Issue 48
Nov 2023

THE BANYAN TREE

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Professor Nick Sevdalis, Academic Director of the Centre for Behavioural and Implementation Science Interventions (BISI), NUS Yong Loo Lin School of Medicine

Q: What are some key principles and concepts of behavioural and implementation sciences that can be applied to improve health outcomes?

A: Human behaviour is not formed in isolation—it is shaped by various factors that are internal and external to the individual, which need to be addressed as a whole in order to be effective at changing behaviour and ultimately, improving outcomes. There are many theories, models and frameworks in behavioural and implementation sciences suitable for healthcare contexts (some are specific to healthcare). They are meant to enable behaviour change or evidence implementation efforts to be more systematic and therefore more likely to succeed, and to facilitate a better understanding of how and why such efforts are (or are not) successful.

Q: What are the common barriers or challenges encountered when integrating behavioural and implementation sciences into healthcare settings, and how can healthcare practitioners and organisations address these challenges to ensure successful implementation and achieve better health outcomes?

A: The first challenge lies in healthcare practitioners and organisations recognising the role of behavioural and implementation sciences. Implementation science is a young field born out of the evidence-based medicine movement in the last few decades, and there is room for more widespread awareness among healthcare professionals regarding the existence of implementation science and its value in improving care and outcomes. Related to this, there needs to be a sufficient workforce adequately trained in behavioural and implementation science methods and skills. It also makes a tremendous difference that healthcare practitioners and organisational leaders champion and support behaviour change and evidence implementation efforts.

Q: In your view, what are the emerging trends or future directions in behavioural and implementation sciences? How do you foresee these trends shaping the future of healthcare delivery and improving health outcomes?

A: It is known that it takes an average of 17 years to turn 14% of original clinical research into benefit for patients—too long and too little! Implementation science is aimed at closing this gap.

The substantial time lag between research discovery and uptake into routine practice is partly due to the conventional stepwise translational research pathway: from basic, pre-clinical research to clinical efficacy and effectiveness research, then finally implementation research. A recent development in implementation science is the emergence of hybrid effectiveness-implementation research designs blending the clinical effectiveness and implementation components—studying clinical effectiveness and implementation simultaneously to speed up the translational process (and there are other advantages too). Looking ahead, there is potential for such hybrid studies to be adopted more and become more integrated into health services.

Q: How do behavioural and implementation sciences work with other disciplines, such as medicine, public health, psychology and sociology, to achieve better health outcomes?

A: Behavioural and implementation sciences are inherently interdisciplinary, in the sense that they are rooted in, built on or overlap with many social science disciplines including behavioural economics, psychology, sociology and organisation studies. Essentially, they draw from social science methodologies for the specific purpose of understanding and influencing human behaviour and use of evidence-based practice and research findings. They can be applied to any pertinent topic area under any health discipline, such as adherence to a treatment by patients, use of a health technology or clinical innovation by clinicians, or uptake of a public health intervention by the general population. Behavioural and implementation sciences do not and cannot work in isolation—collaboration with other disciplines is crucial!

 

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