Designed for Translation

Using the RE-AIM framework, said Dr. Belza, improves the chances that a program will work in real-life settings because it provides a guide for planning, implementing, evaluating, and maintaining programs; assures that developers and implementers address individual as well as organizational-level issues; assists with partnership building (essential for community-based interventions); makes the case for sustainability; and allows comparison across programs.

Dr. Belza then illustrated the experience with a community-based health program for the elderly which was developed at the University of Washington in the early 1990s, has accrued an impressive evidence base, and has been successfully disseminated at over 200 sites across the United States.^1,2 The EnhanceFitness program, a thrice-weekly aerobic, strength, flexibility, and balance protocol for both active and frail elderly, is licensed by Senior Services, the partnering organization originally selected by the University of Washington researchers to disseminate the program.

The program currently has over 6,600 active participants (39% of whom are over age 80, and 24% of whom are people of color), and has been shown in one recent study by Ackerman et al to reduce healthcare costs in Medicare-managed care health plan members who participated in the program.³ Periodic assessment of participants’ performance on several common function tests (arm curls, Up and Go, and chair stands) is a core component of EnhanceFitness and allows both researchers and implementers to track participants’ outcomes—and program successes—over time. The program is also an example of the types of partnerships supported by the CDC, which, in 2005, lent additional funding and infrastructure support to widen the national reach of the program.

To the Next Level

The CDC supports translation of evidence-based interventions through partnering with state health departments, among other agencies, said Dr. Brady. Two years ago, scientific and program staff at the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) at the CDC began meeting to devise a model for improving translation of research into practice. The goal was to help transform dissemination of effective interventions from a mode of passive diffusion into a targeted, intentional process of distributing information and materials to organizations and individuals who can use them to improve health. The resulting NCCDPHP Translation Schematic, said Dr. Brady, is intended to be a generic model that can be applied regardless of disease or condition or type of intervention.

Complementary to the RE-AIM framework, the NCCDPHP Translation Schematic maps out a series of steps to take research from the lab to the community. Although the sequences are mapped in a forward progression—decision to translate, transforming knowledge into products, dissemination/engagement, decision to adopt, practice, and institutionalization—the process involves multiple decision points and feedback loops, noted Dr. Brady. After an intervention has been proven efficacious and effective, the first step toward translation is a conscious decision by the researchers to “take it public.”