• By Dartington SRU
  • Posted on Monday 02nd June, 2008

Lost in Translation

In the near 20 years since the formation of the Society for Prevention Research, the field has transformed. Understanding about the potential causes of children's health and development has made huge strides. There are now many programs shown by rigorous evaluation to be effective. But none of these programs has been fully integrated into mainstream practice. Something is being lost in the translation.The new buzz word in the US prevention field is Type 2 translation research. But what does it mean? The Society has established a task force to map out the territory and make recommendations for future study.The origin of the term comes from medicine and its exploration of the barriers that stood between good science and effective practice. Two major obstacles were identified. Type one was getting 'from the bench to the bedside', or from laboratory to innovative intervention. Type two was about getting the intervention to people who need it.Problems of definition are not going to be easily solved by the Task Force. One problem is that so little of what has traditionally been seen as research for better services is concerned with Type 2 translation. The US National Institutes of Health, for example, has long conceptualized a five-stage process starting with epidemiology followed by etiology, intervention design, effectiveness trials and concluding with what they call dissemination trials. By this definition the first four segments fit with Type 1 issues and only the fifth with Type 2. But the latter is likely to turn out to be the biggest and most challenging task.Other definitional issues abound. What is the difference between diffusion and dissemination? What is meant by intervention or an evidence-based program?These and other questions were aired at a roundtable discussion held on the final day of the SPR conference last week. The discussion was led by Richard Spoth from the University of Iowa and Luanne Rohrbach from the University of Southern California.They considered some of the obstacles to the second type of barrier between science and routine practice. Mark Greenberg from the Prevention Research Center at Penn State University pointed out that ethics committees have yet to work out appropriate standards for Type 2 research studies. Lack of research funds is another problem. Steven Woolf writing in a recent issue of the Journal of the American Medical Association reckons that less than two per cent of research dollars are invested in the Type 2 area.A strong theme of the discussion was the need for scientists and practitioners to better understand each other. Very little is known, for example, about working cultures in the constituent parts of children's services. As Greenberg again pointed out, while scientists bang on about fidelity, schools work on the basis of significant variation from one classroom to the next.Forming alliances with practitioners, going to their conferences and getting a stronger presence from them at scientific meetings was strongly advocated. The links between the Society for Prevention Research and the National Prevention Network, which is more orientated to practitioners, is one manifestation of the changing zeitgeist. Earlier involvement of the community expected to adopt prevention innovation was also strongly advocated.David Hawkins from the Social Development Research Group at the University of Washington and Zili Sloboda, President of the Society, reminded the gathering of how Type 2 considerations were posing much greater challenges for prevention scientists. Two decades ago the focus was on finding something that logically could be expected to work. Now, in addition, there is a need to find interventions that logically can be expected to go to scale and be cost-effective.There was also a keenly felt reminder of how much there is to learn from outside of the prevention science field. Starbucks did not become successful worldwide by doing the kinds of research undertaken by experts at the SPR conference. On the other hand, there is a need to distinguish between supporting the translation of effective programs into everyday practice and supporting research into that translation process.Whatever the challenges there is common agreement that there is much to do in defining Type 2 translation research in the context of children's services, developing appropriate methodologies and, most importantly, prioritizing which of the many many research questions that need to be answered should be tackled first.References Greenwald, P.G, (1990) "Foreword to the book Smoking, tobacco and cancer programs", National Cancer Institute Steven Woolf (2008), "The meaning of translational research and why it matters", Journal of the American Medical Association , 222, (2), 211-213

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