As the largest collaborative global venture in the field of perinatal health research, the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Project has produced a package of clinical standards, tools and guidelines to improve the continuum of care for mothers and newborns (Figure 1). These open-access resources will allow frontline providers across the world to monitor and evaluate pregnancy, as well as neonatal growth and development, using internationally representative standards. We believe that the INTERGROWTH-21st package has enormous potential to improve perinatal health care delivery. However, successful implementation requires managers and providers to appreciate the value of the resources and incorporate them into clinical practice to improve the health of mothers and newborns. Therefore, the task ahead is to transition the INTERGROWTH-21st package from research into practice.
Implementing evidence-based clinical guidelines for integrated maternal and newborn health care is key to improving health outcomes for both mother and baby. Much of the progress made towards Millennium Development Goals 4 and 5 is attributed to the application of research findings and adoption of evidence-based tools.[3, 4] However, the challenges of translating research into practice are many. There is a broad literature base that suggests much can be ‘lost in translation’ on the journey of evidence-based standards from researcher to provider.[5, 6] A mismatch between the idealised research environment and clinical reality often limits the feasibility of successfully applying recommendations. These are challenges that will need to be overcome in the next phase of this project.
At the policy and programmatic levels, despite the growing consensus that a continuum of care approach is critical for the post-2015 health agenda, delivery of healthcare services for mothers and newborns is often disaggregated. Attempting to introduce standards that require integrated maternal and neonatal healthcare delivery when there are often separate, and sometimes competing, priorities will certainly be a challenge. At the individual level, we anticipate that changing provider behaviour will be difficult, especially if providers are not convinced that the changes in behaviour needed to use the INTERGROWTH-21st package provide additional value and/or are feasible in their contextual, particularly resource-poor, settings.[9, 10] Therefore, pre-empting a wide variety of implementation barriers when designing the plan for the dissemination, implementation and use of the INTERGROWTH-21st resources in diverse global settings is essential.
The strategy for translating the INTERGROWTH-21st package from research into practice builds on successful approaches documented in the literature and will evolve from our own experience.[11, 12] A monitoring system will allow for continuous learning throughout the implementation process, enabling us to adapt and tailor our strategy to meet the unique needs of diverse contexts as implementation unfolds. Our strategy will also focus on ensuring local ownership of the implementation process by engaging networks of regional, national and local ‘champions’ to advise and lead the adaptation of the research products to meet the needs of individual providers across the world. The learned experience from data collection and management in the INTERGROWTH-21st Project will inform our approach.
An essential element of our strategy is substantive, hands-on training targeted towards different types of providers and other stakeholders who will use the INTERGROWTH-21st research products in different ways. In addition, focusing on integrating the new tools with existing guidelines and standards will be a way of building capacity to improve quality and prevent unnecessary competition with other valuable clinical tools. To change provider behaviour we must also communicate the value that the new standards will add and support those providers who face implementation barriers.
Translating the INTERGROWTH-21st package will require working at global, regional, national and local levels to achieve optimal uptake. We believe that engaging multi-level actors will open substantive, useful pathways to facilitate multi-directional knowledge transfer. At the global level, we will make the package freely accessible through online platforms that are available to a diverse group of global stakeholders, allowing anyone to use and share the tools with their own regional and local networks. Enabling partners in the INTERGROWTH-21st network to work with other maternal and child health consortia will be a way to support the growing community of policy leaders, programmers, managers and providers focused on improving the continuum of maternal and newborn healthcare. We will also ask our regional and national champions to coordinate with and advise relevant local institutions and individuals on how best to integrate the INTERGROWTH-21st resources into clinical settings on the ground, and identify appropriate dissemination channels and tactics to overcome context-specific implementation barriers. Local champions will serve as entry points into the clinical setting, playing the part of change agents at the frontline of service delivery. We plan to design, implement and evaluate different approaches to introducing the INTERGROWTH-21st package in a wide range of settings around the world, and through rigorous monitoring and evaluation of the dissemination process, we will be able to improve our understanding of the constraints and opportunities that mediate the translation of research-based clinical guidelines into practice.
Part of what makes the INTERGROWTH-21st Project unique is its dedication to collaboration, a value that we fully share. The Maternal Health Task Force, the flagship project of the Women & Health Initiative at the Harvard School of Public Health, and a new member of the INTERGROWTH-21st consortium, is dedicated to shaping collective efforts to improve maternal and newborn health worldwide, serving as a catalyst to address one of the most critical areas in global health and development. We will use a broad array of tactics to contribute to the successful translation of the INTERGROWTH-21st package, including:
- Leveraging our web-based knowledge-sharing platforms to reach multiple audiences;
- Engaging diverse networks of stakeholders;
- Convening discussions and demonstrations of the tools in relevant meetings and conferences; and
- Participating in the design, implementation and evaluation of the most promising approaches to introduce the tools into programmes and services.
Our collective efforts will pay off: the use of these essential tools will strongly contribute to improving maternal and perinatal health globally and especially, in the countries with the highest burden of mortality and morbidity.
Disclosure of interests
Contribution to authorship
AC and AL wrote the manuscript and all the authors read and approved the final version.
Details of ethics approval
The INTERGROWTH-21st Project was approved by the Oxfordshire Research Ethics Committee ‘C’ (reference:08/H0606/139) and the research ethics committees of the individual participating institutions and corresponding health authorities where the Project was implemented.
This project was supported by the INTERGROWTH-21st Grant ID# 49038 from the Bill & Melinda Gates Foundation to the University of Oxford, for which we are very grateful.
A full list of Members of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) and its Committees appears on the preliminary pages of this supplement.