"The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention."

Program Science in Context

Sevgi O. AralRome, ItalyMay 2010

The number of articles on

translation research has

exploded

NIH Conferences on Dissemination and Implementation

2008 2009 2010

300 attendees 9,000 attendees

Health Systems Strengthening

An important component of global health

Implementation/DeliveryScience

BasicScience

ClinicalScience

EvaluationScience

Adapted from James Yon Kim 2009 Keynote address to the NIH Dissemination and Implementation Science Conference.

Health Care Delivery and Implementation Science

Global Health Delivery Project

Implementation

Dissemination

Scale-up

Evidence Based Practice (EBP)

Clinical Practice Improvement (CPI)

Practice Based Evidence (PBE)

Best practices

“What is different in Program Science?”

“This is the same thing as implementation/dissemination/health care delivery/scale up science.”

“This is the same thing as translation research.”

I. It really does NOT matter ̶ we are all after the same thing

“better public health for all ̶ by whatever name you call it”

II. ? some differences between Program Science and other approaches? ̶ Perhaps!

“Does X intervention work for Y clinical problem?”

“What is the best approach for Y clinical problem?”

Joseph Matthew ̶ Indian Pediatrics March 17, 2010

“The dissemination and implementation science initiative not helpful ̶ interventions offered not feasible within the budgetary and health system capacity constraints.”

Tom FarleyNew York City Commissioner of Health

Issues in the implementation and scale-up of scientific findings in prevention program settings

Science

• Treatment and prevention at individual level

• Individual interventions

• Interventions evaluated at one point in time

• Evaluated among “eligibles” who agree to participate in study

Prevention Program

• Control and prevent spread at population level

• Multiplicity of interventions

• Need effective interventions during all phases of epidemics

• Need effective interventions for all ̶ ineligibles and those who refuse to participate included

Issues in the implementation and scale-up of scientific findings in prevention program settings (cont.)

Science

• Interventions evaluated under “ideal” conditions

• Sufficient financial resources

• The “best” human resources

• Interventions evaluated when first implemented

• Internal validity important

Prevention Program

• May work differently under “everyday” conditions

• Insufficient financial resources

• Typical human resources

• Need interventions that work for the duration

• Generalizability important

→ Individual interventions• Expensive• High intensity• Labor intensive• Individual level• Multi-session• Difficult to implement• Non-generalizable

Interventions that require adherence

Interventions that may lead to disinhibitions in other risk behaviors

→ Gap between scientific findings and program needs.

Goal: To identify science based solutions to program dilemmas

• who • when • how

Synthesize evidence

Based on available intervention studies

Based on program questions

Program Science

• Population-based• Produces knowledge about policy and

program interventions that have the potential to impact health at the population level

• Includes interventions that operate within and outside the health sector

Program Science

• Includes interventions that modify social determinants of morbidity

• Includes research into “required and achievable coverage” or reach of interventions

• Includes research into “incremental” or “marginal” benefits of additional interventions

Program Science

• “Incremental” and “marginal” costs of interventions

• Synergies and antagonisms across interventions

• Differential uptake of interventions

Program Science

• Issues of adherence to interventions by the population

• Operational research on implementation of interventions

• Sustainability of interventions and their routinization

Program Science

• Focuses on packages of interventions• Considers issues of resource expansion,

advocacy, and mobilization• Includes evaluation and evaluation

research

Science Program

It’s all semantics

Ready to adaptYour part of the elephant!

Thank you!