RESEARCH & DEVELOPMENT: Embedded research and development – design for RU - for policy & practice change John Walley COMDIS-HSD Research Co-Director HOW TO GUIDE ON RESEARCH & DEVELOPMENT: THE EMBEDDED APPROACH

Problems of getting research into practice The usual research - dissemination model Research “discovers” solutions, then try to “Market” to busy decision-makers & practitioners Is necessary, but not sufficient, as not: start from needs of policy-makers & practitioners a typical service context – so not replicable Evidence products; guidelines, tools - for scale-up. To change policy and practice, best embed research within MoH programme - priorities, policies & sites

Embedded R and D – design for RU - policy and practice change at scale Intervention- trial & qualitative & costing studies Evidence-based intervention-package design to be effective, replicable & sustainable

Communications & RU - COMDIS H Service Delivery Communication related activities include: Priority setting-coordination meetings, MoH Technical working group – eg draft guidelines Steering group, approval, decision to scale up Evidence products (synthesise existing & new K): Clinical, operational, planning etc. guidelines WHO level of evidence & strength of recommendation Training modules & tools – used in scale-up Policy briefs, case studies Peer-reviewed papers See the COMDIS Communications Handbook Research Uptake (RU) The policy and practice change - objectives outcomes achieved

Four stages of research & development: with the policy-makers and users 1. Design and develop, evidence based review, and if required explanatory research 2. Pre-test and pilot the intervention package guidelines, modules, registers and other tools 3. Implement and trial the intervention/ package 4. Support policy and practice change (RU) – go to scale in country, and X countries

Implement and evaluate the intervention Stages of Embedded R and D – leading to policy and practice change (RU) Stages of Embedded R and D Stage 1 Design and develop service delivery package in line with MoH national priorities Stage 2 Pre-test and pilot package (e.g. guidelines, materials and research tools) Stage 3 Implement and evaluate the intervention Stage 4 Support both policy and practice change (RU) nationally and internationally

Embedded R and D for CVD-diabetes in primary care Stage 1 Evidence-b review & generic clinical and life-style guides & package developed China, adapted in line MoH rural insurance and public health package policies Stage 2 Pilot package guidelines, materials. Revision of design of the trial China Stage 3 Implement and evaluate intervention cluster RCT Stage 4 Support both policy and practice change - evidence products - nationally and internationally Similarly in Pakistan, Nigeria, Tanzania & Swaziland

NCDs – CVD-diabetes primary care Design the service delivery package within policies and context - so likely replicable and sustainable ZHEJIANG PROVINCE CDC AND UNIVERSITY COMDIS CHINA AND LEEDS China Cardiovascular disease prevention and control deskguide Identify and manage cardiovascular disease or risk Draft 1 of 6.1.11 CVD risk - Diabetes Drafted clinical & lifestyle guides Pilot on-going Cluster RCT to start April Lunchtime IVI Antibiotics! Antibiotic Misuse & drug resistance Project