In the many discussions I’ve had people about our newly established and growing CLAHRC programme of research and implementation, it often centres on the question of what is Applied Health Research? Is it different from more conventional bio-medical research? It made me think that we need to be a bit more explicit about this thing called Applied Research. So here goes.
Applied health research examines how knowledge is or isn’t used to improve the organisation and delivery of clinical practice, improve efficiency in health services or promote health in society more generally. This sort of knowledge may be derived from most academic disciplines – but the health, medical, social sciences and the humanities have been most prominent in the mix.
Applied health research brings with it the need to understand complexity of the actions of people and their social and technological context.
In a previous blog Tom Monks introduced the notion of system modelling. Systems theory has had an impact across disciplines, encouraging the development of forms of research studying open systems and complexity which is highly relevant to current wider healthcare delivery. The latter is complex and expensive and demand for it increases as populations live longer and develop many versions of co-morbidity, medical and technological innovations are introduced and new health problems are actually created by the routines of clinical practice.
For some time health sciences researchers have argued that this matter of complexity and efficiency needs to be addressed directly. Is practice evidence based? If so how often? How might we get research into practice to maximise its efficiency? If important actors in the system resist evidence how might their behaviour be corrected? How might patients be encouraged to comply with effective clinical interventions? How might prospective patients keep themselves healthy?
Different approaches to these questions have formed the bases of the burgeoning discipline of applied health research. What’s called the GRiP problem (Getting Research into Practice) challenges the notion that more of the same sort of research is required. Those like Andy Oxman suggested a different way forwards. It’s less about more research and more about how might we make best use of what we know already. Also, when knowledge was not used by clinicians or lay people was that from ignorance or for other reasons? Was it sufficient to make more information available to all parties or might efficiency changes require sophisticated knowledge than public information programmes and clinical protocols? The challenge then of affecting changes in clinicians, patients and prospective patients under conditions of complexity became the central consideration for applied health research. So into this picture came the idea of fixing what has been termed the second translational gap.
The Cooksey report of UK health research funding published back in 2006 distinguished between the first translational gap and the second. The first gap of “bench to bedside” referred to the delay of applying the findings of laboratory based research to treatments (at the bedside). The second gap of implementation of evidence into practice – of getting things into practice refers mainly to the context of formal health care settings.
There have been additions and these are of interest to our current CLAHRC agenda. There’s a third translational gap a term coined by one of our sister CLAHRCs (PenCLAHRC) to refer to addressing “the integration of health care as it occurs at the level of the individual patient within the wider context of their lives”. This brings a focus of work to looking at community and domestic settings and brings to the fore a commitment to working with patients and the public. There is potentially a fourth implementation gap which refers not so much to individual patients but the capacity of networks to mobilise and embed resources as part of patient systems of implementation. More on that another time….