As National Close the Gap Day approaches, it is timely to consider the role of translational research in improving Indigenous health.
In the article below, Professor Neil Thomson, director of the Australian Indigenous HealthInfoNet, reviews the different types and uses of translational research, and suggests that Australia is doing relatively well in the field of translational research and Indigenous health.
Using research to help close the gap in Indigenous health
Neil Thomson writes:
National ‘Close the Gap’ Day provides an opportunity to reflect on the extent to which the findings of research and other information are accessible and used to inform Indigenous health practice and policy.
If an analysis of the situation in Indigenous health was undertaken, it would be surprising if it did not reach conclusions similar to those from reviews by the Institute of Medicine (IoM) of the health-care system in the US, and the World Health Organization (WHO) of health internationally.
In reviewing the ‘chasm’ in the US ‘between the health care we have and the care we could have’, the IoM noted the system ‘frequently falls short in … translating knowledge into practice’. The WHO review recognised the need for up-to-date knowledge in ‘bridging the gap between what is known and what is … done’ in health.
Perhaps the most quoted delay between health research and practice is the 40-50 year gap between the recognition in 1747 (and publication in 1753) of the role of citrus fruits in preventing scurvy and their introduction into the diet of British navy sailors in 1795. It’s easy to dismiss this as ‘historical’, but the IoM report cited research that showed ‘an average of about 17 years … for new knowledge … to be incorporated into practice’.
The long delay cited by the IoM occurred at the time increasing attention was being directed at the translation of research into practice. This work, over a decade or more, was described by different terms, including research utilisation/transfer, and knowledge translation.
The term ‘translational research’ emerged from further work by the IoM. The term was applied initially to translation in two areas: from laboratory findings into potential human interventions (termed T1); and from clinical studies into clinical practice (T2).
The need for translational research is, of course, much more general: it extends well beyond these quite narrow areas of medicine, to public and population-level health, and to other disciplines (environment science, and agriculture, for example).
Within health, T3 has been applied to research extending proven clinical practice across health systems, and T4 to research into specific public health interventions (such as infection control).
None of these types, however, captures the more general translation of research at a population-level (such as for Indigenous people or older people). Extending the current typology, this could be referred to as T5 TR, which is the type undertaken by the Australian Indigenous HealthInfoNet (www.healthinfonet.ecu.edu.au) to inform Indigenous health practice and policy.
A central aspect of all types of translational research is knowledge synthesis, drawing on research and other information. The most recognised syntheses are ‘systematic reviews’, which apply to T1 and T2, and at least partly to T3 and T4.
Knowledge synthesis for T5 TR is much more complex, drawing as it does on a wide range of both quantitative and qualitative research, and surveillance and contextual information. With a more explicit direct focus on practitioners than the other types of TR (their focus on practitioners is more indirect), there are two broad categories of T5 knowledge synthesis: ‘decision-support’ (aimed mainly at high/medium-level policy-makers) and ‘knowledge-support’ (aimed mainly at practitioners). (Of course, no T5 syntheses will, in practice, be exclusively of either category.)
The HealthInfoNet has been supported by the Australian Department of Health and Ageing for almost 15 years to make information readily accessible to people working in Indigenous health, so its knowledge syntheses are of mainly of the knowledge-support type.
The HealthInfoNet’s current topic-specific syntheses provide an overview of the issue in terms of: its extent; contributing factors; services (including attention to barriers); and policies and strategies.
Reflecting the breadth of knowledge required for effective health practice, each synthesis is accompanied on its topic section with a range of other information specific to the topic (such as policies and strategies, health promotion and practice resources, programs and projects, organisations, and publications). An increasing number of sections also support a yarning place (electronic network), which enables practitioners and others to share their knowledge and experiences.
The HealthInfoNet also synthesises information about Indigenous health in its annual Overview of Indigenous health status, a comprehensive summary of the major issues.
Many of the topic-specific syntheses are adapted to produce ‘plain language’ forms for workers who haven’t benefitted from upper secondary and/or tertiary education, as is the case for many Indigenous health workers. There are also special sections for some Indigenous health workers, including environmental health and social and emotional wellbeing workers.
The HealthInfoNet’s work in translational research is complemented by that undertaken by the Closing the gap clearinghouse (CTGC), a COAG initiative operated by the Australian Institutes of Health and Welfare and Family Studies. With a focus on high/medium-level decision-makers, the knowledge syntheses coordinated by the CTGC are mainly of the decision-support type. (As well as its CTGC work, the AIHW’s surveillance work makes a major contribution to Indigenous health information.)
It is almost certain that an analysis of Indigenous health of the type mentioned above would come up with a similar conclusion to the WHO review regarding ‘the gap between what is known and what is … being done’.
It is true to say, however, that Australia is probably doing more than other countries in work aimed at bridging the research/knowledge gap.
The complementary nature of the translational work being undertaken by the HealthInfoNet and the CTGC – one targeted at practitioners and the other at high/medium-level decision-makers – means that Australia is quite well positioned to use research much more effectively to inform Indigenous health practice and policy, but also to be an example to the world on how to apply translational research effectively at a population-level.
• More detail about the Indigenous HealthInfoNet in this previous Croakey post.