NATIONAL HEALTH PROMOTION CONFERENCE 2011, Cititel, Mid Valley, K. Lumpur, 10-11 October 2011.

1. NATIONAL HEALTH PROMOTION CONFERENCE 2011,Cititel, Mid Valley, K. Lumpur, 10-11 October 2011. “Translating Research into Health Practices” Dr. Sulaiman Che Rus, Public Health Physician (Epidemiology); Hjh. Zawaha Idris, Health Education Officer, Institute for Health Behavioural Research (IPTK), Ministry of Health, Malaysia.

2. Presentation Outline • History of Research. • Definitions of related terms. • Factors affecting Translating Research into Practice. • Recommendations to researchers on communication. • Case studies of disseminating local research findings.

3. Ibn al-Haytham (Alhazen),965–1039, Basra Early pioneer in development of scientific method

4. Sculpture by Olin Levi Warner(1896) "Research holding the torch of knowledge"

5. TERM:RESEARCH • Old French – “recerchier – search.” • Middle French – “recerche - “to go about seeking/to investigate thoroughly.” • 1577 – Earliest recorded use of term.

6. RESEARCH:DEFINITION (Wikipedia) “the search for knowledge, or as any systematic investigation, to establish novel facts, solve new or existing problems, prove new ideas, or develop new theories, usually using a scientific method.”

7. RESEARCH:DEFINITION (Martin Shuttleworth 2008) “Any gathering of data, information and facts for the advancement of knowledge.”

8. EVIDENCE Includes everything that is used to determine or demonstrate the truth of an assertion. Accumulated through observations of phenomena that occur in the natural world, or which are created as experiments in al laboratory or other controlled conditions.

9. TRANSLATING RESEARCH • Evidence-Based Policy: - Spread from Evidence-based Medicine (EBM): - First coined by Guyatt, 1992. - “the conscientious, explicit and judicious us of the current best evidence in making decisions about the care of individual patients”. (Sackett, 1996) - Concern relationship between research evidence, practice and policy.

10. TRANSLATING RESEARCH Evidence-based policy and practice has grown in interest. Recent studies suggest that there is both the potential to negotiate and communicate the research findings. Most problematic is the gulf between those who commission the research and those who conduct it, and the suppose ultimate beneficiares. (Hovland, 2003) 10

11. TRANSLATING RESEARCH • Knowledge Translation (KT). • Translating Research into Practice (TRIP). • Getting Research into Policy and Practice (GRiPP).

12. TRANSLATING RESEARCH “A dynamic and interactive process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products and strengthen the health care system.”

13. POLICY “A set of decisions to pursue courses of action aimed at achieving defined goals for improving the health situation”. (WHO)

14. POLICY “Plans or statements issued by authority that are designed to direct decisions or actions”. (East-West Center, 2010)

15. POLICY • Technical Policies: “Plans or statements directing how various health and population interventions should be delivered (e.g. Hypertension protocol). • Allocation Policies: “Plans or statements from legislative or executive authorities related to the organization of systems (e.g., Health), the actors involved, or the generation and use of resources.”

16. POLICYMAKERS (DECISION-MAKERS) “Individuals who have the power to make laws, set policies, affect regulations and practices, or allocate resources”. East-West Center, 2010

17. POLICYMAKERS IN MINISTRY OF HEALTH Cabinet (Prime Minister) Post-Cabinet (Minister of Health) Mesyuarat Pagi (KSU) JDPKK (KSU & KPK) JK Teknikal (KPK) PROGRAMMES (Directors)

18. PROBLEMS OF TRANSLATINGRESEARCH TO POLICIES • Validity of research. • Inadequate policy relevant research. • Lack of access to research findings by policymakers. • Poor understanding of policy process by researchers. • Ineffective communication strategies by researchers.

19. PROBLEMS OF TRANSLATINGRESEARCH TO POLICIES • Lack of linkages/understanding/ support of research target group. • Ignorance/inability of policymakers of the existence or importance of research findings. • Policymakers being dismissive, unresponsive or incapable of using research findings. • Other implications – socio-political, economic and cultural. • Validity of knowledge, censorship, and ideology.

20. RESEARCHERS & POLICYMAKERS GAP • Case study in 7 countries: - Many researchers were skeptical about the extent to which research findings were adopted. - Policy makers and managers were themselves skeptical about the about the usefulness of research findings. (COHRED, 2000)

21. NARROWING RESEARCHERS & POLICYMAKERS GAP • Need for mutual trust and respect between researchers and decision-makers. • Recognize each other strengths, weakness, likes and dislikes. • Involve decision-makers in early stage of research development and planning. • Address how research results are communicated and disseminated. • Disseminate research findings to variety of audience fort advocacy. (Tan Sri Ismail Merican, 2006)

22. RECOMMENDATIONS TO RESEARCHERS • Involve policymakers in planning, progress & review of results. • Conduct practical, service implementation research. • Communicate easy-to-read reports & articles. • Provide details of findings to programme managers. • Use multiple media to communicate.

23. Put a face to research findings. • Network with advocates, programme administrators and officials. • Be willing to consider options and alternatives in the face of disagreement. • Provide timely report within planning cycles. • Think through the research findings and recommendations. • Be persistent and positive.

24. COMMUNICATION & DISSEMINATION CHECKLIST • Understand policy makers information needs. • Construct research results in a way that makes ideas useful (e.g., timely reports, use of non-technical language, executive summaries). • Develop clear policy recommendations in research products. • Promote policy entrepreneur skills.

25. Develop a systematic dissemination strategy (including advocacy and campaign techniques). • Build channels of communications (web-sites, publications, media liaison). • Organize workshops, conferences and other public or professional events. • Tailor & target research to user groups & stakeholders.

26. LOCAL RESEARCH UPTAKE • 8th Malaysia Plan: • 57 research projects at the cost of RM13 million. • IRPA funded 21 projects at cost of RM41 million. • Five Patents registered and 4 products commercialized. • 9th Malaysia Plan(2006-2010): • RM90 million allocated for research projects.

27. Case Studies of Research Uptake By IPTK

28. INSTITUT PENYELIDIKAN TINGKAHLAKU KESIHATAN (IPTK) • Formally formed in November 2005. • Staff – 5 Health Education Officers (2 S48, 2 S44 and One S41). • Major research conducted (Principal Researcher - Pn. Zawaha): • Food Poisoning in Kelantan, 2007. • KAP of National Service Trainees (PLKN) in Selangor, 2008. • H1N1 Community Surveys, 2009. • Perceptions of Dengue Control Programme, 2010.

29. FOOD POISONING IN SCHOOLS OF KELANTAN - 2007 • Study conducted in collaboration with JKN Kelantan & MOE. • Comparative study of all 29 school canteens with food poisonings (2004-2006) and without food poisonings (29 schools) in Kelantan. • Study scope: - Microbial contamination of foods & utensils. - Personal hygiene of food handlers. - Food premise inspections. - KAPs.

30. SIGNIFICANT FINDINGS Varying degrees (90 – 10%) of microbial contaminations of food, water, utensils & food handlers. Unsatisfactory hygiene status of more than 60% among the school canteens. 50% of Food Handlers had poor KAP scores .

31. RECOMMENDATIONS & ACTIONS The importance of food safety and hygiene highlighted. Decisions of JKN & MOE: Food handlers need medical examinations & certifications. Compulsory attendance by food handlers on trainings of food handlings health education. Presentations: 6th National Health Conference, USM, Kelantan, 2009. PersidanganKomunikasiKesihatanKebangsaan, 2008. JKN Kelantan, BahagianKualitiMakanan & BahagianKawalanPenyakit, KKM, 2008.

32. HRBS AMONG PLKN TRAINEESSELANGOR - 2008/2009 • Study conducted in all 9 PLKN Camps in Selangor, 12/2008-7/2009: • 6025 trainees participated. • Study conducted in collaboration with MOH and MOD. • Report: • Disseminated to Deputy MOH, KPK & TKPK (P&ST). • Presented to MOH Programme officers in April 2011. • 13 NIH Scientific Meeting, 2010.

33. SIGNIFICANT FINDINGS Male trainees - higher high risk behaviours related to smoking, alcohol, drug abuse and sex. Female trainees - higher prevalence of incomplete meals and lower stress coping skills. Adequate physical activity among all trainees was unsatisfactory.

34. RECOMMENDATIONS An integrated & comprehensive health promotion & prevention program for secondary schools to address identified problems: Cigarette, drug and substance abuse especially among male students. Promotion of physical activity & enhancement of related physical facilities in the schools and community.

35. RECOMMENDATIONS & ACTIONS Promotion of healthy eating. Introduction of sexual health education. Mental health especially on stress coping skills. Actions: Family Health Development Division, MOH has incorporated the findings for the development of health education materials for adolescents.

36. COMMUNITY SURVEYS ON H1N1 • Studies conducted in May & July, Klang Valley & Sept/Oct. 2009 Nation-wide. • Klang Valley Community Surveys: • May – 1460 respondents. • July - 2302 respondents. • Sept/October (5 consequentive weeks) – 6567 respondents nation-wide. • Study scope: • Knowledge on HIVI and control. • Perceptions on control by Ministry of Health.

37. FINDINGS & ACTIONS • More than 90% worried of H1N1. • Knowledge on disease, mode of spread and prevention had increased with subsequent surveys. • Need for emphasis on hand washings and cough etiquettes. • Actions: MOH used the survey results to monitor the effectiveness of control programme.

38. FGDs ON DENGUE CONTROL - 2010 • FGDs Among Public Health Staff on Dengue Control Measures, Selangor, March 2010. • Conducted among serving PPKPs, PKAs and Labourers in Petaling District. • Study conducted with the blessings of JKNS and Petaling Health District. • Report: • Full report given to District Health Office and JKN Selangor. • Presentations to MOH including VBDCP and JKNS

39. RECOMMENDATIONS • Community Complacency: Innovative, client centred and risk communication approaches need to be utilised for individual and community empowerment for the control of dengue: • Messages directed at local community should contain relevant local statistics and risk information. • Development of messages must be based on need assessment of the local community. • Community engagement in dengue control strategies requires more than just information giving but also needs processes for encouraging meaningful community participation founded on the understanding of community attitudes and beliefs.

40. Dengue Control Programme: - The issue of field leadership need to be resolved. Location of Aedesbeeding sites in outbreaks by PKA to be supervised. - Team Work Needed: • Discussion on situational analysis & strategies for control. • Plan both short and long term strategies. • Enforcement efforts - Regular and simplified. • Coordination with local authorities to be enhanced. - Innovations: • Placing Mobile units at outbreak areas. • Rental of vehicles.

41. CONCLUSION • Seize unexpected opportunities; • Local experiences showed the need to involve policymakers to determine the needs and early problem identifications. • Nevertheless, knowledge and skills on communication do contribute towards translating research into policies. • Be Creative with recipes for research translation;

42. WAY FORWARD • Pay great attention to the results of each translational step, and • Multiple factors affect uptake of research findings into policies: - Strengthen research capability & capacity; - improve dissemination of research for different audience; - strengthen networking.

43. INTERLINKED NETWORK • UP the line to superiors & sponsors; • DOWN the line to programme managers & other front line practitioners; • ACROSS the lines to fellow colleagues; and • OUTREACH to service users, their support network & organised client group.

44. “It is not enough to be busy. The question is: what are we busy about?” Henry David Thoreas

45. REFERENCES Crewe E, Young J. Bridging Research and Policy: Context, Evidence and Links. London: Overseas Development Institute, September 2002. Exchange. Communicating health research: How should evidence affect policy and practice. Number 5, April 2005. Access at http//www.healthcomms.org. Haines A, Kuruvilla S, Borchert M. Bridging the implementation gap between knowledge and action for health. Hj. Nordin Saleh. Getting Research into Policy and Practice and Policy Making Process. Lectures, 30 May 2011. Last JM. A Dictionary of Public Health. New York: Oxford University Press, 2007. Shuttleworth, Martyn (2008).”Definition of Research”. Experiment Resources. Experiment-Research.com. Retrieved 14 August 2011. Tan Sri Dato Seri Dr. Hj. Mohd. Ismail Merican. Getting Research into Policy and Practice. 9th NIH Scientific Meeting, 18 September 2006. Tan Sri Dato Seri Dr. Hj. Mohd. Ismail Merican. Translating Research into Practice and Policy. 6th National Pharmacy Research and Development Conference 2010. Wikipedia. Research. Accessed at http//www.wikipedia/research. Retrieved 5 September 2011