This is a guest post by William T. Riley.
“Why fund behavioral intervention research if the interventions found effective are not adopted in practice?” This was a recurring question I heard when meeting with various National Institutes of Health (NIH) institute and center directors to seek their input on the Office of Behavioral and Social Sciences Research (OBSSR) 2017-21 Strategic Plan.
Their perspective is consistent with what our field has acknowledged and worked to address: Health researchers in general – and behavioral and social sciences researchers specifically – cannot be satisfied with leaving our research findings at the water’s edge and hoping these findings will be adopted into practice.
Inadequate translation of research findings into practice is not unique to the behavioral and social sciences, but we do face unique challenges. Social and behavioral interventions do not have the extensive market-driven system and regulatory structures of medical interventions. The delivery of these interventions extends far beyond the healthcare setting and includes communities, schools, workplaces, and societal or population-level policies. Resources for delivery of social and behavioral interventions are limited, yet these interventions tend to be complex and resource intensive, requiring time and training to deliver correctly.
Health researchers in general – and behavioral and social sciences researchers specifically -cannot be satisfied with leaving our research findings at the water’s edge and hoping these findings will be adopted into practice.
Given these issues, one OBSSR scientific priority is to facilitate adoption of behavioral and social sciences research findings in health research and practice. A commentary published in Translational Behavioral Medicine’s June 2017 issue focuses on the challenges and opportunities associated with this priority. The NIH has and will continue to support dissemination and implementation (D&I) research, but more than ongoing support for this research is needed to facilitate adoption.
For example, we need D&I of our D&I research, both in research and in practice. Findings from D&I research have provided useful strategies for facilitating more rapid and robust adoption of evidence-based practice, but these strategies are only useful if they are adopted in research and practice settings.
An expanded repertoire of methods and measures for D&I research is also needed to facilitate adoption. The square peg of the two-arm randomized controlled trial (RCT) seldom fits into the round hole of practice settings with varying populations, contexts, and resources. We should re-examine assumptions of causal inference in the context of pragmatic practice questions, and consider the levels of evidence required to answer the questions pertinent in practice settings.
This re-examination of RCT as the gold standard also needs to include a re-examination of the evidence-based intervention package as the gold standard. Practitioners struggle to deliver evidence-based intervention packages while also accommodating the realities of the settings in which they practice. Planned adaptation acknowledges the tension between implementing programs with fidelity and adapting programs to fit the population, setting, and context, and provides a framework to guide practitioners in adapting programs while encouraging researchers to provide information relevant to adaptation. A shift from intervention packages to intervention principles and their parameters will give practitioners greater flexibility to adapt interventions to their settings.
The square peg of the two-arm randomized controlled trial (RCT) seldom fits into the round hole of practice settings with varying populations, contexts, and resources.
Innovations are transforming the traditional research to practice chasm. Methodological innovations such as ”learning healthcare systems” blur the traditional lines of research and practice. The continued and increasing integration of research within practice settings provides for routine outcome and quality metrics that facilitate continuous evaluation of interventions and their implementation in practice. Technological innovations are automating both the assessment of outcomes in practice settings and the delivery of social and behavioral interventions, expanding the reach and scalability of these interventions.
The OBSSR will work with our colleagues in various NIH institutes, centers, and offices, our partner agencies dedicated to practice implementation, and the behavioral and social sciences research community to facilitate the adoption of behavioral and social sciences into practice, policy, and health research. One indicator that we are making progress is when the NIH can more readily connect the intervention research we fund to the implementation of effective interventions in policy and practice.
William T. Riley, PhD, is director of the Office of Behavioral and Social Sciences Research at the National Institutes of Health.