As the nation's leading public health agency, the Centers for Disease Control and Prevention (CDC) not only conducts public health research but uses the findings to improve the public's health. Critical to CDC's success is enhancing the use of evidence-based practice by our constituents and partners. No area has a more pressing need for bridging research and practice than the prevention and control of chronic diseases. The World Health Organization (WHO) estimated in 2004 that chronic diseases accounted for 56% of deaths and 45% of the global burden of disease (1
). In the United States, at least 80% of adults aged 65 years or older now have at least 1 chronic condition (eg, arthritis, diabetes, hypertension, heart disease) and obesity and its sequelae are threatening the health of future generations (2
). Addressing the burden caused by these chronic health conditions is needed for the health of the nation's people and its economy, as health care spending is likely to increase with the aging of the population. One of the most efficient ways to use our limited public health dollars may be to apply "what we know works" (3
To facilitate understanding of critical translation processes within CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), a group of scientists and practitioners from each of NCCDPHP's divisions and offices formed a workgroup, the Work Group on Translation (WGoT), to share translation-related experiences and observations (4
). Because WGoT members came from various content areas, professional disciplines, and approaches to public health, it quickly became apparent that a common language and conceptualization were required to collaboratively expand our understanding of these processes. In this article, the term translation
is used to mean the process and steps needed and taken to ensure effective and widespread use of evidence-based programs, practices, and policies. Thus translation
is a term for putting knowledge from research or practice into action.
Several theories and frameworks exist to guide or explain aspects and processes involved in translation of evidence-based programs, practices, and policies. Syntheses of translation literature suggest complex processes are involved in diffusing evidenced-based innovations, including individual, organizational, and system-level characteristics that facilitate and hinder translation success (5
). WGoT members developed an organizing framework informed by explicit frameworks (8
), theoretical models (11
), and tacit models in use by the various divisions and programs within NCCDPHP (12
). We needed to create an organizing framework that conceptually would accommodate the various approaches to translation used across the center. Consequently, NCCDPHP's Knowledge to Action (K2A) Framework () and glossary (Box
) were created to foster translation, communication, and collaboration across the center and within and across divisions. The purpose of this article is to present the resulting framework and discuss its use in planning and supporting translation in public health research and practice.
NCCDPHP Knowledge to Action Framework for Public Health.
The framework consists of 3 phases: research, translation, and institutionalization. In the research phase, discovery studies lead to efficacy studies, which lead to effectiveness and implementation studies. The effectiveness and implementation studies lead to a decision to translate; such decisions also lead back to more effectiveness and implementation studies. In the translation phase, the decision to translate leads to turning knowledge into products, dissemination (with engagement), a decision to adopt, and adoption of a practice. There is diffusion of information between practice and effectiveness and implementation studies. Practice, with practice-based evidence, leads back to turning knowledge into products and to effectiveness and implementation studies. Also from practice, practice-based discovery leads back to efficacy studies. Practice also goes forward toward institutionalization. Under each of the 3 phases are supporting structures, and under all of these supporting structures is evaluation.
Box. Glossary for Knowledge to Action Framework
: The original biomedical, behavioral, or epidemiologic factor that stimulated development of an intervention (1
: The extent to which the intended effect or benefits were achieved under optimal conditions (2
: The extent to which the intended effect or benefits that were achieved under optimal conditions are also achieved in real-world settings, and the understanding of the processes by which research findings are put into practice (implementation research) (2
Research supporting structures
: Interrelated elements that enhance the capacity of an organization to effectively plan, implement, evaluate, and sustain the research phase of the intervention process, including marketing, training, technical assistance, financial resources, and organizational capacity (3
Translation: The process and steps needed or taken to ensure effective and widespread use of science-based programs, practices, and policies; a term for the entire process of putting research into practice. The term translation may also be used more narrowly to describe the process of making materials in an intervention linguistically appropriate.
Decision to translate: The decision to create an actionable product based on existing science-based knowledge or the decision to propel an evidence-based program, practice, or policy into widespread use.
Knowledge into products: A systematic process of turning scientific evidence and audience research into programs, policies, interventions, guidelines, tool kits, strategies, and messages that will assist and support audiences or users in putting science into practice.
: A purposeful and facilitated process of distributing information and materials to organizations and individuals who can use them to improve health (2
: The active participation and collaboration of stakeholders who can mobilize resources and influence systems to change policies, programs, and practices (5
Decision to adopt
: The decision at the organizational or community level to implement a program, policy, or practice (7
: Performing the tangible tasks and action steps to achieve public health objectives (9
Translation supporting structures
: Interrelated elements that enhance the capacity of each organization to effectively plan, implement, evaluate, or sustain the translation phase of the intervention process, including marketing, training, technical assistance, financial resources, and organizational capacity (3
Interactions Between Research and Translation Phases
Practice-based discovery: Innovative field-based practices that lack data on their intended effects or benefits.
Practice-based evidence: Data from field-based practices that demonstrate achievement of intended effects or benefits.
: The process through which an innovation spreads via communication channels over time among the members of a social system (4
: The maintenance of an intervention (program, policy, or practice) as an established activity or norm within an organization, community, or other social system (10
: A systematic process for an organization to 1) improve and account for public health actions, and 2) obtain information on its activities, its impacts, and the effectiveness of its work to improve activities and describe accomplishments (11
1. Brownson RC, Kreuter BA, Arrington BA, True WR. Translating scientific discoveries into public health action: how can schools of public health move us forward? Public Health Rep. 2006;121(1):97–103. [PMC free article] [PubMed] 2. Flay BR, Biglan A, Boruch RF, Castro FG, Gottfredson D, Kellam S. Standards of evidence: criteria for efficacy, effectiveness and dissemination. Prev Sci. 2005;6(3):151–175. [PubMed] 3. Robinson KL, Driedger MS, Elliott SJ, Eyles J. Understanding facilitators of barriers to health promotion practice. Health Promot Pract. 2006;7(4):467–476. [PubMed] 4. Lomas J. Diffusion, dissemination, and implementation; who should do what? Ann N Y Acad Sci. 1993;703:226-35; discussion 235-7. [PubMed]
5. CDC/ATSDR Committee on Community Engagement Principles of community engagement. Atlanta (GA): Centers for Disease Control and Prevention; 1997. Coordinated school health programs and academic achievement: a systematic review of the literature.
6. Fawcett SB, Paine-Andrews A, Francisco VT, Schultz JA, Richter KP, Richter KP. Using empowerment theory in collaborative partnerships for community health and development. Am J Community Psychol. 1995;23(5):677–697. [PubMed]
7. Rogers EM. Diffusion of innovations. 3rd edition and 5th edition. New York (NY): Free Press; 1983, 2003.
8. Orlandi MA. Promoting health and preventing disease in health care settings: an analysis of barriers. Prev Med. 1987;16(1):119–130. [PubMed]
9. Green LW, Kreuter MW. Health program planning: an educational and ecological approach. 4th edition. New York (NY): McGraw-Hill; 2005.
10. Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. 4th edition. San Francisco (CA): Jossey-Bass; 2008. p. 317.
11. Centers for Disease Control and Prevention Framework for program evaluation in public health. MMWR Recomm Rep 1999;48(RR-11):2.
12. Mattessich PW. The manager's guide to program evaluation: planning, contracting, and managing for useful results. 4th edition. Saint Paul (MN): Amherst H. Wilder Foundation; 2003.
The K2A Framework is not a causal or theoretical model but a schematic for processes that can be used by practitioners gathering practice-based discoveries or evidence (going from right to left in the framework diagram) and by researchers developing and testing interventions (going from left to right). The framework was designed to be applicable regardless of the disease, condition, or risk factor being addressed and regardless of the type of intervention being considered (ie, program, policy, or practice); to incorporate involvement of all actors in the research and practice communities (including scientists, administrators, policy makers, support systems, and practitioners); and to identify crucial points of interface between them (4
). The K2A Framework reflects the developers' experience in the field, showing that public health practitioners and practitioner-generated innovations are needed for effective translation.
We recognize that each component in the translation process involves multiple decisions necessitating myriad smaller steps. We also recognize that although a framework on paper appears linear, translation processes are nonlinear and recursive (5
). For the sake of parsimony, however, only major components and critical decision points and connections are included in the schematic.