The use of research results: at which stage are we in Brazil?

Marcos Basi Ferraz

T he use of research results: at w hich stage are w e in B razil?

Division of Rheumatology,

Escola Paulista de

edicina - Sao Paulo, Brazil

H

ll-b e in g . T h e W o rld B a n k 's 1 9 9 3 W o rld

D e v e lo p m e n t R e p o rt p re se n te d so m e c o n v in c in g e x a m p le s

th a t in v e stm e n ts in h e a lth re se a rc h a n d d e v e lo p m e n t h a v e

y ie ld e d h ig h re tu rn s in b e tte r h e a lth (1 ,2 ). A lth o u g h t h is

fa c t h a s a lre a d y b e e n n o tic e d , th e re is a c o m m o n a g re e m e n t, h o w e v e r, th a t th e w o rld 's h e a lth re se a rc h

p ro g ra m s h a v e o n ly u se d , so fa r, a sm a ll p o rtio n o f th e ir

p o te n tia l c o n trib u tio n . In a d d itio n to th e fa c t th a t,

a p p a re n tly , th e in v e stm e n t in re se a rc h in d e v e lo p in g

c o u n try h e a lth p ro b le m s h a s p ro b a b ly b e e n sta tic o r e v e n

d e c lin in g o v e r th e p a st d e c a d e (2 ), th e re is a c ritic a l n e e d

a lso fo r g o o d q u a lity re se a rc h . It is h a rd to b e lie v e th a t

Address for correspondence: Marcos Basi Ferraz

McMaster University - HSC

Department of Clinical Epidemiology & Biostatistics 2C7 - 1200 Main Street West - Hamilton . Ontario, Canada - LBN 3Z5

m u c h o f th e re se a rc h b e in g d o n e , m a in ly in th e d e v e lo p in g

w o rld , is o f a d e q u a te sc ie n tific q u a lity to p ro v id e fo r v a lid

fin d in g s.

F u rth e rm o re , m o st o f th e h ig h q u a lity re se a rc h th a t

is p e rfo rm e d in th e se c o u n trie s, in fa c t, is o f lim ite d

re le v a n c e w ith re sp e c t to th e n e e d s o f th e p o o r.

B a se d o n th e se a sp e c ts, th e re is a n u rg e n t n e e d to

n o t o n ly in c re a se q u a n tity , b u t a lso th e q u a lity a n d th e

re le v a n c e o f h e a lth re se a rc h , p a rtic u la rly in th e d e v e lo p in g

w o rld . T ra in in g o f p e rso n n e l a n d e sta b lish m e n t o f c a p a b le

re se a rc h u n its a re o f e x tre m e im p o rta n c e to se rv e a s a re so u rc e b a se fo r su c h a ty p e o f e n d e a v o u r. S im u lta n e o u sly ,

w ith th e stre n g th e n in g c a p a c ity , it is im p o rta n t to re d ire c t

th e re se a rc h to so lv e issu e s o f im p o rta n c e a n d im p ro v e

h e a lth c o n d itio n s.

O n c e th e h e a lth re se a rc h is a v a ila b le , p re se n ts a g o o d

sc ie n tific q u a lity a n d ta c k le s q u e stio n s o f re le v a n c e , th e

la st ste p to o v e rc o m e is th e im p le m e n ta tio n o f a s m a n y o f th e stu d y re su lts a s p o ssib le , a n d th e so o n e st a s p o ssib le .

T h e m a in q u e stio n to b e a n sw e re d b y e a c h c o u n try

w illin g to g o th ro u g h th is p ro c e ss is re la te d to th e d e fin itio n o f th e sta g e a t w h ic h th e c o u n try is in th is p ro c e ss. It is

w e ll-k n o w n th a t fo r th e d e v e lo p m e n t a n d im p le m e n ta tio n

of any research, a m inim um of structure m ust be available.

If the m inim um structure is available, it is im portant not

only to carry through a research project but also to

dissem inate the concepts related to the design,

m easurem ent and evaluation of this research. T he point

being m ade here is that a parallel continuous educational

structure has to be built in order to allow the expansion of

the research initiatives. In this sense, it is im portant to

evaluate and pinpoint the country's stage progress (stage

of developm ent). C om ing back to the issue of credibility,

it is crucial for the researcher w ho is teaching research

m ethodology (or any other discipline) to be credible am ong

his/her colleagues. T he scientific com m unity is structured

in a w ay that values the published research productivity

regardless of its relevance and, therefore, it is im portant

for any researcher to be productive; he w ill attract the

attention and respect ability am ong his colleagues and m ay,

in fact, facilitate his function to spread the know ledge in

term s of research em pow ering. In this sense, in each

setting, the research stage m ust be looked at carefully, and

perhaps in som e places, an irrelevant but published

research m ay be of as m uch value as an extrem ely relevant

research. O nce the credibility is obtained and the

know ledge is spread, it is understandable that all the

attention should be focused on the local level priority

research. A t this stage, the identification of research areas

to be tackled should be carefully exam ined and discussed.

In a w orld of scarce resources, the m ost suitable strategy

should be clearly defined. C ertainly, the inter-disciplinary

approach at the conception of the research project w ould

increase the chances of the im plem entation of its results,

but the m ethodology and its scientific validity should never

be threatened by any group discussion.

R egarding the dissem ination of scientific

inform ation, recently, L om as review ed the routes through

w hich inform ation and its im plications are transm itted from

the biom edical research com m unity to practioners w ho

deliver clinical services or their representative

organizations (3). L om as described 3 phases of research

inform ation transference into clinical practice:

I.

diffusion; 2. A ctive dissem ination; and 3. C oordinated

im plem entation.

P assive diffusion guided the design of research

transfer structures until recently, w here users of

inform ation actively seek after research data from w hich

they can select and appraise inform ation appropriately, and

subsequently m ake research-driven, probable patient care

decisions. B ased on studies published so far practitioners'

behaviour is only loosely connected to form ally published

research studies (4,5). T he continuous grow ing in the

volum e of literature certainly posed an obstacle to passive

diffusion. A ctive dissem ination em erged then as a solution

for the im m ense am ount of scientific data being generated

and not fully consum ed. A ctive dissem ination is based on

the w ork of groups of people w ho are ideally credible to

accurately synthesize and dissem inate inform ation and its

im plication for clinical practice, in form ats such as practice

guidelines. T he overall validity of the synthesis or its

applicability to a particular local environm ent m ay be in

question. It requires, therefore, the synthesis (and update)

of the scientific literature in the m ost, if not all specialities

and sub-specialities, w hich is understandably com plex. In

the third and m ore recently adopted strategy, the

coordinated im plem entation, research inform ation m ust

be carefully em bedded in m ultiple routes of influence in

order to pressure practitioners for applying it to patient

care. In this scenario em erges the overall practice

environm ent, w here the adm inistrative, educational,

econom ic and com m unity environm ents interact w ith the

practitioner forcing the adoption of research findings into

local practice.

F inally, the im pact of research inform ation depends

on its ability to change not only beliefs but also policy

assum ptions w ithin the relevant audiences(6). It is

im portant to em phasize that raw inform ation is not usable

know ledge and a process is needed to transform the

research inform ation into know ledge usable in policy

practice. D ecisionm akers targets have to be identified and

reached, and the public has to be directed to a certain level

of know ledge. T his constitutes the fertile ground on w hich

use of certain types of research inform ation m ay be m ade

in the future(6).

In conclusion, all strategies should be considered

(thought about, w eighted, com pared) and used to enhance

the utilization of research results. It should also be kept in

m ind that developed and developing countries or even

different developing countries face distinct stages in

research developm ent and im plem entation. R esearch

quality and researcher credibility should be established

before or at least sim ultaneously w ith im plem entation of

any research result; therefore, all the stages to achieve this

status should also be considered and respected.

REFERENCES

I. International B ank for R econstruction and D evelopm ent.

W o rld D ev elo p m en t R ep o rt 1 9 9 3 : In v estin g in H ealth .

N ew Y o"rk, O xford U niversity P ress, 1993, p. 168.

2 . A n o n y m o u s . S tre n g th e n in g th e c o n trib u tio n o f H e a lth

R e s e a rc h , Is s u e s , N e e d s , O p tio n s , Q u e s tio n s . C o n fe re n c e

D is c u s s io n P a p e r. C o n fe re n c e o n F u tu re P a rtn e rs h ip s fo r th e

A c c e le ra tio n o f H e a lth .d e v e lo p m e n t. O tta w a , O c to b e r, 1 9 9 3 .

3 . L O M A S , J . - R e ta ilin g R e s e a rc h : In c re a s in g th e ro le o f

E v id e n c e in C lin ic a l s e rv ic e s fo r C h ild b irth .

The Milbank

Quarterly

4 . E D D Y , D .M . - C lin ic a l P o lic ie s a n d th e Q u a lity o f C lin ic a l

P ra c tic e .

New England Journal

1 9 8 2 .

5 . H A Y N E S , R .B . - L o o s e C o n n e c tio n s b e tw e e n P e e r-R e v ie w e d

c lin ic a l J o u rn a ls a n d C lin ic a l P ra c tic e . A n n a l~

of Internal

Medicine

6 . L O M A S , J . - F in d in g A u d ie n c e s , C h a n g in g B e lie fs : T h e

S tru c tu re o f R e s e a rc h U s e in C a n a d ia n H e a lth P o lic y . J

Health Politics, Policy and Law