Caroline Fiennes: It's not enough for research to be right - it must travel to where it makes a real difference

'Research uptake' can sometimes take years, but more work is required if we are to understand how this difficult art works, says our columnist

Caroline Fiennes
Caroline Fiennes

Every schoolchild knows vitamin C prevents scurvy. But when James Lind, a Scottish naval surgeon, made that discovery in experiments that began in 1747, how long was it until the British Navy started to provide citrus fruit and juice to sailors? At the time, scurvy was killing more sailors than military action, so the answer is surprising: more than 40 years.

"Research uptake", as this is known, is a difficult art. Luckily it's becoming a discipline in its own right, with two strands – uptake by governments in policy and uptake by front-line practitioners. Charities and charitable funders produce research and insights that we hope will be taken up in both strands.

The scurvy story shows that it's not enough to be right, even if the insight is important to national security and cheap to implement. In last year's BBC Reith Lectures, Dr Atul Gawande talked about how his Indian grandmother died of malaria well after chloroquine was discovered to be a prophylaxis. The news must travel to where it's needed.

Research uptake in front-line practice is helped if the research is readily digestible. The five-a-day campaign gained traction because we could all remember it and can count to five; but the campaign to limit the number of grammes of salt we eat each day did not, because that number was too hard to count. Medical colleges and regulators provide doctors with clinical practice guidelines – briefing papers that allow doctors quickly to refer to or cite research evidence during their working day. These guidelines improve care because they're simple: they're normally two pages long, address a specific situation and show which suggestions are based on solid evidence and which are our best guess, based on the available research.

Perhaps more charities that deliver services could experiment with codifying procedures into guides for front-line workers. This, of course, raises the question of how to ensure that research is absorbed into those guides, and here too there is much to learn. An analysis of the uptake of biomedical research funded by the Wellcome Trust into clinical practice guidelines found that it tends to take about eight years – a finding corroborated by similar studies.

Surprisingly, there seems to be more analysis of research uptake by governments in developing countries than in developed ones. Abhijit Banerjee and Esther Duflo, development economists at the Massachusetts Institute of Technology in the US, identified three barriers in their work in 18 developing countries. Of these, ignorance is the easiest to address, because it can be solved by good events, publications and press. Inertia and ideology are harder to overcome.

The economists find that the key to influencing government to act on research is to involve officials before it begins.

Similarly, in the UK the Department for International Development's guidelines for its grantees on increasing research uptake stresses that it is a social process in which relationships are important.

Perhaps charities should note when they succeed or fail in getting research taken up by other organisations, and when they absorb it themselves, so that over time we hone our research uptake skills.

Caroline Fiennes is director of Giving Evidence and author of It Ain't What You Give

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