Translational Research and Women’s Health; How important is this to improve Clinical Practice?

Authors: Gayathri Delanerolle^1,2 Julie Taylor³

¹Digital Evidence Based Medicine Lab

²Southern Health NHS Foundation Trust

³University of Birmingham

Translational research is a multidisciplinary approach to scientific inquiry that aims to bridge the gap between basic scientific discoveries and their application in clinical settings. The primary goal of translational research is to implement experimental findings to benefit human health and society by way of a practical solution.

The process of translational research typically involves several distinct phases, or the three-step stages as described below;

• Step 1: Bench-to-Bedside: this step involves the translation of basic science based research, often from a laboratory setting to a clinical setting by way of understanding the mechanisms of diseases and testing the identified interventions for optimal therapeutic benefit. More commonly, clinical trials would be conducted during this step.
• Step 2: Practice-to-Community: this step involves the assessment of real-world implementation and wider impact on public health. Often, effectiveness of the assessment would be reported to better understand the impact of the said intervention.
• Step 3: Community-to-Population:  this step involves the dissemination and implementation of effective treatments or interventions on a large scale, considering population-wide factors and addressing health disparities.

There appears to be a lack of specificity across the above steps when assessing intervention suitability and acceptability in a women’s health context. For example, the Medical Research Council (MRC) based in the UK implemented a framework to develop and implement complex interventions research. This takes an efficacy, effectiveness, theory based and/or systems perspective where trade-offs exist between unbiased answers and more uncertain answers to broader and, complex interventions. Complex interventions could be developed and assessed either sequentially or using multi-phase approaches¹. These can be quite useful in the context of women’s health and whilst some adaptations could be made, there are several steps this framework does not consider. For example personalised intervention development and multi-work stream assessments using a single program can provide innovative solutions in a shorter time-frame and also prevent research waste in the event the intervention shows reduced efficacy and effectiveness.

Translational research therefore is vital for women’s health as it is incredibly valuable and plays a crucial role in advancing healthcare outcomes for women. In the context of women’s health, translational research bridges the gap between basic science and medical practice, allowing for the development of new and improved diagnostic tools, treatments, and preventive strategies that specifically address women’s unique health needs in the following ways:

• Addressing sex and gender differences: Women and men can have different physiological responses to diseases and treatments due to biological and hormonal differences. Translational research helps identify and address these sex and gender disparities, leading to more personalised and effective healthcare for women.
• Advancing reproductive health: Translational research has led to significant advancements in reproductive health, including improved contraception options, fertility treatments, and better management of pregnancy-related complications.
• Enhancing disease prevention and management: Translational research allows for a deeper understanding of the risk factors and mechanisms of various health conditions that predominantly or exclusively affect women, such as breast cancer, ovarian cancer, and osteoporosis. This knowledge aids in the development of targeted prevention and treatment strategies.
• Encouraging women’s participation in clinical trials: Historically, women have been underrepresented in clinical trials, leading to gaps in knowledge about how treatments affect them. Translational research encourages more inclusive trial designs that consider gender-specific factors and ensure that treatment outcomes are representative of the broader population.
• Improving mental health care: Translational research has shed light on the unique mental health challenges faced by women, including mood disorders and postpartum depression. This research helps develop tailored interventions to improve mental health outcomes in women.
• Tackling women’s health disparities: Translational research also focuses on addressing health disparities experienced by various groups of women, including those from marginalized communities. By understanding and tailoring interventions to specific populations, healthcare outcomes can be improved for everyone.
• Influencing health policy: Translational research findings often have implications for health policy. When policymakers are informed by robust scientific evidence about women’s health, they can develop more effective and equitable healthcare policies and programmes that are beneficial for children as well. The socioeconomic benefit by way of influencing policies can benefit national economic policies that provide continuous financial returns.

To conduct translational research specific to women’s health, several important steps are required which combine scientific, health system and policy efforts to promote and support research to address the unique needs of women. A few key steps to consider are as follows:

• Increase funding: Governments, research institutions, and private organisations should allocate more funding specifically for women’s health translational research. Adequate funding will attract researchers and enable them to conduct comprehensive studies on various aspects of women’s health
• Encourage multidisciplinary collaboration: Translational research often requires collaboration between researchers from different disciplines, such as basic scientists, clinicians, epidemiologists, and public health experts. Creating platforms and incentives for interdisciplinary collaboration can facilitate the exchange of ideas and expertise, leading to more comprehensive research outcomes.
• Promote sex-inclusive research: Historically, many research studies have excluded women or failed to adequately account for sex differences in their analyses. Encouraging sex-inclusive research designs ensures that findings are applicable to both men and women, leading to better understanding and treatment of health conditions that may affect them differently.
• Increase women’s representation in clinical trials: Women have been underrepresented in clinical trials, leading to gaps in knowledge about how treatments affect them. By increasing women’s participation in clinical research, we can better understand gender-specific responses to treatments and ensure that interventions are optimised for women’s health.
• Address health disparities: Women from marginalised communities may face unique health challenges and disparities. Researchers should focus on addressing these disparities and designing interventions that are culturally sensitive and tailored to the specific needs of diverse populations.
• Include gender-sensitive study designs: Researchers should use gender-sensitive study designs to account for the roles of biological sex, gender identity, and gender roles in health outcomes. This includes considering gender-based differences in risk factors, symptom presentation, and treatment responses.
• Enhance data collection and analysis: Improved data collection methods should be adopted to gather sex-disaggregated data and account for gender differences. Robust data analysis techniques should be employed to identify sex-specific patterns and trends in health outcomes.
• Support training and education: Providing training and educational opportunities in women’s health translational research will attract more researchers to this field and build a strong workforce with specialised knowledge and skills.
• Engage policymakers and stakeholders: Collaboration with policymakers and healthcare stakeholders is essential to ensure that research findings are translated into effective policies and programs that positively impact women’s health.
• Promote public awareness and advocacy: Raising awareness about the importance of women’s health translational research and advocating for increased support and funding can garner public and political support for these initiatives.

By implementing these steps, we can enhance the quality and quantity of translational research in women’s health, leading to improved healthcare outcomes and better overall health for women by way of improving our clinical practices.

References

1. Kivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021 Sep 30;374:n2061