NATIONAL HEALTH PROMOTION CONFERENCE 2011, Cititel, Mid Valley, K. Lumpur, 10-11 October 2011. “Translating Research into Health Practices”. Dr. Sulaiman Che Rus, Public Health Physician (Epidemiology); Hjh. Zawaha Idris, Health Education Officer, - PowerPoint PPT Presentation
NATIONAL HEALTH PROMOTION CONFERENCE 2011, NATIONAL HEALTH PROMOTION CONFERENCE 2011, Cititel, Mid Valley, K. Lumpur, 10-11 October 2011. Cititel, Mid Valley, K. Lumpur, 10-11 October 2011. “ “ Translating Research Translating Research into Health Practices” into Health Practices” Dr. Sulaiman Che Rus, Public Health Physician (Epidemiology); Dr. Sulaiman Che Rus, Public Health Physician (Epidemiology); Hjh. Zawaha Idris, Health Education Officer, Hjh. Zawaha Idris, Health Education Officer, Institute for Health Behavioural Research (IPTK), Institute for Health Behavioural Research (IPTK), Ministry of Health, Malaysia. Ministry of Health, Malaysia. 1
Transcript
NATIONAL HEALTH PROMOTION CONFERENCE 2011,NATIONAL HEALTH PROMOTION CONFERENCE 2011,Cititel, Mid Valley, K. Lumpur, 10-11 October 2011.Cititel, Mid Valley, K. Lumpur, 10-11 October 2011.
““Translating ResearchTranslating Research
into Health Practices”into Health Practices”
Dr. Sulaiman Che Rus, Public Health Physician (Epidemiology);Dr. Sulaiman Che Rus, Public Health Physician (Epidemiology);
Hjh. Zawaha Idris, Health Education Officer,Hjh. Zawaha Idris, Health Education Officer,
Institute for Health Behavioural Research (IPTK),Institute for Health Behavioural Research (IPTK),
Ministry of Health, Malaysia.Ministry of Health, Malaysia.
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Presentation OutlinePresentation Outline
History of Research.History of Research.
Definitions of related terms.Definitions of related terms.
Factors affecting Translating Research Factors affecting Translating Research into Practice.into Practice.
Recommendations to researchers on Recommendations to researchers on communication.communication.
Case studies of disseminating local Case studies of disseminating local research findings. research findings.
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Ibn al-Haytham (Alhazen),Ibn al-Haytham (Alhazen),965–1039, Basra965–1039, Basra
Early pioneer in development of scientific method
Sculpture by Olin Levi WarnerSculpture by Olin Levi Warner (1896) (1896)
"Research Research holding the holding the torch of torch of knowledgeknowledge"
TERM:RESEARCHTERM:RESEARCH
Old French – “recerchier – Old French – “recerchier – search.”search.”
Middle French – “Middle French – “recercherecerche - “ - “to to go about seeking/to investigate go about seeking/to investigate thoroughlythoroughly.”.”
1577 – Earliest recorded use of 1577 – Earliest recorded use of term.term.
RESEARCH:DEFINITIONRESEARCH:DEFINITION
““the search for knowledge, or the search for knowledge, or as any systematic investigation, as any systematic investigation, to establish novel facts, solve to establish novel facts, solve new or existing problems, prove new or existing problems, prove new ideas, or develop new new ideas, or develop new theories, usually using a theories, usually using a scientific method.”scientific method.”
(Wikipedia)(Wikipedia)
RESEARCH:DEFINITIONRESEARCH:DEFINITION
““Any gathering of data, Any gathering of data, information and facts for information and facts for the advancement of the advancement of knowledge.”knowledge.”
Includes everything that is used to Includes everything that is used to determine or demonstrate the truth of an determine or demonstrate the truth of an assertion.assertion.
Accumulated through observations of Accumulated through observations of phenomena that occur in the natural world, phenomena that occur in the natural world, or which are created as experiments in al or which are created as experiments in al laboratory or other controlled conditions.laboratory or other controlled conditions.
TRANSLATING RESEARCHTRANSLATING RESEARCH
Evidence-Based Policy:Evidence-Based Policy: - Spread from Evidence-based Medicine (EBM):- Spread from Evidence-based Medicine (EBM):
- First coined by Guyatt, 1992.- First coined by Guyatt, 1992.
- “the conscientious, explicit and judicious us of - “the conscientious, explicit and judicious us of the current best evidence in making decisions about the current best evidence in making decisions about the care of individual patients”.the care of individual patients”.
(Sackett, 1996) (Sackett, 1996)
- Concern relationship between research - Concern relationship between research evidence, practice and policy.evidence, practice and policy.
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TRANSLATING RESEARCHTRANSLATING RESEARCH
Evidence-based policy and practice has Evidence-based policy and practice has grown in interest.grown in interest.Recent studies suggest that there is both the Recent studies suggest that there is both the potential to negotiate and communicate the potential to negotiate and communicate the research findings.research findings.Most problematic is the gulf between those Most problematic is the gulf between those who commission the research and those who who commission the research and those who conduct it, and the suppose ultimate conduct it, and the suppose ultimate beneficiares.beneficiares.
Translating Research into Practice Translating Research into Practice (TRIP).(TRIP).
Getting Research into Policy and Getting Research into Policy and Practice (GRiPP).Practice (GRiPP).
TRANSLATING RESEARCHTRANSLATING RESEARCH
““A dynamic and interactive process that A dynamic and interactive process that includes the synthesis, dissemination, includes the synthesis, dissemination, exchange and ethically sound exchange and ethically sound application of knowledge to improve application of knowledge to improve health, provide more effective health health, provide more effective health services and products and strengthen services and products and strengthen the health care system.”the health care system.”
(CIHR 2007)(CIHR 2007)
POLICYPOLICY
““A set of decisions to pursue A set of decisions to pursue courses of action aimed at courses of action aimed at achieving defined goals for achieving defined goals for
improving the health situation”.improving the health situation”.
(WHO)(WHO)
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POLICYPOLICY
““Plans or statements issued by Plans or statements issued by authority that are designed to authority that are designed to direct decisions or actions”.direct decisions or actions”.
(East-West Center, 2010)(East-West Center, 2010)
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POLICYPOLICY
1.1. Technical Policies:Technical Policies:““Plans or statements directing how various Plans or statements directing how various health and population interventions should health and population interventions should be delivered (e.g. Hypertension protocol).be delivered (e.g. Hypertension protocol).
2.2. Allocation Policies:Allocation Policies:““Plans or statements from legislative or Plans or statements from legislative or executive authorities related to the executive authorities related to the organization of systems (e.g., Health), the organization of systems (e.g., Health), the actors involved, or the generation and use of actors involved, or the generation and use of resources.”resources.”
““Individuals who have the Individuals who have the power to make laws, set power to make laws, set
policies, affect regulations and policies, affect regulations and practices, or allocate practices, or allocate
resources”.resources”.
East-West Center, 2010East-West Center, 2010
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Cabinet (Prime MinisterCabinet (Prime Minister)
POLICYMAKERS IN MINISTRY OF HEALTHPOLICYMAKERS IN MINISTRY OF HEALTH
Post-Cabinet (Minister of HealthPost-Cabinet (Minister of Health)
Mesyuarat Pagi (KSUMesyuarat Pagi (KSU) JDPKK (KSU & KPK)JDPKK (KSU & KPK)
JK Teknikal (KPKJK Teknikal (KPK)
PROGRAMMES (Directors)PROGRAMMES (Directors)
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PROBLEMS OF TRANSLATINGPROBLEMS OF TRANSLATINGRESEARCH TO POLICIESRESEARCH TO POLICIES
Validity of research. Validity of research. Inadequate policy relevant research.Inadequate policy relevant research.Lack of access to research findings by Lack of access to research findings by policymakers.policymakers.Poor understanding of policy process Poor understanding of policy process by researchers.by researchers.Ineffective communication strategies Ineffective communication strategies by researchers.by researchers.
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Lack of linkages/understanding/ support of Lack of linkages/understanding/ support of research target group.research target group.
Ignorance/inability of policymakers of the Ignorance/inability of policymakers of the existence or importance of research findings.existence or importance of research findings.
Policymakers being dismissive, Policymakers being dismissive, unresponsive or incapable of using research unresponsive or incapable of using research findings.findings.
Other implications – socio-political, Other implications – socio-political, economic and cultural.economic and cultural.
Validity of knowledge, censorship, and Validity of knowledge, censorship, and ideology.ideology.
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PROBLEMS OF TRANSLATINGRESEARCH TO POLICIES
RESEARCHERS & RESEARCHERS & POLICYMAKERS GAPPOLICYMAKERS GAP
Case study in 7 countries:Case study in 7 countries:
- Many researchers were skeptical about - Many researchers were skeptical about the extent to which research findings were the extent to which research findings were adopted.adopted.
- Policy makers and managers were - Policy makers and managers were themselves skeptical about the about the themselves skeptical about the about the usefulness of research findings.usefulness of research findings.
(COHRED, 2000)(COHRED, 2000)
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NARROWING RESEARCHERS &NARROWING RESEARCHERS & POLICYMAKERS GAP POLICYMAKERS GAP
Need for mutual trust and respect between Need for mutual trust and respect between researchers and decision-makers.researchers and decision-makers.Recognize each other strengths, weakness, Recognize each other strengths, weakness, likes and dislikes.likes and dislikes.Involve decision-makers in early stage of Involve decision-makers in early stage of research development and planning.research development and planning.Address how research results are Address how research results are communicated and disseminated.communicated and disseminated.Disseminate research findings to variety of Disseminate research findings to variety of audience fort advocacyaudience fort advocacy..
(Tan Sri Ismail Merican, 2006)(Tan Sri Ismail Merican, 2006)2121
RECOMMENDATIONS TO RECOMMENDATIONS TO RESEARCHERSRESEARCHERS
Involve policymakers in planning, progress Involve policymakers in planning, progress & review of results.& review of results.Conduct practical, service implementation Conduct practical, service implementation research.research.Communicate easy-to-read reports & Communicate easy-to-read reports & articles.articles.Provide details of findings to programme Provide details of findings to programme managers.managers.Use multiple media to communicate. Use multiple media to communicate.
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Put a face to research findings.Put a face to research findings.
Network with advocates, programme Network with advocates, programme administrators and officials.administrators and officials.
Be willing to consider options and Be willing to consider options and alternatives in the face of disagreement.alternatives in the face of disagreement.
Provide timely report within planning cycles.Provide timely report within planning cycles.
Think through the research findings and Think through the research findings and recommendations.recommendations.
Be persistent and positive.Be persistent and positive.
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COMMUNICATION & COMMUNICATION & DISSEMINATION CHECKLISTDISSEMINATION CHECKLIST
Understand policy makers information Understand policy makers information needs.needs.
Construct research results in a way that Construct research results in a way that makes ideas useful (e.g., timely reports, makes ideas useful (e.g., timely reports, use of non-technical language, executive use of non-technical language, executive summaries).summaries).
Develop clear policy recommendations Develop clear policy recommendations in research products.in research products.
Develop a systematic dissemination Develop a systematic dissemination strategy (including advocacy and campaign strategy (including advocacy and campaign techniques).techniques).
Build channels of communications (web-Build channels of communications (web-sites, publications, media liaison).sites, publications, media liaison).
Organize workshops, conferences and Organize workshops, conferences and other public or professional events.other public or professional events.
Tailor & target research to user groups & Tailor & target research to user groups & stakeholders.stakeholders.
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LOCAL RESEARCH UPTAKELOCAL RESEARCH UPTAKE
88thth Malaysia Plan: Malaysia Plan:– 57 research projects at the cost of RM13 57 research projects at the cost of RM13
million.million.– IRPA funded 21 projects at cost of RM41 IRPA funded 21 projects at cost of RM41
million.million.– Five Patents registered and 4 products Five Patents registered and 4 products
commercialized. commercialized.
99thth Malaysia Plan(2006-2010): Malaysia Plan(2006-2010):– RM90 million allocated for research RM90 million allocated for research
projects.projects.
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Case Studies ofCase Studies ofResearch Uptake By Research Uptake By
Formally formed in November 2005.Formally formed in November 2005.Staff – 5 Health Education Officers (2 S48, Staff – 5 Health Education Officers (2 S48, 2 S44 and One S41).2 S44 and One S41).Major research conducted (Principal Major research conducted (Principal Researcher - Pn. Zawaha):Researcher - Pn. Zawaha):
1.1. Food Poisoning in Kelantan, 2007.Food Poisoning in Kelantan, 2007.2.2. KAP of National Service Trainees (PLKN) KAP of National Service Trainees (PLKN)
in Selangor, 2008.in Selangor, 2008.3.3. H1N1 Community Surveys, 2009.H1N1 Community Surveys, 2009.4.4. Perceptions of Dengue Control Perceptions of Dengue Control
Programme, 2010. Programme, 2010.
FOOD POISONING IN SCHOOLSFOOD POISONING IN SCHOOLS OF KELANTAN - 2007 OF KELANTAN - 2007
Study conducted in collaboration with JKN Study conducted in collaboration with JKN Kelantan & MOE.Kelantan & MOE.Comparative study of all 29 school canteens Comparative study of all 29 school canteens with food poisonings (2004-2006) and without with food poisonings (2004-2006) and without food poisonings (29 schools) in Kelantan.food poisonings (29 schools) in Kelantan.Study scope:Study scope:- Microbial contamination of foods & utensils.- Microbial contamination of foods & utensils.- Personal hygiene of food handlers.- Personal hygiene of food handlers.- Food premise inspections.- Food premise inspections.- KAPs.- KAPs.
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SIGNIFICANT FINDINGSSIGNIFICANT FINDINGS
Varying degrees (90 – 10%) of Varying degrees (90 – 10%) of microbial contaminations of food, microbial contaminations of food, water, utensils & food handlers.water, utensils & food handlers.
Unsatisfactory hygiene status of Unsatisfactory hygiene status of more than 60% among the school more than 60% among the school canteens.canteens.
50% of Food Handlers had poor 50% of Food Handlers had poor KAP scores .KAP scores .
The importance of food safety and hygiene highlighted.The importance of food safety and hygiene highlighted. Decisions of JKN & MOE:Decisions of JKN & MOE:
o Food handlers need medical examinations & certifications.Food handlers need medical examinations & certifications.o Compulsory attendance by food handlers on trainings of food handlings Compulsory attendance by food handlers on trainings of food handlings
health education.health education. Presentations:Presentations:
o 66thth National Health Conference, USM, Kelantan, 2009. National Health Conference, USM, Kelantan, 2009.o Persidangan Komunikasi Kesihatan Kebangsaan, 2008.Persidangan Komunikasi Kesihatan Kebangsaan, 2008.o JKN Kelantan, Bahagian Kualiti Makanan & Bahagian Kawalan JKN Kelantan, Bahagian Kualiti Makanan & Bahagian Kawalan
Penyakit, KKM, 2008.Penyakit, KKM, 2008.
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HRBS AMONG PLKN TRAINEESHRBS AMONG PLKN TRAINEESSELANGOR - 2008/2009SELANGOR - 2008/2009
Study conducted in all 9 PLKN Camps in Study conducted in all 9 PLKN Camps in Selangor, 12/2008-7/2009:Selangor, 12/2008-7/2009:o 6025 trainees participated.6025 trainees participated.Study conducted in collaboration with MOH Study conducted in collaboration with MOH and MOD.and MOD.Report:Report:o Disseminated to Deputy MOH, KPK & Disseminated to Deputy MOH, KPK &
TKPK (P&ST).TKPK (P&ST).o Presented to MOH Programme officers in Presented to MOH Programme officers in
Male trainees - higher high risk Male trainees - higher high risk behaviours related to smoking, behaviours related to smoking, alcohol, drug abuse and sex.alcohol, drug abuse and sex.
Female trainees - higher prevalence Female trainees - higher prevalence of incomplete meals and lower stress of incomplete meals and lower stress coping skills.coping skills.
Adequate physical activity among all Adequate physical activity among all trainees was unsatisfactory.trainees was unsatisfactory.
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RECOMMENDATIONSRECOMMENDATIONS
An integrated & comprehensive health An integrated & comprehensive health promotion & prevention program for promotion & prevention program for secondary schools to address identified secondary schools to address identified problemsproblems::
Cigarette, drug and substance abuse Cigarette, drug and substance abuse especially among male students.especially among male students.
Promotion of physical activity & Promotion of physical activity & enhancement of related physical facilities enhancement of related physical facilities in the schools and community. in the schools and community.
Promotion of healthy eating.Promotion of healthy eating.
Introduction of sexual health education. Introduction of sexual health education.
Mental health especially on stress coping Mental health especially on stress coping skills.skills.
Actions:Actions: Family Health Development Family Health Development Division, MOH has incorporated the Division, MOH has incorporated the findings for the development of health findings for the development of health education materials for adolescents. education materials for adolescents.
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COMMUNITY SURVEYSCOMMUNITY SURVEYS ON H1N1 ON H1N1
Studies conducted in May & July, Klang Valley & Studies conducted in May & July, Klang Valley & Sept/Oct. 2009 Nation-wide.Sept/Oct. 2009 Nation-wide.Klang Valley Community Surveys:Klang Valley Community Surveys:o May – 1460 respondents.May – 1460 respondents.o July - 2302 respondents.July - 2302 respondents.o Sept/October (5 consequentive weeks) – 6567 Sept/October (5 consequentive weeks) – 6567
respondents nation-wide. respondents nation-wide. Study scope:Study scope:o Knowledge on HIVI and control.Knowledge on HIVI and control.o Perceptions on control by Ministry of Perceptions on control by Ministry of
Health.Health. 3636
FINDINGS & ACTIONSFINDINGS & ACTIONS
More than 90% worried of H1N1.More than 90% worried of H1N1.Knowledge on disease, mode of spread Knowledge on disease, mode of spread
and prevention had increased with and prevention had increased with subsequent surveys.subsequent surveys.
Need for emphasis on hand washings Need for emphasis on hand washings and cough etiquettes.and cough etiquettes.
ActionsActions: MOH used the survey results to : MOH used the survey results to monitor the effectiveness of control monitor the effectiveness of control programme.programme.
FGDs ON DENGUEFGDs ON DENGUE CONTROL - 2010 CONTROL - 2010
1.1. FGDs Among Public Health Staff on Dengue FGDs Among Public Health Staff on Dengue Control Measures, Selangor, March 2010.Control Measures, Selangor, March 2010.o Conducted among serving PPKPs, PKAs Conducted among serving PPKPs, PKAs
and Labourers in Petaling District.and Labourers in Petaling District.o Study conducted with the blessings of JKNS Study conducted with the blessings of JKNS
and Petaling Health District.and Petaling Health District.Report: Report: o Full report given to District Health Office and Full report given to District Health Office and
JKN Selangor.JKN Selangor.o Presentations to MOH including VBDCP and Presentations to MOH including VBDCP and
JKNS JKNS
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RECOMMENDATIONSRECOMMENDATIONS
o Community Complacency:Community Complacency:Innovative, client centred and risk communication Innovative, client centred and risk communication approaches need to be utilised for individual and approaches need to be utilised for individual and community empowerment for the control of dengue:community empowerment for the control of dengue:o Messages directed at local community should contain Messages directed at local community should contain
relevant local statistics and risk information.relevant local statistics and risk information.o Development of messages must be based on need Development of messages must be based on need
assessment of the local community.assessment of the local community.o Community engagement in dengue control strategies Community engagement in dengue control strategies
requires more than just information giving but also needs requires more than just information giving but also needs processes for encouraging meaningful community processes for encouraging meaningful community participation founded on the understanding of community participation founded on the understanding of community attitudes and beliefs.attitudes and beliefs.
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o Dengue Control Programme:Dengue Control Programme:
- The issue of field leadership need to be resolved. Location of - The issue of field leadership need to be resolved. Location of Aedes beeding sites in outbreaks by PKA to be supervised.Aedes beeding sites in outbreaks by PKA to be supervised.
- - Team Work NeededTeam Work Needed::• Discussion on situational analysis & strategies for Discussion on situational analysis & strategies for
control.control.• Plan both short and long term strategies.Plan both short and long term strategies.• Enforcement efforts - Regular and simplified.Enforcement efforts - Regular and simplified.• Coordination with local authorities to be enhanced.Coordination with local authorities to be enhanced.
- - Innovations:Innovations:• Placing Mobile units at outbreak areas.Placing Mobile units at outbreak areas.• Rental of vehicles.Rental of vehicles.
Local experiences showed the need to involve Local experiences showed the need to involve policymakers to determine the needs and policymakers to determine the needs and early problem identifications.early problem identifications.
Nevertheless, knowledge and skills on Nevertheless, knowledge and skills on communication do contribute towards communication do contribute towards translating research into policies. translating research into policies.
Be Creative with recipes for research Be Creative with recipes for research translation;translation;
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WAY FORWARDWAY FORWARD
Pay great attention to the results of each Pay great attention to the results of each translational step, andtranslational step, and
Multiple factors affect uptake of research Multiple factors affect uptake of research findings into policies:findings into policies:
- Strengthen research capability & - Strengthen research capability & capacity;capacity;
- improve dissemination of research for - improve dissemination of research for different audience;different audience;
UPUP the line to superiors & sponsors; the line to superiors & sponsors;
DOWNDOWN the line to programme managers & the line to programme managers & other front line practitioners;other front line practitioners;
ACROSSACROSS the lines to fellow colleagues; the lines to fellow colleagues; andand
OUTREACHOUTREACH to service users, their to service users, their support network & organised client group.support network & organised client group.
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““It is not enough to be It is not enough to be busy. The question is: busy. The question is:
what are we busy about?”what are we busy about?”
Henry David ThoreasHenry David Thoreas
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REFERENCESREFERENCES
Crewe E, Young J. Bridging Research and Policy: Context, Evidence and Crewe E, Young J. Bridging Research and Policy: Context, Evidence and Links. London: Overseas Development Institute, September 2002.Links. London: Overseas Development Institute, September 2002.Exchange. Communicating health research: How should evidence affect Exchange. Communicating health research: How should evidence affect policy and practice. Number 5, April 2005. Access at policy and practice. Number 5, April 2005. Access at http//www.healthcomms.org.http//www.healthcomms.org.Haines A, Kuruvilla S, Borchert M. Bridging the implementation gap Haines A, Kuruvilla S, Borchert M. Bridging the implementation gap between knowledge and action for health.between knowledge and action for health.Hj. Nordin Saleh. Getting Research into Policy and Practice and Policy Hj. Nordin Saleh. Getting Research into Policy and Practice and Policy Making Process. Lectures, 30 May 2011.Making Process. Lectures, 30 May 2011.Last JM. A Dictionary of Public Health. New York: Oxford University Last JM. A Dictionary of Public Health. New York: Oxford University Press, 2007.Press, 2007.Shuttleworth, Martyn (2008).”Definition of Research”. Shuttleworth, Martyn (2008).”Definition of Research”. Experiment Experiment ResourcesResources. Experiment-Research.com. Retrieved 14 August 2011.. Experiment-Research.com. Retrieved 14 August 2011.Tan Sri Dato Seri Dr. Hj. Mohd. Ismail Merican. Getting Research into Tan Sri Dato Seri Dr. Hj. Mohd. Ismail Merican. Getting Research into Policy and Practice. 9Policy and Practice. 9thth NIH Scientific Meeting, 18 September 2006. NIH Scientific Meeting, 18 September 2006. Tan Sri Dato Seri Dr. Hj. Mohd. Ismail Merican. Translating Research into Tan Sri Dato Seri Dr. Hj. Mohd. Ismail Merican. Translating Research into Practice and Policy. 6Practice and Policy. 6thth National Pharmacy Research and Development National Pharmacy Research and Development Conference 2010.Conference 2010.Wikipedia. Research. Accessed at http//www.wikipedia/research. Retrieved Wikipedia. Research. Accessed at http//www.wikipedia/research. Retrieved 5 September 20115 September 2011
