changes - science is cumulative • Early results often lessen over time Your Health Net: http://navigatingeffectivetreatments.org.au/. Developed by CHCP

18. Knowledge-to-Action Cycle Graham, J EvalClinPract2006, 26:13-24

20. Knowledge Skills What theory? Theoretical Domains Framework Beliefs about capabilities Environmental context and resources Social/Professional role and identity Social influences Beliefs about consequences Emotion Goals Optimism Reinforcement Memory, Attention and decision processes Behavioural regulation Intentions Michie et al 2005, J Qual Safe Health Care Cane, O'Connor, Michie. 2012 Implement Sci

21. KhonKaen University, KhonKaen, Thailand • University of Philippines, Manila, The Philippines • Royal College of Medicine Perak, Ipoh, Malaysia • GajdahMada University, Jogjakarta, Indonesia • University of Sydney, Sydney, Australia • MonashUniversity, Melbourne, Australia • University of Adelaide, Australia

22. Magnesium sulphate for eclampsia and pre-eclampsia Corticosteroids prior to pre-term birth Antibiotics for pPROM External cephalic version for breech presentation Continuous support for women in labour Suture materials for perineal repair Vacuum rather than forceps for operative delivery Intra-operative antibiotics at time of caesarean section Active management for the third stage of labour Hepatitis B immunization for newborns Mural at KKU Hospital, Thailand

23. Clinicians in maternal units (midwives, nurses, doctors) and managers and librarians Step 1: Who needs to do what differently? Knowledge, skills, social influences, beliefs about consequences, resources and the nature of the behaviours Step 2: Using a theoretical framework, which barriers and enablers need to be addressed? Access to information, training in EBP, training in clinical skills, audit & feedback, fellowships Step 3: Which intervention components could overcome the modifiable barriers and enhance the enablers? Step 4: How will we measurebehaviour change? Clinical practice measures and patient outcome measures

24. Promoting and sustaining access to research in different formats for different users “Just as ready access to ‘clean’ drinking water has come to be seen as a public health mile-stone of the 19th century, so, in the future, ready access to ‘clean’ health information might well be dubbed as a major public health achievement of this century.” Paul Glasziou, MJA 2002 177 532-3.

26. Number of Cochrane Reviews and Protocols Plus 705,000 records in CENTRAL

28. Informing consumers Spanish 5124 summaries French 3759 summaries Portuguese, Croatian, Japanese, Taiwanese and Indonesian

29. Consumers (patients and carers)

32. Informing clinicians

34. http://ukcc.cochrane.org/guidelines-project

35. Early days… Research must be actively pursued and developed and as fast as new knowledge is acquired it must be applied Commonwealth Minister for Health William (Billy) Hughes, 1936

36. Acknowledgements • Jeremy Grimshaw • Denise O’Connor • Simon French • Joanne McKenzie • Sophie Hill • Steve McDonald • Jill Francis • Philippa Middleton • Susan Michie • Rachelle Buchbinder • Jonathan Craig • David Tovey • Tari Turner