Public Health Research and Practice Should Coexist

June 27, 2019|11:55 a.m.| Wendy Braund, MD, MPH

Wendy BraundPractice-based research is the investigation of a topic of interest in a real-world setting and (ideally) the application of the findings in relevant programs, settings, or populations. It is commonly conducted in public health agencies and can take many forms. According to the 2016 ASTHO Profile, almost all state health agencies (SHA) participate in research, with 90 percent of SHAs reporting “collecting, exchanging, or reporting data for a study,” and “disseminating research findings to key stakeholders.” More than 80 percent of SHAs report “analyzing and interpreting study data and findings,” “applying research findings to practices within [their] organization,” or “identifying topics and questions relevant to public health practice.”

These activities are vital. This is how we grow the evidence base in public health. All too often, there is “insufficient evidence” in the literature to determine an intervention’s effectiveness and that will only change with the increased conduct, publication, and dissemination of practice-based research.

Implementation science is less common in public health practice. Defined as, “the study of methods to promote the integration of research findings and evidence into healthcare policy and practice,” the goal of implementation science is “to understand the behavior of healthcare professionals and other stakeholders as a key variable in the sustainable uptake, adoption, and implementation of evidence-based interventions.” Implementation science attempts to decrease the “implementation gap”—the time lag between the generation of new knowledge and its translation into actual practice. It can be used to test new approaches to the application or integration of findings into programs or policies and evaluate their relative effectiveness. Using the tools of implementation science greatly increases the likelihood that the results of practice-based research will be incorporated into actual practice.

Both practice-based research and implementation science are important. And yet neither receives adequate effort in public health practice. Why? Health agencies are focused on serving their populations and research is not often the highest priority. In addition, in the resource-constrained environment of public health practice, there is often a reticence (or lack of support) when it comes to allocating funds for research or evaluation, as it diverts resources that could otherwise be used for program operations. All too often, public health agency staff don’t have the necessary skills. This is particularly true of implementation science, an emerging field which has only just begun to be formally taught in public health programs, with only one public health program reporting it integrated into the curriculum to date.

What can be done to address this challenge? Health departments should explore academic partnerships, support training dedicated to translating practice-based research, and work to integrate implementation science in the public health sector.

Develop academic partnerships
Increasingly, health agencies are establishing mutually beneficial partnerships with academia. Agencies collect and hold extensive data that could be analyzed by experts in schools and programs of public health. In addition, researchers in academic settings could conduct studies in agencies or in conjunction with agencies in the communities they serve. Practitioners can bring real world experience to the classroom to encourage students to apply their burgeoning research skills to projects, but many agencies don’t currently have the capacity to accomplish this. Academic-practice partnerships might be formalized through a memorandum of understanding into the creation of an academic health department, or they could be more informal or ad hoc, based on a specific need or interest.

Teach practice-based research
There is an ongoing need to cultivate practice-based research skills among our current public and future public health workforce. In addition to addressing knowledge gaps in core or emerging areas of public health science, there is growing capacity among public health training centers and other entities charged with supporting the current workforce to deliver content in strategic skills such as data analytics and systems thinking. These cross-cutting skills can prepare health agency staff to make better use of their data and cultivate partnerships with other disciplines with skillsets that complement public health. There is also an imperative provide students with practice-relevant education. They need the skills to analyze “messy” data and produce conclusions that have real-world implications. They need opportunities to conduct research in agencies and communities, addressing public health issues with all their practice-based confounders.

Integrate implementation science in public health
Finally, we need to embrace implementation science in public health, as is being done in the healthcare delivery system and other sectors. It needs to be widely incorporated into public health curriculum and we need to determine ways to increase the competence of our current public health workforce in this skillset. Health agencies need to become part of the “learning healthcare system,” as articulated by the Institute of Medicine’s Committee on the Learning Health Care System in America. Recommendations intended for the clinical sector, such as improved data utility, stronger community linkages, and performance transparency, are clearly also applicable to health agencies. Funding to support these activities and grow these skills would be helpful, as it would provide much needed resources while also acknowledging its importance in the field.

Research and practice can and should coexist. As public health leaders, we can and should do a better job of disseminating research and applying it to improve public health programs and policies. Practice-based research and implementation science are fundamental to the creation of “learning public health agencies,” while will, in the end, better prepare public health to tackle the new and emerging issues that face public health professionals.

Wendy E. Braund, MD, MPH, is director of the Center for Public Heath Practice, associate dean for public health practice, and professor of health policy and management at the University of Pittsburgh. Braund previously served as state health officer and public health division administrator at the Wyoming Department of Health.

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