Often we hear recommendations, we read guidelines, or are taught about what works to prevent or manage a disease, and we think, yes, but when are we going to move from “we must” to “we will”?
In the case of Chronic Obstructive Pulmonary Disease (COPD), public health specialists, clinicians, patients and care-givers mostly know what the do’s and don’ts are, but are missing the answers about how to translate them into real-life; how do we move from theory to practice?
Implementation science is about answering these questions.
What is Chronic Obstructive Pulmonary Disease (COPD)?
COPD is an umbrella name for non-contagious conditions that permanently restrict breathing capacity, such as emphysema and chronic bronchitis. Because of the damage is localised to the lungs, symptoms include wheezing, shortness of breath, persistent cough and chest tightness, . After cardio-vascular diseases and cancer, and together with asthma (chronic respiratory diseases), it is ranked as the third noncommunicable disease (NCD) in terms of prevalence and incidence and leading cause of death worldwide. While COPD can’t be cured, symptoms can be eased with access to appropriate medical care and treatment, particularly when screening detects COPD early. Almost 90% of COPD deaths occur in low- and middle-income countries.
“Total deaths from COPD are projected to increase by more than 30% in the next 10 years without interventions to cut risks, particularly exposure to tobacco smoke.” - ECC
Implementation science: moving from theory to practice with FRESH AIR
The World Health Organisation (WHO) defines implementation research as: “the form of research that… identifies optimal approaches for a particular setting, and promotes the uptake of research findings: ultimately, it leads to improved health care and its delivery.”
FRESH AIR specifically focuses on what works, for whom, in different contexts for COPD and asthma, in low and middle income countries (LMIC) or with vulnerable populations in higher income countries. The aim, as per any implementation science plan is to assess how existing research knowledge generated by academic studies is adaptable to on-the ground reality in an accessible and equitable manner. The project consortium members, working in Vietnam, Uganda, rural Greece and the Kyrgyz Republic are implementing evidence-based practices in the prevention, diagnosis and treatment of chronic lung diseases, based on the main risk factors: smoking and indoor air pollution due to cooking and heating. We are assessing if these can be implemented in primary care and scaled up in the existing low resource contexts and, where possible, in the three years of the programme, their impact.
For instance, using interviews in villages and remote areas, our teams assess the local population’s knowledge and beliefs about the risk factors and test tobacco dependence treatment interventions and pulmonary rehabilitation. The introduction of safer cooking stoves and raising awareness about the harm of indoor smoke are also key components. The consortium is beginning to analyse baseline data, and to start rolling out some of the interventions, and should have a first set of results by the end of 2017.