Bringing It Home: Our Imperative To Translate Reproductive Health Research Into Real Practice Change

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The majority of the professional communities who read this journal — reproductive health researchers, scientists, health care providers and advocates — are rewarded for their efforts with fresh insights and late-breaking research. Our field has a good handle on what needs to be done, and our research pipeline is bursting: We have identified the gaps, conducted needed research and are constantly seeking funds to do more.

But there are two glaring exceptions that make our progress unsustainable. We will ultimately fail if (a) we do not assertively identify and pursue equitable links between clinical and behavioral science and (b) the outcomes from our well-designed research projects do not see the light of day in actual practice.

Reproductive health, with its exceptional research agenda, cadre of talented and committed professionals and critical health care focus, has the potential to serve as a model for innovation. Very few fields encompass such a broad variety of fundamental but culturally taboo topics that impact almost everyone in some way: sexuality, abortion, sexually transmitted infections, HIV/AIDS, contraception, teen pregnancy, etc. In the end, we are presented with a resolvable paradox: researchers, providers and patients are not very eager to broach this hotbed of issues — especially in the United States. But we must do it to positively impact public health.^{1, 2, 3, 4, 5}

Another factor that impacts our growth as a field: medical practice is slow to change. Take the example of maternal use of steroids prior for preterm birth. We had plenty of evidence to support its use, and providers took decades to accept this treatment into standard practice.^{6, 7, 8}

How can we create practice change when we face cultural aversion about the focus of our work, an academic and clinical practice environment that is reluctant to change and our own professional and personal biases that we sometimes hide even from ourselves?

The good news is that we have already established a platform for innovation that can be expanded beyond its current focus on OB/GYN and family practice physicians to all members of the health care team. Research and clinical practice in family planning have undergone tremendous changes over the last decade. This is largely due to the expansion of academic programs and medical training in family planning, the development of key fellowship programs and the growth of the Society of Family Planning (SFP), an academic society devoted to the discipline.⁹ One result of these advances is a tremendous increase in the volume and quality of family planning research.

It is now incumbent on the reproductive health community to assure that the most significant findings from this research effort are translated into common practice for all members of the health care team.

Here are some suggestions for innovative ways to build on our work:

New training and education platforms: Develop and participate in education and training venues that incorporate evidence-based approaches to learning. Behavioral research shows that group interactions, multiple interventions over time (e.g., team-based, small group discussions, hands-on training), virtual learning environments, health coaching, mentoring and other novel methods contribute to what is called the learning continuum. These novel approaches, when combined, are more likely to result in clinician behavior change than standard didactic presentations.^{10, 11, 12}

The Association of Reproductive Health Professionals (ARHP) Reproductive Health (RH) clinical conference draws dedicated practitioners who want to gain exposure to the most impactful research in the field and take home key practice points for change. This year's meeting, Reproductive Health 2011 in September, will focus on translating important advances in the field — largely driven by SFP, ARHP members and the authors of Contraceptive Technology — into clinical practice. The ARHP will be incorporating inventive, evidence-based educational platforms to ensure that key practice points are absorbed and put into action. The ARHP's goal is to create an environment that encourages group interactions that accommodate individual learning styles, incorporate the latest in adult learning theory and evidence-based education and training methods for professionals, use both new and proven technologies and deliver practice points that are easy to implement.

To develop the RH2011 curriculum, we looked at the comments from previous attendees, conducted a series of member surveys, consulted with clinical and behavioral science experts and sought advice from representatives of all members of the health care team. The Education Planning Committee focused on seven topic areas in reproductive health that reflect the clinical priorities identified by ARHP's members and leadership, including contraception, abortion, multipurpose prevention technologies, healthy sexuality, reproductive and environmental health, maternal and child health, and the impact of chronic medical conditions on reproductive health.¹³

Set big goals for public health behavior change: Despite considerable energy spent over the last few decades in clinical research in family planning and the best efforts of a highly committed field, we have yet to see a decline in the US rate of unintended pregnancies. While there have been decreases in abortion rates and improved access to and use of highly effective contraception, we need to seek every opportunity to expand this trend.¹⁴ The ultimate measure of our success would be a decline in the rate of unintended pregnancy, not just for wealthy, white, educated women but for everyone. Translating research supporting practices that reduce unplanned pregnancy into clinical practice is paramount in this effort, and providing this information to practitioners who deliver reproductive health services, especially in resource-poor areas, will have a great impact.

Embrace innovation: Innovation has become a buzzword, but is an essential concept for our field if we aim to create real change in practice. We must embrace new approaches to education (i.e., virtual learning, team-based learning, practice improvement projects and others), to clinical practice and to the development of combination prevention technologies that enhance sexual and reproductive health.¹⁵

Plan for significant changes in health care delivery systems in the United States: The definition of “primary care” is changing rapidly with the new medical home model that is being implemented across the country.¹⁶ This will impact you in some way over the next several years, so work now to incorporate this assumption into your practice and you are more likely to be successful.^{17, 18, 19}

Accept and work with our own cognitive biases: We ignore our personal and professional biases at our patients' peril (i.e., sexual health interviews, subspecialty silos, patient sexual orientation, potential family violence). While empathy and caring are essential, judgment — even if unintended or unknown to us — can interfere with effective patient care.²⁰

It is long past time to intensify our efforts to apply what we have learned through research into practice — and not just in our relatively small professional community, but beyond to other specialties and disciplines. We need to bring our reproductive health expertise, our high-quality, evidence-based research and our knowledge of adult learning theory to all clinicians who can make a difference in public health.

Wayne C. Shields
President and CEO
Association of Reproductive Health Professionals
Washington, DC

Ellen L. Cohen
Association of Reproductive Health Professionals
Washington, DC

David Turok
Department of Obstetrics and Gynecology
Family Planning Fellowship
University of Utah School of Medicine
Salt Lake City, UT

References

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18. Nutting PA, Crabtree BF, Miller WL, Stange KC, Stewart E, Jaén C. Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project. Health Aff (Millwood). 2011;30:439–445
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Used with permission from Elsevier, Inc.