How are research results transferred and implemented into practice? And what can we do to facilitate and improve implementation? This was the focus of a symposium at Vision 2017 in The Hague, organised by InZicht on the 26th of June 2017. The symposium offered interesting lessons from best practices in various countries and networks.
Innovation through research ranges from establishing patient panels to hi-tech medical innovations. A very broad selection of projects is presented in four 15-minute talks. These have one crucial element in common: a close collaboration between science, practice and the client group. It’s a key factor for successful implementation.
'There are three important factors influencing the success of implementation of research knowledge into practice: co-creation between research and practice, making knowledge transferable and involving all stakeholders, including visually impaired people.'
'These are major lessons from InZicht (Dutch for ‘InSight’), a research programme in the Netherlands that started in 1998.
Another lesson learned: always use a planned strategy for active systematic implementation. Key element of such a strategy is the participation of people with a visual impairment, from the very start of each research project. In InZicht the client group is actively involved, for example in assessing research applications and as members of research and implementation teams. The programme also organises meetings for researchers, care professionals, policy makers and people with a visual impairment. Some examples of tools for disseminating knowledge are smartphone apps and serious games. One of the latter is The world of EMPA, a game for care givers, parents and students. Players will discover the effect of sensitive and empathetic responses. The game stimulates active learning and makes knowledge easily transferable, thus promoting the implementation of important research findings.'
‘To enhance the quality of the services available, it is very important to be relevant to a large number of people. This is why RNIB teamed up with SpecSavers, a company that covers more than 80% of the British market. Our common goal: transforming eye health in the UK.'
'As a leading sight loss charity in the UK, the Royal National Institute of Blind People (RNIB) promotes a close interaction between research and practice and involves customers in the research and implementation cycle. One of the instruments we develop with SpecSavers is the Sight loss data tool, which holds and reports on a range of sight loss and eye health indicators. RNIB also developed Ten Principles of good practice in vision rehabilitation. We did so by reviewing literature and research evidence, gathering feedback from service users and a range of practitioners. Customers were equipped as spokespersons to promote the Ten Principles to their local councils. In all of our work the role of visually impaired people is central. Customer panels are strategically engaged and steer our work. In the end their every day problems need to be solved.’
‘Good research enhances the effectiveness of interventions, facilitates problem solving and supports the incorporation of new technology. To ONCE, the Spanish organisation of and for people with severe visual problems, research is an important means to improve quality of life.'
'Many of ONCE’s projects aim at improving accessibility. An example is the ACCEDO project, which promotes digital skills that enable pupils with visual disabilities to read and write effectively in inclusive environments. We are also involved in medical research on the prevention of blindness, ranging from the study of specific pathologies to the development of visual neuro-prostheses. Research can only become ‘best practice’ if we ensure that results are actually carried out. This is why we focus on continuously updating the knowledge of professionals through specialised publications and the maintenance of our technical library. The exchange of experience and good practices is promoted by rewarding outstanding initiatives. We do so through competitions targeting in-house and external professionals. Our key factors of success: direct participation of the target group, close collaboration between research and practice and targeted support to practitioners.’
‘The European network ENVITER is a forum for the exchange of knowledge, expertise and experience, providing a platform for like-minded professionals and service providers. Our projects focus on the ‘TER’ in our name: training, education and research.’
‘ENVITER, the European Network for Vision Impairment Training Education & Research, comprises a variety of specialist organisations from across Europe, all tasked with serving the needs of people with vision loss. Our aim is to implement standards and methodologies of professional practice, which will enable the inclusion of people with visual impairments within their communities. By coordinating European project funding, we also minimise duplication of resource expenditure on service development. A good example of our ‘TER-focus’ is EASI, the European Academy on Sensory Impairments, which provides courses, raises awareness and shares information and expertise. EASI is one of our means to bring the results of research projects back to practitioners and people with visual impairments. With 24 members in 16 countries our network is still growing. We invite all others to join in, so we can continue making ENVITER useful to all.’
What is needed to implement research findings in a way that is useful to all people with vision impairments? Three client representatives share their views from a clients’ perspective and discuss these with participants.
The discussion starts with three short statements by the members of the panel. Peter Zwart, volunteer at the Oogvereniging, the Dutch association for people with visual impairments, expresses two wishes. Let researchers give both professionals and clients an equal representative role in their projects. Secondly, involve clients from the very beginning of each research project, before you even design the study. An important method to do so is a client panel, but it all starts with simply going out and talk to people. What are their problems? What questions do they have? How could research help to find useful answers? Birgitta Blokland, secretary general of the European Blind Union (EBU), invites every researcher present to contact EBU with their research ideas. ‘We will put through your questions to our member organisations in 44 countries. They can connect you to people with visual impairments. Research should be needs driven, so always include the expertise of the people you’re doing it for.’
Low vision rehabilitation, a global right. The theme of the Vision 2017 congress is strongly reflected in the panel discussion. This is illustrated bij an important remark from a participant who steps forward from the audience. ‘If needs should be the main inspiration for research, let’s realise ourselves that we tend to forget about the largest group of clients involved: people in developing countries. To put it a bit bluntly: 99% of all recourses spent on research helps only 1% of the people with visual impairments, namely those living in the Western world. If we want to work on dissemination and translate research to the world, I would like to speak on behalf of the other 99% not to leave them aside.’ Penny Hartin, CEO of the World Blind Union, agrees with the speaker. ‘Research is indispensible for effective advocacy, also to enhance the situation in developing countries. We need evidence to get better service levels worldwide. This advocacy should not only be done in ‘our’ part of the world, but also on a UN level.’ Speaking of implementation Hartin stresses the importance of worldwide access to knowledge, in order to stop re-inventing the wheel. ‘Let us all co-operate to share results. This also makes a lot of sense for supporting developing countries.’
Els van Gessele, programme secretary of InZicht, makes another important point. ‘We talk about dissemination of knowledge, which certainly is very important. But implementation is not only about knowledge. We should make sure knowledge can be used to change daily practice. This asks for continuous support of both professionals and people with visual impairments.’ Hartin and Blokland agree strongly with this pledge to take a wider view on implementation. They stress that researchers should not only deliver results, but must also actively communicate about the implications of their findings in daily practice. In other words: the job is not done once your article is published! A member of the patient panel of InZicht takes the floor: ‘the keyword is communication. Over the past years I’ve experienced the importance of communicating with researchers about their ideas, their work and their results. Our input as patients can really make a difference.’ And how do we involve the ‘quiet people’ who might be just a bit too ‘shy’ to participate? As far as Hartin is concerned ‘outreach’ is the keyword here: ‘go out and find people where they actually live. If you just ask them, I’m sure they will be more than willing to join you.’
After the InZicht-symposium co-chair Peter Verstraten reflects on the presentations and the discussion in this session. He is impressed by the strong focus on client participation in the presentations. And he sees a big challenge in addressing the needs of large parts of the world population, who still struggle with problems the West has been able to leave behind already.
To Peter Verstraten the central message of the InZicht symposium at Vision 2017 is very clear: participation of both people with visual impairments and practitioners is crucial to successfully implement results of scientific research. He is enthusiastic about the clear focus on client participation ONCE (Spain) and RNIB (UK) showed in their presentations. ‘Useful research starts with questions that come from the challenges occurring in daily life. Or in the professional setting of rehabilitation practitioners. ONCE and RNIB have incorporated this by working together with people with visual impairments in the very heart of their organisations. They can more successfully bring findings back to practice, since this is exactly where they picked up their research questions in the first place. A good example of an effective innovation cycle.’
In daily life Verstraten is programme manager Expertise, Innovation & Knowledge at the Robert Coppes Stichting, one of the Dutch rehabilitation centres for people with visual impairments. From his point of view, he knows the Netherlands is doing quite well on implementation. ‘Usually implementation rates from scientific research will not exceed a mere 8%, sometimes 10%. But the InZicht programme reaches a far higher level, with an implementation rate of around 25%.’ One of the success factors is the long term on which InZicht operates, to date almost 20 years already. ‘I’ve been involved in a project that was initiated back in 2000. What started as a revalidation programme for a specific client group gradually developed into a participation programme for all elderly people with visual impairments. Nowadays this programme is used in 15 countries, mainly introduced by client organisations. This underlines how important participation is for successful implementation.’
Verstraten is specifically impressed by the passionate pledge from the audience not to ‘forget’ the large population with visual impairments in developing countries. 'There are still numerous problems to deal with to effectively prevent diseases or circumstances that cause severe impairment, often at a very young age. So let’s also invest in research that helps solving these problems.’ Verstraten is clear about the challenges that come with this. ‘The main research expertise is still to be found on this side of the world. Advocacy is needed, plus international collaboration. So that in the end everybody in need will profit from new findings in the field of visual impairment research.’
In the InZicht programme three rehabilitation centres (Royal Dutch Visio, Bartiméus and Robert Coppes Foundation) and the Netherlands Organisation for Health Research and Development (ZonMw) work together to fund research and to bridge the gap between scientific research and practice. To promote implementation the rehabilitation centres developed a policy of knowledge transfer and learning within their organisations.
In the past 19 years InZicht has funded many different research projects with the financial aid of the rehabilitation centres. Various activities, such as newsletters, site visits, annual meeting-days, implementation workshops, and implementation projects are organised by InZicht to stimulate and facilitate implementation. InZicht and the three rehabilitation centres joined forces to organise this special symposium on implementation at the Vision 2017 congress in The Hague, the Netherlands.
Text: Marc van Bijsterveldt Photography: Robert Tjalondo