The Research-Practice Cycle: What is it and why is it important?

A challenge often faced by researchers is the process of research translation. That is, ensuring that any new knowledge that is gained through our research is then effectively used and applied in clinical practice and in treatment settings. Research tells us it takes an average of 17 years for a health innovation to be applied in practice in some health areas!

Research translation is particularly important in the field of eating disorders. We know that 70% of people with an eating disorder do not receive any treatment at all, and of those who do access help, only 1 in 5 receive treatment that is evidence-based. This needs to change if we are to improve rates of recovery and reduce the impact of eating disorders on people’s health and wellbeing. There are a number of barriers that we need to address in order to achieve this – research translation can help.

InsideOut is engaged in a raft of research projects and collaborations, with the aim of improving outcomes for people with eating disorders and their loved ones. Read about some of them here and here.

To make sure our research findings make it from the lab to the clinic (and improve people’s lives), our work at InsideOut follows the research-practice cycle. At its simplest, this means that the work we do spans across the lifecycle of a research project: from conception and research innovation, through to experimental trials in real-world settings and the implementation of treatment that works across the health system to create system change. Our findings are then used to inform health service policy and future research, and to contribute to the knowledge base – both nationally and globally. And so the cycle continues, creating an iterative process where translation (i.e. knowledge application) is incorporated into the research process. But wait, there’s more!

What is the research-practice cycle?

This graphic of the research-practice cycle is taken from the recently launched Australian Eating Disorder Research & Translation Strategy 2021-2031, which was developed by InsideOut, in collaboration with hundreds of eating disorder experts and peak bodies from across Australia.

You can read more about the strategy, its implementation, and why it is urgently needed here.

The Research-Practice Cycle. Image taken from the Australian Eating Disorder Research & Translation Strategy 2021-2031.

The Strategy highlights the research-practice cycle as a vital approach to ensuring that research is effectively translated into clinical practice, and ultimately, that is does what it is intended to do – improve outcomes for people living with eating disorders.

To better describe each of the stages of the research-practice cycle, and why each individual stage is important, we will draw upon examples from InsideOut’s current projects.

1. A research question is identified:

To start, an issue or area of need is identified. This is often a gap identified by researchers in the literature, by clinicians working on the ground, and/or by people with a lived experience – who tell us what research will help transform their lives and their health care journey. A research question is then developed through a co-design process (that means, in collaboration with people who are impacted by research – such as people with eating disorders, carers and clinicians).

For our BEeT (Binge Eating eTherapy) program, the question we asked was: Can we use an online CBT program to effectively treat people who experience bulimia nervosa/binge eating disorder?

This was identified as an important area of need because, although we have effective treatments for people with bulimia nervosa (i.e., CBT), there a number of barriers to accessibility. These include limited access to trained clinicians, treatment expenses, geographical limitations, and stigma regarding help seeking. Self-help interventions, delivered via a digital platform, have the potential to overcome these barriers, because they are easily accessible, cost-effective, and require minimal clinician support.

2. Co-design across all stages:

Co-design is central to all of InsideOut’s work and to every stage of the research-practice cycle. This means that everything from the research question, to the design of programs and interventions, are designed in collaboration with experts in the field and, importantly, with people with lived experience of eating disorder.

BEeT, for instance, was designed using feedback from users of the program with lived experience of eating disorder and the input of clinicians who specialise in working with people who have eating disorders.

3. Research = knowledge production:

This stage refers to the conduct of high quality and theoretically sound research that results in the generation of new knowledge.

For InsideOut, this means using innovation, harnessing and building on our existing relationships (nationally and around the world) and collaborating with the brightest minds in the field of eating disorders, as well as those in mental health and outside the field. Some recent examples include: the Genome project, investigating the role of microbiome in the development of eating disorders; a trial for family therapy provided over Telehealth to make evidence-based therapy more accessible for regional and rural families; and the development of eTherapy sessions that help people who have eating disorders, or those who are worried about their eating behaviours, to develop skills to help them to recover or get back on track.

Our focus is on knowledge production that has the potential to result in meaningful and impactful outcomes for people with eating disorders, their families and supports.  

4. Translation = knowledge application:

This important stage in the cycle refers to the process of ensuring that research findings are translated into practice, that new knowledge is applied.

This means, for example, that we are seeking ways in which evidence-based knowledge can be made more accessible to health professionals on the frontline, or to people who are working in other places where eating disorders might be detected or prevented (for example, in school settings, or in gyms). One of our latest studies is evaluating the effectiveness of targeted “micro learning” for time poor GPs, delivered digitally at intervals. Our research has confirmed the effectiveness of some of our eLearning courses for health and mental health professionals, in managing and treating people with eating disorders using evidence-based treatments and interventions.

An important element of our work is that our programs are evaluated in real-world settings. For example, our BEeT program is being trialled in headspace clinics across Australia.

5. Implementation = practice change: 

Examining whether long-lasting changes are observed in practice and evaluating which approaches or techniques can best promote the adoption and implementation of evidence-based treatments and findings. 

One of the aims of the NSW Service Plan for People with Eating Disorders is to embed evidence-based practice into the health system. A recent evaluation found that a local eating disorder coordinator, working in each of the state’s LHDs, has proven to be fundamental in achieving local change and implementation. It found that having someone skilled in eating disorders in a central role, able to provide support across the LHD, was viewed as a strong enabler.

6. BETTER OUTCOMES:

If we follow each step of the research-practice cycle, we are confident that we will support better outcomes for people with eating disorders and their loved ones.

Indeed, an important feature of the research-practice cycle is that it is an ongoing and iterative process. What we observe through research is used to inform and improve our treatment programs, policies, resources, and interventions, and to guide future research.

As highlighted in the National Research and Translation Strategy:

“…the research–practice cycle is ongoing. It is always important to question what we do and to collaboratively identify better ways of working and ways to keep improving people’s health and wellbeing. Great treatment, prevention, cure and recovery, are rarely the result of a single innovation, but rather the iterative process of researching and improving treatment.”

As our mission states, InsideOut is committed to innovative research, collaboration and an enduring path of inquiry, to transform research into inspired clinical practice. Our ability to practice each step of the cycle in house, is an exciting and important aspect to all of our work.