New discussion: Implementation Research - engaging everyone, not just scientists!

7 August, 2016

Improving access to medical treatments and other health services

Join HIFA today for a major thematic discussion on Implementation Research. The discussion will launch on 8 August 2016 and will continue through to 19 September 2016. We are grateful for support from the World Health Organization (WHO), the Special Programme for Research and Training in Tropical Diseases (TDR) and The Lancet.

Why do we need implementation research?

Millions of children and hundreds of thousands of women die every year from diseases that are preventable with basic, existing interventions such as oral reydration solution, WAter and Sanitation Hygiene (WASH), and antibiotics. Most of these deaths are occurring because of failure to deliver these interventions where and when they are needed. Similarly, millions of people with mental health problems, diabetes, hypertension, cancer fail to receive timely interventions to prevent and manage disease. Indeed, every area of health and disease is affected by implementation issues. Implementation research aims to improve the way medical treatments and other health services are delivered in low- and middle-income countries. It can be described as a 'systematic approach to understanding and addressing barriers to effective and quality implementation of health interventions, strategies and policies' (see TDR Toolkit). Implementation research addresses a wide range of questions, including (but by no means limited to) questions around how to improve the availability and use of health information (the central challenge of HIFA).

Objectives of the discussion

1. To raise awareness and understanding of implementation research: what it is, why it's important, how it is done. 2. To learn from researchers and others who have been involved in implementation research. 3. To learn from those who have used or applied the findings of implementation research (eg guideline developers, policymakers, health managers, frontline health workers...). 4. To hear from those in the field - and especially frontline healthcare providers - about what *they* consider are the main challenges in improving access to all for medical treatments and other health services. 5. To promote collaboration between researchers and healthcare providers.

Questions for discussion

1. Have you ever heard of implementation research? What do you think of it? 2. Have you been involved in any implementation research? Can you tell us about your experience? What was your group able to accomplish and how? What were the challenges? 3. Have you used or applied the the results of implementation research? How? What were the benefits?What were the challenges? 4. If you are a frontline healthcare provider, what are the key challenges in making medical treatments and other health services available to the population you serve? What needs to be done to better understand and address these challenges? Can you suggest implementation research questions that might be explored through implementation research. 5. How does your community (local community, country, professional group) view health research? How could you get them involved? 6. What is needed to strengthen national and international capacity to undertake and apply implementation research?

How will the discussion be taken forward?

A summary of the discussion will be made available for all. It is hoped the discussion will help clarify understanding of implementation research among HIFA members and identify some priority implementation issues that need to be addressed. HIFA members may see opportunities for engagement in future implementation research. The discussion will also help inform future international conferences, including the Cochrane Colloquium (Seoul, South Korea, 23-27 October 2016) and the Global Symposium on Health Systems Research (Vancouver, 14-18 November 2016)

Implementation research: How does it work?

Implementation research is different from other forms of research because it demands different perspectives and skill sets beyond those of research. It brings together teams of people – not only researchers but also disease control officers, community members and policy-makers. These teams identify practical problems that are preventing people from getting the healthcare they need. They develop a research question, with the goal of finding a solution that they can quickly put into practice. [1,2] Advocates, NGOs, and healthcare practitioners – doctors, nurses and community health workers – can participate in and even initiate implementation research, since these are the people who see the problems and are best placed to develop the solutions. Research costs are generally modest, yet the studies have the potential for a huge magnifier effect, extending the impact of health interventions. 'Context plays a central role in implementation research. Context can include the social, cultural, economic, political, legal, and physical environment, as well as the institutional setting, comprising various stakeholders and their interactions, and the demographic and epidemiological conditions. The structure of the health systems (for example, the roles played by governments, non-governmental organisations, other private providers, and citizens) is particularly important for implementation research on health.' [2]

Implementation research: How are the results applied in policy and practice?

Leading scientific journals have established sections promoting the publication of such research and some (eg BMC Implementation Science - open access) focus specifically on implementation issues. A Medline search on Dissemination and Implementation Science (scroll down to PubMed: Search for Dissemination and Implementation Science) reveals more than 15,000 papers, from 1979 to the present day. Implementation research has been used to develop new ways of getting bednets and malaria medications to remote communities; getting an annual treatment to prevent river blindness to more than 60 million Africans; and increasing the numbers of antiretroviral drugs for human immunodeficiency virus (HIV). Implementation research contributes a growing part of the evidence base used by the WHO, which promotes, supports, publishes and evaluates such research. Implementation research is increasingly important in the development of WHO guidelines and recommendations, and in the development and implementation of national health policies.


[1] Peters DH et al. Implementation research: what it is and how to do it. BMJ 2013;347:f6753

2] Hales S et al. Reporting guidelines for implementation and operational research. Bulletin of the World Health Organization 2016;94:58-64

Further reading: Implementation research toolkit developed by TDR

Notes on terminology

1. The terminology around implementation research can be confusing. 'Across different healthcare systems, different terms describe these efforts including quality assurance, quality improvement, knowledge translation, knowledge utilisation, knowledge transfer and exchange, innovation diffusion, implementation research, research utilisation, evidence-informed policy, and evidence-informed health systems. These different terms often cover related and overlapping constructs.' Grimshaw et al 2012 2. 'In the United Kingdom and Europe, the terms implementation science and research utilization are being used. In the United States, the terms dissemination, diffusion, knowledge, distribution transfer, and uptake are being used [as well as implementation science]. In Canada, knowledge translation and exchanges are more commonly used.' Khalil H 2016