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Health service research and evidence based practice
Mind the gap: use of evidence in commentaries on MMR in professional journals (1988–2007)
  1. S. Hilton1,
  2. K. Hunt1,
  3. M. Langan1,
  4. V. Hamilton2,
  5. M. Petticrew3,
  6. H. Bedford4
  1. 1
    MRC Social and Public Health Sciences Unit, Glasgow, UK
  2. 2
    University of Glasgow, Glasgow, UK
  3. 3
    London School of Hygiene and Tropical Medicine, London, UK
  4. 4
    UCL Institute of Child Health, London, UK

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    To examine how journals and magazines disseminate research evidence and guidance on best practice to health professionals by analysing the alignment between commentaries on MMR evidence in journals, and key events in the MMR controversy.


    Content analysis of published commentaries on MMR (1988–2007).

    Data Sources

    Commentaries and articles in six commonly-read UK publications aimed at community health practitioners, identified through interviews with health visitors, practice nurses, GPs and medical librarians (n = 20), and through a survey conducted at the Community Practitioners and Health Visiting Association Annual Conference in 2007.

    Main Outcome Measures

    Number of comment pieces by publication, year and article type; trends in the focus, and tone (positive, neutral, negative, mixed) and whether recommendations on MMR were included.


    860 articles met the inclusion criteria (British Medical Journal n = 104, Community Practitioner n = 45, Health Visitor n = 24, Practice Nurse n = 61, Nursing Standard n = 61 and Pulse n = 565). Of these, 264 (31%) made some reference to evidence endorsing the safety of MMR. Around one in ten were rated as negative (10.9%, n = 29) or neutral (11.3%, n = 30) in relation to MMR safety, and nearly a quarter (22.7%, n = 60) were rated as “mixed”. In 2000, despite growing public concerns and widespread media coverage, fewer than 20 comment pieces were published. From 2001–2003 the tone of many articles was negative, mixed or neutral, thus conveying ambiguous or negative messages about MMR safety to health professionals, though from 2004 the tone changed and most comment pieces were broadly positive. Overall less than a quarter of comment pieces (n = 196, 22.7%) included reference to current recommendations or other guidance on MMR. This was particularly notable in the period from 1998–2001, following publication of the Wakefield paper in 1998.


    During the MMR controversy journals and magazines aimed at health professionals may have added to uncertainty among practitioners by failing to reinforce current practice with evidence-based recommendations about MMR safety. The findings raise questions about how far journals and magazines should go in supporting current public health policy, and how far they should leave readers to make up their own minds.