SAN FRANCISCO—You have designed, tested, and validated an exercise intervention for elderly people with arthritis. How do you go about disseminating this intervention so that it will reach its target population and be sustainable over time?
“We are all too familiar with the experience,” said Basia Belza, PhD, RN, the Aljoya Endowed Professor in Aging at the University of Washington School of Nursing in Seattle, “in which we work with randomized controlled trials or testing of interventions and find them to be very effective. And yet we find, all too infrequently, that the intervention actually gets disseminated out to the community.”
In “Designing for Translation: Bridging the Gap between Research and Widespread Implementation of Community-Based Interventions,” a session at the October 2008 ACR/ARHP Annual Scientific Meeting, Dr. Belza and her colleague Teresa J. Brady, PhD, senior behavioral scientist in the arthritis program at the Centers for Disease Control and Prevention (CDC) in Atlanta, addressed the persistent challenges of disseminating research-validated, community-based interventions for those with chronic disease.
The goal, they said, is to employ scientific methods to guide efforts to increase dissemination and implementation. Savvy academic and public health researchers have now learned, emphasized Dr. Brady, that “You can’t just throw an intervention out into the universe and think it will run smoothly—you have to invest in the infrastructure that will help that intervention be successful.”
Reach That Target
At the University of Washington in Seattle, Dr. Belza and her colleagues have been collaborating with agencies and organizations in the public health sector to develop ways to consciously move evidence-based interventions out into the community, where they can benefit those most in need.
The session “Designing for Translation: Bridging the Gap between Research and Widespread Implementation of Community-Based Interventions” was recorded and is available via ACR’s Session-Select at www.rheumatology.org/annual.
In addition, the ACR has developed a free patient education fact sheet on exercise and arthritis, which can be downloaded from www.rheumatology.org/public.
Even lab-tested programs may not be designed in a way to facilitate evaluation of their real-world effectiveness. Investigators need to know, for instance, whether their intervention will be equally efficacious if delivered in a Chinese Baptist church, on a Native American reservation, or in a YMCA with a highly educated cohort of retirees. Dr. Belza, who leads the coordinating center for the CDC-funded Healthy Aging Research Network, described a framework, designed by Russell Glasgow and colleagues, that can be used to evaluate sustainability and public health impact of research-validated efficacious interventions. (See “RE-AIM Framework,” p. 20.)