Research into practice: why is it so difficult to get a GRIP? A discussion paper

Abstract

BackgroundGetting research into practice is extraordinarily convoluted and difficult. The UK is often said to have a great record in invention and research but a poor record in development. The same most certainly applies to health services, to public health, and to healthy public policy. The application of the best evidence for what works in public health and healthy public policy cannot be systematic and all-embracing because knowledge is not systematic and comprehensive. However, for the ethical practice of public health, we need to ensure that when we know an intervention works it is implemented properly, in accordance with the same implementation protocols devised for the research, implemented at scale, and likely to deliver the effect sizes predicted to a large number of beneficiaries in the population. So why is it so difficult to get research into practice? MethodsSandwell Public Health Department leads for the Birmingham Black Country Collaboration for Leadership in Applied Health Research and Care (CLARHC-BBC), researching housing and health, secondary prevention of cardiovascular disease, and leading on knowledge dissemination for healthy public policy, including criminal justice and health. Sandwell is one of the few service public health departments in the country to lead a CLARHC theme. This report describes case histories of getting research into practice from these programmes: the Marshall–Sandwell model of cardiovascular risk stratification for the secondary prevention of cardiovascular disease; the methadone maintenance programme for treatment and rehabilitation of opiate drug users; the housing and health data warehouse; and the use of peer support workers to increase breastfeeding in a deprived inner city population. FindingsThere have been substantial and positive outcomes in each of these programmes: 70 fewer deaths per year from cardiovascular disease since 2007, when the risk stratification programme was rolled out; a 30% fall in domestic burglary since 2004 alongside a doubling of delivery of methadone maintenance programmes; a fall in excess winter deaths alongside achievement of the decent housing standard for all council housing energy ratings; and a rise of over 10% in breastfeeding rates to 37% since the implementation of breastfeeding support workers. Only the first two programmes could claim high-level evidence to justify their implementation. There is negative evidence for breastfeeding support workers from CLARHC-BBC. Implementing a non-evidence-based programme that seems to work may be harmful in distracting attention to underlying positive factors. InterpretationThe barriers to getting research into practice are professional, political, institutional, managerial, and, in some cases, personal. Professionals have to be persuaded in sufficient number of the value of an intervention; institutions need to be persuaded it is affordable and deliverable; planning and commissioning cycles need to be met at the right point in the calendar; and personal and political prejudices of the “not invented here”, “not in my backyard”, or “not in my term of office” variety need to be overcome. The presentation describes some of Sandwell Public Health Department's efforts to develop embedded research in service practice from our experience in the CLARHC-BBC. We have appointed senior lecturer sessions, research lead time, statistical inputs, and health economist time, and we have sought to bring our academic staff alongside service practitioners. The presentation will ask challenging questions about why and where there seems to be a disconnect between researchers and service practitioners. The presentation discusses how higher education and NHS interests create barriers that prevent the best research being brought to service implementation and how the two interests compete and are kept at a distance. FundingFunding for the individual projects described came from National Institute for Health Research (for CLARHC-BBC), Home Office West Midlands, and Sandwell Primary Care Trust.