The University of Newcastle, Australia

Putting research into practice

Behavioural scientist Associate Professor Chris Paul learned some important lessons about health research implementation very early on in her career.

A /  Professor Christine Paul

“We made one of the classic mistakes in that we didn’t really talk to the people who were the end users of our findings when we started.”

“Looking back now I can see how naïve I was.

“I thought I’d l find the answer to a question and then people would implement my discoveries. But that’s not what happens.”

As part of her PhD project, Chris compared how different health information pamphlets were received by their intended audience. Whereas some of the material had been prepared following traditional graphic design guidelines, others had been made to contravene design and information principles.

Contrary to her initial hypothesis, there was no real difference in how the information was interpreted, despite there being a lot of variation in the pamphlets’ design.

“We hadn’t really been talking to the developers of the content – if we had then we would have known that when we actually had our results that they would effectively reject them.

“And that’s just the way it is.

“You can’t just drop a finding on people who are very invested in doing something in a certain way.

“They have to actually come on the journey with you.”

Since those early days, Chris has gone on to conduct research alongside with a number of health service providers and policy makers – a way of ensuring that her work is sufficiently translated into practise.

Her current collaborators include the Cancer Councils of NSW and Victoria, Hunter Cancer Research Alliance (HCRA), NSW Ministry of Health, Cancer Institute NSW, Baker IDI Heart and Diabetes Institute, Aboriginal Community Controlled Health Services, Diabetes WA, National Stroke Foundation  and many clinicians across Australia, the United States and United Kingdom.

Currently, Chris is focussed on a number of projects running in cooperation with Cancer Councils.

“Those projects have been founded out of mutual interest.

“We sat down and had discussions about what they were interested in doing and asked ourselves what we could bring to that.

“We’re making sure that we’re answering questions that they want to answer.”

Communication and cancer consultants

At the moment, Chris’ research team is focused on the Cancer Council’s flagship 13 11 20 Cancer Information and Support Service (CISS). As part of one particular project, they are researching the differences between talking to a CISS consultant and typing to one.

While an increasing number of health support services are opting to provide an online instant messaging, or ‘chat’, option, there is little research into how best to adapt traditional telephone practises for this new channel.

“For structured health intervention strategies, like cognitive behavioural therapy, there’s plenty of evidence which supports the idea that online services, when conducted well, can be just as successful as face to face interactions.

“But for something broader, like the services provided by CISS, there are particular things which remain a challenge. There’s very little research around how to convey emotional information for example. There’s not much evidence for how to best modify a phone conversation to an online chat conversation.”

In order to address these questions, Chris is in the process of conducting a trial comparing the outcomes of the two types of service.

“We’ll also look at the content of the conversation to see what was different about the types of interactions.”

Running in parallel with this project, Chris is investigating the different approaches to mental health assessment used by clinicians and CISS consultants.

“There’s this preconception in clinical circles that because clinicians have a lot of professional skills, they’ll all have the ability to have a conversation with someone and get through to a point where they can identify whether they might be depressed or anxious.

“But that’s not as consistent across individual clinicians as you might expect. There's actually a strong evidence base around the value of doing things in a very defined way.

“If health care providers use some scales which are valid for identifying depression or anxiety, and questions are asked consistently in the same kind of way, they get a much better result.”

Chris is interested in seeing whether this evidence from traditional clinical practise will also translate to the setting of the CISS.

“While the consultants are quite used to being attentive to silences or tone of voice, we want to see whether using a structured approach would be beneficial.”

“(The Cancer Council) are actually being very forward thinking in that they are taking something from a clinical setting and asking if that works in their community setting. They're being very worldly in that way .”

Another project is designed to empower cancer patients to quit smoking. The project involves seven hospitals across NSW and is helping oncology clinics to translate the evidence of smoking cessation into practice.

“Currently many patients are not aware that if they quit smoking after their diagnosis they are more likely to cope better with treatment and get a better outcome. Not all cancer patients receive the support they need to quit, but this is one of the Cancer Institute NSW Top 10 implementation science research ‘gaps’ that we’ve been working on with colleagues across the state,” Chris adds.

Solariums, sun damage and skin cancer

Throughout her career as a behavioural scientist, Chris remembers her work with the NSW Solaria Compliance Working Group as being one of the highlights.

Chris was working with the Cancer Council, researching sun protection and skin cancer in the 1990s and the field was becoming increasingly overwhelmed with evidence linking regular solarium use to skin cancer development.

At the time, there was a voluntary standard of practise wherein solarium providers would inform customers of the health risks involved with sun bed usage.

“Cancer Council NSW funded us to us to do some simulated customer research. We sent people into those commercial establishments to ask questions about the sun beds and make an appointment to use them.

“The results of our study, and a number of others which came out later, all pretty much told the same story - that the voluntary standards weren't being followed.”

Chris’ research marked the beginning of the end of commercial solaria in NSW.

In an attempt to stall government regulation, the Solarium Association proposed a trial period wherein they would work with their members to foster a culture of responsibility and appropriate customer care.

When Chris and her collaborators repeated their research a few years later however, they observed no change in practise.

“That put the state government in the position where they were able to regulate against solaria.”

At this time, 26-year-old Clare Oliver, who had been diagnosed with melanoma and attributed her cancer to regular solarium use, came forward with her story. Her willingness to speak publicly about her situation arguably catalysed legislative reform, with the support of research by the UON team and others.

“When you put the research and that kind of story like Clare’s together, that's what really brings policy makers to the point of being prepared to change legislation.”