BRIDGING THE GAP BETWEEN EVIDENCE AND EVERYDAY CARE
How implementation science helps make research usable in real-world settings
By Chava Kurtz and Ximena Ramos Salas
Why do some promising ideas improve lives in one setting, yet struggle in another? And why can strong evidence fail to change everyday practice?
Take an older adult living with multiple health conditions, trying to keep track of symptoms, medication, appointments, and everyday responsibilities. A self-management tool may look effective in research. But whether it helps in practice depends on much more than the tool itself. It depends on whether it is accessible, understandable, supported, and meaningful within the context of that person’s life. Implementation science helps us understand this gap between evidence and everyday care.
MAKING EVIDENCE MEANINGFUL
For this reason, the journey from research to practice cannot be understood as a simple handover. Knowledge is not produced in one place and then neatly inserted into another. It is interpreted, adapted, and sometimes resisted or ignored. What works in one clinic, city, country, or population may not work in the same way elsewhere. Organisations, policies, resources, and peoples lived realities differ. People also differ in what they need, value, can access, and what is possible in their circumstances.
For example, evidence-based obesity guidelines may recommend multidisciplinary care, long-term follow-up, behavioural support, medication, or surgery. Yet in everyday practice, these recommendations may be difficult to implement if services are unavailable, treatments are not reimbursed, or people avoid care because of previous experiences of weight stigma or judgement from healthcare professionals. In these situations, implementation is not simply a matter of applying the guideline. It requires attention to how care is delivered, whether it is acceptable and accessible, and whether it respects the priorities and experiences of the person receiving care.
This perspective is especially important when thinking about healthy ageing. Ageing does not happen in a single place or moment. It unfolds across the life course, under different social conditions, and often alongside multiple health conditions. The person described in a guideline may look very different from the person sitting in front of a clinician, or from the person trying to manage health, care, relationships, and everyday responsibilities. Healthy ageing is shaped by biology, social conditions, access to care, language, stigma, and everyday environments. That means evidence cannot simply be transferred unchanged across populations or settings. It must consider diversity in people, communities, and lived experience. It must also recognise that people are not just recipients of care or targets of recommendations, but active participants in their own lives and healthcare, making decisions within the conditions available to them.
ADAPTING TO THE CONTEXT
As paper became more affordable, doctors’ ability to record data about their patients improved.5 With technological progress like computing, accessing data has become easier, and the scale at which it is collected has increased exponentially in the last thirty years. One estimate puts the amount of healthcare data generated a year at 2.3 zettabytes of data – that’s about 2.3 trillion DVDs’ worth of information.6
Modern healthcare data can inform many different aspects of a patient’s care. By 2011, over 50% of doctors were using electronic health records.7 These provide healthcare service providers with a widespread view of a patient’s health. Digital tools, such as wearable devices and mobile health applications, are frequently used by healthcare professionals in targeted interventions before the onset of, or to help monitor or treat health conditions or diseases. For example, information about blood sugar levels, diet or activity levels could help clinicians diagnose, monitor or treat type 2 diabetes. They also enable citizens to manage and take control of their own health.
CHANGING THE QUESTION
Implementation science also changes the questions we ask. It moves us beyond “Does this work?” towards questions such as: for whom, in what circumstances, with what support, and at what cost to people and systems? It asks which parts of an intervention are essential, which can be adapted, and what needs to change for evidence to become feasible, acceptable, and sustainable in practice.
For a project like STAGE, these questions matter. STAGE is concerned with healthy ageing across the life course and with the realities of living with multiple health conditions. Producing knowledge is only part of the task. Equally important is understanding how that knowledge becomes meaningful and usable across different care settings and populations. Insights from implementation science help keep these practical questions in view. They remind us that person-centred care is not only about what we know, but also about how that knowledge is translated, adapted, and made useful in context.
This is particularly relevant as health research and innovation move quickly. New digital tools, apps, and forms of self-management support are constantly being developed and tested. These may offer important opportunities, but they also raise familiar questions. Who are they designed for? Who can access them? How do they fit into everyday care? What support do people need to use them? How might they work differently across settings, communities, and generations?
As new possibilities emerge, the challenge is not only to generate evidence about them, but also to understand how they can be used meaningfully, fairly, and sustainably in practice. That matters for research, but also for how recommendations are developed, how services are designed, and how care is delivered in everyday life.
Implementation science helps ensure that evidence becomes usable in everyday care. In healthy ageing research, where people’s needs and circumstances vary widely, this practical focus is essential to making meaningful improvements in people’s lives.
REFERENCES
Bauer, Mark S., and JoAnn Kirchner. “Implementation science: What is it and why should I care?.” Psychiatry research 283 (2020): 112376.
Bauer, Mark S., et al. “An introduction to implementation science for the non-specialist.” BMC psychology 3.1 (2015): 32.
Braithwaite, Jeffrey, et al. “When complexity science meets implementation science: a theoretical and empirical analysis of systems change.” BMC medicine 16.1 (2018): 63.
Greenhalgh, Trisha, et al. “Diffusion of innovations in service organizations: systematic review and recommendations.” The milbank quarterly 82.4 (2004): 581-629.
Greenhalgh, Trisha, and Chrysanthi Papoutsi. “Studying complexity in health services research: desperately seeking an overdue paradigm shift.” BMC medicine 16.1 (2018): 95.
Kirk SFL, Ramos Salas X, Alberga AS, Russell-Mayhew S. Canadian Adult Obesity Clinical Practice Guidelines: Reducing Weight Bias in Obesity Management, Practice and Policy. Available from: https://obesitycanada.ca/guidelines/weightbias.
Plsek, Paul E., and Trisha Greenhalgh. “The challenge of complexity in health care.” Bmj 323.7313 (2001): 625-628.
Sarkies, Mitchell N., et al. “Making implementation science more real.” BMC Medical Research Methodology 22.1 (2022): 178.