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g n i t e e M l Dissemination, Implementation, Knowledge a u Translation, and Scale up of Nutrition and n Physical Activity Interventions in the Pursuit n of a Public Health Impact A 7 1 0 Paul A. Estabrooks, PhD 2 A Twitter:

  1. g n i t e e M l Dissemination, Implementation, Knowledge a u Translation, and Scale up of Nutrition and n Physical Activity Interventions in the Pursuit n of a Public Health Impact A 7 1 0 Paul A. Estabrooks, PhD 2 A Twitter: @paul_estabrooks P Email: paul.estabrooks@unmc.edu N B S I

  2. g n i t e e M l a u n n A 7 1 0 2 A P N B S I

  3. g n i t e e M l a u n n A 7 1 0 2 A P N B S I

  4. g n i t e e M l a u n n A 7 1 0 2 A P N B S I

  5. g n i t e e M l a u n n A 7 1 0 2 A P N B S I

  6. g n i t Who is this talk for? e e M • Scientists seeking to have a public health impact l with their work. a u n • Scientists that are interested in service provision, n but aren’t looking to be service providers or policy A implementers. 7 1 • Scientists interested in close collaboration with 0 2 community organizations, health care settings, and/or systems that provide services or interface A with the populations that could benefit from health P promotion N B S I

  7. g n i t What is the message? e e M • Current knowledge translation, dissemination, l implementation, and scalability research is a struggling due to an over-reliance on evidence- u n based interventions relative to evidence-informed n principles. A • Co-production of evidence is promising for 7 improving practice and participant outcomes. 1 0 2 • Ideas for moving research in translational science forward A P • A call to action for more clearly defining this area N of research within the broader spectrum of B translational science S I

  8. g n i t Dissemination & Implementation e e M Dissemination & Scalability Implementation l a Sustainability u n Implementation n A Adaptation 7 1 Effectiveness 0 Studies 2 - Adaptation to real world settings Evidence-based interventions: A Efficacy Trials Interventions that have - Randomized Control P undergone sufficient scientific Trials (RCTs) N evaluation to be considered effective Pre-Intervention B - Feasibility and S pilot trials Lobb and Colditz Annual Review of Public Health 2013; 34: 235-251 . I

  9. g n i t Knowledge Translation e e M – A dynamic and iterative process that includes synthesis, dissemination , exchange and ethically-sound application of knowledge to improve the l health of Canadians, provide more effective health services and a products and strengthen the health care system . u n n • Synthesis of existing research. A • Dissemination to stakeholders (patients, practitioners, policy makers) could include engaging stakeholders in developing and executing dissemination 7 plan, tools creation, and media engagement. 1 0 • Exchange- interaction between the knowledge user and the researcher, 2 resulting in mutual learning. A • Ethics- activities are consistent with ethical principles and norms, social P values, as well as legal and other regulatory frameworks – while keeping in N mind that principles, values and laws can compete among and between each other at any given point in time. B S http://www.cihr-irsc.gc.ca/e/29418.html#1 I

  10. g n i t Scalability & Scale Up e e M – efficacious interventions expanded under real world conditions to reach a greater proportion of the eligible population, while retaining l effectiveness . (Milat, King, Bauman, & Redman, 2011) a u n n A 7 – extending the reach of an intervention by institutionalizing the intervention 1 within a given organization/region or by replicating it in other localities , 0 cities, or states or both (Reis et al., 2016). 2 A P N B S I

  11. g n i What is a public health impact? t e e M l a u n n A 7 1 0 2 A P N B Glasgow, Vogt, and Boles, 1999 S I

  12. g n i t A KT, D&I, Scale-up Commonalities e e M – Sufficient scientific evaluation based on a hierarchy l of evidence . a u n n – Movement of an evidence-based product from A science to practice. 7 1 0 – Providing the evidence-based product with ‘how 2 to’ resources and support (and a focus on fidelity A while allowing modest adaptation ) will result in P N quality knowledge translation. B S I

  13. g n i t A challenge… Stakeholders… e e M – Often do not share the value of a hierarchy l of evidence… and value multiple types of a u information, some more than traditional n n research evidence. A 7 – May actively criticize evidence-base as not 1 0 relevant. 2 • Not like my… place, people, resources, A system. P N • Not like… me. B S I

  14. g n i t A challenge… Stakeholders… e e M – Have unique knowledge, skills, and strategies that l a are often rolled over with an evidence-based u n intervention’s roll out or scale up. n A – These challenges can put a researcher on his/her 7 1 heels on 3 fronts—defending why some evidence is 0 better than other, needing methods to avoid 2 localism, and challenging local stakeholder A P expertise. N B S I

  15. g n i t An Example from Scotland e e M – The Scottish Style of policymaking is built on: l a • high levels of consultation with stakeholders to gather oral and u written evidence n • a willingness to form partnerships with local policymakers rather than impose national policies n A – Successful case studies of this approach did not highlight 7 the hierarchy of evidence or scientific information, but 1 rather focused on 0 2 • user-testimony A • assets-based approaches (i.e., use of existing resources) P • short- term local evaluation of costs or resources saved N • better short-term outcomes for the service users B • higher community engagement S Cairney, 2016 I

  16. g n i t Advice for scientists e e M • Within this climate of decision making, some l a policy researchers have concluded that u n scientists should: n A • focus on evidence of the active ingredient of interventions 7 1 • understand that the intervention and delivery 0 2 channels will take a particular form that may not be what it was in ‘the research world’ based on A the level of engagement of community bodies, non- P governmental organizations and/or service users. N B S Cairney, 2016 I

  17. g n i t e e M l a u Current KT, D&I, and scalability n research is struggling due to an over- n A reliance on evidence-based interventions relative to evidence- 7 1 informed principles. 0 2 A P N B S I

  18. g n i t A solution: co-production of e e evidence M • Integration of scientific and community/clinical systems l a to address questions that are scientifically innovative and u have practical implications for stakeholders. n • A process of developing sustainable program, practice, or n policy approaches using a vertical and horizontal A systems approach . 7 1 • Research synthesis focuses on evidence-based 0 principles (i.e., active ingredients) rather than products. 2 A • Organizational or system governance, values, resources, strategies and structure are leveraged to design for scale P and sustainability . N B S Estabrooks & Glasgow, 2006; Cairey & Oliver, 2017 I

  19. g n Co-Production of Research: i t A Simple Idea e e M Evidence-Based Delivery Sites Strategies l Organization a Cooperative Extension Tested in u Extension Multiple Settings n Research Staff Delivery Office Current Heath Programs Available Resources n Frequent Contact Limited Staff Time Critical Elements Space Limits Fit Peer Sharing A Group feedback Agents Sense of Distinction Group goal setting Walk Kansas 7 Group Roles Re-invention of 1 intervention retaining Office Staff Engagement critical elements but 0 Diverse Samples reducing contact 2 Scheduling & Cost of Delivery Design Fit A P N Demonstration Project B S Estabrooks, Bradshaw, Dzewaltowski, & Smith-Ray, ABM, 2008; I Estabrooks & Glasgow, AJPM, 2006

  20. g n i t 25000 e e 20000 Number of Participants M 15000 10000 l 400 a 5000 Active 350 u Insufficient 0 Weekly minutes of moderate PA 2002 2003 2004 2005 2006 300 n Inactive Year 250 n 200 A 150 100 7 50 1 0 0 Baseline 6M Follow-Up 2 A P N B S I Estabrooks et al., Annals of Behavioral Medicine, 2008

  21. g n i t e e M l a u n n A 7 1 0 2 A P N B S Estabrooks, Harden, Almeida, Hill, Johnson, Greenawald, in progress I

  22. g n i t e Who is involved? e M l a u Interdisciplinary n Obesity Researchers n A Integrated Research-Practice 7 Partnership 1 0 Central and 2 Inter-professional Regional Health Program A System Delivery Staff Administrators P N B S I

  23. g n i t Carilion Healthy Lifestyle Study e e Problem Prioritization & Research Questions M • Problem Prioritization l • 68% of patients have a BMI >25 (target population) a and ask nurse care coordinators about weight loss. u n • Patient education handouts to support weight loss. n • Nursing leadership would like a systematic approach A • Research Questions 7 1 • What is the best way to increase evidence-based 0 weight management support through Care 2 Coordinators? A • How feasible is it? P • Can an adapted evidence-based approach help N patients lose a clinically meaningful amount of B weight? S I

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