Putting women's, children's and adolescents’ health at the heart of our preoccupation: bridging the evidence to practice gaps : JBI Evidence Implementation

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Putting women's, children's and adolescents’ health at the heart of our preoccupation: bridging the evidence to practice gaps

Ramelet, Anne-Sylvie PhD

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JBI Evidence Implementation 21(1):p 1-2, March 2023. | DOI: 10.1097/XEB.0000000000000368
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Women, children and adolescents are particularly vulnerable to poorer health when compared with the general population. Poor mother's health has a direct impact on child's development. Early-life illness and childhood traumatic experiences pose a major risk to their health and development, and can have dramatic short-term and long-term consequences for individuals, families and community. It is, therefore, crucial to put women's, children's and adolescents’ health at the heart of our preoccupation to ensure evidence is put into practice to provide the best possible care and ensure women, children, and adolescents everywhere benefit from effective treatment and interventions and improve outcomes.

JBI has identified three main knowledge translation gaps: gap 1 between the need for new knowledge in relation to a health issue and the generation of that knowledge producing new evidence; gap 2 between available evidence and its clinical application (it can take up between 18 to more than 50 years from discovery to implementation1); gap 3 between the clinical application and the development of routine clinical practice and policy.2 In the following section of this editorial, we will look at the state of research related to women, children and adolescents.

Women: The 1.2 million women from the What Women Want global advocacy campaign identified priorities to improve quality maternal and reproductive healthcare; being heard and treated with respect and dignity being the top one priority.3 Models of care focused on the person and family, such as midwife-led continuity model of care, encompass this core value. An overview of Cochrane systematic reviews shows unequivocal evidence of the benefits of midwife-led model of care on women's and newborn's outcomes, including decreased maternal and newborn mortality, stillbirth, preterm birth, low birthweight and interventions during labour, as well as better psychological outcomes.4–6 Midwifery-led model of care is recommended worldwide, but even in countries where it is standard practice (mainly in the UK, Australia and North America), widespread implementation is limited.7 Although there is always a need for new knowledge because of the rapidly changing healthcare environment, there is a clear need to facilitate the transfer of available evidence into clinical practice (gap 2) and implement it into routine care and policies (gap 3).

Children and adolescents: Conducting clinical research involving infants, children and adolescents is, in many aspects, more complex than research in adults. Challenges include legal and regulatory complexity, ethical concerns, relatively small numbers of children with serious medical problems, the need for developmentally appropriate outcome measures, availability of valid age-appropriate self-reported or proxy-reported questionnaires, parental consent and children's assent, and adaptation of research procedures and settings to accommodate children's physical, cognitive and emotional development.8 As a result, there is a paucity of high-level evidence from clinical studies for many pediatric diseases and interventions. Most pediatric studies registered in ClinicalTrials.gov are small-scale, single-center and not funded by industry or government agencies. The number of published experimental and quasi-experimental studies and systematic reviews is small compared with adult studies.9 A recent report of the state of research in nursing from 2000 and 2019 shows a steady increase of research output in the last two decades, mainly in North America, Europe and Oceania. Although, the analysis did not differentiate between research involving adults and research involving infants, children and adolescents, we can probably assume that the trend was similar in both populations.10 For children and adolescents, it thus appears that there is an important need for new evidence generation (gap 1) and to optimize on the limited existing evidence by accelerating the research uptake in clinical practice (gap 2).

Translation of evidence into practice is challenging, because the healthcare environment is rapidly changing, technology and medical treatment and interventions evolve over time and become more and more complex, and patients and family needs and preferences change over time. Women, parents as primary carers of their child, and adolescents should be considered as partners in this process. Patient and child involvement in research becomes the norm. In a scoping review, Rouncefield-Swales et al. analyzed 40 studies that included children's and young people's contributions to public involvement and engagement activities in health-related research. Children and young people contributed to four levels of engagement: design and development of the study, undertaking/managing the study, analysis and interpretation of the results, and dissemination, implementation, monitoring and evaluation.11 Although children's public involvement is at its premise, it is encouraging to be able to provide some evidence that children and young people can be involved in the implementation phase of the research process.

It is well acknowledged that context and implementation factors have a significant impact on the success of the implementation. There are numerous frameworks used in implementation sciences.12 They can be classified into five categories focusing on: process, determinants (barriers and enablers), classic theories, implementation theories (e.g. COM-B) and evaluation.12 For instance, the Consolidated Framework for Implementation Research (CFIR) or the JBI seven-phase approach to evidence implementation, to name two, are useful frameworks to help with identifying the contextual factors that can hinder or facilitate the implementation process.13,14

This first issue for 2023 of the JBI evidence implementation special collection on women's, children's and adolescents’ health showcases implementation projects in different parts of the world. These reports are very useful because they demonstrate, using different frameworks to guide the implementation process, the different factors that played a critical part in the success of implementation in their local context. What is interesting though is that the barriers and enablers are quite transversal and could inform other similar projects in different contexts. The articles published in this special collection will contribute to close the gaps between generation of new evidence and its translation into clinical practice.


Conflicts of interest

The author reports no conflicts of interest.


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A video commentary on implementation project titled: How do health professionals prioritise clinical areas for implementation of evidence into practice? The commentary is provided by Andrea Rochon RN, MNSc, Research Assistant, Queen's University, Ontario, Canada