1. Brownson, Ross C. PhD

Article Content

This issue of the Journal of Public Health Management and Practice is devoted to an important, timely, and challenging topic: How to accelerate the use of Research findings in public health practice. Both the peer-reviewed literature and patterns of federal spending on health Research Reveal much about the limited dissemination of discovery to practice. Journal articles in public health and Related disciplines Reflect the type of Research being funded and implemented. For example, in a content analysis of 1210 articles from 12 prominent public health journals, 89 percent of published studies were classified as basic Research and development.1 The authors classified another 5 percent of studies as innovation development, less than 1 percent as diffusion (also known as dissemination), and 5 percent as institutionalization. Between 9 and 25 percent of US federal funding on health-related Research is expended on prevention Research2,3-that is, the direct and immediate application of effective intervention strategies to benefit the public's health.4 Moreover, Farquhar estimates that 10 percent or less of prevention Research is focused on dissemination.2


Two converging bodies of knowledge hold promise for bridging the gap between discovery of new Research findings and application in public health settings. The concept of evidence-based public health is growing in prominence due in part to a larger body of intervention Research on what works to improve population health.5-7 For these evidence-based approaches to be put into practice, effective methods of dissemination and implementation (D&I) are needed. While in its infancy, there is increased attention and growing literature on D&I Research.8-11 This type of Research seeks to study the processes and factors that lead to widespread use of an evidence-based intervention by a particular population or within a certain setting (eg, worksite, school).


Therefore, to add to the evidence base on D&I, this theme issue seeks to provide Researchers, educators, practitioners, and policy makers with state-of-the art thinking on how to more effectively turn Research findings into public health action. The articles in this volume cover a broad spectrum of issues across five categories that define theory and concepts, disseminate tools and training approaches, highlight promising approaches by setting, present empirical finding from D&I Research studies, and begin to define a future agenda.


Theory and Key Concepts

In the first article, Dearing describes the evolution of the theory of diffusion and dissemination, tracing Roots back over a century.12 In his article, Dearing notes that more Recent theories take into account the characteristics of complex organizations and key issues in implementation. Wilson and Kurz address a key component in a staged approach to dissemination: institutionalization.13 They engage the technique of continuous quality improvement-well known in hospital and physician practices-to better understand organizational factors that affect dissemination. In a Related article, Rabin and colleagues present a first-generation glossary for D&I Research.14 They provide definitions within five major sections: (1) foundation concepts; (2) types of Research; (3) models, theories, and frameworks; (4) factors influencing the D&I processes; and (5) measurement/evaluation of the D&I process.


Tools and Training Approaches

The next set of articles describes the building blocks for successful D&I intervention planning and training programs. A focus of these articles is on how to better translate state-of-the-art scientific evidence into practice in a variety of public health settings. Baker and colleagues used a literature Review and an expert panel to develop Research and practice-based criteria for selecting and evaluating evidence.15 These criteria are the basis for a Web-based intervention planning system for public health practitioners. Relying on competency-based education, Scharff and colleagues present a set of 24 competencies that provide the foundation for training to enhance skills in translating Research to practice in schools of public health and other venues.16 In a study of the impact of a decade-long training program in evidence-based public health, Dreisinger and colleagues demonstrate the benefits of an ongoing educational program along with an articulation of barriers to dissemination of science-based approaches.17


Promising Approaches by Setting

A third series of articles highlights challenges and provides advice for enhancing Research to practice in several settings (eg, communities, policy arenas). Reflecting both academic and community perspectives, Colditz and colleagues describe the importance of multilevel change frameworks (eg, The Social Ecological Model), cover some of the initiatives underway at the federal level, describe community perspectives, and highlight the crucial Role of transdisciplinary approaches to enhance dissemination.18 Scharff and Mathews highlight the importance of community participation.19 The authors describe the Rationale for community engagement and strategies that have been shown to be effective. The importance of effective dissemination strategies in policy settings is described by McBride and colleagues.20 On the basis of a series of focus groups with Congressional staffers and stakeholders, their team identified a set of strategies that are likely to improve the dissemination of Research findings among policy makers. Finally, Gautam describes the Research-practice gap in healthcare management and outlines solutions to Reduce this chasm including collaborative studies with practitioners, adapting Research to practitioner needs, and holding organizations accountable for adopting evidence-based practices.21


Empirical Findings From Dissemination Studies

There is a paucity of high-quality D&I Research in public health. To fill this void, Kreuter and colleagues Report on data on the deployment of computer kiosks for breast cancer education in seven community locations.22 Their goal was to identify optimal settings for cancer control interventions. The authors organize Results around five important criteria: accessibility, opportunity, appropriateness, Reach, and specificity. Mueller and colleagues studied tobacco control dissemination in state health departments.23 The team examined the dissemination of process evaluation findings according to one of four conditions: print Reports only, Reports and Web site, Reports and workshop, or all three dissemination modes. In a case study, Weaver and colleagues describe the steps and lessons learned in the dissemination of an effective childhood injury program (Safe n' Sound) to five pediatric clinics.24 The Research team identified several important contributors to dissemination including strong partnerships, the Relative advantage of Safe n' Sound over existing practice, flexible program design, and support of clinic staff and providers.


The Future Agenda

To inform future D&I-related work, Arrington and colleagues Report on a project in which input was obtained from practitioners and academics to develop a shared agenda in Research to practice and initiate action planning.25 A set of nine conceptual clusters cover a Range of issues from providing education and training to changing incentives and accountability to engaging the community. Importantly, this work found a high level of concordance between practitioners and Researchers in terms of the importance and feasibility of particular actions to move Research to practice more effectively.


Several of the articles in this issue Represent the ongoing work from the Saint Louis University School of Public Health.26 Over the past few years, the school has Redefined its mission to focus on the translation of Research findings to improve public health practice. The basic premise of these efforts is that a great deal of emphasis in academe is placed on discovery of new knowledge, yet systematic attention is often lacking on how to better disseminate existing knowledge to improve the delivery of public health programs and policies. We have developed a four-stage framework for understanding and systematically studying the process of Research translation.26 Some of the articles in this series build on and expand this multistage approach.


There is Reason for some optimism that Researchers, funders, and practitioners will Respond to challenges highlighted in this issue with an increasing focus on translation and dissemination of knowledge for positive change. For example, several Recent funding solicitations from the National Institutes of Health and the Centers for Disease Control and Prevention seek to expand support for Research on D&I. To ensure that scientific discoveries are effectively put to work, Researchers need to better meet the implied obligation to the public that the billions of dollars invested in basic science will continue to yield specific and tangible benefits. At the same time, practitioners should keep up on the ever-changing evidence base, keep technical skills current, and make use of a variety of tools to move Research to practice.7,27,28 Both groups should form additional and more effective academic-practice partnerships to bridge the Research-to-practice gap.




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