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Box 2 The mismatch between the worlds of research and implementation: an example from health

From: Transdisciplinary working to shape systematic reviews and interpret the findings: commentary

The proposed solution of ‘directly observed therapy’ (DOT), a practice that involves healthcare practitioners observing patients taking their treatment, is not well supported by systematic review evidence regarding distinct approaches to implementation of directly observed therapy [9], including incentives and enablers [10], or reminders [11]. Whilst these reviews, drawing on randomised controlled trials, provided some useful inputs to specific technical recommendations being made by the World Health Organization at the time, in broader policy terms they offer disappointing findings to national policy makers frustrated by the “real world” where: conflicts disrupting health systems; practitioners favouring patients they considered most deprived and therefore most deserving; and patients finding the timing of the treatment and incentive (a midday meal) inconvenient [10]. Moreover, many of these reviews considered DOT without a comparator, and reviewed individual interventions alone, rather than typical packages of interventions, which is insufficient [11]. This example highlights the importance and need to consider the ‘financial and logistical barriers to care; approaches that motivate patients and staff; and defaulter follow-up’ [9]; in programmes of care and the systematic reviews that inform them.