In moving health and social service programs from planning into action, it is essential to understand the extent to which the knowledge gained from research should influence the actions taken by organizations and agencies that provide services (e.g., government, nongovernment organizations [NGOs]). The complexity of the challenges in translating lessons learned from science into different service settings, as well as into public policy, requires a multifaceted approach to accelerate the integration of research with practice. In this paper, the relationship between science and service is examined within the contexts of the scientific, health practice, and policy communities largely from a public sector perspective within the United States.
Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation.
If we keep on doing what we have been doing, we are going to keep on getting what we have been getting. Concerns about the gap between science and practice are longstanding. There is a need for new approaches to supplement the existing approaches of research to practice models and the evolving community-centered models for bridging this gap. In this article, we present the Interactive Systems Framework for Dissemination and Implementation (ISF) that uses aspects of research to practice models and of community-centered models. The framework presents three systems: the Prevention Synthesis and Translation System (which distills information about innovations and translates it into user-friendly formats); the Prevention Support System (which provides training, technical assistance or other support to users in the field); and the Prevention Delivery System (which implements innovations in the world of practice). The framework is intended to be used by different types of stakeholders (e.g., funders, practitioners, researchers) who can use it to see prevention not only through the lens of their own needs and perspectives, but also as a way to better understand the needs of other stakeholders and systems. It provides a heuristic for understanding the needs, barriers, and resources of the different systems, as well as a structure for summarizing existing research and for illuminating priority areas for new research and action.
Translational research seeks to improve health care by promoting action and change in real-world health care settings. Although translational research advocates a break from the traditional researcher-initiated approach to science, strategies to successfully engage clinicians and leaders of health care delivery organizations in research are still under development. We propose that applying the principles of community-based participatory research in a way that considers delivery systems-including their leaders, clinicians, and staff-as a focal community can enhance the ability of translational research to improve health care. Applying participatory research methods, such as engaging in collaborative partnerships, building on existing community strengths, investing in long-term relationships, and engaging in research as a cyclical, iterative process, can be a successful approach to sustainable quality improvement at the systems level.
Despite the quickening momentum of genomic discovery, the communication, behavioral, and social sciences research needed for translating this discovery into public health applications has lagged behind. The National Human Genome Research Institute held a 2-day workshop in October 2008 convening an interdisciplinary group of scientists to recommend forward-looking priorities for translational research. This research agenda would be designed to redress the top three risk factors (tobacco use, poor diet, and physical inactivity) that contribute to the four major chronic diseases (heart disease, type 2 diabetes, lung disease, and many cancers) and account for half of all deaths worldwide. Three priority research areas were identified: (1) improving the public's genetic literacy in order to enhance consumer skills; (2) gauging whether genomic information improves risk communication and adoption of healthier behaviors more than current approaches; and (3) exploring whether genomic discovery in concert with emerging technologies can elucidate new behavioral intervention targets. Important crosscutting themes also were identified, including the need to: (1) anticipate directions of genomic discovery; (2) take an agnostic scientific perspective in framing research questions asking whether genomic discovery adds value to other health promotion efforts; and (3) consider multiple levels of influence and systems that contribute to important public health problems. The priorities and themes offer a framework for a variety of stakeholders, including those who develop priorities for research funding, interdisciplinary teams engaged in genomics research, and policymakers grappling with how to use the products born of genomics research to address public health challenges.
Genetically informed research on behavioral outcomes holds substantial promise for guiding efforts to enhance the efficacy and effectiveness of preventive interventions, but it also poses considerable challenges given the complexities of the dynamic interplay between genes and environment. This paper introduces a relatively uncommon research design, called microtrials, to provide a means of translating basic research findings into prevention trials, particularly through introducing genetic effects into prevention models. Microtrials are defined as randomized experiments testing the effects of relatively brief and focused environmental manipulations designed to suppress specific risk mechanisms or enhance specific protective mechanisms, but not to bring about full treatment or prevention effects in distal outcomes. Microtrial methods are described in detail, with discussion of their unique advantages for translating this knowledge base into prevention research. We end by raising several issues to consider when constructing genetically sensitive microtrials.
The shift from isolated researchers working in their individual laboratories to diverse research teams working in collaboration towards a common goal is a fundamental element of the Clinical and Translational Science Award (CTSA) (http://www.ctsaweb.org/). What is often misunderstood, however, is the depth and breadth of the translational paradigm. The NIH Roadmap discusses two basic steps of translation. First, basic science research must be translated to humans (the so-called T1 translation), and then secondarily translated into clinical practice (T2 translation) (http://nihroadmap.nih.gov/). Further work has demonstrated that in fact this second phase of translation includes two separate steps, first knowledge from T1 translational studies must be translated to patients (T2), and then we must translate our knowledge into actual clinical practice (T3 translation) (Westfall et al. 2007). Closer scrutiny, however, reveals more complexity and the need for many levels of translation. In this essay, I will briefly outline some of the myriad levels of translation necessary, and provide some examples to illustrate why further work is needed at these levels. Further, I will briefly describe the CTSA Consortium and discuss how this new model of research is attempting to address some of these needs.
Improving population health requires understanding and changing societal structures and functions, but countervailing forces sometimes undermine those changes, thus reflecting the adaptive complexity inherent in public health systems. The purpose of this paper is to propose systems thinking as a conceptual rubric for the practice of team science in public health, and transdisciplinary, translational research as a catalyst for promoting the functional efficiency of science. The paper lays a foundation for the conceptual understanding of systems thinking and transdisciplinary research, and will provide illustrative examples within and beyond public health. A set of recommendations for a systems-centric approach to translational science will be presented.
In the past few decades, significant advances have been made related to understanding, preventing, and treating chronic disease. Given these many advances across multiple disciplines, it is unclear why the potential for yielding substantial reduction in disease has not been achieved overall and across various subgroups. Socioeconomic and racial/ethnic disparities in a wide range of disease outcomes persist, and a number of studies highlight the importance of further improving behavioral risk-factor prevalence on a population level. The goal of this paper is to explore the role of transdisciplinary collaboration in the translation of research related to these vexing public health problems, and, in particular, to explore factors that appear to facilitate effective and sustainable translation. Transdisciplinary collaboration also has great potential to speed the rate of adoption of evidence-based practices. Examples of transdisciplinary collaborations in academic and community settings are provided, along with factors that may influence the long-term outcomes of transdisciplinary efforts.
Translational and transdisciplinary research is needed to tackle complex public health problems. This article has three aims. Firstly, to determine how academics and non-academics (practitioners, policy makers and community workers) identified with the goals of the UKCRC Centre of Excellence for Public Health in Northern Ireland and how their attitudes varied in terms of knowledge brokerage and translation. Secondly, to map and analyse the network structure of the public health sector and the placement of the Centre within this. Thirdly, to aggregate responses from members of the network by work setting to construct the trans-sectoral network and devise the Root Mean Sum of Squares to determine the quality and potential value of connections across this network. The analysis was based on data collected from 98 individuals who attended the launch of the Centre in June 2008. Analysis of participant expectations and personal goals suggests that the academic members of the network were more likely to expect the work of the Centre to produce new knowledge than non-academics, but less likely to expect the Centre to generate health interventions and influence health policy. Academics were also less strongly oriented than non-academics to knowledge transfer as a personal goal, though more confident that research findings would be diffused beyond the immediate network. A central core of five nodes is crucial to the overall configuration of the regional public health network in Northern Ireland, with the Centre being well placed to exert influence within this. Though the overall network structure is fairly robust, the connections between some component parts of the network--such as academics and the third sector--are unidirectional. Identifying these differences and core network structure is key to translational and transdisciplinary research. Though exemplified in a regional study, these techniques are generalisable and applicable to many networks of interest: public health, interdisciplinary research or organisational involvement and stakeholder linkage.
The role of biobehavioral sciences is critically evaluated within the model for translational research proposed in the NIH Roadmap. Concern is expressed regarding the lack of specification and representation of intervening disciplines along the translational chain from assessment to treatment to outcome. The implications of this model on the future of developmental psychopathology are discussed. A new model is proposed that emphasizes the role of biobehavioral sciences in translational research focusing on psychiatric disorders.
The systematic translation of evidence-based research findings, tools, and information into practice is critical to improving the quality of our nation's health. However, despite several decades of advances in developing medical knowledge based on high-quality empirical evidence, widespread implementation of these findings into practice in diverse applied settings has not been achieved. This article reviews definitions and conceptual models that describe the translation of research from basic discovery to real-world applications, summarizes the various issues involved in the process of translation, discusses multiple barriers, and provides recommendations to surmount these hurdles. Areas of further research in this arena are suggested. Finally, the article concludes that translational research is an important area to continue to pursue requiring long-term collaborative commitment among researchers and practitioners.
Despite dramatic advances in the molecular pathogenesis of disease, translation of basic biomedical research into safe and effective clinical applications remains a slow, expensive, and failure-prone endeavor. To pursue opportunities for disruptive translational innovation, the U.S. National Institutes of Health (NIH) intends to establish a new entity, the National Center for Advancing Translational Sciences (NCATS). The mission of NCATS is to catalyze the generation of innovative methods and technologies that will enhance the development, testing, and implementation of diagnostics and therapeutics across a wide range of diseases and conditions. The new center's activities will complement, and not compete with, translational research being carried out at NIH and elsewhere in the public and private sectors.
Evidence-based preventive interventions developed over the past two decades represent great potential for enhancing public health and well-being. Research confirming the limited extent to which these interventions have been broadly and effectively implemented, however, indicates much progress is needed to achieve population-level impact. In part, progress requires Type 2 translation research that investigates the complex processes and systems through which evidence-based interventions are adopted, implemented, and sustained on a large scale, with a strong orientation toward devising empirically-driven strategies for increasing their population impact. In this article, we address two core challenges to the advancement of T2 translation research: (1) building infrastructure and capacity to support systems-oriented scaling up of evidence-based interventions, with well-integrated practice-oriented T2 research, and (2) developing an agenda and improving research methods for advancing T2 translation science. We also summarize a heuristic "Translation Science to Population Impact (TSci Impact) Framework." It articulates key considerations in addressing the core challenges, with three components that represent: (1) four phases of translation functions to be investigated (pre-adoption, adoption, implementation, and sustainability); (2) the multiple contexts in which translation occurs, ranging from community to national levels; and (3) necessary practice and research infrastructure supports. Discussion of the framework addresses the critical roles of practitioner-scientist partnerships and networks, governmental agencies and policies at all levels, plus financing partnerships and structures, all required for both infrastructure development and advances in the science. The article concludes with two sets of recommended action steps that could provide impetus for advancing the next generation of T2 translation science and, in turn, potentially enhance the health and well-being of subsequent generations of youth and families.