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dc.contributor.advisorCrowther, Caroline Anneen
dc.contributor.advisorGreen, Sallyen
dc.contributor.authorMiddleton, Philippa Fairfaxen
dc.description.abstractBackground: There is an increasing expectation by governments and communities that health research will lead to health and health system improvements, yet developing the necessary science behind translation and implementation of research findings into policy and practice has been neglected and underfunded. Aims: • to investigate the contribution made by Australian randomised controlled trials and Cochrane systematic reviews in maternal and perinatal health to improvements in the health and wellbeing of women, babies and their families in Australia and internationally; • to evaluate different ways of assessing impact and to identify the most effective methods for informing future strategies to improve generation, synthesis, translation and implementation of research into health impact. Methods: I used mixed methods (bibliometric and social media analyses; survey of triallists (quantitative and qualitative); case studies; systematic reviews of observational studies; systematic reviews of interventions; an overview; cohort studies; a randomised controlled trial; clinical practice guidelines; and implementation studies). I used behaviour change theory to explore uptake and implementation of research and developed a research, translation and impact cycle to chart the flow from knowledge to impact. For the cohort of Australian maternal and perinatal randomised controlled trials, I compiled a database of all known trials published between 1986 and 2014. For the survey of triallists I developed a questionnaire using the Behaviour Change Wheel to assess perceptions related to capability, opportunity and motivation and the influences of these on uptake and implementation. Results: In a cohort of over 500 Australian maternal and perinatal randomised trials, multi-centre design, National Health and Medical Research Council or equivalent funding, and larger sample sizes were associated with higher citation rates, increased inclusion in syntheses and policy documents. More recent trials (published from 2011-2014) also showed improvements compared with trials from 1986-2010. In the survey of triallists, fellow health professionals were thought to be aware of trial findings only 50% of the time, but skill deficits were not major barriers to implementation. When trial results were widely known, confidence in the findings was sometimes low. Trials with null results were difficult to interpret and there was some lack of clarity about who should be responsible for translation and implementation. Emerging citation and social media systems such as Altmetric could increase visibility of research and change some of the ways that impact is currently measured. In three case studies addressing different stages of translation, I have demonstrated how integrating a research, translation and impact cycle with behaviour change theory can explain, predict and shape practice and policy change. These case studies were: closing an important research gap (reminder systems for women with previous gestational diabetes); initiatives to highlight the importance of stillbirth and its prevention (including development of a tool to assess the impact of bibliographic citations); and the implementation of antenatal magnesium sulphate for fetal neuroprotection (a project exemplifying rapid and effective implementation). Conclusions: Maternal and perinatal research in Australia has made a major contribution to better health and health systems. I have shown that this impact could be even greater with improved translation processes such as making research more implementation ready, strengthening networks and using coordinated approaches to accelerate uptake and impact.en
dc.subjectmaternal and child health; perinatal epidemiology research impact; research translation; research implementationen
dc.titleMaternal and perinatal research conducted in Australia: generation, synthesis, translation, implementation and impact.en
dc.contributor.schoolSchool of Paediatrics and Reproductive Healthen
dc.provenanceThis electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
dc.description.dissertationThesis (Ph.D.) -- University of Adelaide, School of Paediatrics and Reproductive Health, 2015en
Appears in Collections:Research Theses

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