The Science of Translational Research: What We Know (and What We Need to Know) For Closing Evidence - Practice Gaps

Publication Date: July 2006

Publisher: Kaiser Permanente; Robert Wood Johnson Foundation

Author(s): J.W. Dearing

Research Area: Health

Type: Report

Abstract:

This report recognizes two types of translational research: external validity studies and diffusion of innovation studies. External validity studies measure how well internally valid interventions fare when tested in real situations. The author lists five aspects of a program that can be used to gauge its likely external validity: surface similarity, ruling out irrelevancies, making discriminations, interpolation and extrapolation, and causal explanation. Construct validity, another important concept in translational research, refers to understanding why an intervention is able to achieve effects in order to transfer the success of a program to other venues or populations.

U.S. health education and systems suffer particularly from a dearth of dissemination and replication of effective programs and innovations, a fact that is delaying the improvement of U.S. health care. The author states that emphasizing diffusion of programs—across networks, organizations and states—rather than emphasizing only innovation itself, is the purpose of translation research and should be the focus of both private foundations and federal agencies. Bridging the chasm between what researchers know and what practitioners collectively do is the goal of translational research. Understanding innovation attributes is important to achieving diffusion of innovations. Important attributions related to adoption of innovations are cost, effectiveness, compatibility, simplicity, observability and the ability to be used in trials. Also important in achieving adoption of innovations are opinion leaders, clustering of innovations and their timing.

Numerous problems impede the diffusion of innovations and knowledge: lack of communication between researchers and practitioners, the fact that evidence of effectiveness is not a strong predictor of adoption, that more information does not necessarily produce better results and that societal systems are set up to resist change. However, combining external validity and diffusion studies can work synergistically to translate and diffuse research into better health care practices. Both traditions "begin with evidence-based interventions" and both must be aided by instruction in the practice of translation.