Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia.
BACKGROUND
The evidence base for improving reproductive health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Little is known about the factors affecting the use of evidence by policy makers and clinicians, particularly in developing countries. The objective of this study was to examine the factors that might affect the translation of randomised controlled trial (RCT) findings into policies and practice in developing countries.


METHODS
The recent publication of an important RCT on the use of magnesium sulphate to treat pre-eclampsia provided an opportunity to explore how research findings might be translated into policy. A range of research methods, including a survey, group interview and observations with RCT collaborators and a survey of WHO drug information officers, regulatory officials and obstetricians in 12 countries, were undertaken to identify barriers and facilitators to knowledge translation.


RESULTS
It proved difficult to obtain reliable data regarding the availability and use of commonly used drugs in many countries. The perceived barriers to implementing RCT findings regarding the use of magnesium sulphate for pre-eclampsia include drug licensing and availability; inadequate and poorly implemented clinical guidelines; and lack of political support for policy change. However, there were significant regional and national differences in the importance of specific barriers.


CONCLUSIONS
The policy changes needed to ensure widespread availability and use of magnesium sulphate are variable and complex. Difficulties in obtaining information on availability and use are combined with the wide range of barriers across settings, including a lack of support from policy makers. This makes it difficult to envisage any single intervention strategy that might be used to promote the uptake of research findings on magnesium sulphate into policy across the study settings. The publication of important trials may therefore not have the impacts on health care that researchers hope for.
Aaserud
Morten
M
Norwegian Knowledge Centre for Health Services, Box 7004 St. Olavs Plass, N-0130 Oslo, Norway. morten.aaserud@kunnskapssenteret.no
Lewin
Simon
S
Innvaer
Simon
S
Paulsen
Elizabeth J
EJ
Dahlgren
Astrid T
AT
Trommald
Mari
M
Duley
Lelia
L
Zwarenstein
Merrick
M
Oxman
Andrew D
AD
D000927:Anticonvulsants / Q000600:supply & distribution / Q000627:therapeutic use*; D003906:Developing Countries; D018954:Drugs, Essential / Q000600:supply & distribution; D019317:Evidence-Based Medicine; D005260:Female; D006291:Health Policy; D006801:Humans; D007880:Legislation, Drug; D008278:Magnesium Sulfate / Q000600:supply & distribution / Q000627:therapeutic use*; D008428:Maternal Mortality; D009774:Obstetrics / Q000592:standards*; D019982:Organizational Case Studies; D011225:Pre-Eclampsia / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic
D000927:Anticonvulsants; D018954:Drugs, Essential; D008278:Magnesium Sulfate