How to get research into practice: first get practice into
John Walley,a M Amir Khan,b Sayed Karam Shah,c Sophie Witter d & Xiaolin Wei a
Discovering ways to increase access to tional research should emerge out of action, and participate within national
and delivery of interventions is a major an ongoing partnership with a national programme working groups to design
challenge. Typically research is divorced programme. This includes the process the intervention and draft the guidelines
from implementation, which has led of prioritizing, developing, conducting and materials required for implemen-
to a growing literature about how to and disseminating research, and is part tation. They can conduct the research
get research into practice. However, of national expansion of services. together with the national programme
operational research is best prioritized, Operational research should focus on and advise on the national scale-up.
designed, implemented and replicated local opportunities for going to scale. The The main point is that the national
from within national programmes. first stage is to explore the options that programme implements both the exist-
The current model for most inter- are under consideration for implementa- ing service and the intervention being
national health service research is based tion and then design research to inform tested (as they will replicate nationally
on the assumption that the research the choice of how that implementation if it is found effective). Researchers can
community “discovers” solutions and should best be carried out. For maxi- carry out any data-gathering that is over
then tries to market them to busy mum effect, it is often useful to focus and above the routine (e.g. structured
decision-makers and practitioners. attention on situations where there are interviews or collection of cost data).
The problem of failing to get research resources available from international Research and programme develop-
into policy and practice is well known. or national agencies, but where some ment should be linked. The development
Much debate focuses on the effective- technical or organizational block has pre- components should run alongside the
ness of different approaches to dissemi- vented them from being used effectively. research, with technical assistance being
nation and behaviour change.1–4 This is The research questions may be based provided on programme frameworks
a significant issue when trying to influ- on an understanding of the barriers and operational plans. The intervention
ence individual practitioners. Another to large-scale access.6 Then trials and research guidelines and training mate-
focus is on developing the capacity social and economic studies can be rials should also be adapted and used
of research institutions in developing embedded within programme sites, for successful expansion of whichever
countries, with the expectation that and provide knowledge on how to modality is supported by the opera-
this will increase the relevance and local overcome these barriers and deliver ef- tional research results.
ownership of results.5 We argue that fective interventions, as in Pakistan.7–9 By focusing on specific obstacles,
these two approaches are necessary but Because these operational issues are embedded research improves resource use
not sufficient. The aim should not be commonly relevant to other high-bur- and hence resource availability. Done
to perfect techniques of feeding results den countries, the publication of the well, operations research not only helps
to decision-makers, but to start from results should have international as make effective use of existing internal
the perspective of the decision-makers well as national influence. and external resources, but also assists
even before devising the questions. This Interventions to be evaluated should programme managers to mobilize
means “getting practice into research”. be realistic, given the resource constraints further support once successful imple-
This approach is not appropriate in that setting. Trial designs will vary mentation has been demonstrated.
for research into new and untried treat- according to the circumstances, but the Supporting programmes to conduct
ments where efficacy has not been estab- key point is that the intervention is not research is the best way to build capacity.
lished, but should become the norm for implemented according to some kind of The embedded research approach
operational research, by which we un- international ideal, relying on additional should also build local research capacity.
A track record of successful country re-
derstand research into how an interven- resources, but is integrated into existing
search helps local research teams to bid
tion is implemented. It is an approach health systems and is carried out using
for further funding. Health programme
that is gaining ground in the developed the resources which will be available for
managers in developing countries are
north, but which has even greater appli- eventual scale-up. Unless the resource
increasingly recognizing the value of
cation in resource-constrained settings. expectations are realistic, there will be
research and are setting up their own
Here, based on our experience in China, no follow-up to research.
research teams. O
Pakistan and elsewhere, are some key The national programme should
considerations: implement the intervention, while
Operational research should be researchers facilitate. References
embedded in local programmes. Opera- Researchers can act as a catalyst for Available at http://who.int/bulletin
Communicable Disease Research Programme, Nuffield International Health and Development Centre, Leeds Institute of Health Sciences, University of Leeds, 71-75
Clarendon Road, Leeds LS2 9PL, England. Correspondence to John Walley (e-mail: email@example.com).
Association for Social Development, Islamabad, Pakistan.
WHO Afghanistan Country Office, Kabul, Afghanistan.
Health Economist, University of Aberdeen, Scotland.
424 Bulletin of the World Health Organization | June 2007, 85 (6)
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