• No results found

Translating Translation: What do we know? What can we do better?

N/A
N/A
Protected

Academic year: 2021

Share "Translating Translation: What do we know? What can we do better?"

Copied!
68
0
0

Loading.... (view fulltext now)

Full text

(1)

Translating “Translation:” What do

we know? What can we do better?

Rita K. Noonan, PhD

Associate Director for Program Development National Center for Injury Prevention & Control

(2)

“Discovery to delivery”

10-17 year delay. A generation

AHRQ data:

$95 Billion in development,

but only 1% to study

implementation

(3)

17 years ago??

On the radio:

, Montell

Jordan

(4)

What stars looked like…

Jennifer Anniston Oprah, George, Plastic Surgery

(5)

What I looked like in 1995…

(6)

The Problem

We have strategies that “work”

Little research to understand

adoption & effective use

Poor use of resources & scientific

discoveries

Result: more death, disability, and

injury

(7)

CENTRAL IDEA

(8)

The Research-Practice Process

Define the Problem

Develop & Test Prevention

Strategies

Assure Widespread

Adoption

Identify Risk & Protective Factors

(9)

The Dissemination/

Implementation Process

Develop & Test Prevention Strategies Dissemination/ Implementation Process Assure Widespread Adoption RESEARCH PRACTICE

(10)

Why the black box?

• Training

• Reward Structures

• R&D Bias in Funding

(11)
(12)

If You Build It…

(excerpts from Emshoff 2008)

• They may not find it

• They may not feel invited

• They may find it irrelevant

• They may think they already have it

• They may rebuild it

• They may love it & want 10 more.

(13)

What’s In a Name?

Knowledge to Action Research to Practice Knowledge Translation Knowledge Transfer Technology Transfer Diffusion Diffusion of Innovation Implementation Dissemination and Implementation Translation Science to Service

(14)

Whatever we call it…

(15)

It’s a Simple Question -

What are the best modalities for

disseminating what kinds of information to what kinds of individuals within what types of organizations about what kinds of programs - leading to what decisions

about adoption - leading to what

dimensions and levels of fidelity and

adaptation, as moderated by what kinds of capacity building, technical assistance, training, monitoring, and supervision?

(16)

Distilling the Information— Prevention Research System Supporting the Work—Prevention Support System Putting It Into Practice—Prevention Delivery System

Synthesis General Capacity Building Innovation-Specific Capacity Building General Capacity Use Innovation-Specific Capacity Use Policy Climate Funding

Existing Research and Theory Translation

Interactive Systems Framework

(17)

Distilling the Information— Prevention Research System Supporting the Work—Prevention Support System Putting It Into Practice—Prevention Delivery System

Synthesis General Capacity Building Innovation-Specific Capacity Building General Capacity Use Innovation-Specific Capacity Use Policy Climate Funding

Existing Research and Theory Translation

Interactive Systems Framework

(18)
(19)

Distillation System

• Knowledge of end users’ preferences,

learning style, networks

• User-friendly, accessible materials

• Core components

• Include end users in creation and

(20)

How do we communicate?

"If I look at the

mass I will never

act. If I look at the

one, I will."

(21)

Dearing’s Top 10

Dissemination Mistakes

1. We assume evidence matters in the decision making of potential adopters

2. We substitute our perceptions of those of potential adopters

3. We use intervention creators as intervention communicators

4. We introduce interventions too early

5. We assume that information will influence decision-making

(22)

6. We confuse authority with influence

7. We allow the first to adopt (innovators) to self-select into our dissemination efforts

8. We fail to distinguish among change agents, authority figures, opinion leaders and

innovation champions

9. We select demonstration sites on criteria of motivation and capacity

10.We advocate single interventions as the solution to a problem

(23)

Distilling the Information— Prevention Research System Supporting the Work—Prevention Support System Putting It Into Practice—Prevention Delivery System

Synthesis General Capacity Building Innovation-Specific Capacity Building General Capacity Use Innovation-Specific Capacity Use Policy Climate Funding

Existing Research and Theory Translation

Interactive Systems Framework

(24)
(25)

Scalability and Scaling Up

We often ask: “Is it scalable?”

“Is it feasible?” (Arby’s Test Kitchen)

We need to ask:

(26)
(27)

Support (capacity-building) System

* Knowledge is not sufficient to change

behavior. Think: smoking, fast food.

* Capacity:

motivation, skill sets,

training, infrastructure, staff.

• Fixsen’s Core Implementation

Components (compensatory)

(28)

Importance of Capacity

• Systematic Training

• Coaching and Monitoring

• Leadership – key to findings

• All these influence

(29)

Joyce & Showers Meta-Analysis (2002)

Component Knowledge Skill

Demonstration Use in Class Theory & Discussion 10% 5% 0% Training Demo 30% 20% 0% Practice & Feedback 60% 60% 5% Coaching in Classroom 95% 95% 95%

(30)

To Achieve Health Impact:

We need 2 things

1. Effective Interventions

2. Effective Implementation

(31)

Effectiveness – 2 axes

HI Effectiveness HI Implementation *Model program implemented with fidelity HI Effectiveness LO Implementation

*Half of model program sessions are delivered

LO Effectiveness HI Implementation

*DARE implemented

with fidelity to content and delivery format

LO Effectiveness LO Implementation *One-hour session in assembly hall delivered by a boring person

(32)

Distilling the Information— Prevention Research System Supporting the Work—Prevention Support System Putting It Into Practice—Prevention Delivery System

Synthesis General Capacity Building Innovation-Specific Capacity Building General Capacity Use Innovation-Specific Capacity Use Policy Climate Funding

Existing Research and Theory Translation

Interactive Systems Framework

(33)

Delivery (or practice) System

• Adoption influenced by individual users’

perceptions (e.g., Hard to use? Do I benefit?)

• Ex: DARE Program. Widely adopted, but

not effective. Why so popular?

• Organizational factors: fit with mission?

Culture? Administrative support? Bureaucratic obstacles?

(34)

Adoption/Diffusion Principles

Rogers, 1962 Diffusion of Innovations

relative advantage – compared to alternatives

compatibility - the consistency of the innovation with the

values and needs of an adopter

complexity - the simplicity or complexity of the innovation

itself

trialability - the ability to try out an innovation

observability - the ability to observe directly the effects and

benefits of the innovation

* flexibility degree to which the program/strategy can be adapted to local conditions

(35)

Program Fidelity

 The degree of fit between the protocol, program model or developer-defined

components of a program and its actual implementation in a given organizational or community setting – consistency with a curriculum, protocol, manual, or guidelines

(36)

AS CONCEPTUALIZED BY THE EXECUTIVE DIRECTOR

AS SPECIFIED IN THE GRANT PROPOSAL

(37)

AS DESIGNED BY THE PROGRAM

MANAGER

AS PRODUCED BY THE STAFF

(38)

AS INSTALLED AT THE USER SITE

(39)
(40)

Nudges & Persuasion

Choice Architecture:

Healthy Defaults

Anchors

Follow the Herd

Loss Aversion

(41)

What does this mean for public

health?

• We all have a role in closing gap

• “perfect science” not always useful in

real world

• We want both “evidence-based

practice” AND “practice-based

evidence”

(42)

What can we do?

• Start with existing efforts & evaluate

• Understand what practitioners need

• Design and evaluate strategies that

are feasible to use in organizations

characterized by:

Limited resources

High turnover rates

(43)

What can we do?

• Build capacity before dissemination

• Follow DOI and social marketing

• Emphasize benefits to adopters

• Bundle interventions

(44)

Read more…

Special Issue, June 2008

New version, 2013

Collection illuminates

CDC framework

(45)

Case Study

How would you translate

health care provider clinical

guidelines to increase older

adult fall prevention

assessments?

(46)

Effective Fall Prevention

Clinical assessment,

treatment, referral & follow-up

_______

Gillespie, Cochrane Database Systematic Review, 2003 AGS/BGS, Clinical Practice Guideline, 2010

(47)

Formative Research

Individual interviews w providers

Recognize falls are a threat for their older patients

Lack information about standardized

assessment methods & evidence-based prevention strategies

Tend to be reactive rather than proactive in addressing falls

(48)

Focus Groups

Primary care providers

Geriatricians

Nurses

Nurse practitioners

(49)
(50)
(51)
(52)

Stay Independent

(53)

Provider Resources

Provider materials in a spiral

binder with tabs

(54)
(55)
(56)

Instructions for Measuring

Orthostatic Blood Pressure

(57)
(58)

Talking with Patients Based on Stages of Change

(59)

Summary of

patient’s fall

risk factors

(60)

Referral Forms

(61)
(62)
(63)

Wall Chart

Integrating fall risk reduction into

(64)
(65)
(66)

Handout of

simple leg

strengthening

(67)

Next Steps with

Train providers to

use materials

Link w community

programs

(68)

Thank you!

Rita K. Noonan, PhD.

770-488-1532

References

Related documents

For the Tree View , the grid displays columns for Planning Unit, Plan Cycle (where you can start or exclude a planning unit), Approvals Status, Sub-Status, Current Owner,

In so doing, we exploit newly collected polling data to determine (1) whether Americans are ready to end felon disenfranchisement, and (2) under what circumstances they believe

Figure 1, Viewshed Map, displays the location of the proposed Project site, the historic Anza Trail Corridor, historic expedition campsites and locations of character photos taken

When applying risk man- agement to METT-TSL during mission analysis, leaders and staffs should look for hazards that affect both tactical and accident risks.. They must identify

Therefore, go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have

[r]

The main objective of this work was to develop, implement, and evaluate a web-based scheduling application for a collaborative preparation of class schedules at

altera showed a distinct effect on the emergence and survival of annual and perennial species 28.. and negatively affected the growth of individuals belonging to both groups