What is the process of translating scientific findings to the real world known as?
The National Center for Advancing Translational Sciences (NCATS) explains more about translational science in the video below.
Biomedical Translation Translational research seeks to produce more meaningful, applicable results that directly benefit human health. The goal of translational research is to translate (move) basic science discoveries more quickly and efficiently into practice. At TRI we provide numerous targeted resources to address barriers that can curb productivity and the swift translation of research into new health care advances. Translational research:
Translational research is often classified by which stage of translation (from beginning research to societal application and impact) it falls into. The T Spectrum (Translational Spectrum) below illustrates the different stages of translational research. NCATS, which supports the work of TRI, studies translation on a system-wide level as a scientific and operational problem. The NCATS website states that:
Dr. Marita G. Titler is a Professor, the Rhetaugh G. Dumas Endowed Chair, and the Department Chair of Systems, Populations and Leadership in the University of Michigan, School of Nursing. Her program of research is in outcomes effectiveness and implementation science and is supported by federal and foundation funding. She has been PI on five funded translation and outcomes effectiveness studies, and co-investigator on numerous
other funded investigations. Dr. Titler is the PI of the T32 institutional training grant Complexity: Innovations in Promoting Health and Safety (T32 NR016914). She has published over 150 papers in referred journals including Medical Care, Health Services Research, and Implementation Science. She has served on national committees including the National Advisory Council for AHRQ, and the Committee on Standards for Developing Trustworthy Clinical Practice Guidelines for the Institute of Medicine.
She is a member of the National Academy of Medicine and has received numerous awards for her work including the American Organization of Nurse Executives National Researcher Award, the Sigma Theta Tau International Elizabeth McWilliams Miller Award, and the President’s award from the Friends of NINR.
Abstract
Key words: Translation science, models and theories, terminology, implementation science The gap between the availability of evidence and application in care delivery contributes to poor health outcomes...Translation science is a rapidly growing area of investigation. A number of healthcare practices have an evidence-base but they are not yet a part of routine care. The gap between the availability of evidence and application in care delivery contributes to poor health outcomes such as obesity, healthcare-acquired infections, and injurious falls (Centers for Disease Control and Prevention [CDC], 2016; Conway, Pogorzelska, Larson, & Stone, 2012; Shever, Titler, Mackin, & Kueny, 2011; Sving, Gunningberg, Högman, & Mamhidir, 2012; Titler et al., 2016). Although United States (U.S.) spending in health exceeds that of all developed nations, key measures of health lag behind, particularly for preventable chronic conditions and associated functional decline (Squires & Anderson, 2015). Multiple opportunities abound for implementation of evidence to improve population health and healthcare delivery (Institute of Medicine [IOM], 2009; IOM, 2011a; IOM, 2011b, IOM, 2012a; IOM, 2012b; IOM, 2013a; National Academies of Sciences, Engineering and Medicine [NAM], 2015). Furthermore, Clinical and Translational Science Award (CTSA) Programs, funded by NIH, are expected to partner with communities, practices, and clinicians in translating findings from research into practices and community programs (IOM, 2013b). The field of translation science investigates which implementation strategies work to promote use of evidence-based practices...The field of translation science investigates which implementation strategies work to promote use of evidence-based practices (EBPs) for whom, in what types of settings, and uncovers the mechanisms by which they work. Advancements in translation science can expedite integration of evidence in practice to improve care delivery, population health, and health outcomes (Henly et al., 2015). This article offers a basic overview of translation science and issues in the field. Historical OverviewNursing has a rich history of using research in practice... Nursing has a rich history of using research in practice pioneered by Florence Nightingale (Nightingale, 1858; 1859; 1863a; 1863b). Evidence-based practice (previously called research utilization) was advanced by several initiatives, including the:
...diversity of terminology impedes efforts to synthesize, advance, and apply findings from translation science. These seminal projects provided a strong foundation for evidence-based practice (EBP). Today, many nurses lead the healthcare agenda for EBP (Dickinson & Shever, 2012; Kelley, 2010; Kueny, Shever, Lehan Mackin, & Titler, 2015; Mark, Titler & Lattimer, 2014; Shever & Dickinson, 2013; Titler & Moore, 2010; Titler, 2010; Titler, 2011; Titler, 2014; Titler et al., 2017), and translation science (Dobbins et al., 2009; Estabrooks et al., 2008; McCormack et al., 2013; Newhouse, Bobay, Dykes, Stevens, & Titler, 2013; Rycroft-Malone et al., 2012; Shuman, Ploutz-Snyder, & Titler, 2018; Shuman, Xie, Herr, & Titler, 2017; Slaughter & Snelgrove-Clark, 2015; Titler et al., 2009; Titler et al., 2016; Titler et al., 2017; Wilson et al., 2016). As a result, the scientific body of knowledge translation in healthcare is growing (Titler, 2014). Definition of TermsTerminology is an issue in translation science (Colquhoun et al., 2014; Lokker, McKibbon, Colquhoun, & Hempel, 2015; McKibbon et al., 2010). For example, McKibbon and colleagues (2010) identified 100 different terms to describe translation research. This diversity of terminology impedes efforts to synthesize, advance, and apply findings from translation science. Lack of a common language makes it difficult for researchers to learn from each other’s studies; to collaborate across geographic boundaries and disciplines; and to search for and synthesize scientific findings (Colquhoun et al., 2014). One important distinction is the difference between conduct of research and EBP. An overview of terminology is in Table 1. One important distinction is the difference between conduct of research and EBP. Evidence-based practice and conduct of research have distinct purposes, questions, approaches, and evaluation methods. Conduct of research is the systematic investigation of a phenomenon that addresses research questions or hypotheses to create generalizable knowledge and advance the state of the science (LoBiondo-Wood & Haber, 2018). In contrast, EBP is the conscientious and judicious use of current best evidence in conjunction with clinical expertise, patient values, and circumstances to guide healthcare decisions (Straus, Richardson, Glasziou, Richardson, & Haynes, 2011; Titler, 2014). Another important distinction is the difference between EBP and translation science, also known as implementation science. “Best evidence” includes findings from randomized controlled trials, evidence from other scientific designs such as descriptive and qualitative research, as well as information from case reports and scientific principles. When enough research evidence is available, practice should be guided by research findings in conjunction with clinical expertise and patient values. In some cases, however, a sufficient research base may not be available, and health care decision-making is informed by other evidence sources such as scientific principles, quality improvement data, or quality improvement reports published in peer reviewed journals. ...EBP and translation science, though related, are not interchangeable terms. Another important distinction is the difference between EBP and translation science, also known as implementation science. Translation science is conduct of research. It focuses on testing implementation interventions to improve uptake and use of evidence to improve patient outcomes and population health, as well as to clarify what implementation strategies work for whom, in what settings, and why (Eccles & Mittman, 2006; Titler, 2014). An emerging body of knowledge in translation science provides a scientific base for guiding the selection of implementation strategies to promote adoption of EBPs in real-world settings (Dobbins et al., 2009; Titler, 2010; Titler et al., 2016). Thus EBP and translation science, though related, are not interchangeable terms. EBP is the actual application of evidence in practice (the “doing of” EBP), whereas translation science is the study of implementation interventions, factors, and contextual variables that effect knowledge uptake and use in practices and communities. Translation science is research; various research designs and methods are used to address the research questions or hypotheses (Titler, 2014). Table 1. Terms Used in EBP and Translation/Implementation Science
[Modified from Titler, LoBiondo-Wood, & Haber, J, (in press)] Theories and Models of Translation ScienceThere are multiple theories and models in translation science (See Table 2). A recent study of 223 implementation scientists, representing 12 countries, found that they used over 100 different theories spanning multiple disciplines (Birken, Powell, Shea et al., 2017). In a qualitative review of implementation theories, models and frameworks, Nilsen (2015) noted 3 organizing aims for their use: 1) to describe or guide the process of translating research into practice; 2) to understand and/or explain what influences implementation outcomes; and 3) to evaluate implementation. Within the first aim are process models that specify steps for promoting use of research in practice; these models are often called action models of EBP (e.g., Iowa Model, Knowledge to Action model), with most originating from the nursing discipline (Nilsen, 2015). Classic theories are those derived from other disciplines... Within the second aim (to understand/explain) are determinate frameworks, classic theories, and implementation theories. Determinate frameworks (e.g., Consolidated Framework for Implementation Research) describe domains of factors that influence implementation outcomes such as alignment of practice behaviors with the evidence-base. Classic theories are those derived from other disciplines such as psychology, sociology, and organizational theory that are applied to implementation studies. Examples include the Theory of Planned Behavior and Rogers’ Diffusion of Innovation Theory, which is considered the most influential theory in implementation science. Implementation theories are those that have been developed or adapted by researchers for use in implementation science (e.g., Normalization Process Theory) to guide the understanding and explanation of certain aspects of implementation. Within the third aim (to evaluate implementation) are those frameworks that provide a structure for evaluating implementation efforts. The RE-AIM framework (Glasgow, Vogt, & Boles, 1999) is an example of a commonly used evaluation framework particularly in public health. Table 2. Example of Theories, Frameworks and Models in Translation/Implementation Science
An issue in translation science is how these theories are applied.An issue in translation science is how these theories are applied. Application of these theories is meant to facilitate the identification of determinants of implementation, guide the selection of implementation strategies, and inform all phases of the research, including the constructs to be measured and the relationships among constructs to be tested (Birken, Powell, Shea et al., 2017). Several implementation scientists have noted, however, that these theories are not used, are used superficially, or are misused in translation science (Birken, Powell, Shea et al., 2017; Davies, Walker & Grimshaw, 2010; Gaglio et al., 2013; Kirk et al., 2016; Tinkle, Kimball, Haozous, Shuster, & Meize-Grochowski, 2013). This poses a substantial challenge for generalizing findings across diverse settings. Implementation StrategiesThere are multiple implementation strategies that have been tested and/or used for promoting adoption of EBPs. Implementation is a dynamic, iterative process. There are multiple implementation strategies that have been tested and/or used for promoting adoption of EBPs (Colquhoun et al., 2014; Colquhoun, Squires, Kolehmainen, Fraser, & Grimshaw, 2017; Grimshaw, Eccles, Lavis, Hill, & Squires, 2012; Lokker et al., 2015; McCormack et al., 2013; Michie, Atkins & West, 2014; Rycroft-Malone et al., 2012; Scott et al., 2012). The Translation Research Model (TRM), based on Rogers’ (2003) seminal work on diffusion of innovations, is useful for guiding selection of implementation strategies (Titler & Everett, 2001; Titler et al., 2009; Titler et al., 2016). According to this model (see Figure 1), adoption of EBPs is influenced by four key areas:
Successful implementation requires strategies to address each of these four areas (Titler, 2010; Titler et al., 2016). Table 3 provides examples of implementation strategies organized by the four components of the TRM. Figure 1. Translation Research Model (Figure used with permission) Table 3. Examples of Implementation Strategies for each Component of the Translation Research Model
Issues regarding implementation strategies in translation science include lack of agreement about naming of the implementation intervention and/or strategy (ontology); inconsistencies in the descriptions of interventions and their content; lack of an agreed upon classification system or taxonomy of implementation interventions; lack of clarity regarding the target of the intervention (e.g., organization, clinicians, teams of practitioners, or some combination thereof); description of the intervention dose; and selection and measurement of the primary end-points for determining effectiveness (Alexander & Hearld, 2012; Bornbaum, Kornas, Peirson, & Rosella 2015; Colquhoun et al., 2014; Grimshaw et al., 2012; Lokker et al., 2015; Martinez, Lewis, & Weiner, 2014; Titler & Shuman, 2017). These issues continue to be debated among investigators and are not uncommon in a young, transdisciplinary area of science. Context and ImplementationContext matters and is widely acknowledged as an important influence on implementation outcomes.Context matters and is widely acknowledged as an important influence on implementation outcomes (Birken et al., 2016; Jacobs, Weiner, & Bunger, 2014; May, 2013; May et al., 2016). Context for implementation of EBPs has traditionally been defined as the physical setting, with little attention to the dynamics of the practice environment (Chambers, Glasgow, & Stange, 2013; May, Johnson, & Finch, 2016). Context refers to the characteristics of the setting of implementation and the social dynamic factors in which implementation processes occur (May et al., 2016; Squires et al., 2015). Setting encompasses the structural factors, such as the physical or operational characteristics of the setting (e.g., staffing, unit size, types of patients) (Birken, Powell, Presseau et al., 2017; May et al., 2016). Social dynamic factors pertain to the roles, relationships, and dynamics of the individuals and groups within a practice setting (Birken, Powell, Presseau et al., 2017; May et al., 2016). Context factors that impact implementation include:
Investigators studying implementation should incorporate these dynamic context factors into their research. Implementation studies have traditionally included structural factors that influence adoption of EBPs but few studies have included the social dynamic factors, such as organizational capacity, EBP leadership behaviors, and climate for EBP implementation (Shuman, Powers et al., 2018). Instruments are available to assess a variety of context factors (Chaudoir, Dugan, & Barr, 2013; Titler & Anderson, in press). For example, the Implementation Climate Scale (ICS) is a reliable and valid instrument consisting of 18 items that evaluates the extent (1= slight extent to 4 = very great extent) that the unit/practice setting prioritizes and values EBP. All items are anchored to a specific practice setting as a point of reference (Ehrhart, Aarons, & Farahnak, 2014). Investigators studying implementation should incorporate these dynamic context factors into their research. Incorporating measures such as these into implementation studies will provide insights into why some implementation strategies work in some settings and not others, and the mechanisms underlying the effectiveness of these strategies. We are unlikely to close the critical gap between research and practice if studies do not examine the interplay between dynamic context factors and the implementation strategies used to promote uptake of EBPs. Results of the assessment can be examined for opportunities to strengthen organizational capacity for EBP and to guide organizational interventions/programs... In addition, context factors that impact implementation should be routinely assessed by healthcare systems to build strong organizational capacity for adoption of EBPs. Results of the assessment can be examined for opportunities to strengthen organizational capacity for EBP and to guide organizational interventions/programs to address these areas of opportunity. For example, if scores for hiring staff that value EBP are low, an organization may want to examine hiring practices and interview questions used in selection of staff. ConclusionTranslation science is a relatively new area of investigation and nurse scientists are setting directions in this field. Nurse scientists have a rich history and are making major contributions to EBP and translation science. Translation science is a relatively new area of investigation and nurse scientists are setting directions in this field. An overview of terminology, examples of theories and models of translation science, descriptions of various implementation strategies, and the importance of context in implementation science have been presented. Challenges noted include diversity of terminology associated with translation science, multiple theoretical models with inconsistent or underuse to guide implementation research, lack of agreement of an ontology and taxonomy of implementation strategies, underdeveloped methods for calculating implementation intervention dose, and controversies regarding methods for measurement of implementation effectiveness. Dynamic context factors are emerging as an important area to address in implementation research. This field of investigation continues to provide multiple opportunities for nurse scientists and practicing clinicians to address application of evidence in practice to improve care delivery, patient outcomes, and population health. AuthorsMarita G. Titler,
PhD, RN, FAAN Dr. Marita G. Titler is a Professor, the Rhetaugh G. Dumas Endowed Chair, and the Department Chair of Systems, Populations and Leadership in the University of Michigan, School of Nursing. Her program of research is in outcomes effectiveness and implementation science and is supported by federal and foundation funding. She has been PI on five funded translation and outcomes effectiveness studies, and co-investigator on numerous other funded investigations. Dr. Titler is the PI of the T32 institutional training grant Complexity: Innovations in Promoting Health and Safety (T32 NR016914). She has published over 150 papers in referred journals including Medical Care, Health Services Research, and Implementation Science. She has served on national committees including the National Advisory Council for AHRQ, and the Committee on Standards for Developing Trustworthy Clinical Practice Guidelines for the Institute of Medicine. 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Terms Used in EBP and Translation/Implementation Science
[Modified from Titler, LoBiondo-Wood, & Haber, J, (in press)] Table 2. Example of Theories, Frameworks and Models in Translation/Implementation Science
Figure 1. Translation Research Model (Figure used with permission) Table 3. Examples of Implementation Strategies for each Component of the Translation Research Model
May 31, 2018 DOI: 10.3912/OJIN.Vol23No02Man01 https://doi.org/10.3912/OJIN.Vol23No02Man01 Citation: Titler, M.G., (May 31, 2018) "Translation Research in Practice: An Introduction" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 2, Manuscript 1. Related Articles
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