In appreciation of “Amplifying practitioner perspectives to strengthen implementation science”, with caveats

In the March 2019 “Dispatches from Implementation Science at NCI,” in the Commentary, “Amplifying Practitioner Perspectives to Strengthen Implementation Science,” Margaret Farrell provides a strong statement for the role and inclusion of public health practitioners in collaboration with researchers in the implementation and dissemination of evidence-based public health intervention strategies (1).  Actualizing this perspective is not only important, it is critical to advance the impact and benefit of public health strategies.  As Ms. Farrell points out, there has been considerable progress in this researcher-practitioner linkage.  Interestingly, twenty-four years (!) ago in a commentary in Health Education Research (Theory and Practice), “Advancing the link between health promotion researchers and practitioners: a commentary” (2), in a review of a number of publications and current interventions at the time, we advocated for approaches in implementation and dissemination (without naming it so at that time) that provide for a strong partnership between researchers and practitioners, identified respective roles to some degree, and recommended that “an applied research agenda, enhanced diffusion, and stronger links between research and practice should inevitably strengthen health education practice.”  Several NCI intervention studies and applications were cited as good examples of advancing the approach.  We cited recommendations by our colleague, Brick Lancaster (3), of which several have implicitly become a part of what NCI’s Implementation Sciences team and others have since made a reality, such as developing a national training mechanism for practitioners to utilize behavioral research in program planning and implementation; speed up transfer of technologies and products; and encourage practitioners to be proactive in seeking involvement, counsel and interaction with researchers.

In advocating for this partnership, we frequently cite Dr. Lawrence Green’s excellent framing: “If We Want More Evidence-Based Practice, We Need More Practice-Based Evidence” (4). This oft-cited quote really gets to the core of the matter – it is a necessary reciprocal relationship.  Unfortunately, the practice side of the relationship is not always included in the informing of the broader platform, as Dr. Green highlights. This was also highlighted by Ammerman and colleagues, in a 2014 article published in the Annual Review of Public Health, in which they reviewed numerous very strong dimensions of practice-based evidence in public health, stating “public health challenges today are chronic and complex and require joint effort from academic researchers in partnership with clinical and public health practitioners to identify and implement sustainable solutions in the real world…Practice-based research offers researchers and practitioners an underutilized way forward, an opportunity to work together to design and test feasible, evidence-based programs to address our greatest challenges”(5).

Assuring stronger evidence-based public health practice has been enhanced by such actions as the work of Ross Brownson and colleagues in developing and implementing training in evidence-based public health (6,7,8) and the CDC/NCI funded Cancer Prevention and Control Research Network (CPCRN) (9) and others in integrating evidence-based public health into practice.  The Annual Review of Public Health 2018 highlighted progress in integrating Implementation Science and Public Health, and Dr. Chambers of NCI highlighted the theme of the collection in a commentary which pointed to the rapid growth of the field but highlighted via the articles in the collection that the strong progress also necessitates progress in closing the gaps on integration with practice and sustainability (10).  The current state was recently summarized by Marcus Plescia (11), in which he concludes, “Better integrating the science and practice of applied public health will result in more effective and appropriate interventions to scale in states and communities around the nation.”

The network of CDC funded Prevention Research Centers (12, 13) has also contributed to strengthening the researcher-practitioner linkage.  The work of CDC and others in disseminating evidence-based approaches from the Community Guide to Preventive Services has helped to inform a strong approach to evidence-based practice.  The work of the NCI Implementation Science Team and its partners in developing such tools as Cancer P.L.A.N.E.T. (14) and the Research to Reality site (15) has been extremely valuable to the integration of evidence into practice. In addition, the Annual Conference on the Science of Dissemination and Implementation in Health (D&I), co-hosted by the National Institutes of Health (NIH) and AcademyHealth, is heading into its 12^th year. This annual event has offered a strong contribution, and has provided the self-description that it “helps realize the full potential of evidence to optimize health and health care by bridging the gap between research, practice, and policy.”  I would offer a challenge to this description, however, and state that the conference is very strong for the research portion of the continuum, and would benefit from an intentional effort to advance the practice and policy portion of the continuum, specifically as we look at the practitioner contribution and the practice-informed evidence or research base component.  In order to accelerate the translation of research into public health practice, it is clear that both community engagement and practitioner engagement must be a strong part of the process.

In the blog piece by Ms. Farrell, she indicated that ‘two areas where implementation science researchers may be uniquely able to inform practice is around scalability and sustainability.” This is certainly the case. The paper by Greenhalgh and Papoutsi (16) highlighted in this issue of the Implementation Science Newsletter points out that “spread (replicating an intervention) and scalability (building infrastructure to support full scale implementation) are difficult.”  I would add a variation of the scalability issue, that is – tailoring from one population or setting to another (regardless of size/scale).  A valuable contribution to advancing the practitioner role and utilization of implementation science strategies is the recent creation and delivery of a course for MPH students and public health practitioners at the UNC Gillings School of Public Health (17.)  In the NCI blog post, Ms. Farrell discusses a new opportunity to advance the practitioner contribution to the process – the release of “Implementation Science At A Glance” (18).  This resource will definitely add to the opportunity to advance the practitioner understanding, role and adoption of the concepts and tools of implementation science in delivering quality public health interventions.  In addition, the two funding opportunities recently released by NCI in this field: Implementation Science for Cancer Control – both the P50 Developing Centers and the P50 Advanced Centers opportunities provide a significant opportunity for strengthening the researcher-practitioner relationship (19, 20). The key will be to actualize the issues discussed here, framed by Dr. Green’s quote, and have a strong and robust practitioner engagement in these Implementation Centers and at NCI in contributing to the role the NCI Implementation Science staff and others will play in the success of the Centers.  This is a very timely opportunity to advance the practitioner role and strongly contribute to the practice of public health by the researchers, practitioners and the Implementation Centers overall. The key to success is engagement of a triad – researcher, practitioner, and community. With that, I applaud, Ms. Farrell’s final comment, “We must be creative and tireless in our commitment to ensure that implementation science approaches speed up translation not just from research to practice but to create the venues and opportunities for cancer control practitioners to authentically inform implementation science,” and look to NCI, the funded Implementation Centers, and the field as a whole to make it a reality.

Randy Schwartz, MSPH, is a nationally recognized public health professional with over thirty years’ experience in implementing health promotion/disease prevention initiatives in state health department and voluntary health organizations with an emphasis on chronic disease prevention and control, cancer control and community-based health promotion.  Randy is President of Public Health Systems Consultants, Inc., and is a Public Health Consultant with the National Association of Chronic Disease Directors (NACDD). He brings extensive expertise in building capacity of public health professionals and organizations, linking research and practice, building community-clinical linkages, and integrating public health practice in a transforming health care delivery system. He is currently a Public Health Consultant and adjunct faculty member for Public Health academic programs, including the University of North Carolina Online MPH Program. Randy served as Sr. VP, Health Systems at the American Cancer Society national Cancer Control Department and was VP, Health Systems for the New England Division of ACS. Prior to work at ACS, he was Director of the Division of Community and Family Health of the Maine Bureau of Health (now Maine CDC), where he worked for seventeen years, fifteen of which were in a senior position as a Division Director. In that role, he directed all chronic disease prevention and control and health promotion programs (including cancer control, CVD prevention, tobacco prevention and control and community health promotion), as well as the maternal and child health and public health nursing programs. In these positions he has directed the implementation and evaluation of health promotion/disease prevention interventions (with a concentration in cancer prevention and control/tobacco control) in multiple settings including community, worksite, health care and public policy.

Randy is the Founding Editor of the journal, Health Promotion Practice, a journal of the Society for Public Health Education (SOPHE). He has been awarded the Society for Public Health Education’s Distinguished Fellow Award, the Society’s highest honor.

1. Farrell, M. “Amplifying Practitioner Perspectives to Strengthen Implementation Science”, Dispatches from Implementation Science at NCI https://cancercontrol.cancer.gov/IS/blog/2019/03-amplifying-practitioner-perspectives-to-strengthen-implementation-science.html#_ftnref1

2. Schwartz, R., Capwell E. “Advancing the link between health promotion researchers and practitioners:  a commentary.”  Health Education Research, Theory and Practice, Vol. 10, No. 3, September 1995, pp. i-vi.

3. Lancaster, B. (1992) Closing the gap between research and practice. Health Education Quarterly, 19, 408-411

4. Green, LW, Public Health Asks of Systems Science: To Advance Our Evidence-Based Practice, Can You Help Us Get More Practice-Based Evidence? Am J Public Health. 2006; 96:406–409.

5. Ammerman, A, Smith, TW, Calancie, L., Practice-based evidence in public health: improving reach, relevance, and results, Annual Review of Public Health. 2014; 35: 47–63.

6. Brownson R, Baker E, Deshpande A, Gillespie K. Evidence-Based Public Health. 3rd ed. New York: Oxford University Press; 2018.

7. Brownson RC, Ballew P, Kittur ND, et al. Developing competencies for training practitioners in evidence based cancer control. J Cancer Educ. 2009;24(3):186-193.

8. Brownson RC, Gurney JG, Land GH. Evidence-based decision making in public health. J Public Health Manag Pract. Sep 1999;5(5):86-97.

9. Cancer Prevention and Control Research Network (CPCRN), Putting Public Health Evidence in Action Training Workshop, http://cpcrn.org/pub/evidence-in-action/

10. Chambers, DA, Commentary: Increasing the Connectivity Between Implementation Science and Public Health: Advancing Methodology, Evidence Integration, and Sustainability, Annual Review of Public Health2018 39:1, 1-4

11. Plescia, M. The Science and Practice of Applied Public Health, Journal of Public Health Management and Practice, March/April 2019, vol. 25, n 2.

12. https://www.cdc.gov/prc/index.htm

13. (Eds) Ammerman, A; Brownson, R; Harris, JR; Massoudi, M. Prevention Research Centers Program – 30^th Anniversary: Translating Applied Public Health Research into Policy and Practice, Am J Prev Med, Supplement, V.52, Issue 3, March 2017

14. https://cancercontrolplanet.cancer.gov/planet/

15. https://researchtoreality.cancer.gov/

16. Greenhalgh, T and Papoutsi, C., Spreading and scaling up innovation and improvement, BMJ 2019; 365:12068

17. Ramaswamy, R, Mosnier,J, Reed K, Powell BJ, and Schenck., Building Capacity for Public Health 3.0: Introducing Implementation Science Into an MPH Curriculum, Implementation Science, (2019) 14:18

18. National Cancer Institute, “Implementation Science at a Glance, A Guide for Cancer Control Practitioners”, NIH Publication Number 19-CA-8055, 2019.

19. https://grants.nih.gov/grants/guide/rfa-files/rfa-ca-19-005.html

20. https://grants.nih.gov/grants/guide/rfa-files/rfa-ca-19-006.html