Article

How Can We Increase Translation of Research into Practice? Types of Evidence Needed

Kaiser Permanente Colorado, Denver, CO 80231, USA.
Annual Review of Public Health (Impact Factor: 6.47). 02/2007; 28(1):413-33. DOI: 10.1146/annurev.publhealth.28.021406.144145
Source: PubMed

ABSTRACT

This review summarizes key factors that have interfered with translation of research to practice and what public health researchers can do to hasten such transfer, focusing on characteristics of interventions, target settings, and research designs. The need to address context and to utilize research, review, and reporting practices that address external validity issues-such as designs that focus on replication, and practical clinical and behavioral trials-are emphasized. Although there has been increased emphasis on social-ecological interventions that go beyond the individual level, interventions often address each component as if it were an independent intervention. Greater attention is needed to connectedness across program levels and components. Finally, examples are provided of evaluation models and current programs that can help accelerate translation of research to practice and policy.

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    • "Despite considerable support for the implementation of screening and brief intervention for alcohol consumption among pregnant women in Australia [16, 17] , there has been little evaluation of the factors which influence the implementation of these interventions by primary providers of antenatal care. Our understanding of the factors which influence health professionals' behaviour is incomplete [19], and there is a recognised gap between evidence-based recommendations and practice [20]. Midwives have been identified as important providers of alcohol education [21] due to their key role in assessing the risks associated with alcohol use during pregnancy and providing appropriate interventions to mitigate risks to maternal and fetal health. "
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    ABSTRACT: Background: Prenatal alcohol exposure is an important modifiable cause of adverse fetal outcomes during and following pregnancy. Midwives are key providers of antenatal care, and it is important to understand the factors which influence their ability to provide appropriate advice and support to women about alcohol use in pregnancy. The main aim of this study was to develop a psychometrically valid scale to evaluate midwives' beliefs about assessing alcohol use during pregnancy. Method: A self-administered questionnaire was developed to evaluate midwives' beliefs about assessing alcohol use during pregnancy, including beliefs about positive and negative consequences of asking about alcohol use, and beliefs about capacity to assess alcohol use. The questionnaire was sent to 245 midwives working for a state-wide country health service in Western Australia. Exploratory factor analysis was used to identify the latent constructs assessed by the 36 belief items and provide initial construct validation of the Asking About Alcohol (AAA) Scale. Results: Of the 166 (67.8 %) midwives who responded to the survey, 160 (96.4 %) completed one or more of the belief items and were included in this analysis. Factor analysis identified six subscales which assessed beliefs about discomfort, capacity, effectiveness, role, trust and knowledge. Midwives held the most positive beliefs about their capacity to ask and the effectiveness of asking about alcohol use, and the least positive beliefs about women's knowledge about alcohol use and discomfort associated with asking about alcohol use in pregnancy. Midwives' beliefs about their role and the effectiveness of asking were most strongly associated with the intention to ask all pregnant women about alcohol use during pregnancy (r = -0.59, p < 0.001 and r = -0.52, p < 0.001). Conclusions: Our analysis has identified key constructs underlying midwives' beliefs about the assessment of alcohol use during pregnancy. The AAA Scale provides a basis for improved clarity and consistency in the conceptualisation and measurement of midwives' beliefs which can be used to enhance our understanding of factors influencing midwives' ability to deliver interventions to prevent alcohol use during pregnancy. The constructs identified in this exploratory analysis require confirmatory analysis to support their validity and generalizability.
    Full-text · Article · Dec 2015 · BMC Pregnancy and Childbirth
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    • "No single intervention will solve all problems in a community. For several reasons, even the best evidence-based interventions produce relatively small effects when taken to scale [7], meaning they affect only a portion of the population, or the effects are small for any one person or institution but important and large when extrapolated to the population as a whole. Different interventions also target particular outcomes or sub-populations (e.g., developmental stages, age groups, risk status). "
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    ABSTRACT: Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evaluation that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies. The major challenges we discuss concern (a) multiple contexts of evaluation/research, (b) complexity of packages of interventions, and (c) phases of evaluation/research questions. We suggest multiple alternative research designs that maintain rigor but accommodate these challenges and highlight the need for measurement systems. Longitudinal data collection and a standardized continuous measurement system are fundamental to the evaluation and refinement of complex multicomponent interventions. To be useful to T3–T5 translational research efforts in neighborhoods and communities, such a system would include assessments of the reach, implementation, effects on immediate outcomes, and effects of the comprehensive intervention package on more distal health outcomes.
    Full-text · Article · Nov 2015 · Translational Behavioral Medicine
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    • "Exploring how health professionals might adapt into effective teams underpins several models of chronic disease management, in particular the Chronic Care Model (CCM) [14]. While there are a number of approaches to weight management available (including those delivered by the private sector, and broad public health media campaigns) the CCM refers directly to clinical health services, the focus of this research. "
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    ABSTRACT: Background: Integrating professional expertise in diet, exercise and behavioural support may provide more effective preventive health services but this needs testing. We describe the design and baseline results of a trial in the Illawarra region of New South Wales, Australia. Methods: The HealthTrack study is a 12month randomised controlled trial testing effects of a novel interdisciplinary lifestyle intervention versus usual care. The study recruited overweight and obese adults 25-54yrs. resident in the Illawarra. Primary outcomes were weight, and secondary outcomes were disease risk factors (lipids, glucose, blood pressure), and behaviour (diet, activity, and psychological factors). Protocols, recruitment and baseline characteristics are reported. Results: Between May 2014 and April 2015, 377 participants were recruited and randomised. The median age (IQR) of the mostly female sample (74%) was 45 (37-51) years. The sample comprised obese (BMI 32 (29-35) kg/m(2)) well educated (79% post school qualifications) non-smokers (96%). A high proportion reported suffering from anxiety (26.8%) and depression (33.7%). Metabolic syndrome was identified in 34.9% of the sample. Conclusions: The HealthTrack study sample was recruited to test the effectiveness of an interdisciplinary approach to preventive healthcare in self-identified overweight adults in the Illawarra region. The profile of participants gives some indication of those likely to use services similar to the trial design.
    Preview · Article · Oct 2015 · Contemporary clinical trials
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