Why Don’t We See More Translation of Health Promotion Research to Practice? Rethinking the Efficacy-to-Effectiveness Transition
Open accessAbstract
The gap between research and practice is well documented. We address one of the underlying reasons for this gap: the assumption that effectiveness research naturally and logically follows from successful efficacy research. These 2 research traditions have evolved different methods and values; consequently, there are inherent differences between the characteristics of a successful efficacy intervention versus those of an effectiveness one. Moderating factors that limit robustness across settings, populations, and intervention staff need to be addressed in efficacy studies, as well as in effectiveness trials. Greater attention needs to be paid to documenting intervention reach, adoption, implementation, and maintenance. Recommendations are offered to help close the gap between efficacy and effectiveness research and to guide evaluation and possible adoption of new programs.
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Current conceptions of research designs fail to maximize clinical utility for practicing clinicians and other decision makers, for example through a failure to focus on external validity or implementation-related barriers and facilitators to routine use and sustainability of effective practices.
“In addition, it has been suggested that current conceptions of research designs fail to “maximize clinical utility for practicing clinicians and other decision makers”18; for example, through a failure to focus on external validity or implementation-related barriers and facilitators to routine use and sustainability of “effective” practices.4,21,22”
From Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact (2012) · cites this paper as [4]
The impetus to blend or explicitly link research traditions in the service of accelerating scientific progress and enhancing public health impact is not at all new, and the idea of blending clinical effectiveness and implementation research elements is also not new.
“The impetus to blend or explicitly link research traditions in the service of accelerating scientific progress and enhancing public health impact is not at all new,4,38–40 and the idea of blending clinical effectiveness and implementation research elements is also not new.”
From Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact (2012) · cites this paper as [4]
Evidence for determining which interventions are evidence based often comes from systematic reviews of controlled trials that prioritize internal validity over external validity.
“Often, this evidence comes from systematic reviews of controlled trials that prioritize internal validity (e.g., does the intervention work?) over external validity (e.g., can the findings be generalized, and among what populations and settings?) (48, 54).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [48]
These studies tend to be conducted in well-resourced settings and unrepresentative populations, making the conditions of implementation also unrepresentative.
“These studies also tend to be conducted in well-resourced settings and unrepresentative populations, making the conditions of implementation also unrepresentative (48).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [48]
Program effects demonstrated under idealized or laboratory conditions often do not translate into sustainable programs in practice.
“Increasingly, researchers are learning that program effects demonstrated under idealized or laboratory conditions often do not translate into sustainable programs in practice [44, 45].”
From Social Network Analysis for Program Implementation (2015) · cites this paper as [45]
The transfer of evidence into routine practice often does not happen as desired.
“the transfer of such evidence into routine practice often does not happen as desired [1-3].”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [2]
The fidelity of delivery of physical activity interventions is suboptimal.
“as is the fidelity of delivery of PA interventions [2,10,11].”
From Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research (2014) · cites this paper as [2]
With current approaches, translation can be difficult and slow, sometimes taking 15 to 20 years.
“Despite its importance, such translation research is relatively rare (6–8), perhaps because using current approaches translation can be arduous and slow, sometimes taking 15 to 20 years (9, 10).”
From The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions (2011) · cites this paper as [10]
Intervention effectiveness is an important driver of intervention adoption and support.
“Because intervention effectiveness is an important driver of intervention adoption and support, it is important that smoking cessation intervention optimization using MOST identifies intervention components and levels that deliver significant benefit in real-world healthcare settings with diverse real-world populations (10, 44).”
From The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions (2011) · cites this paper as [10]
Researchers raise the question whether interventions that are successful in efficacy studies are also effective in the real world.
“This is problematic as researchers raise the question whether interventions that are successful in efficacy studies are also effective in the real world (56).”
From How can physical activity be promoted among children and adolescents? A systematic review of reviews across settings (2019) · cites this paper as [56]
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- Authors
- Glasgow, R. E., Lichtenstein, E., & Marcus, A. C.
- Affiliations
- Oregon Research Institute (US)
- ORCID
- Glasgow, Russell E.
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2003-08
- Volume
- 93
- Issue
- 8
- Pages
- 1261-1267
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC1447950
- OpenAlex
- W2090482282
- Cited by
- 1,836
- References
- 49
- Citations by year
- 2026: 43 · 2025: 38 · 2024: 72 · 2023: 50 · 2022: 69 · 2021: 101 · 2020: 71 · 2019: 100 · 2018: 84 · 2017: 80 · 2016: 91 · 2015: 126 · 2014: 102 · 2013: 103 · 2012: 116
- FWCI
- 107.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- Agency for Healthcare Research and Quality (HS-10123, R18 HS010123)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Keywords
- research-practice gap, health promotion interventions, effectiveness research, efficacy research, intervention implementation, intervention maintenance, intervention adoption, intervention reach, program evaluation, translation of research
- MeSH terms
- Diffusion of Innovation, Health Promotion, Health Services Research, Humans, Practice Patterns, Physicians', Research Design, United States, Public Health Practice, Outcome Assessment, Health Care, Evidence-Based Medicine, Information Dissemination
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