Action needed on prevention and collaboration implementation research

Professor Luke Wolfenden, The Australian Prevention Partnership Centre

The Prevention Centre’s Leadership Executive and several key partners have reflected on the importance of a coordinated, collaborative national approach to prevention practice, research and policy. Our 17 co-authors have published a call to action in the Australian and New Zealand Journal of Public Health to maximise investment and coordinate research in this area.

We have noted while 50% of all known health risk factors could be redressed with known, effective preventive policies or practices, widespread uptake of effective prevention is uncommon. The Public Health Association of Australia (PHAA) has not been alone in highlighting that the lack of focus and funding in prevention may be one reason why opportunities for addressing the current challenges to the Australian health system are missed. A critical impediment is there is insufficient field-level evidence on how to best enact effective prevention interventions ‘at scale’ when there are the resources available to do so. In addressing this gap, research has considerable potential to improve the health and well-being of the country.

The National Preventive Health Strategy 2021-2030, released last December, is a pivotal moment for prevention in Australia. Reviews of past prevention initiatives, including the National Partnership Agreement on Preventive Health, show successful action requires evidence-informed implementation strategies. We must heed past lessons to make the most of the opportunities that a national prevention strategy presents. The Strategy is explicit in acknowledging that using proven prevention programs would lead to healthier people. It suggests focusing on better governance mechanisms, greater funding for prevention, workforce capacity building and investment in data systems. While it acknowledges the need for a greater focus on implementation research to boost policy efforts, it provides little guidance about how this can be done.

Our new paper A call to action: More collaborative implementation research is needed to prevent chronic disease explains how this could be achieved for prevention agencies at the local, state and national levels. It stresses a need for such agencies to have a leading role in the generation of policy and practice-relevant evidence needed to support their usage of prevention initiatives at scale.

Greater engagement of key prevention agencies in research prioritisation and more funding will enable investments in prevention research to occur in areas with the greatest potential for results including:

• Increased investment in research for chronic disease prevention. We need sufficient increase in both national (NHMRC/MRFF-level) and state-level investment in implementation research in prevention to transform our current capacity, alongside tracking systems to trace investment flow and benefit.
• Harnessing ‘learning health system’ approaches to increase uptake of effective preventive interventions. We urge further exploration and development of learning-from-practice, as part of collaborative partnerships between researchers, policy makers and practitioners.
• Building infrastructure for collaborative practice research in prevention. We need greater infrastructure development for research in prevention: training, data systems, processes of ethical review and more practitioner-scientists working across research and practice contexts.
• Encouraging collective priority-setting and co-ordination of implementation research. National, cross-jurisdictional structures for research co-ordination in prevention are needed, including joint priority setting, research registries and collaborations.
• Fostering national, state and local leadership in prevention research. Leadership operating at all levels should encourage infrastructure investment, innovation, multi-sector problem solving, critical reflection, and learning.

Increased investment in supporting learning health system approaches to prevention, prioritising evidence needs, facilitating relevant research collaboration and co-ordination, and leadership at multiple levels, are all required to utilise limited resources and guide effective chronic disease prevention action.

Professor Wolfenden is an NHMRC Fellow at the University of Newcastle, Co-Director of the WHO Collaborating Centre on Evidence and NCD program implementation, Director of the National Centre of Implementation Science and a member of The Australian Prevention Partnership Centre’s Leadership Executive.

Co-authors included Emeritus Professor Penelope Hawe, Professor Lucie Rychetnik, Dr Rachel Sutherland, Courtney Barnes, Dr Serene Yoong, Distinguished Professor Billie Giles-Corti, Adjunct Professor Jo Mitchell, Emeritus Professor Adrian Bauman AO, Adjunct Professor Andrew J. Milat, Dr Li Kheng Chai, Sara Mayfield, Nadia Mastersson, Associate Professor Louise Freebairn, Associate Professor Gary Sacks, Professor Andrew Wilson, Dr Annemarie Wright and Professor John Wiggers. Their paper will be published on 24 June 2022 in the Australia and New Zealand Journal of Public Health. (DOI: 10.1111/1753-6405.13270).