Communicating health research (7) Role of local evidence in policy and practice

17 August, 2022

Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control.

(with thanks to Irina Ibraghimova and LRC Network)

'What local, contextual evidence is needed when transferring and adapting an intervention or strategy to a specific LMIC setting?' This paper aims to answer this question with regards to cancer prevention and control. Citation, abstract and a comment from me below.

CITATION: JCO Glob Oncol. 2022 Aug;8:e2200054. doi: 10.1200/GO.22.00054.

Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control.

Parascandola M(1), Neta G(2), Salloum RG(3), Shelley D(4), Rositch AF(5).

PURPOSE: Although the global burden of cancer falls increasingly on low- and middle-income countries (LMICs), much of the evidence for cancer prevention and control comes from high-income countries and may not be directly applicable to LMIC settings. In this paper, we focus on the following question: When the majority of the evidence supporting an evidence-based intervention or implementation strategy comes from high-income countries, what local, contextual evidence is needed when transferring and adapting an intervention or strategy to a specific LMIC setting?

METHODS: We draw on an existing framework (the Population, Intervention, Environment, Transfer-T process model) for assessing transferability of interventions between distinct settings and apply the model to two case studies as learning examples involving implementation of tobacco use treatment guidelines and self sampling for human papillomavirus DNA in cervical cancer screening.

RESULTS: These two case studies illustrate how researchers, policymakers, practitioners, and consumers may approach the need for local evidence from different perspectives and with different priorities. As uses and expectations around local evidence may be different for different groups, aligning these priorities through multistakeholder engagement in which all parties participate in defining the questions and cocreating the solutions is critical, along with promoting standardized reporting of contextual factors.

CONCLUSION: Local, contextual evidence can be important for both researchers and practitioners, and its absence may hinder translation of research and implementation efforts across different settings. However, it is essential for researchers, practitioners, and other stakeholders to be able to clearly articulate the type of data needed and why it is important. In particular, where resources are limited, evidence generation should be prioritized to address real needs and gaps in knowledge.

COMMENT (NPW): In the full text, the authors 'offer some additional tools and best practices for researchers to consider', drawing on the broader literature and their own experience:

'1. Engage stakeholders: Whole system stakeholders should be involved from the start in identifying priorities, framing research questions and participating in study design decisions to both build commitment and to ensure that relevant data needs are addressed. Stakeholder groups should include implementers as well as policymakers.

2. Apply conceptual frameworks: Conceptual frameworks and theories, such as the Consolidated Framework for Implementation Research...

3. Use hybrid study designs when feasible: Study designs should consider and include process, context, and outcome measures aligned with stakeholder priorities...

4. Promote standardized context reporting: Publications often lack information about context. Standardized reporting of the context in which an intervention was tested would allow for greater understanding of the role of local factors and transferability...

5. Embed capacity building: To account for local context in the design, conduct, and interpretation of research studies, it is essential to have participation of skilled local researchers...'

I invite comments on any of the above.

Also, it seems to me that the challenge of systematically merging global with local evidence is huge and highly complex. Do you have practical experience of such synthesis? What are the most promising approaches?

Best wishes, Neil

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

Working in official relations with WHO