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

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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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Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

Paul Nathan, Elizabeth Barrett, John M. Lachin … (2002)

Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.

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Diffusion of innovations in service organizations: systematic review and recommendations.

Trisha Greenhalgh, Glenn Robert, Fraser Macfarlane … (2004)

This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.