Submitted by Judith Bauer, PhD, FDAA
Associate Professor, University of Queensland, Brisbane
PEN Translational Research Leader, DAA
Closing the Evidence-to-Practice Gap
Translating research into practice is an international issue challenging all health professions. This evidence to practice gap has been recognized for over 20 years and timeframes of 15-17 years for research to be implemented are not uncommon (1). Although there have been advances in technology which have closed some of this gap in recent years such as electronic submission of manuscripts to journals, decreased review times and early online view of accepted articles, the uptake of new evidence by practitioners. Glasziou & Haynes (2) coined the phrase ‘practice famine amid the evidence glut’ to describe this ongoing issue.
The ICDA 2010 consensus statement on evidence based dietetic practice identifies important elements such as ‘asking questions, systematically finding and assessing the quality of evidence as well as combining that information with expertise or experiences and the client or community values to guide decision-making’. One of the key barriers is lack of awareness of new evidence. This is not surprising given that in 2013 there were over 20,000 new PubMed nutrition citations, 76 journals in the field of nutrition and dietetics (3) and many of our colleagues publish outside the field of dietetics in specialized medical journals. It is increasingly difficult to maintain currency in one area of practice, let alone have a good overview of all of the domains of dietetic practice. Dietitians need to be both aware of and savvy users of technology to advance their practice and become familiar with databases that contain synthesized information.
The PEN system has evidence-based, peer-reviewed answers to practice questions across the diverse domains of dietetic practice. The historic PEN partnership of Dietitians of Canada, The British Dietetic Association and Dietitians Association of Australia is helping to close the evidence to practice gap and advance dietetics internationally.
Even when we are aware of new evidence and accept that our practice needs to change, there may be a number of recognized implementation barriers related to the healthcare system. These may relate to policy, interdisciplinary team roles and behaviours, financial constraints, patient beliefs and expectations to name a few. It is important to identify a comprehensive list of barriers and enablers by consulting with the interdisciplinary team and other key stakeholders to ensure all issues are identified and addressed.
There are a number of frameworks for behavior change interventions that can be used to identify appropriate strategies based on the sources of behavior. An excellent example is the Behaviour Change Wheel developed by Mitchie et al (4) from a systematic review of existing frameworks. It consists of a hub of essential conditions (capability, opportunity and motivation) surrounded by nine intervention functions aimed at addressing deficits in one or more of these conditions and around this are seven categories of policy that may enable the interventions to take place.
Improving the implementation of evidence based dietetics practice is a key priority for our profession and a challenge we must all embrace and strive to practice famine amid the evidence glut (2).
References:
1) Contopoulos-Ioannidis, D.G.,Alexiou, G.A., Gouvias, T. C., Ioannidis, J. P. A. (2008). Life Cycle of Translational Research for Medical Interventions Science, 321 (5894), 1298-1299. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18772421
2) Glasziou, P., & Haynes, B. (2005). The paths from research to improved health outcomes. Evidence Based Nursing, 8(2), 36-38. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15830412
3) 2012 Journal Citation Reports® Science Edition (Thomson Reuters, 2012).
4) Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21513547