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Open Access Highly Accessed Research article

Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia

Morten Aaserud1*, Simon Lewin23, Simon Innvaer1, Elizabeth J Paulsen1, Astrid T Dahlgren1, Mari Trommald4, Lelia Duley5, Merrick Zwarenstein36 and Andrew D Oxman1

Author Affiliations

1 Norwegian Knowledge Centre for Health Services, Box 7004 St. Olavs Plass, N-0130 Oslo, Norway

2 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

3 Health Systems Research Unit, Medical Research Council of South Africa, South Africa

4 Directorate for Health and Social Affairs, Postbox 7000 St. Olavs plass, N-0130 Oslo, Norway

5 Department of Psychiatry and Behavioural Sciences, 15 Hyde Terrace, Leeds LS2 9JT, UK

6 Institute for Clinical Evaluative Sciences, University of Toronto, G1 06, 2075, Bayview Avenue, Toronto, ON, Canada M4N 3M5

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BMC Health Services Research 2005, 5:68  doi:10.1186/1472-6963-5-68

Published: 1 November 2005

Abstract

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.

Conclusion

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.