thomas r. prohaska, phd college of health and human ... · thomas r. prohaska, phd . college of...
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Thomas R. Prohaska, PhD College of Health and Human Services George Mason University Fairfax, Virginia
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1. Describe the overall process of translation of research to practice
2. Identify key transition points in the translation of research 3. Apply the RE-AIM framework to research translation and
dissemination 4. List at least five major barriers associated with successful
and timely translation of research to broader dissemination
5. Describe at least 3 strategies that facilitate translation of research
6. Differentiate between translation of research and translational research
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“The transition of scientifically tested research findings to community-based health promotion programs is often slow, fragmented, and subject to speculation by the practitioner community.”
“The ‘lessons learned’ from practitioners who develop and administer health behavior intervention programs for the benefit of their communities are slow to influence subsequent health behavior research.” Prohaska et al 2000
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Average 17 yrs for a fraction of efficacious treatments to move into practice Balas, et al., www.ahrq.gov/clinic/trip1997
1943 Papanicolaou test perfected; 1995 Screening programs for cervical cancer
established in all states 1964 US Surgeon General’s Advisory Committee
concludes that smoking causes disease 1993 Statewide tobacco control programs
established in all states
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Translation: is a process by which innovations in research are applied to other settings, populations and conditions not previously applied
Translational research is the science of accelerating of research to its useful application
Vague, dependent on scientific perspective (e.g. biomedical-bench to bedside; social behavioral-research to community practice)
Transitional chain; proximal to distal, with natural transitions links often divided by discipline
Dependent of the “consumer” individual, clinic, agency, community.
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What is the incidence and prevalence of various types and levels of PA among diverse older populations?
What are the health benefits of PA and the consequences of sedentary behavior among older populations?
What are the antecedents, factors and mechanisms influence the initiation, maintenance and non- participation in PA among older adults
Can we intervene on PA and if so, under what conditions and settings does this work best?
Can we develop interventions and policies to maintain PA activity in older populations and if so, what are the criteria which to evaluate their success?
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Delays in the research process Limitations in the communication of research
findings Use of Theory and Research Models Unidirectional nature of the transition Constraints in program application Different measures of outcomes and success
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Differences in Focus on outcomes Attention to Treatment Fidelity Program Adaptation External and Internal Validity Program Reach
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Researcher –validated measures established by the research community
Program Planner—cost effectiveness and compatibility with agency priorities
Older participant-- valued meaningful and observable outcomes
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Refers to the methodological strategies used to monitor and enhance the reliability and validity of the intervention
Is a process by which investigator ensures the quality, reliability and validity of the intervention
Is a method to ensure that the essential elements of the intervention and only the intervention account for study outcomes
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Without adequate assessment of treatment fidelity, ineffective programs may become widely disseminated (something other than the intervention accounted for the success) and potentially successful programs may be prematurely rejected.
Assessment of treatment fidelity can improve study design, improve effectiveness of the intervention, reduce program “drift” and facilitate research/program dissemination
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Practitioners may adapt program components to fit their circumstances, at times compromising the effectiveness of the program
Monitoring of treatment fidelity is frequently excluded during wider dissemination
Program may no longer have the same effect in the community as it had under more controlled and monitored settings
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Reflect a consideration of the special characteristics needs and preferences of its target groups
Include interventions which clearly and
effectively reduce a targeted risk factor and are appropriate for a particular setting
Identify and implement interventions which
make optimum use of available resources
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Healthy Aging Research Network
Social Ecologic Model of Healthy Aging
Individual
Interpersonal
Institutional
Community
Public Policy
Modified/ Sources: McLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev Med
Physical Environment
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RE Reach and Efficacy/Effectiveness AIM Adoption Implementation and Maintenance The impact of research dissemination is evaluated
in terms of 1) depth and range of settings in which the
research innovation is adopted 2) degree to which the research innovation is
implemented as intended and, 3) degree to which the research is maintained
and institutionalized in these settings
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Reach: How do I reach the targeted population? Effectiveness: How do I know my intervention is
effective? Adoption: How do I develop organizational
support to deliver my intervention? Implementation: How do I ensure the intervention
is delivered properly? Maintenance: How do I incorporate the
intervention so that it is delivered over the long term?
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Greater attention to recruitment attrition in research (who did not participate and why)
Identify differences in research populations versus translation targeted populations
Expand research populations to be more generalizable to real world populations
Ensure that recruitment materials and procedures are appropriately tailored to assure diversity
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Involve potential organizations in the research Identify barriers associated with willingness to
adopt research innovations Identify factors associated with early versus later
adopters through translation research
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Identify “essential elements” of research
innovation Continue to monitor fidelity and provide
feedback on breaches of treatment fidelity Track modifications of research intervention
and monitor consequences (positive and negative) of modification
Incorporate successful adaptations into new research
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Differentiate between levels of maintenance (e.g., program & participant maintenance)
Monitor programs attrition and participation Conduct translational research on preventing
relapse and promoting reactivation at the program and participant level.
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Participatory research interactions Involvement of organizational partners in the
research Identify mutually agreeable goals and outcomes
and organizational needs Identify and promote “internal champions”
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Funding sources: National Institute on Aging, Robert Wood Johnson
Foundation, Center for Disease Control and Prevention, Administration on Aging, local foundations
Research activities: observational and qualitative studies, RCTs, evidence-
based reviews, community demonstration projects, large scale research demonstration projects, best practices evaluations, national demonstration projects.
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Translational research multidisciplinary partnerships Healthy Aging Research Network (HAN) 7
universities, advisory group to the Centers for Disease Control and Prevention
Senior Health Alliance Promoting Exercise (SHAPE) National Center on Aging (partner on program
dissemination) Research Community Advisory Boards (CABs) older
adults, local stakeholders, agency internal champions
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Research translation activities - RCTs in university setting with sedentary healthy older
adults -RCTs exercise interventions among sedentary older
adults with arthritis -Church and Community-based exercise interventions
with minority older adults -Evidence based reviews of physical activity with older
adults by chronic illness and level of fraility
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Provide opportunities for direct communication and interaction between researchers, practitioners and organization members likely to adopt the research innovations
Provide collaborative multidisciplinary research opportunities to promote mutual learning experiences
Work within organizational settings to identify barriers and to implement programs
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Include outcome measures in your research that is relevant to the priorities of organization and group settings where the research would be disseminated
Focus greater attention to external validity, recruitment attrition and similar factors that would qualify wider dissemination of the research
Expand the populations and settings in which the research is conducted (real world application)
Identify the “essential elements” of the research required and develop protocols that assure treatment fidelity
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Prohaska, T., Peters, K., & Warren, J (2000) Health Behavior: From Research to Community Practice. In G. Albrecht, R Fitzpatrick & S. Scrimshaw (Eds.) The Handbook of Social Studies in Health and Medicine, Sage, London
Prohaska, T., Belansky, E., Belza, B., Buchner, D., et. al. (2006) Physical Activity, Public Health, and Aging: Critical Issues and Research Priorities. Journal of Gerontology, Social Sciences, 61B, 5, S267-273.
Prohaska, T. & Peters, K. (2007). Physical Activity and cognitive functioning: Translating research to practice using a public health approach. Alzehiemer’s & Dementia 3, S58-S64.
Prohaska, T., Smith-Ray, R. & Glasgow (2012). Translation dissemination and Implementation Issues. In (Thomas Prohaska, Lynda Anderson and Robert Binstock, eds.) Public Health for an Aging Society, Johns Hopkins University Press.
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