Overview of Translational Research, Implementation Science, and Scale-Up

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Lindsay Nettlefold Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada

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Samantha M. Gray Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
Aging and Population Health Lab, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada

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Joanie Sims-Gould Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada

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Heather A. McKay Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
Department of Family Practice, University of British Columbia, Vancouver, BC, Canada

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Interventions that prove efficacious and effective in research settings must move beyond initial testing and be integrated into routine use. However, on average it takes 17 years for just 14% of clinical research to move into regular practice (Balas & Boren, 2000; Morris et al., 2011). The gap between what is known from research studies and what gets done in the real world is often referred to as the know-do gap (Green et al., 2009; World Health Organization, 2006).

Once effective interventions/programs are integrated into a specific setting, policy makers (e.g., governments and health authorities) and funders want to know how interventions that enhanced health on a small scale can be disseminated on a broader scale to positively impact population health. Despite the importance of implementing effective interventions at broad scale to improve population health, few physical activity interventions have been scaled-up (Gray et al., 2021; Lane et al., 2021; Naylor et al., 2015; Reis et al., 2016), which generates the implementation to scale-up gap. Moving research findings into practice and then scaling-up is critical to achieve a return on investment in the research landscape and to improve health outcomes in a broader population (Colditz & Emmons, 2018).

Translational Research and Implementation Science

As noted in the preceding Editorial Commentary, Translational Research seeks to produce meaningful and positively impactful results that directly benefit human health and wellness by facilitating multidisciplinary collaborations among basic science, clinical researchers, and health/wellness educators and practitioners. Implementation Science is the “scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care” (Eccles & Mittman, 2006, p. 1). Implementation is defined as “the process of putting to use or integrating evidence-based interventions within a setting” (Rabin et al., 2008, p. 118). There are many (>60) frameworks, models, and theories that serve to guide implementation (Tabak et al., 2012); however, their selection is not always systematic (Birken et al., 2017) and relatively few physical activity intervention studies cite implementation frameworks (Gray et al., 2021).

To understand how, why, and how well an intervention worked (or did not work), what happened as the intervention was delivered in real-world settings, and how stakeholders and participants responded to the intervention, data must be collected about implementation (Bauman & Nutbeam, 2014). The implementation evaluation should collect data to better understand factors that influenced implementation (i.e., implementation determinants, such as context, feasibility, and appropriateness) as well as measure implementation outcomes (e.g., dose and fidelity; Fixsen et al., 2005; McKay et al., 2019). To date, few interventions described indicators they assessed to evaluate implementation/scale-up (Gray et al., 2021).

Scale-Up

Relatively little is known about mechanisms that support or inhibit scale-up of effective interventions (Catford, 2009; Milat et al., 2014). Scale-up is defined as “the process by which health interventions shown to be efficacious on a small scale and/or under controlled conditions are expanded under real world conditions into broader policy or practice” (Milat et al., 2015, p. 2) or as “eliberate efforts to increase the impact of innovations successfully tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting basis” (World Health Organization, 2010, p. 2). Although we use the term scale-up, others may prefer the term dissemination. Dissemination is defined as “an active approach of spreading evidence-based interventions to the target audience via determined channels using planned strategies” (Rabin et al., 2008, p. 118). Despite the importance of scale-up to improve population health, less than 5% of physical activity interventions for older adults, for example, have been scaled-up (Gray et al., 2021). Of those, thoughtful, planned evaluation of scale-up was lacking; few interventions were guided by a scale-up framework, and none clearly measured indicators of scale-up (Gray et al., 2021).

Summary

This brief overview is intended to orient readers to critically relevant fields of translational research and implementation and scale-up science, especially as they relate to health and wellness promotion and many other aspects of kinesiology research and practice. It is incumbent on kinesiologists to adopt and effectively use principles and practices from translational research and implementation and scale-up science, if our discipline is to continue to positively impact the health of people at a population level.

References

  • Balas, E.A., & Boren, S.A. (2000). Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics, (1), 6570.

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  • Bauman, A., & Nutbeam, D. (2014). Evaluation in a nutshell (2nd ed.). McGraw Hill Education.

  • Birken, S.A., Powell, B.J., Shea, C.M., Haines, E.R., Alexis Kirk, M., Leeman, J., … Presseau, J. (2017). Criteria for selecting implementation science theories and frameworks: Results from an international survey. Implementation Science, 12(1), Article 124. https://doi.org/10.1186/s13012-017-0656-y

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    • Export Citation
  • Catford, J. (2009). Advancing the ‘science of delivery’ of health promotion: Not just the ‘science of discovery.’ Health Promotion International, 24(1), 15. https://doi.org/10.1093/heapro/dap003

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    • Search Google Scholar
    • Export Citation
  • Colditz, G.A., & Emmons, K.M. (2018). Chapter 1: The promise and challenges of dissemination and implementation research. In R.C. Brownson, G.A. Colditz, & E.K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (2nd ed., pp. 1–18). Oxford University Press.

    • Search Google Scholar
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  • Eccles, M.P., & Mittman, B.S. (2006). Welcome to implementation science. Implementation Science, 1, Article 1. https://doi.org/10.1186/1748-5908-1-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fixsen, D.L., Naoom, S.F., Blase, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. University of South Florida Louis de la Parte Florida Mental Health Institute; National Implementation Research Network.

    • Search Google Scholar
    • Export Citation
  • Gray, S.M., McKay, H.A., Nettlefold, L., Race, D., Macdonald, H.M., Naylor, P.J., & Sims-Gould, J. (2021). Physical activity is good for older adults-but is programme implementation being overlooked? A systematic review of intervention studies that reported frameworks or measures of implementation. British Journal of Sports Medicine, 55, 8491. https://doi.org/10.1136/bjsports-2020-102465

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Green, L.W., Ottoson, J.M., Garcia, C., & Hiatt, R.A. (2009). Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annual Review of Public Health, 30, 151174. https://doi.org/10.1146/annurev.publhealth.031308.100049

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lane, C., McCrabb, S., Nathan, N., Naylor, P.J., Bauman, A., Milat, A., … Wolfenden, L. (2021). How effective are physical activity interventions when they are scaled-up: A systematic review. International Journal of Behavioral Nutrition & Physical Activity, 18(1), Article 16. https://doi.org/10.1186/s12966-021-01080-4

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    • Search Google Scholar
    • Export Citation
  • McKay, H., Naylor, P.-J., Lau, E., Gray, S.M., Wolfenden, L., Milat, A., Bauman, A., Race, D., Nettlefold, L., & Sims-Gould, J. (2019). Implementation and scale-up of physical activity and behavioural nutrition interventions: an evaluation roadmap. International Journal of Behavioral Nutrition & Physical Activity, 16(1), Article 102. https://doi.org/10.1186/s12966-019-0868-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Milat, A.J., Bauman, A., & Redman, S. (2015). Narrative review of models and success factors for scaling up public health interventions. Implementation Science, 10, Article 113.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Milat, A.J., King, L., Newson, R., Wolfenden, L., Rissel, C., Bauman, A., & Redman, S. (2014). Increasing the scale and adoption of population health interventions: Experiences and perspectives of policy makers, practitioners, and researchers. Health Research Policy and Systems, 12, Article 18.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Morris, Z.S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510520. https://doi.org/10.1258/jrsm.2011.110180

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Naylor, P.J., Nettlefold, L., Race, D., Hoy, C., Ashe, M.C., Higgins, J.W., & McKay, H. (2015). Implementation of school based physical activity interventions: A systematic review. Preventive Medicine, 72, 95115. https://doi.org/10.1016/j.ypmed.2014.12.034

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rabin, B.A., Brownson, R.C., Haire-Joshu, D., Kreuter, M.W., & Weaver, N.L. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 14(2), 117123. https://doi.org/10.1097/01.PHH.0000311888.06252.bb

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reis, R.S., Salvo, D., Ogilvie, D., Lambert, E.V., Goenka, S., & Brownson, R.C. (2016). Scaling up physical activity interventions worldwide: Stepping up to larger and smarter approaches to get people moving. The Lancet, 388(10051), 13371348.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tabak, R.G., Khoong, E.C., Chambers, D.A., & Brownson, R.C. (2012). Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine, 43(3), 337350. https://doi.org/10.1016/j.amepre.2012.05.024

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2006). Bridging the “know–do” gap: Meeting on knowledge translation in global health. WHO ExpandNet.

  • World Health Organization. (2010). Nine steps for developing a scaling-up strategy. WHO ExpandNet.

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  • Expand
  • Balas, E.A., & Boren, S.A. (2000). Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics, (1), 6570.

    • Search Google Scholar
    • Export Citation
  • Bauman, A., & Nutbeam, D. (2014). Evaluation in a nutshell (2nd ed.). McGraw Hill Education.

  • Birken, S.A., Powell, B.J., Shea, C.M., Haines, E.R., Alexis Kirk, M., Leeman, J., … Presseau, J. (2017). Criteria for selecting implementation science theories and frameworks: Results from an international survey. Implementation Science, 12(1), Article 124. https://doi.org/10.1186/s13012-017-0656-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Catford, J. (2009). Advancing the ‘science of delivery’ of health promotion: Not just the ‘science of discovery.’ Health Promotion International, 24(1), 15. https://doi.org/10.1093/heapro/dap003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Colditz, G.A., & Emmons, K.M. (2018). Chapter 1: The promise and challenges of dissemination and implementation research. In R.C. Brownson, G.A. Colditz, & E.K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (2nd ed., pp. 1–18). Oxford University Press.

    • Search Google Scholar
    • Export Citation
  • Eccles, M.P., & Mittman, B.S. (2006). Welcome to implementation science. Implementation Science, 1, Article 1. https://doi.org/10.1186/1748-5908-1-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fixsen, D.L., Naoom, S.F., Blase, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. University of South Florida Louis de la Parte Florida Mental Health Institute; National Implementation Research Network.

    • Search Google Scholar
    • Export Citation
  • Gray, S.M., McKay, H.A., Nettlefold, L., Race, D., Macdonald, H.M., Naylor, P.J., & Sims-Gould, J. (2021). Physical activity is good for older adults-but is programme implementation being overlooked? A systematic review of intervention studies that reported frameworks or measures of implementation. British Journal of Sports Medicine, 55, 8491. https://doi.org/10.1136/bjsports-2020-102465

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Green, L.W., Ottoson, J.M., Garcia, C., & Hiatt, R.A. (2009). Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annual Review of Public Health, 30, 151174. https://doi.org/10.1146/annurev.publhealth.031308.100049

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lane, C., McCrabb, S., Nathan, N., Naylor, P.J., Bauman, A., Milat, A., … Wolfenden, L. (2021). How effective are physical activity interventions when they are scaled-up: A systematic review. International Journal of Behavioral Nutrition & Physical Activity, 18(1), Article 16. https://doi.org/10.1186/s12966-021-01080-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McKay, H., Naylor, P.-J., Lau, E., Gray, S.M., Wolfenden, L., Milat, A., Bauman, A., Race, D., Nettlefold, L., & Sims-Gould, J. (2019). Implementation and scale-up of physical activity and behavioural nutrition interventions: an evaluation roadmap. International Journal of Behavioral Nutrition & Physical Activity, 16(1), Article 102. https://doi.org/10.1186/s12966-019-0868-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Milat, A.J., Bauman, A., & Redman, S. (2015). Narrative review of models and success factors for scaling up public health interventions. Implementation Science, 10, Article 113.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Milat, A.J., King, L., Newson, R., Wolfenden, L., Rissel, C., Bauman, A., & Redman, S. (2014). Increasing the scale and adoption of population health interventions: Experiences and perspectives of policy makers, practitioners, and researchers. Health Research Policy and Systems, 12, Article 18.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Morris, Z.S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510520. https://doi.org/10.1258/jrsm.2011.110180

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Naylor, P.J., Nettlefold, L., Race, D., Hoy, C., Ashe, M.C., Higgins, J.W., & McKay, H. (2015). Implementation of school based physical activity interventions: A systematic review. Preventive Medicine, 72, 95115. https://doi.org/10.1016/j.ypmed.2014.12.034

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rabin, B.A., Brownson, R.C., Haire-Joshu, D., Kreuter, M.W., & Weaver, N.L. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 14(2), 117123. https://doi.org/10.1097/01.PHH.0000311888.06252.bb

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reis, R.S., Salvo, D., Ogilvie, D., Lambert, E.V., Goenka, S., & Brownson, R.C. (2016). Scaling up physical activity interventions worldwide: Stepping up to larger and smarter approaches to get people moving. The Lancet, 388(10051), 13371348.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tabak, R.G., Khoong, E.C., Chambers, D.A., & Brownson, R.C. (2012). Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine, 43(3), 337350. https://doi.org/10.1016/j.amepre.2012.05.024

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2006). Bridging the “know–do” gap: Meeting on knowledge translation in global health. WHO ExpandNet.

  • World Health Organization. (2010). Nine steps for developing a scaling-up strategy. WHO ExpandNet.

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