Frameworks and Tools for Translating Research

1. Frameworks and Tools for Translating Research Mary Altpeter, UNC Institute on Aging IOA Seminar February 26, 2009

2. Overview • Terminology • Common barriers to research translation • The RE-AIM framework • Diffusion of Innovation theory • The dissemination/utilization process

3. Terminology • 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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. RE-AIM components

10. 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?

11. 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?

12. 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?

13. 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?

14. 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

15. 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

16. 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

17. 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

18. 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

19. Website: http://re-aim.org

20. 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

21. 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)

22. 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).

23. 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)

24. 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.

25. 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?

26. Dissemination/Utilization: For what aim? 4E’s • 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).

27. 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

28. 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

29. 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

30. 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

31. Questions? Thank you! Mary_Altpeter@unc.edu 966-0499