Re: https://www.hifa.org/dgroups-rss/open-access-25-removing-barriers-betwee...
Dear Rabia,
Thank you for your message a few days ago. You ask four important questions. I shall try to answer the first question and look forward to comments by others on the other three.
"1. How can open access initiatives do more to support translation of evidence into practice, especially in low-resource settings?"
For the purpose of this discussion we are looking particularly at 'peer-reviewed academic research papers, which are mostly published in biomedical research journals'.
https://www.hifa.org/dgroups-rss/open-access-1-please-forward-message-yo...
So, one approach to your question is to ask 'how can open access to peer-reviewed academic research papers support translation of evidence into practice?
The first aspect of this question leads us to ask: "How important is access to the full text of original research to inform practice?".
There is an interesting anecdote in a paper by Virginia Barbour and colleagues:
'Arthur Amman, President of Global Strategies for HIV Prevention (www.globalstrategies.org), tells the following story: “I recently met a physician from southern Africa, engaged in perinatal HIV prevention, whose primary access to information was abstracts posted on
the Internet. Based on a single abstract, they had altered their perinatal HIV prevention program from an effective therapy to one with lesser efficacy. Had they read the full text article they would have undoubtedly realized that the study results were based on shortterm follow-up, a small pivotal group, incomplete data, and were unlikely to be applicable to their country situation. Their decision to alter treatment based solely on the abstract’s conclusions may have resulted in increased perinatal HIV transmission.”
At first sight, we may say this is a classic example of where access to the full text is critical. It would be interesting to have more information about the case, including a citation for the article in question. It seems that access to the full text would have made a difference. However, the story illustrates a more fundamental issue: it seems that the health professionals had a flawed approach to evidence-informed practice. The development of a perinatal HIV prevention program should never be dependent on the full text of a single research study, let alone an abstract. Such a program demands a rigorous approach based cumulative evidence from systematic review. A first step would have been to identify whether there is a current international guideline on this topic from a body such as WHO or UNAIDS. This guidance would neeed to be formally studied and adapted by a team of health professionals in South Africa, usually led by the Ministry of Health, and taking into account the cumulative evidence available in South Africa as well as economic and cultural considerations.
Access to the full text of research will usually be a positive, but it is even more important for health professionals to take an evidence-informed appropach to policy and practice, recognising the limitations of single studies.
We have discussed previously on HIFA how the term 'evidence-informed practice' continues to be misunderstood. We have heard for example that there are many healthcare providers who will base a clinical decision on the findings of a single study, misunderstanding that doing so is 'evidence-informed practice' (it isn't). Evidence-informed practice demands that healthcare providers make their decisions on the cumulative evidence, as provided by systematic reviews (which in turn inform recommendations and guidelines).
The impact of open access on translation of evidence into practice will therefore depend not only on everyone having access to the full text, but as much (if not more) on knowing when and how such full text is to used.
As Unni Gopinathan has mentioned, open access also has an important impact (both positive and negative) on the development of systematic reviews.
https://www.hifa.org/dgroups-rss/open-access-33-open-access-and-availabi...
I look forward to further discussion on the above and your other questions:
"2. What can be done to make open access content more usable and understandable for frontline health workers who may not have research training?
3. Could open access platforms collaborate more with those developing guidelines, job aids, and community health materials, so that synthesized evidence flows more efficiently to end users?
4. And perhaps most importantly — how do we ensure that quality and relevance move hand in hand, so that open access truly helps close the gap between evidence and impact?"
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org