Bridging the gap between research and clinical practice where it matters most : support for evidence-based practice in crises, low and middle income countries and hospitals

There is a gap between health research and health care, a substantial difference between what we know works and what we do in practice. As a result each year there are millions of avoidable deaths, innumerable avoidable episodes of illness and huge waste of resources. This ‘know-do gap’ is global, independent of setting and speciality. Closing the gap is a particular priority in three areas: in crisis settings where the level of resourcing is lowest, in low and middle income countries (LMICs) where the burden of disease is greatest, and in hospitals, the health sector which receives the largest proportion of healthcare funding. This thesis consists of a series of studies investigating the use of research summaries and clinical practice guidelines (CPGs) as knowledge translation tools to bridge the gap in these crucial settings. The studies examine the value and effectiveness of these tools and identify the factors that limit their impact, with the aim of enabling more effective strategies to translate research into practice in these settings. The studies in this thesis employ a range of methods and include an evaluation of research summaries for crisis settings called ‘Evidence Aid’, an examination of the methods for developing evidence-based CPGs, an investigation of the research used to develop current CPGs for crisis settings, an exploration of the barriers to evidence-based CPG development in eleven hospitals in South East Asia and Australia and development of a potential method to overcome these barriers. The results of these studies demonstrate that healthcare decision-makers in crisis settings, LMICs and hospitals are aware of the ‘know-do gap’ and they value tools aiming to address it, such as research summaries and CPGs. However, the studies also identify multiple, substantial barriers that mean these tools are not effectively bridging the gap between research and clinical practice in the settings examined in this thesis. These barriers can be broadly categorised as limitations in relevance of research, resources and relationships between researchers and healthcare decision-makers. There is a deficit of research which has been conducted in, or is relevant to the settings investigated in this thesis. When potentially relevant research is available, adequate description of the context in which the research was undertaken is rarely provided, either in the original research or in subsequent summaries, so relevance is difficult to assess. The limited resources in crises, LMICs and hospitals lead to major impediments to use of research to guide practice. These include lack of time, lack of skills and lack of information technology infrastructure. Lack of relationships between researchers, research synthesisers and healthcare decision-makers is another major barrier. This is both a barrier to identifying what research is needed in knowledge translation tools and a barrier to getting these tools used. By identifying and exploring these barriers, the results of this research will support development of more effective strategies to overcome the ‘know-do gap’ in crisis, LMIC and hospital settings. The pragmatic CPG developmental model presented in this thesis is one such strategy which is tailored to the needs of these settings. Strategies such as this have the potential to improve clinical practice and resource use and, ultimately, better prevent and treat illness and save lives.