A gap often exists between research findings and the desired outcome of putting them into use to improve health service delivery, policies, and practices. But this issue of Network highlights several factors that can facilitate the speed and ease of moving research to practice. How various factors can coincide to produce rapid utilization of research findings is illustrated by acceptance of the antiretroviral nevirapine to prevent mother-to-child transmission of HIV in the developing world. Also described in the issue is a pilot initiative by the Kenya Ministry of Health and some 15 partner organizations (including FHI) to increase access to the intrauterine device (IUD) based on research that IUDs are safe, highly effective, and cost-effective over the long term. Finally, this issue of Network offers guidance for identifying worthy research results, as well as various interventions considered to be "best practices" for reproductive health care.
In this issue
Introduction: Moving Research into Practice
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. Bridging the research to practice gap, however, is rarely straightforward. 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. Several Research Utilization Web Resources are also provided here.
Identifying Worthy Medical Research
Women's health care has long suffered many unproved, worthless, and harmful practices based on faulty (or no) medical research evidence. Such inappropriate medical practices can be reduced, however, if health care providers embrace evidence-based medicine: a systematic, diligent search for the best available evidence on a given clinical question. This article helps guide health care providers so they can find and identify research results worthy of putting into practice. Major evidence-based systematic reviews of the literature and evidence-based practice guidelines are discussed, and Other Evidence-Based Medical Web Resources are listed. U.S. Preventive Services Task Force criteria for reviewing and grading the Quality of Evidence of Effectiveness of interventions also are presented.
How Are 'Best Practices' Identified and Adopted?
This article describes various systematic efforts to classify and encourage the adoption of "best practices" in reproductive health, ranging from specific training techniques or medical procedures to entire programs. 'Best Practices' Web Resources provide additional sources of information on the topic.
Pivotal Points of Change
Many factors can facilitate the speed and ease with which research results are incorporated into practice. Highlighted in this article are four such factors: straightforward research findings; extensive dissemination of findings; supportive economic, political, or programmatic environments in which the research is conducted and implemented; and increased interactions among researchers, policy-makers, and practitioners. Examples of successful utilization of research findings are given in four case studies: Nevirapine Results Quickly Put into Practice, Community-Based Distribution Project Expands beyond Mali, IUD Insertion by Nurse-Midwives Increases Use, and A Single-Visit Approach for Cervical Cancer Prevention. These examples serve to illustrate that successful utilization of research is most likely when various facilitating factors exist.
'Rehabilitating' the IUD
A pilot initiative to reintroduce the intrauterine device (IUD) in Kenya, launched in February 2003 by the Kenya Ministry of Health in collaboration with some 15 partner organizations, is a potential model for activities to promote research utilization. This article highlights the importance of Ministry of Health commitment to the initiative, and how building capacity depends on systematic provider training (Good Training Gives Providers Confidence to Insert IUDs) and attention to supply issues. It also describes advocacy efforts to dispel myths about the IUD and plans for continuous monitoring and evaluation of the initiative. The need to foster strong partnerships with key implementing and policy organizations, as well as professional associations (Professional Associations Are Vital Partners), is emphasized.
Research Involving FHI Collaboration Produces Change
This article describes three research projects in which FHI has recently participated that are changing contraceptive service provision and recommendations. A seven-country study, for example, has shown that ligation and excision vasectomy is more effective when it includes fascial interposition. Various studies have revealed that the spermicide nonoxynol-9 (N-9) does not protect against HIV, gonorrhea, and chlamydial infection. Finally, a checklist developed by FHI to help rule out pregnancy in nonmenstruating clients who request contraceptives has been shown to be more than 99 percent effective at identifying nonpregnant women.
Is Your Research Improving Health Services?
What is the relevance of research for improving health services and outcomes? This question should ideally be considered when research questions are being formulated to ensure that the research will be relevant to practice. Certainly, it must be considered once research results are available and related promising interventions to improve health are being selected for implementation. Subsequently, the challenge is to determine short-term performance, intermediate outcome, or long-term impact of research or interventions. This article describes these challenges, then explains how the intermediate outcome of efforts to introduce a checklist to rule out pregnancy among nonmenstruating family planning clients is being evaluated.
YouthLens: Research That Guides Reproductive Health Efforts for Youth
Several specific conclusions concerning young people's reproductive health that were based on 39 rigorously evaluated programmatic interventions are described in this article. The interventions were identified by the FOCUS on Young Adults Program, which operated from 1995 to 2001. The FOCUS End of Program Report has been synthesized into a 32-page summary, and information for obtaining a copy of that summary is given here.
