1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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
CVD risk - Diabetes
Drafted clinical & lifestyle guides
Pilot on-going
Cluster RCT to start April
Lunchtime IVI Antibiotics!
Antibiotic Misuse & drug resistance Project