“To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications.”—Louis Pasteur
There is a large gap between the volume of public health knowledge generated through research and the application of that research in community settings.1–3 Too often, public health scholars do not translate or disseminate this research for use in community settings where it is likely to have positive impacts.4
Both the empirical literature and patterns of federal spending on health research reveal much about the limited dissemination of discovery to practice. Two studies in the literature show the extent of dissemination and institutionalization of effective interventions. In a content analysis of 1,210 articles from 12 prominent public health journals, 89% of published studies were classified as basic research and development.5 The authors classified another 5% of studies as innovation development, less than 1% as diffusion, and 5% as institutionalization. Similarly, Sallis and colleagues conducted a content analysis of four journals and found 2% to 20% of articles fell in a phase defined as “translate research to practice.”6 In 2003, the United States spent more than $27 billion on health-related research.7 Between 9% and 25% of this amount was expended on prevention research,8,9 i.e., the direct and immediate application of effective intervention strategies to benefit the public’s health.10 Farquhar has estimated that 10% or less of prevention research is focused on dissemination.8
In clinical disciplines such as medicine and nursing, a similar gap exists between discovery and application. Despite advances in evidence-based medicine,11,12 systematic application of clinical research findings to improve patient care remains limited.13–15 In a review of the quality of care among patients in the United States, only 60% of those with chronic conditions received recommended care.16 Studies of dissemination of evidence-based guidelines (aka, consensus statements) suggest that awareness varies widely across medical subspecialty, with awareness ranging from as low as 20% among cardiac surgeons to 90% to 95% among obstetricians.17 The dissemination gap for clinical research also has a time component. A review suggested that it took an average of 17 years for 14% of original (i.e., discovery) research to be integrated into physician practice.18 In general, dissemination of clinical guidelines using passive methods (e.g., publication of consensus statements in professional journals, mass mailings) has been ineffective, resulting in only small changes in the uptake of a new practice,19 and single-source prevention messages are generally ineffective.20
The literature suggests that effective dissemination of an evidence-based program often calls for time-efficient approaches, ongoing training, and a high organizational value on research-informed practice.21 Further, the dissemination of a research discovery among organizations, practitioner groups, or the general public is likely to occur in stages.22 The decision to adopt, accept, and utilize an innovation is not an instantaneous act, but more often a process.
In this article, we describe a four-stage approach for translation and dissemination (T&D) of research discoveries into public health action. We discuss key actions that will improve our ability to progress through these stages. We focus on measures that can be stimulated or enhanced by academic higher education, particularly among schools of public health.