Bridging the gap between research and practice
A story set in the middle of the ocean seems an unlikely place for Jill Francis, City's new Professor of Health Services Research, to begin her inaugural lecture. But it was there, aboard the H.M.S Salisbury in 1747, that James Lind carried out a pioneering study to investigate the effects of different dietary supplements on scurvy.
Lind, the ship's surgeon, selected 12 members of the crew and administered supplements such as cider, vinegar, seawater, garlic, oranges and lemons, and other foods to see if it had any effect on their conditions. He noticed that the most rapid and visible improvements came to his patients who received the citrus fruits. It is considered to be the first clinical trial of the modern era.
However, although the importance of Lind's findings on scurvy were recognised at the time, it was not until 48 years later that an official Admiralty order was issued on the supply of lemon juice to ships. With this, scurvy disappeared almost completely from the British Royal Navy.
More than 200 years later the gap between research, guidelines and actual practice is still evident and it is this research/practice gap that lies at heart of the research being undertaken by City's new Professor of Health Services Research, Jill Francis.
During the course of her lecture she outlined a number of the international studies she has been working on with colleagues around the world, particularly Australasia, Canada and the UK. These studies focus on supporting people to change their behaviour in the light of new (or not-so-new) medical evidence. One series of studies examined the common referral of patients who present with lower back pain for x-rays despite evidence that show they provide 'negligible diagnostic benefit and expose the patient unnecessarily to radiation.'
Another study illustrated how evidence about intentions and behaviour can be used to design new services such as screening for eye health.
Professor Francis proposed that understanding behaviour, and behaviour change, is essential at all levels of the health system if we are to translate evidence into practice for improving health.