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Frameworks and Tools for Translating Research. Mary Altpeter, UNC Institute on Aging. IOA Seminar February 26, 2009. Overview. Terminology Common barriers to research translation The RE-AIM framework Diffusion of Innovation theory The dissemination/utilization process. Terminology.

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frameworks and tools for translating research

Frameworks and Tools for Translating Research

Mary Altpeter, UNC Institute on Aging

IOA Seminar

February 26, 2009

  • Terminology
  • Common barriers to research translation
  • The RE-AIM framework
  • Diffusion of Innovation theory
  • The dissemination/utilization process
  • research finding = new knowledge = innovation
    • (e.g., new understanding of determinants, new method, new intervention, new tool)
  • knowledge transformation = process of synthesizing and summarizing for application
    • for future research or translation into practical application
    • by researchers, clinicians, community providers and/or policy-makers, patients, their caregivers
barriers to research translation researchers issues
Barriers to Research Translation: Researchers’ issues
  • present studies in ways that are incomprehensible and irrelevant to end-users
  • disseminate findings ineffectively, resulting in a “scattershot” approach for transfer of knowledge
  • give little attention to knowledge transfer because it is often not funded or is the least funded activity of a research project
barriers to research translation innovation issues
Barriers to Research Translation: Innovation issues
  • insufficiently compelling to overcome the influence of prior experiences, beliefs, and habits, and practice policies, and the inertia of complex systems of care in local environments
  • derived in settings that are not congruent with the realities of clinical or community practice
barriers to research translation practitioners issues
Barriers to Research Translation: Practitioners’ issues
  • do not have sufficient scientific literacy and statistical skills to read research
  • lack self-efficacy, have low outcome expectancies and limited organizational support to use research
reaim framework diffusion of innovation theory dissemination process
REAIM Framework, Diffusion of Innovation Theory, Dissemination Process
  • address the barriers in the knowledge transformation process
  • guide researchers through a systematic process of communicating findings that will be relevant to:
    • ongoing research about mechanisms and interventions;
    • clinical and community provider practice in real world settings;
    • patient and caregiver decision-making and health behaviors in every day life; and
    • related health care policies
  • Ultimately, can help accelerate knowledge transfer
purposes of re aim framework
  • Focus on impact of research efforts
  • Broaden the criteria used to evaluate programs to include external validity
  • Evaluate issues relevant to program adoption, implementation, and sustainability
  • Help close the gap between research studies and practice by
    • Informing design of interventions
    • Providing guides for adoptees
    • Suggesting standard reporting criteria

(Glasgow, 1999, 2000, 2004, 2006)

what is reach
What is “REACH”?
  • Focuses on the population you want to address – the “end-users”
    • Children, adults, older adults
    • Families, spouses
    • Caregivers
    • Clinicians
    • Service providers
    • Policy-makers
    • Researchers
    • Others?
why is reach important
Why is “REACH” important?
  • Focuses on “Representativeness”
  • Am I reaching the right population?
    • Which/how many individuals need to learn about my innovation?
    • What are their characteristics that are important to know about them (income, education, ethnic group, etc)?
    • How much training/intervention do they need?
why is effectivness important
Why is “EFFECTIVNESS” important?
  • Focuses on impact
    • Am I providing individual-level health benefits related to behaviors, attitudes and/or improving quality of life?
    • Am I improving practice or policies?
    • Am I unintentionally causing negative consequences or harm?
    • What are the costs?
why is adoption important
Why is “ADOPTION” important?
  • Focuses on the “middle-man” - staffing, partnering organizations and settings where the innovation/intervention can be offered
    • Can partners help support my intervention/translation efforts?
    • Are partners “representative” of the target population characteristics I’m trying to reach?
    • Are partner settings appropriate and accessible for who I want to reach?
why is implementation important
Why is “IMPLEMENTATION” important?
  • Focuses on consistency (fidelity) of innovation/intervention delivery no matter how often it’s delivered
    • By clinicians and community partners
    • By patients and caregivers
    • By program administrators and policy makers
    • Across settings
strategies to assure implementation fidelity
Strategies to Assure Implementation Fidelity
  • Articulation of essential factors
  • Written guidelines
  • Training
  • Observation to monitor for compliance
  • Consultations about intervention challenges or changes
  • Plan for implementation setbacks
balancing fidelity and adaptation
Balancing Fidelity and Adaptation

Identify essential innovation/intervention elements

Consider how approach may need to differ for different groups

Employ cultural/age /gender appropriate examples

why is maintenance important
Why is “MAINTENANCE” important?
  • Focuses on sustaining individual-level benefits participants (older adults, caregivers, clinicians) experience AND
  • Focuses on sustaining the program-level innovation/intervention over the long-run
  • Monitors impact on thehealth issue at the population level
how to sustain efforts
How To Sustain Efforts
  • Follow-up with target population to gauge satisfaction
  • Follow-up with staff and community partners to learn challenges, opportunities and successes
roger s diffusion of innovation
Roger’s Diffusion of Innovation
  • “Diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system" (Rogers, 2003).
  • Innovations spread through society, first by acceptance of “early adopters” followed by the majority, until the innovation is commonly accepted.
  • Framework for identifying key attributes and factors of innovations/transformative knowledge
8 key attributes of a new innovation that affect the rate of adoption
8 Key Attributes of A New Innovation That Affect the Rate of Adoption

Whether the innovation entails…

  • communicability – can be clearly described and communicated
  • relative advantage – perceived as superior to existing practice and more beneficial than other alternatives
  • complexity – is easy to implement
  • compatibility – fits well within the existing environment and prior experiences and values of the adopter

(Rogers, 1962; Rogers, 1986; Rogers, 2003)

8 key attributes of a new innovation that affect the rate of adoption1
8 Key Attributes of A New Innovation That Affect the Rate of Adoption

Whether the innovation entails…

  • revisability – can be customized to fit individual needs and contexts
  • trialability – an interested researcher, practitioner, patient or caregiver can use the innovation on a trial basis
  • observability – results can be easily measured and readily observed
  • reversibility - can be easily discontinued if it is deemed to be not working
  • (Rogers, 1962; Rogers, 1986; Rogers, 2003).
moderators of adoption and implementation
Moderators of Adoption and Implementation
  • whether there is minimal risk
  • commitment of time and costs
  • support for implementation
  • presence of a champion
  • previous success or failures with adoption of innovations

(Rogers, 1962; Rogers, 1986; Rogers, 2003)

dissemination utilization
  • By contrast to diffusion, dissemination refers to the specific steps of actively facilitating widespread adoption(Rogers, 2003).
  • Steps:
    • clearly identify who will be adopting the new findings (e.g., other researchers, clinicians, community service providers, patients, caregivers)
    • define what opportunities exist for reaching adopters
    • provide essential information about new findings including relevance to practice, every day life or research
    • strategize specific ways to build awareness about the new findings.
dissemination utilization 4 key questions
Dissemination/Utilization: 4 Key questions
  • To whom do I disseminate my research findings?
  • What level of learning and application do I want to impart to knowledge users?
  • In what manner and through what channels do I disseminate my research findings?
  • How can I accelerate this process?
dissemination utilization for what aim
Dissemination/Utilization: For what aim?


  • Increase knowledge
    • provideexposureto new knowledge/innovation –
  • Increase knowledge and attitudes
    • provideexperienceswith new knowledge/innovation (e.g., new assessment tool)
  • Increase competence
    • develop expertise in application of new knowledge (e.g., building patient skills in symptom recognition and management),
  • Increase utilization over time
    • embed new knowledge into daily clinical practice or policy or patient behavior

(Farkas et al, 2003).

dissemination utilization approaches
Dissemination/Utilization Approaches
  • Researchers
    • Exposure – articles, seminars, emails/listservs, web-based information
    • Experience – mentorship, curricula
    • Expertise – internship, training manuals
    • Embedding - ongoing research funding and technical assistance
dissemination utilization approaches1
Dissemination/Utilization Approaches
  • Service Providers/Administrators/Policy-makers
    • Exposure - conferences, popular/professional media, electronic user groups/bulletin boards
    • Experience – videos, internships, program visits
    • Expertise – manuals, training programs (in-person, web-based)
    • Embedding – programmatic systems-level technical assistance, organizational development, ongoing supervision/advocacy
dissemination utilization approaches2
Dissemination/Utilization Approaches
  • Patients and their caregivers
    • Exposure - popular media, community lectures, web-based consumer sites
    • Experience – role models
    • Expertise – manuals, videotapes and training programs (in-person, web-based)
    • Embedding - ongoing support meetings, feedback tools
putting it altogether
Putting it altogether
  • Consider translation and dissemination issues at research planning and implementation stages
  • Clearly define the “it” is you want to translate
  • Clearly define the target audience
  • What impact do you want “it” to have? (short-term and over the long-run)
  • Assess the feasibility of translating “it”
  • Identify “partners” to help
  • Identify the early adopters
  • Specify aim of dissemination – 4 E’s

Thank you!