Translating Research to Public Health Action

During a recent keynote presentation at the Innovation in Infectious Diseases Research symposium, I gave the following challenge: To really translate research to public health action, we need to understand what meaningful collaboration looks like.
 
Research and innovation are essential for improving people’s health and saving lives. Vaccines prevent devastating infections and illnesses. Drugs help manage and treat diseases. Diagnostic tools, medical devices, and other health-related interventions help providers anticipate, prevent, diagnose, and manage illnesses. With health systems and policymakers increasingly focused on how to optimize the health of populations, the research community faces a growing need to deliver useful data and products and action-oriented evidence. From the start of research projects, we must consider the path through development and delivery of a solution. Even while the research is being conducted, it is important to plan and anticipate how to test a tool or technology, how to introduce it, and who will use and pay for it.
 
Research funding agencies around the world are making translational research a key priority. In Australia, the National Health and Medical Research Council established a translation faculty, funds translation research centers and fellowships, and has implemented a suite of initiatives under the banner of research translation. The Canadian Institutes of Health Research publishes stories about the impact of health research on its website. U.K. DFID funds a Research to Action program that provides resources for the strategic and practical needs of people trying to improve the uptake of development research.  The U.S. National Institutes of Health has approximately 1,200 principal investigators conducting biomedical or behavioral research who work in scientific laboratories, hospital clinics, and fieldwork stations around the world and who share their accomplishments through a “Research to Action” website.
 

Research Translation: What Does it Really Mean?

One of the challenges in the field of research translation is that people interpret and apply the associated terms in different ways. For many, the term research translation refers to the ‘bench-to-bedside’ process, which involves applying knowledge from basic sciences to produce new medicines, devices and treatment options for patients. In this conceptualization, the interface between basic science and clinical medicine is particularly important, whereby a promising new treatment can be used clinically and commercialized. For others, such as those in public health and health services research whose work focuses on healthcare delivery systems and improving population health, the primary outcome is translating research into policy and practice.
 
Research translation is often used interchangeably with other related terms, including ‘knowledge translation’, ‘knowledge to action’ and ‘evidence-based practice.’ All these terms describe a gap between research knowledge and its application to treatment options, policy and practice, and acknowledge the importance of closing this gap. Regardless of the perspective taken, there is agreement that this process is dynamic, involving interaction between the context, researchers and end users of research knowledge. To measure the success of translation efforts, there is a clear need for conceptual frameworks that can describe and measure the key elements of the research translation process.


Frameworks for Translating Research into Practice

There is a growing body of literature describing frameworks for translating research evidence into practice. These frameworks have been applied in a myriad of settings, including basic and medical sciences, public health, clinical research, disease management, guideline development, global health, environmental health and preventive medicine. These frameworks have successfully supported knowledge translation in a number of sectors across health and beyond.
 
Four frameworks that can take research and innovations to market include:
 
  1. Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM)
  2. Translational research continuum or ‘T’ Models
  3. Knowledge to Action (KTA)
  4. Promoting Action on Research Implementation in Health Services (PARiHS)
 
These four frameworks describe how to bridge gaps between research knowledge and its application to treatment options, policy and practice. The frameworks acknowledge the difficulty of closing the gap between research and practice — a gap in part caused by a failure of research to meet the information needs of policymakers  and practitioners. They also underscore that research designs can give insufficient attention to real-world contexts and the complex interaction of these factors.
 
Frameworks can help map the process of translating research evidence into practice, and facilitate selection of appropriate study designs to address barriers, evaluate outcomes and address sustainability. It is important to note that when applying any framework, we must adapt research knowledge to the local context, and include the involvement of stakeholders and the target audience.
 
We can make dramatic progress in public health and development if research institutions, governments, foundations, nongovernment organizations, and private industry join together to generate new discoveries and new technologies. We must foster bold innovation and identify and pursue potentially transformative ideas, despite a high risk of failure.
 
Much has been written about the importance of ensuring that research evidence informs decisions. What can we do to understand and improve the ways in which researchers get their work translated into policy? Frameworks, tools, and case-studies exist that promote cross-discipline collaboration among researchers, funders, and policymakers. These resources can help ensure the development of sustainable solutions that will have impact at the greatest possible scale.
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