Research interventions need to be trialled in the clinical setting rather than academic institutions to improve the evidence to practice research gap.
Currently only 14% of evidence-based research is implemented in the clinical setting and it takes as long as 17 years.
The figures were presented by Behavioural and Implementation Scientist Professor Luke Wolfenden, Director of the National Health and Medical Research Centre (NHMRC) for Research Excellence, in the webinar Implementation Science and the Prevention of Chronic Disease.
Co-Director of the WHO Collaborating Centre for National Chronic Disease Program Implementation, Professor Wolfenden, said that existing evidence-based interventions could prevent half of all cancers occurring today.
“There is an enormous gap against what should be done to improve patient health and what happens in practice. This is across almost all fields.”
“There is attrition in the pipeline which has resulted in not as much research innovation as we would have like to have seen.”
Professor Wolfenden’s research addresses primary modifiable risks, including obesity, diet, physical inactivity, alcohol and tobacco use.
Over the past five years his work has focused on trialling interventions to reduce modifiable chronic disease risks in the community; and trialling dissemination and implementation strategies to increase the adoption of evidence-based chronic disease prevention practices by organisations in the community.
Professor Wolfenden outlined three barriers to implementation of research by health practitioners:
- Adaptation or modification of interventions for the local clinical setting.
- Lack of evidence on how to best implement interventions.
- Implementation is characterised by bursts followed by prolonged periods of latency.
An example of the research to practice gap in school-based childhood health interventions found:
- Less than 5% of childcare centres comply with dietary guidelines.
- Less than 30% of schools comply with physical activity guidelines.
Efforts to address the research to practice gap have included: increasing awareness of research; having dedicated funding schemes; and capacity building and investing in infrastructure such as through the Cochrane Collaboration and other databases to curate the most relevant research to policy makers and clinicians.
“However, new approaches need to be embedded in clinical and public health practice,” said Professor Wolfenden.
Rather than university institutions as the hub for research trials, we need to move the centre of gravity from universities into the public health system – into the real-world setting, he said.
There needs to be novel partnerships and health workforce transformation along with examination of the interaction between intervention, implementation and the context, argues Professor Wolfenden.
“Often there is a difficulty to identify what works for whom in what context. We need a nuanced assessment.
“New models are required where research is conducted in the contexts it is to be applied with end-users who will apply it.
“We need to test efficacy of our interventions and we need to consider the context and population we are applying it to.
“We also need to employ harmonised methods that builds directly off prior knowledge and which seeks to contribute to generalised knowledge.”
Some current projects using implementation science to address chronic disease risk factors include:
- Engaging maternity services to address smoking, alcohol consumption and weight gain in pregnancy.
- Learning health systems approach to optimise implementation of prevention programs – reducing the risk factors in young children.
- Public health law: making it work for the prevention of chronic disease.
The Maridulu Budyari Gumal SPHERE Implementation Science Platform – Implementation Science and the Prevention of Chronic Disease was presented by special guest speaker, Professor Luke Wolfenden on 24 October 2022. The recording is now available.