A Proposal to Speed Translation of Healthcare Research Into Practice

Dramatic Change Is Needed


      Efficacy trials have generated interventions to improve health behaviors and biomarkers. However, these efforts have had limited impact on practice and policy. It is suggested that key methodologic and contextual issues have contributed to this state of affairs. Current research paradigms generally have not provided the answers needed for more probable and more rapid translation. A major shift is proposed to produce research with more rapid clinical, public health, and policy impact.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Campbell M.
        • Fitzpatrick R.
        • Haines A.
        • et al.
        Framework for design and evaluation of complex interventions to improve health.
        BMJ. 2000; 321: 694-696
        • Hawe P.
        • Shiell A.
        • Riley T.
        Complex interventions: how “out of control” can a randomised controlled trial be?.
        BMJ. 2004; 328: 1561-1563
        • Flay B.R.
        Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs.
        Prev Med. 1986; 15: 451-474
        • Fisher J.D.
        • Fisher W.A.
        Changing AIDS-risk behavior.
        Psychol Bull. 1992; 111: 455-474
        • Woolf S.H.
        • Johnson R.E.
        Inattention to the fidelity of health care delivery is costing lives.
        Am J Public Health. 2007; 97: 1732-1733
        • Green L.W.
        • Glasgow R.E.
        Evaluating the relevance, generalization, and applicability of research: issues in external validity and translation methodology.
        Eval Health Prof. 2006; 29: 126-153
        • Rothwell P.M.
        External validity of randomised controlled trials: to whom do the results of this trial apply?.
        Lancet. 2005; 365: 82-93
        • Green L.W.
        • Glasgow R.E.
        • Atkins D.
        • Stange K.C.
        Getting evidence from science to practice: Slips “twixt cup and lip.”.
        Am J Prev Med. 2009; 37: S187-S191
        • Khoury M.J.
        • Gwinn M.
        • Yoon P.W.
        • Dowling N.
        • Moore C.A.
        • Bradley L.
        The continuum of translation research in genomic medicine: how can we accelerate the appropriate integration of human genome discoveries into health care and disease prevention?.
        Genet Med. 2007; 9: 665-674
        • Greenhalgh T.
        • Robert G.
        • Macfarlane F.
        • Bate P.
        • Kyriakidou O.
        Diffusion of innovations in service organizations: systematic review and recommendations.
        Milbank Q. 2004; 82: 581-629
        • Green L.W.
        • Ottoson J.M.
        • Garcia C.
        • Hiatt R.A.
        Diffusion theory and knowledge dissemination, utilization, and integration in public health.
        Annu Rev Public Health. 2009; 30: 151-174
        • Lenfant C.
        Clinical research to clinical practice—lost in translation?.
        N Engl J Med. 2003; 349: 868-874
        • Glasgow R.E.
        • Green L.W.
        • Klesges L.M.
        • et al.
        External validity: we need to do more.
        Ann Behav Med. 2006; 31: 105-108
        • Thorpe K.E.
        • Zwarenstein M.
        • Oxman A.D.
        • et al.
        A pragmatic–explanatory continuum indicator summary (PRECIS): a tool to help trial designers.
        CMAJ. 2009; 180: E47-E57
        • Etheredge L.M.
        A rapid-learning health system: what would a rapid-learning health system look like, and how might we get there?.
        Health Aff. 2007; Web Exclusive Collection: w107-w118
        • Hsu H.S.
        • Gupta G.
        An overview of the FDA draft guidance on adaptive design clinical trials.
        Date: 2010
        • Zwarenstein M.
        • Treweek S.
        • Gagnier J.J.
        • et al.
        Improving the reporting of pragmatic trials: an extension of the CONSORT statement.
        BMJ. 2008; 337: a2390
        • Kreuter M.W.
        • DeRosa C.
        • Howze E.H.
        • Baldwin G.T.
        Understanding wicked problems: a key to advancing environmental health promotion.
        Health Educ Behav. 2004; 31: 441-454
        • Axelrod R.
        • Cohen M.D.
        Harnessing complexity: organizational implications of a scientific frontier.
        Simon & Schuster, New York2000
        • Thomas P.
        Integrating primary health care.
        Radcliffe Publishing, Oxford, England2006
        • Ioannidis J.P.
        Evolution and translation of research findings: from bench to where.
        PLOS Clin Trials. 2006; 1: e36
        • Kuhn T.S.
        The structure of scientific revolutions.
        3rd ed. University of Chicago Press, Chicago1996
        • Chalmers A.G.
        What is this thing called science.
        3rd ed. Queensland Press, Lucia, Queensland, Australia1999
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Green L.W.
        • Ottosen J.M.
        From efficacy to effectiveness to community and back: evidence-based practice vs. practice-based evidence.
        Proceedings from conference: From Clinical Trials to Community: The Science of Translating Diabetes and Obesity Research; 2004. Jan 12–13, 2004; Bethesda MD. National Institutes of Diabetes, Digestive and Kidney Diseases, Bethesda MD2004
      1. Ottoson J.M. Hawe P. New directions for evaluation: knowledge utilization, diffusion, implantation, transfer, and translation: implications for evaluation. 2009 (Hoboken NJ)
        • Hawkins G.
        • Sanson-Fisher R.W.
        • Shakeshaft A.
        • D'Este C.
        • Green L.W.
        The multiple-baseline design for evaluating population-based research.
        Am J Prev Med. 2007; 33: 162-168
        • Des Jarlais D.C.
        • Lyles C.
        • Crepaz N.
        • TREND Group
        Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement.
        Am J Public Health. 2004; 94: 361-366
        • Glasgow R.E.
        • Linnan L.A.
        Evaluation of theory-based interventions.
        in: Glanz K. Rimer B.K. Viswanath K. Health behavior and health education: theory, research, and practice. 4th ed. Jossey-Bass, San Francisco CA2008: 487-508
        • Brownson R.C.
        • Baker E.A.
        • Leet T.L.
        • Gillespie K.N.
        Evidence-based public health.
        Oxford University Press, New York2003
        • Bandura A.
        Self-efficacy: the exercise of control.
        W.H. Freeman, New York1997
        • Sidman M.
        Tactics of scientific research: evaluating experimental data in psychology.
        5th ed. Basic Books, New York1960
        • Glasgow R.E.
        What types of evidence are most needed to advance behavioral medicine?.
        Ann Behav Med. 2008; 35: 19-25
        • Wade D.T.
        Research into the black box of rehabilitation: the risks of Type III error.
        Clin Rehabil. 2001; 15: 1-4
        • Pawson R.
        • Greenhalgh T.
        • Harvey G.
        • Walshe K.
        Realist review: a new method of systematic review designed for complex policy interventions.
        J Health Serv Res Policy. 2005; 10: S21-S39
        • Cronbach L.H.
        • Glesser G.C.
        • Nanda H.
        • Rajaratnam N.
        The dependability of behavioral measurements: theory of generalizability for scores and profiles.
        Wiley, New York1972
        • Agency for Health Care Research and Quality
        Practice-based research networks.
        • HMO Research Network
        • National Cancer Institute
        Cancer Intervention and Surveillance Modeling Network (CISNET).
        • Schensul J.J.
        Community, culture and sustainability in multilevel dynamic systems intervention science.
        Am J Community Psychol. 2009; 43: 241-256
        • Auchincloss A.H.
        • Riolo R.L.
        • Brown D.G.
        • Cook J.
        • Diez Roux A.V.
        An agent-based model of income inequalities in diet in the context of residential segregation.
        Am J Prev Med. 2011; 40: 303-311
        • Maglio P.P.
        • Mabry P.L.
        Agent-based models and systems science approaches to public health.
        Am J Prev Med. 2011; 40: 392-394
        • Stern M.
        • Williams K.
        • Eddy D.
        • Kahn R.
        Validation of prediction of diabetes by the Archimedes model and comparison with other predicting models.
        Diabetes Care. 2008; 31: 1670-1671
        • Yang Y.
        • Diez Roux A.V.
        • Auchincloss A.H.
        • Rodriguez D.A.
        • Brown D.G.
        A spatial agent-based model for the simulation of adults' daily walking within a city.
        Am J Prev Med. 2011; 40: 353-361
        • Shojania K.G.
        • Grimshaw J.M.
        Evidence-based quality improvement: the state of the science.
        Health Aff. 2005; 24: 138-150
        • Gold M.R.
        • Siegel J.E.
        • Russell L.B.
        • Weinstein M.C.
        Cost effectiveness in health and medicine.
        Oxford University Press, New York2003
        • Ritzwoller D.P.
        • Sukhanova A.
        • Gaglio B.
        • Glasgow R.E.
        Costing behavioral interventions: a practical guide to enhance translation.
        Ann Behav Med. 2009; 37: 218-227
        • Glasgow R.E.
        • Edwards L.L.
        • Whitesides H.
        • Carroll N.
        • Sanders T.J.
        • McCray B.L.
        Reach and effectiveness of DVD and in-person diabetes self-management education.
        Chronic Illn. 2009; 5: 243-249
        • Wermeling P.R.
        • van den Donk M.
        • Gorter K.J.
        • Ardine de Wit G.
        • van der Graaf Y.
        • Rutten G.E.
        Towards a more efficient diabetes control in primary care: six-monthly monitoring compared with three-monthly monitoring in type 2 diabetes—The EFFIMODI trial.
        BMC Fam Pract. 2010; 11: 35
        • Klesges L.M.
        • Estabrooks P.A.
        • Glasgow R.E.
        • Dzewaltowski D.
        Beginning with the application in mind: designing and planning health behavior change interventions to enhance dissemination.
        Ann Behav Med. 2005; 29: 66-75
        • Glasgow R.E.
        • Strycker L.A.
        • Kurz D.
        • et al.
        Recruitment for an Internet-based diabetes self-management program: scientific and ethical implications.
        Ann Behav Med. 2010; 40: 40-48
        • Glasgow R.E.
        • Klesges L.M.
        • Dzewaltowski D.A.
        • Estabrooks P.A.
        • Vogt T.M.
        Evaluating the overall impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues.
        Health Educ Res. 2006; 21: 688-694
        • Lei X.
        • Yuan Y.
        • Yin G.
        Bayesian phase II adaptive randomization by jointly modeling time-to-event efficacy and binary toxicity.
        Lifetime Data Anal. 2011; 17: 156-174
        • Stroebel C.K.
        • McDaniel Jr, R.R.
        • Crabtree B.F.
        • Miller W.L.
        • Nutting P.A.
        • Stange K.C.
        How complexity science can inform a reflective process for improvement in primary care practices.
        Jt Comm J Qual Patient Saf. 2005; 31: 438-446
        • Litaker D.
        • Tomolo A.
        • Liberatore V.
        • Stange K.C.
        • Aron D.
        Using complexity theory to build interventions that improve health care delivery in primary care.
        J Gen Intern Med. 2006; 21: S30-S34
        • Tunis S.R.
        • Stryer D.B.
        • Clancey C.M.
        Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy.
        JAMA. 2003; 290: 1624-1632
        • Glasgow R.E.
        • Magid D.J.
        • Beck A.
        • Ritzwoller D.
        • Estabrooks P.A.
        Practical clinical trials for translating research to practice: design and measurement recommendations.
        Med Care. 2005; 43: 551-557
        • Wu S.Y.
        • Pearson M.
        • Schaefer J.
        Assessing the implementation of the Chronic Care Model in Quality Improvement Collaboratives: does baseline system support for chronic care matter.
        RAND, Santa Monica CA2003
        • Glasgow R.E.
        • Steiner J.F.
        Comparative effectiveness research to accelerate translation: recommendations for “CERT-T.”.
        in: Brownson R.C. Colditz G. Proctor E. Oxford University Press, New York2010
        • Campbell M.
        • Fitzpatrick R.
        • Haines A.
        • et al.
        Framework for design and evaluation of complex interventions to improve health.
        BMJ. 2000; 321: 694-696
        • Emanuel E.J.
        • Wendler D.
        • Killen J.
        • Grady C.
        What makes clinical research in developing countries ethical?.
        J Infect Dis. 2004; 189: 930-937
        • Benatar S.R.
        Avoiding exploitation in clinical research.
        Camb Q Health Ethics. 2000; 9: 562-565
        • Biglan A.
        Changing cultural practices: a contextualist framework for intervention research.
        Context Press, Reno NV1995
        • Selby J.V.
        • Schmittidiel J.A.
        • Lee J.
        • et al.
        Meaningful variation in performance: what does variation in quality tell us about improving quality?.
        Med Care. 2010; 48: 133-139
        • Craig P.
        • Dieppe P.
        • Macintyre S.
        • Michie S.
        • Nazareth I.
        • Petticrew M.
        Developing and evaluating complex interventions: the new Medical Research Council guidance.
        BMJ. 2008; 337: a1655