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Bauer AG, Shah B, Johnson N, Aduloju-Ajijola N, Bowe-Thompson C, Christensen K, Berkley-Patton JY. Feasibility and Acceptability of the Project Faith Influencing Transformation Intervention in Faith-Based Settings. HEALTH EDUCATION & BEHAVIOR 2024; 51:291-301. [PMID: 37978814 DOI: 10.1177/10901981231211538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
African Americans (AAs) are disproportionately burdened with diabetes and prediabetes. Predominately AA churches may be optimal settings for reaching AAs at greatest diabetes risk, along with related morbidities and mortalities. The current study used the RE-AIM framework to qualitatively examine the feasibility, acceptability, and satisfaction with the Project Faith Influencing Transformation (FIT) intervention, a diabetes risk reduction intervention in AA churches. Participants were (N = 21) church and community members who also participated in the larger Project FIT intervention and were primarily female, with an average age of 60 years (SD = 11.1). Participants completed a brief survey and focus group discussion. Participants discussed intervention effectiveness in changing health behaviors and outcomes, with high rates of adoption, acceptability, and satisfaction across churches that conducted the intervention. Participants also discussed outreach to members of the broader community, the role of the pastor, and challenges to intervention implementation and maintenance-tailored strategies to improve intervention effectiveness are discussed. Given the significant diabetes disparities that exist for AAs, it is imperative to continue to investigate best practices for reaching communities served by churches with sustainable, relevant health programming. This study has the potential to inform more effective, tailored diabetes prevention interventions for high-risk AAs in faith-based settings.
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Affiliation(s)
- Alexandria G Bauer
- Rutgers University-New Brunswick, Piscataway, NJ, USA
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Binoy Shah
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nia Johnson
- Saint Louis University School of Medicine, St. Louis, MO, USA
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Pratte KA, Beals J, Johnson A, Bullock A, Manson SM, Jiang L. Recruitment and effectiveness by cohort in a case management intervention among American Indians and Alaska Natives with diabetes. Transl Behav Med 2019; 9:749-758. [PMID: 29982838 PMCID: PMC7184863 DOI: 10.1093/tbm/iby068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In real-world settings, eligible populations and intervention effectiveness for a translational intervention likely vary across time. To determine the optimal strategies for effective large-scale implementation of evidence-based interventions, it is critical to investigate these potential variabilities. The purpose of this study is to evaluate whether patient characteristics and intervention effectiveness differed by year of enrollment in a multiyear evidence-based translational intervention. The Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project is an intensive case management intervention designed to reduce cardiovascular disease risk among American Indians and Alaska Natives with diabetes. SDPI-HH participants recruited from 2006 through 2008 were included. Baseline characteristics were compared by year of enrollment. We also evaluated the differences in improvements in clinical and behavioral risk factors for cardiovascular disease among participants recruited in different years. The baseline characteristics of the three cohorts significantly differed in demographics, diabetes duration, health behaviors, level of motivation, and clinical measures. Improvements in 13 clinical and behavioral outcomes also differed by enrollment year with the 2006 cohort having the greatest number of significant improvements and the highest rates of participation and retention. Further investigation into the ways to modify the intensive case management model to address differences in levels of motivation and participation is warranted to improve the management of chronic disease in Indian health. Given the evolving nature of translational initiatives of this kind, our analysis results highlight the need to understand and adapt during the natural progression of health behavioral interventions.
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Affiliation(s)
- Katherine A Pratte
- Department of Epidemiology, University of California Irvine, School of Medicine, Irvine, CA, USA
| | - Janette Beals
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ann Johnson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California Irvine, School of Medicine, Irvine, CA, USA
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Tabak RG, Schwarz CD, Kemner A, Schechtman KB, Steger-May K, Byrth V, Haire-Joshu D. Disseminating and implementing a lifestyle-based healthy weight program for mothers in a national organization: a study protocol for a cluster randomized trial. Implement Sci 2019; 14:68. [PMID: 31238955 PMCID: PMC6593605 DOI: 10.1186/s13012-019-0916-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Excessive weight gain among young adult women age 18–45 years is an alarming and overlooked trend that must be addressed to reverse the epidemics of obesity and chronic disease. During this vulnerable period, women tend to gain disproportionally large amounts of weight compared to men and to other life periods. Healthy Eating and Active Living Taught at Home (HEALTH) is a lifestyle modification intervention developed in partnership with Parents as Teachers (PAT), a national home visiting, community-based organization with significant reach in this population. HEALTH prevented weight gain, promoted sustained weight loss, and reduced waist circumference. PAT provides parent–child education and services free of charge to nearly 170,000 families through up to 25 free home visits per year until the child enters kindergarten. Methods This study extends effectiveness findings with a pragmatic cluster randomized controlled trial to evaluate dissemination and implementation (D&I) of HEALTH across three levels (mother, parent educator, PAT site). The trial will evaluate the effect of HEALTH and the HEALTH training curriculum (implementation strategy) on weight among mothers with overweight and obesity across the USA (N = 252 HEALTH; N = 252 usual care). Parent educators from 28 existing PAT sites (14 HEALTH, 14 usual care) will receive the HEALTH training curriculum through PAT National Center, using PAT’s existing training infrastructure, as a continuing education opportunity. An extensive evaluation, guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), will determine implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and adaptation) at the parent educator level. The Conceptual Framework for Implementation Research will characterize determinants that influence HEALTH D&I at three levels: mother, parent educator, and PAT site to enhance external validity (reach and maintenance). Discussion Embedding intervention content within existing delivery channels can help expand the reach of evidence-based interventions. Interventions, which have been adapted, can still be effective even if the effect is reduced and can still achieve population impact by reaching a broader set of the population. The current study will build on this to test not only the effectiveness of HEALTH in real-world PAT implementation nationwide, but also elements critical to D&I, implementation outcomes, and the context for implementation. Trial registration https://ClinicalTrials.gov, NCT03758638. Registered 29 November 2018 Electronic supplementary material The online version of this article (10.1186/s13012-019-0916-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Allison Kemner
- Research and Quality, Parents as Teachers, 2228 Ball Drive, St. Louis, MO, 63146, USA
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., CB 8067, St. Louis, MO, 63110-1093, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., CB 8067, St. Louis, MO, 63110-1093, USA
| | - Veronda Byrth
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
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Im EO, Kong EH. What Is the Status Quo of Evidence-Based Community Health Nursing? Res Theory Nurs Pract 2017; 31:156-178. [DOI: 10.1891/1541-6577.31.2.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose:With an increasing emphasis on evidence-based nursing in general,evidence-based practicehas become a buzzword among community health nurses in many countries. Despite the global interests, evidence-based community health nursing is not even clearly defined in the literature and very little is known about the current status of evidence-based community health nursing. Therefore, the purpose of this article is to identify the status quo of evidence-based nursing in community health nursing through an integrative literature review.Methods:Four electronic databases were searched from the earliest year to 2016 with combinations of keywords. Twenty-six eligible articles were reviewed, and the characteristics reflecting the current status of evidence-based community health nursing were extracted.Results:Through the content analysis process, 6 characteristics were identified. First, in evidence-based community health nursing, the needs of clients, families, caregivers, and health care professionals were identified and assessed. Second, interventions were planned based on systematic reviews on various relevant sources. Third, various types of research methods were used. Fourth, available resources were assessed and used, and the findings of cost estimation, cost/effectiveness, or cost/benefit analyses were reported. Fifth, training, support, monitoring, and coordination were included as major components. Finally, the evidence used and/or found in the studies was evaluated, disseminated, and updated as the last step.Implications for Practice:Community health nurses are required to continuously integrate, implement, evaluate, disseminate, and update their evidence for future evidence-based community health nursing.
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Harris ML, Dolja-Gore X, Kendig H, Byles JE. End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study. BMC Health Serv Res 2016; 16:484. [PMID: 27613597 PMCID: PMC5017050 DOI: 10.1186/s12913-016-1729-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 08/30/2016] [Indexed: 11/12/2022] Open
Abstract
Background Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use. Methods Survey data from 1,205 decedents from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS). Results 85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and ‘other’ causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation. Conclusions Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1729-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa L Harris
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Xenia Dolja-Gore
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Hal Kendig
- Centre for Research on Ageing, Health and Wellbeing, College of Medicine, Biology and Environment, Australian National University, Mills Road, Acton, ACT, Australia.,ARC Centre of Excellence in Population Ageing Research, Sydney, NSW, 2033, Australia
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,ARC Centre of Excellence in Population Ageing Research, Sydney, NSW, 2033, Australia
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Harden SM, Gaglio B, Shoup JA, Kinney KA, Johnson SB, Brito F, Blackman KCA, Zoellner JM, Hill JL, Almeida FA, Glasgow RE, Estabrooks PA. Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: a systematic review. Syst Rev 2015; 4:155. [PMID: 26547687 PMCID: PMC4637141 DOI: 10.1186/s13643-015-0141-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/23/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was developed to determine potential public health impact of interventions (i.e., programs, policy, and practice). The purpose of this systematic review was to determine (1) comparative results across accurately reported RE-AIM indicators, (2) relevant information when there remains under-reporting or misclassification of data across each dimension, (3) the degree to which authors intervened to improve outcomes related to each dimension, and (4) the number of articles reporting RE-AIM dimensions for a given study. METHODS In April 2013, a systematic search of the RE-AIM framework was completed in PubMed, PSYCHInfo, EbscoHost, Web of Science, and Scopus. Evidence was analyzed until January 2015. RESULTS Eighty-two interventions that included empirical data related to at least one of the RE-AIM dimensions were included in the review. Across these interventions, they reached a median sample size of 320 participants (M = 4894 ± 28,256). Summarizing the effectiveness indicators, we found that: the average participation rate was 45 % (±28 %), 89 % of the interventions reported positive changes in the primary outcome and 11 interventions reported broader outcomes (e.g., quality of life). As for individual-level maintenance, 11 % of studies showed effects ≥6 months post-program. Average setting and staff adoption rates were 75 % (±32 %) and 79 % (±28 %), respectively. Interventions reported being delivered as intended (82 % (±16 %)) and 22 % intervention reported adaptations to delivery. There were insufficient data to determine average maintenance at the organizational level. Data on costs associated with each dimension were infrequent and disparate: four studies reported costs of recruitment, two reported intervention costs per participant, and two reported adoption costs. CONCLUSIONS The RE-AIM framework has been employed in a variety of populations and settings for the planning, delivery, and evaluation of behavioral interventions. This review highlights inconsistencies in the degree to which authors reported each dimension in its entirety as well as inaccuracies in reporting indicators within each dimension. Further, there are few interventions that aim to improve outcomes related to reach, adoption, implementation, and maintenance.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Bridget Gaglio
- Communication and Dissemination Research, Patient-Centered Outcomes Research Institute, Washington, DC, 20036, USA.
| | - Jo Ann Shoup
- School of Public Affairs, University of Colorado, Denver, CO, 80204, USA. .,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, US.
| | - Kimberlee A Kinney
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Sallie Beth Johnson
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Fabiana Brito
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Kacie C A Blackman
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Jamie M Zoellner
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Jennie L Hill
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Fabio A Almeida
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Family and Community Medicine, Carilion Clinic, Roanoke, VA, 24016, USA.
| | - Russell E Glasgow
- Family Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Paul A Estabrooks
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Family and Community Medicine, Carilion Clinic, Roanoke, VA, 24016, USA.
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Franklin CM, Bernhardt JM, Lopez RP, Long-Middleton ER, Davis S. Interprofessional Teamwork and Collaboration Between Community Health Workers and Healthcare Teams: An Integrative Review. Health Serv Res Manag Epidemiol 2015; 2:2333392815573312. [PMID: 28462254 PMCID: PMC5266454 DOI: 10.1177/2333392815573312] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Community Health Workers (CHWs) serve as a means of improving outcomes for underserved populations. However, their relationship within health care teams is not well studied. The purpose of this integrative review was to examine published research reports that demonstrated positive health outcomes as a result of CHW intervention to identify interprofessional teamwork and collaboration between CHWs and health care teams. METHODS A total of 47 studies spanning 33 years were reviewed using an integrative literature review methodology for evidence to support the following assumptions of effective interprofessional teamwork between CHWs and health care teams: (1) shared understanding of roles, norms, values, and goals of the team; (2) egalitarianism; (3) cooperation; (4) interdependence; and(5) synergy. RESULTS Of the 47 studies, 12 reported at least one assumption of effective interprofessional teamwork. Four studies demonstrated all 5 assumptions of interprofessional teamwork. CONCLUSIONS Four studies identified in this integrative review serve as exemplars for effective interprofessional teamwork between CHWs and health care teams. Further study is needed to describe the nature of interprofessional teamwork and collaboration in relation to patient health outcomes.
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Affiliation(s)
- Catherine M. Franklin
- Department of Family Medicine, East Boston Neighborhood Health Center, East Boston, MA, USA
| | - Jean M. Bernhardt
- School of Nursing, MGH Institute of Health Professions, Boston, MA, USA
| | - Ruth Palan Lopez
- School of Nursing, MGH Institute of Health Professions, Boston, MA, USA
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Islam N, Riley L, Wyatt L, Tandon SD, Tanner M, Mukherji-Ratnam R, Rey M, Trinh-Shevrin C. Protocol for the DREAM Project (Diabetes Research, Education, and Action for Minorities): a randomized trial of a community health worker intervention to improve diabetic management and control among Bangladeshi adults in NYC. BMC Public Health 2014; 14:177. [PMID: 24548534 PMCID: PMC3933368 DOI: 10.1186/1471-2458-14-177] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 02/11/2014] [Indexed: 11/24/2022] Open
Abstract
Background New York City (NYC) is currently home to the largest Bangladeshi population in the United States (US) at approximately 62,000 individuals. The high prevalence of Type 2 diabetes mellitus (T2DM) among Bangladeshis has been well documented in Bangladesh, as well as in Canada and the United Kingdom (UK). However, little is known about the diabetes prevalence and management practices of US Bangladeshis. This paper describes the protocol for a Community Health Worker (CHW) intervention to improve diabetic management and control among Bangladeshis with diabetes in NYC. Methods/Design For a two-arm, randomized controlled trial (RCT), investigators will recruit a sample of 256 participants, all of whom are 1) of Bangladeshi descent, 2) residing in NYC, 3) diagnosed with T2DM and a recent Hemoglobin A1c (HbA1c) of ≥ 6.5, and 4) between the ages of 21–85. The treatment group receives a six-month CHW-led intervention consisting of five monthly group educational sessions, two one-on-one visits, and follow-up phone calls as needed from a CHW. The control group receives an introductory educational session only. Primary and secondary outcomes include clinical and behavioral measures, such as HbA1c and weight change, access to and utilization of care (i.e. appointment keeping and use of specialty care), and knowledge and practice of physical activity and healthful eating. Additionally, information regarding CHW characteristics, the processes and mechanisms for influencing healthful behavior change, and fidelity of the intervention are collected. Outcomes are measured at Baseline, 3-Months, 6-Months for both groups, and at 12-Months for the treatment group. Discussion To our knowledge, this study represents the first attempt to document the efficacy of T2DM management strategies in the NYC Bangladeshi population. Thus, future qualitative and quantitative findings of the submitted protocol will fill an important gap in the health disparities literature. Trial registration NCT02041598
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Affiliation(s)
| | - Lindsey Riley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 8 F, New York, NY 10016, USA.
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Wendler MC, Kirkbride G, Wade K, Ferrell L. Translational research: a concept analysis. Res Theory Nurs Pract 2014; 27:214-32. [PMID: 24422334 DOI: 10.1891/1541-6577.27.3.214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED BACKGROUND/CONCEPTUAL FRAMEWORK: Little is known about which approaches facilitate adoption and sustainment of evidence-based practice change in the highly complex care environments that constitute clinical practice today. The purpose of this article was to complete a concept analysis of translational research using a modified Walker and Avant approach. DESIGN/DATA COLLECTION: Using a rigorous and thorough review of the recent health care literature generated by a deep electronic search from 2004-2011, 85 appropriate documents were retrieved. Close reading of the articles by three coresearchers yielded an analysis of the emerging concept of translational research. DATA ANALYSIS Using the iterative process described by Walker and Avant, a tentative definition of the concept of translational research, along with antecedents and consequences were identified. Implications for health care professionals in education, practice, and research are offered. Further research is needed to determine the adequacy of the definition, to identify empirical referents, and to guide theory development. RESULTS The study resulted in a theoretical definition of the concept of translational research, along with identification of antecedents and consequences and a description of an ideal or model case to illustrate the definition. IMPLICATIONS/CONCLUSIONS Implications for practice and education include the importance of focusing on translational research approaches that may reduce the research-practice gap in health care, thereby improving patient care delivery. Research is needed to determine the usefulness of the definition in health care clinical practice.
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Affiliation(s)
- M Cecilia Wendler
- Nursing Research and Academic Partnerships, Memorial Medical Center, Springfield, Illinois 62781-0001, USA.
| | - Geri Kirkbride
- Nursing Research and Academic Partnerships, Memorial Medical Center, Springfield, Illinois 62781-0001, USA
| | - Kristen Wade
- Nursing Research and Academic Partnerships, Memorial Medical Center, Springfield, Illinois 62781-0001, USA
| | - Lynne Ferrell
- Nursing Research and Academic Partnerships, Memorial Medical Center, Springfield, Illinois 62781-0001, USA
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Goris J, Komaric N, Guandalini A, Francis D, Hawes E. Effectiveness of multicultural health workers in chronic disease prevention and self-management in culturally and linguistically diverse populations: a systematic literature review. Aust J Prim Health 2013; 19:14-37. [DOI: 10.1071/py11130] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 02/10/2012] [Indexed: 11/23/2022]
Abstract
With a large and increasing culturally and linguistically diverse (CALD) population, the Australian health care system faces challenges in the provision of accessible culturally competent health care. Communities at higher risk of chronic disease include CALD communities. Overseas, multicultural health workers (MHWs) have been increasingly integrated in the delivery of culturally relevant primary health care to CALD communities. The objective of this systematic review was to examine the effectiveness of MHW interventions in chronic disease prevention and self-management in CALD populations with the aim to inform policy development of effective health care in CALD communities in Australia. A systematic review protocol was developed and computerised searches were conducted of multiple electronic databases from 1 January 1995 until 1 November 2010. Thirty-nine studies were identified including 31 randomised controlled trials. Many of the studies focussed on poor and underserved ethnic minorities. Several studies reported significant improvements in participants’ chronic disease prevention and self-management outcomes and meta-analyses identified a positive trend associated with MHW intervention. Australian Government policies express the need for targeted inventions for CALD communities. The broader systemic application of MHWs in Australian primary health care may provide one of the most useful targeted interventions for CALD communities.
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Cadzow RB, Craig M, Rowe J, Kahn LS. Transforming community members into diabetes cultural health brokers: the Neighborhood Health Talker project. DIABETES EDUCATOR 2012; 39:100-8. [PMID: 23150528 DOI: 10.1177/0145721712465342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate a community-based diabetes education pilot project. The Neighborhood Health Talker project aimed to train and implement cultural health brokers primarily targeting communities of color to improve community members' diabetes knowledge and diabetes self-management skills. A secondary aim was to establish diabetes resource libraries accessible to communities that normally experience barriers to these resources. METHODS Recruited community members completed 1 week of formal training developed by a multidisciplinary team in Buffalo, NY. The effect of training was evaluated through the use of baseline surveys, a pretest/posttest covering all training content, and daily quizzes evaluating knowledge relevant to each of the five training modules. Trained NHTs then held at least five community conversations in various locations and administered anonymous postconversation surveys to participants. Descriptive statistics and qualitative analysis techniques were used to summarize test, quiz, and survey results. RESULTS Twelve women and 1 man completed the training program. Working alone as well as in pairs, each held at least five community conversations reaching over 700 community members of all ages over 3 months and established 8 diabetes resource libraries in the community. All trainees increased their diabetes knowledge and confidence as well as their abilities to perform the tasks of a cultural health broker. Trainees also indicated that the goals they set at training initiation were met. CONCLUSIONS The training was successful in increasing trainee knowledge and confidence about diabetes prevention and self-management. Participants not only developed proficiency in discussing diabetes, they also made important lifestyle changes that demonstrated their commitment to the cause and the project. Low-cost initiatives like this are easily reproducible in other communities of color and could be modified to meet the needs of other communities as well.
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Affiliation(s)
- Renee B Cadzow
- Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, Buffalo, New York, New York
State Area Health Education Center System (NYS AHEC) Statewide Office, Buffalo, New York, D’Youville College, Department of Health Services Administration, Buffalo, New York (Dr Cadzow)
| | - Mary Craig
- Erie Niagara Area Health Education Center (EN AHEC), Buffalo, New York (Ms Craig)
| | - Jimmy Rowe
- Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, Buffalo, New York; Health Association
of Niagara County Inc. (HANCI), Niagara Falls, New York (Rev Rowe)
| | - Linda S Kahn
- Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo, Buffalo, New York (Dr Kahn)
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Abstract
Community health workers (CHWs) have gained prominence in health care, recognizing the influence of community and environment on health. This study evaluates CHWs' efforts to assess patients' readiness to change and facilitate self-management goal setting. Six pairs of community health centers were randomly assigned to employ CHWs on health care teams. Each team worked with a defined population of patients. We assessed changes in documented patient self-management goals and clinical measures from both control and intervention CHCs before and after deploying CHWs, finding a significant increase in self-management goal setting between the intervention and control health centers.
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13
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Mount DL, Davis C, Kennedy B, Raatz S, Dotson K, Gary-Webb TL, Thomas S, Johnson KC, Espeland MA. Factors influencing enrollment of African Americans in the Look AHEAD trial. Clin Trials 2011; 9:80-9. [PMID: 22064686 DOI: 10.1177/1740774511427929] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many factors have been identified that influence the recruitment of African Americans into clinical trials; however, the influence of eligibility criteria may not be widely appreciated. We used the experience from the Look AHEAD (Action for Health in Diabetes) trial screening process to examine the differential impact eligibility criteria had on the enrollment of African Americans compared to other volunteers. METHODS Look AHEAD is a large randomized clinical trial to examine whether assignment to an intensive lifestyle intervention designed to produce and maintain weight loss reduces the long-term risk of major cardiovascular events in adults with type 2 diabetes. Differences in the screening, eligibility, and enrollment rates between African Americans and members of other racial/ethnic groups were examined to identify possible reasons. RESULTS Look AHEAD screened 28,735 individuals for enrollment, including 6226 (21.7%) who were self-identified African Americans. Of these volunteers, 12.9% of the African Americans compared to 19.3% of all other screenees ultimately enrolled (p < 0.001). African Americans no more often than others were lost to follow-up or refused to attend clinic visits to establish eligibility. Furthermore, the enrollment rates of individuals with histories of cardiovascular disease and diabetes therapy did not markedly differ between the ethnic groups. Higher prevalence of adverse levels of blood pressure, heart rate, HbA1c, and serum creatinine among African American screenees accounted for the greater proportions excluded (all p < 0.001). CONCLUSIONS Compared to non-African Americans, African American were more often ineligible for the Look AHEAD trial due to comorbid conditions. Monitoring trial eligibility criteria for differential impact, and modifying them when appropriate, may ensure greater enrollment yields.
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Affiliation(s)
- David L Mount
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Katz DL, Murimi M, Gonzalez A, Njike V, Green LW. From controlled trial to community adoption: the multisite translational community trial. Am J Public Health 2011; 101:e17-27. [PMID: 21680935 DOI: 10.2105/ajph.2010.300104] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Methods for translating the findings of controlled trials, such as the Diabetes Prevention Program, into real-world community application have not been clearly defined. A standardized research methodology for making and evaluating such a transition is needed. We introduce the multisite translational community trial (mTCT) as the research analog to the multisite randomized controlled trial. The mTCT is adapted to incorporate the principles and practices of community-based participatory research and the increased relevance and generalizability gained from diverse community settings. The mTCT is a tool designed to bridge the gap between what a clinical trial demonstrates can work in principle and what is needed to make it workable and effective in real-world settings. Its utility could be put to the test, in particular with practice-based research networks such as the Prevention Research Centers.
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Affiliation(s)
- David L Katz
- Yale-Griffin Prevention Research Center, Derby, CT 06418, USA.
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DePue JD, Rosen RK, Batts-Turner M, Bereolos N, House M, Held RF, Nu'usolia O, Tuitele J, Goldstein MG, McGarvey ST. Cultural translation of interventions: diabetes care in American Samoa. Am J Public Health 2010; 100:2085-93. [PMID: 20864729 DOI: 10.2105/ajph.2009.170134] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Translation of research advances into clinical practice for at-risk communities is important to eliminate disease disparities. Adult type 2 diabetes prevalence in the US territory of American Samoa is 21.5%, but little intervention research has been carried out there. We discuss our experience with cultural translation, drawing on an emerging implementation science, which aims to build a knowledge base on adapting interventions to real-world settings. We offer examples from our behavioral intervention study, Diabetes Care in American Samoa, which was adapted from Project Sugar 2, a nurse and community health worker intervention to support diabetes self-management among urban African Americans. The challenges we experienced and solutions we used may inform adaptations of interventions in other settings.
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Affiliation(s)
- Judith D DePue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02903, USA.
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Abstract
OBJECTIVES We conducted a systematic review on outcomes and costs of community health worker (CHW) interventions. CHWs are increasingly expected to improve health outcomes cost-effectively for the underserved. RESEARCH DESIGN We searched Medline, Cochrane Collaboration resources, and the Cumulative Index to Nursing and Allied Health Literature for studies conducted in the United States and published in English from 1980 through November 2008. We dually reviewed abstracts, full-text articles, data abstractions, quality ratings, and strength of evidence grades and resolved disagreements by consensus. RESULTS We included 53 studies on outcomes of CHW interventions and 6 on cost or cost-effectiveness. For outcomes, limited evidence (5 studies) suggests that CHW interventions can improve participant knowledge compared with alternative approaches or no intervention. We found mixed evidence for participant behavior change (22 studies) and health outcomes (27 studies). Some studies suggested that CHW interventions can result in greater improvements in participant behavior and health outcomes compared with various alternatives, but other studies suggested that CHW interventions provide no statistically different benefits than alternatives. We found low or moderate strength of evidence suggesting that CHWs can increase appropriate health care utilization for some interventions (30 studies). Six studies with economic information yielded insufficient data to evaluate the cost-effectiveness of CHW interventions relative to other interventions. CONCLUSIONS CHWs can improve outcomes for underserved populations for some health conditions. The effectiveness of CHWs in many health care areas requires further research that addresses the methodologic limitations of prior studies and that contributes to translating research into practice.
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Burns D, Soward ACM, Skelly AH, Leeman J, Carlson J. Effective recruitment and retention strategies for older members of rural minorities. THE DIABETES EDUCATOR 2008; 34:1045-52. [PMID: 19075086 DOI: 10.1177/0145721708325764] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this article was to describe effective recruitment and retention strategies used in a community-based intervention study for older, rural African American women with type 2 diabetes. METHODS The study's design was a randomized control test using a 3-group experimental design in a sample of 180 older, rural African American women (55 years of age and older), with type 2 diabetes. The study employed a range of strategies to successfully recruit and retain older African American women. These strategies were initially developed based on a review of the literature and the investigators' prior experience. They were modified as the research progressed. RESULTS More than a quarter of the participants were recruited from outpatient clinics. In-person outreach to health care providers was essential to engage and retain their help in recruiting patients. The research team made it easy and rewarding for women to participate in the study by providing a toll-free phone number, culturally appropriate intervention materials, intervention in the home, and incentives. Developing a relationship of trust with participants and the community was critical throughout the study period. Through the use of these strategies, the target enrollment of 180 women was met with 91% retention rate at the completion of the study. CONCLUSION The use of multiple strategies can enhance recruitment and retention of rural, older African American women into a research study. Strategies are most effective when they build a relationship of trust with participants and the community and make it easy and rewarding for women to participate.
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Affiliation(s)
- Dorothy Burns
- The School of Nursing at Hampton University, Hampton, Virginia (Dr Burns)
| | - April C M Soward
- The University of North Carolina at Chapel Hill (Ms Soward, Dr Skelly, Dr Leeman, Mr Carlson)
| | - Anne H Skelly
- The University of North Carolina at Chapel Hill (Ms Soward, Dr Skelly, Dr Leeman, Mr Carlson)
| | - Jennifer Leeman
- The University of North Carolina at Chapel Hill (Ms Soward, Dr Skelly, Dr Leeman, Mr Carlson)
| | - John Carlson
- The University of North Carolina at Chapel Hill (Ms Soward, Dr Skelly, Dr Leeman, Mr Carlson)
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Efficacious, effective, and embedded interventions: implementation research in infectious disease control. BMC Public Health 2008; 8:343. [PMID: 18826655 PMCID: PMC2567977 DOI: 10.1186/1471-2458-8-343] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 10/01/2008] [Indexed: 11/19/2022] Open
Abstract
Background Research in infectious disease control is heavily skewed towards high end technology; development of new drugs, vaccines and clinical interventions. Oft ignored, is the evidence to inform the best strategies that ensure the embedding of interventions into health systems and amongst populations. In this paper we undertake an analysis of the challenge in the development of research for the sustainable implementation of disease control interventions. Results We highlight the fundamental differences between the research paradigms associated with the development of technologies and interventions for disease control on the one hand and the research paradigms required for enhancing the sustainable uptake of those very same interventions within the communities on the other. We provide a definition for implementation research in an attempt to underscore its critical role and explore the multidisciplinary science needed to address the challenges in disease control. Conclusion The greatest value for money in health research lies in the sustainable and effective implementation of already proven, efficacious solutions. The development of implementation research that can help provide some solutions on how this can be achieved is sorely needed.
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Hawthorne K, Robles Y, Cannings-John R, Edwards AG. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. Cochrane Database Syst Rev 2008:CD006424. [PMID: 18646153 DOI: 10.1002/14651858.cd006424.pub2] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ethnic minority groups in upper-middle and high income countries tend to be socio-economically disadvantaged and to have higher prevalence of type 2 diabetes than the majority population. OBJECTIVES To assess the effectiveness of culturally appropriate diabetes health education on important outcome measures in type 2 diabetes. SEARCH STRATEGY We searched the The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, SIGLE and reference lists of articles. We also contacted authors in the field and handsearched commonly encountered journals. SELECTION CRITERIA RCTs of culturally appropriate diabetes health education for people over 16 years with type 2 diabetes mellitus from named ethnic minority groups resident in upper-middle or high income countries. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. Where there were disagreements in selection of papers for inclusion, all four authors discussed the studies. We contacted study authors for additional information when data appeared to be missing or needed clarification. MAIN RESULTS Eleven trials involving 1603 people were included, with ten trials providing suitable data for entry into meta-analysis. Glycaemic control (HbA1c), showed an improvement following culturally appropriate health education at three months (weight mean difference (WMD) - 0.3%, 95% CI -0.6 to -0.01), and at six months (WMD -0.6%, 95% CI -0.9 to -0.4), compared with control groups who received 'usual care'. This effect was not significant at 12 months post intervention (WMD -0.1%, 95% CI -0.4 to 0.2). Knowledge scores also improved in the intervention groups at three months (standardised mean difference (SMD) 0.6, 95% CI 0.4 to 0.7), six months (SMD 0.5, 95% CI 0.3 to 0.7) and twelve months (SMD 0.4, 95% CI 0.1 to 0.6) post intervention. Other outcome measures both clinical (such as lipid levels, and blood pressure) and patient centred (quality of life measures, attitude scores and measures of patient empowerment and self-efficacy) showed no significant improvement compared with control groups. AUTHORS' CONCLUSIONS Culturally appropriate diabetes health education appears to have short term effects on glycaemic control and knowledge of diabetes and healthy lifestyles. None of the studies were long-term, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of studies made subgroup comparisons difficult to interpret with confidence. There is a need for long-term, standardised multi-centre RCTs that compare different types and intensities of culturally appropriate health education within defined ethnic minority groups.
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Affiliation(s)
- Kamila Hawthorne
- Department of Primary Care and Public Health, Cardiff University, 3rd Floor, Neuadd Meirionnydd Building. School of Medicine, Heath Park, Cardiff, UK, CF14 4XN
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Leeman J, Skelly AH, Burns D, Carlson J, Soward A. Tailoring a diabetes self-care intervention for use with older, rural African American women. THE DIABETES EDUCATOR 2008; 34:310-7. [PMID: 18375780 DOI: 10.1177/0145721708316623] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to tailor a diabetes management intervention to the cultural and age-related needs and preferences of older, rural African American women. METHODS Findings from exploratory research, clinical experience, and review of the literature were used to inform the development of a culture- and function-specific intervention. Findings informed the design of the intervention, format of intervention delivery, format of intervention materials, and training provided to interventionists. Intervention materials were reviewed by a community advisory board, and the intervention was pilot tested with 43 women. RESULTS The intervention's delivery was tailored to the needs of older African American women through the use of 1-hour, in-home sessions that used a storytelling format to share information. The design of the intervention individualized its content to each woman's symptom experience, self-care practices, and coping strategies. Extensive training sensitized intervention nurses to coping strategies (spirituality, church, family) and barriers to self-care (functional limitations, stress, the multi-caregiver role) that are common among older African American women. Intervention materials were culturally sensitive and in large-print format. CONCLUSIONS African American women's cultural background may have a strong influence on health behaviors and beliefs. Older women's health behaviors are further influenced by changes in their functional abilities. Therefore, the authors tailored a diabetes self-care management intervention to be specific to older African American women's cultural and functional differences. An initial pilot of the intervention found high levels of participant satisfaction with the intervention, improvements in diabetes self-care practices, and a trend toward greater metabolic control.
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Affiliation(s)
- Jennifer Leeman
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Funded through grant R01 NR008582 from the National Institute of Nursing Research to the School of Nursing, University of North Carolina at Chapel Hill
| | - Anne H Skelly
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Funded through grant R01 NR008582 from the National Institute of Nursing Research to the School of Nursing, University of North Carolina at Chapel Hill
| | - Dorothy Burns
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Funded through grant R01 NR008582 from the National Institute of Nursing Research to the School of Nursing, University of North Carolina at Chapel Hill
| | - John Carlson
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Funded through grant R01 NR008582 from the National Institute of Nursing Research to the School of Nursing, University of North Carolina at Chapel Hill
| | - April Soward
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Funded through grant R01 NR008582 from the National Institute of Nursing Research to the School of Nursing, University of North Carolina at Chapel Hill
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Serrano E, Anderson J, Chapman-Novakofski K. Not lost in translation: nutrition education, a critical component of translational research. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2007; 39:164-70. [PMID: 17493567 DOI: 10.1016/j.jneb.2006.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 12/04/2006] [Accepted: 12/05/2006] [Indexed: 05/15/2023]
Abstract
Translational research is an emerging field of science, embracing disciplines in medicine and public health to create a full-spectrum research agenda. Often described as science "from bench to bedside and back again," translational research may be better described as "from bench to behavior," as it strives to apply laboratory results to clinical settings. Because the demand for translational research has emerged, it is critical for nutrition educators to ensure that translational research includes community and policy areas and to recognize themselves as translation researchers. The purpose of this report is to provide a framework for nutrition educators to better understand translational research and to recognize their role in translational research, using type 2 diabetes as an example.
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Affiliation(s)
- Elena Serrano
- Department of Human Nutrition, Foods, & Exercise, Virginia Polytechnic Institute & State University, Blacksburg, VA 24061-0430, USA.
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