Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of health care providers.
- Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of health care providers.
- Guindon GE, Lavis JN, Becerra-Posada F, Malek-Afzali H, Shi G, Yesudian CA, Hoffman SJ
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Background: Gaps continue to exist between research-based evidenceand clinical practice. We surveyed health care providers in10 low- and middle-income countries about their use of research-basedevidence and examined factors that may facilitate or impedesuch use.
Methods: We surveyed 1499 health care providers practising inone of four areas relevant to the Millennium Development Goals(prevention of malaria, care of women seeking contraception,care of children with diarrhea and care of patients with tuberculosis)in each of China, Ghana, India, Iran, Kazakhstan, Laos, Mexico,Pakistan, Senegal and Tanzania.
Results: The proportion of respondents who reported that researchwas likely to change their clinical practice if performed andpublished in their own country (84.6% and 86.0% respectively)was higher than the proportion who reported the same about researchand publications from their region (66.4% and 63.1%) or fromhigh-income countries (55.8% and 55.5%). Respondents who weremost likely to report that the use of research-based evidenceled to changes in their practice included those who reportedusing clinical practice guidelines in paper format (odds ratio[OR] 1.54, 95% confidence interval [CI] 1.03–2.28), usingscientific journals from their own country in paper format (OR1.70, 95% CI 1.26–2.28), viewing the quality of researchperformed in their country as above average or excellent (OR1.93, 95% CI 1.16–3.22); trusting systematic reviews ofrandomized controlled trials (OR 1.59, 95% CI 1.08–2.35);and having easy access to the Internet (OR 1.90, 95% CI 1.19–3.02).
Interpretation: Locally conducted or published research hasplayed an important role in changing the professional practiceof health care providers surveyed in low- and middle-incomecountries. Increased investments in local research, or at leastin locally adapted publications of research-based evidence fromother settings, are therefore needed. Although access to theInternet was viewed as a significant factor in whether research-basedevidence led to concrete changes in practice, few respondentsreported having easy access to the Internet. Therefore, effortsto improve Internet access in clinical settings need to be accelerated.
Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of health care providers. Guindon GE, Lavis JN, Becerra-Posada F, Malek-Afzali H, Shi G, Yesudian CA et al. CMAJ 2010; 182(9):E362-72.