Frameworks and Tools for Translating Research

1. Frameworks and Tools for Translating Research  Mary Altpeter, UNC Institute on Aging

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

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

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 the health issue at the population level

18. How To Sustain Efforts

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 provides a framework for identifying key attributes and factors of the “innovations” (transformative knowledge) researchers must identify in order to actively engage in the dissemination process to enhance ongoing research efforts or to make a difference in real world clinical practice or patient and caregiver lives. provides a framework for identifying key attributes and factors of the “innovations” (transformative knowledge) researchers must identify in order to actively engage in the dissemination process to enhance ongoing research efforts or to make a difference in real world clinical practice or patient and caregiver lives.

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? Increase knowledge provide exposure to new knowledge/innovation – Increase knowledge and attitudes provide experiences with 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

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