The Translation Research Core is comprised of six components: 1) community engagement and outreach, 2) cultural adaptation of interventions, 3) health literacy, 4) health information technologies, 5) dissemination and implementation, and 6) sustainability. These components were identified based upon the experience gained and feedback received from the previous 5 years of NIDDK-funding. The specific components reflect the greatest strengths of the Research Base, the most frequent requests for training and technical assistance received during the first 5 years, and greater efficiency in orchestrating the resources to address these needs.
Community Engagement and Outreach
Leadership: Meredth Fort, PhD, Assistant Professor, Colorado School of Public Health, University of Colorado
Background: Community involvement in research is often plagued by obstacles such as difficulty engaging the community in setting research priorities that affect patients; absence of trust of medical research by the community; lack of systematic methods to inform research of community perspectives before, during, and after the research process; and lack of coordinated recruitment for clinical and translational research through an informed community.
Aims: The Community Engagement and Outreach Component focuses on overcoming obstacles to community involvement in translation research by equipping investigators to enable community residents to more actively participate in the full spectrum of research from conception to communication of results. Our work emphasizes four basic principles: collaboration between researchers and community leaders, education for community members about the benefits of research, facilitation of community engagement through meaningful vehicles of engagement, and transformation from a traditional unidirectional approach to an engaged partner approach with bidirectional efforts.
Leadership: Spero M. Manson, PhD, Distinguished Professor of Public Health and Psychiatry and Director of the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado
Background: A common, though often incorrect, assumption is that using an evidence-based practice simply requires one to identify an intervention that has been rigorously tested using scientific methods, to implement it, and to evaluate its effect. However, the interaction between practitioner knowledge, skills, and judgment and patient history, beliefs, and circumstances often alter the delivery of an intervention with unwanted consequences.
Aims: The Cultural Adaptation of Intervention Component is intended to help investigators think about how social and cultural context can inform the content, format, and delivery of an intervention in ways that strengthen its effectiveness, without weakening its scientific rigor. The work of our Research Base investigators illustrates that cultural adaptation can preserve the effectiveness of evidence-based practices and can enhance the results attained in broader based trials.
Leadership: Angela G. Brega, PhD, Associate Professor, Colorado School of Public Health, University of Colorado
Background: Patient outcomes are improved when interventions address the needs of patients with limited health literacy. If an intervention does not address health literacy, educational messages may be difficult for many participants to understand and act upon. The high prevalence of health literacy limitations is concerning in light of research demonstrating a link between health literacy and diabetes-related behaviors and outcomes.
Aims: The Health Literacy Component focuses on helping investigators address health literacy limitations for research targeting Native people by ensuring written intervention materials are understandable to all patients, spoken communication follows principles of clear communication, and that numeric information is presented in a manner known to facilitate comprehension.
Leadership: Sheana S. Bull, PhD, MPH, Professor and Assistant Vice Chancellor for Digital Education, Colorado School of Public Health, University of Colorado
Background: The recent proliferation of wireless and mobile technologies provides an opportunity to connect health-related information in the real-world. Mobile phone use has been rapidly and widely adopted among virtually all demographic groups, providing access to those populations most in need of diabetes-related interventions.
Aims: The Health Information Technologies Component focuses on exploring mobile health (mHealth) technologies that can make a significant difference to public health and health care delivery. Through mhealth technologies, our Research Base investigators are able to capture multiple sources of health data, such as detailed information about physical activity/location, physiological responses, and activities over extended periods of time. The use of mHealth methodologies is changing public health and health care on a large scale.
Leadership: Amy Huebschmann, MD, MS, FACP, Associate Professor, Department of Internal Medicine, University of Colorado
Background: To bring about intervention or service change, one must understand how and why information about preventive services, disease management, and other interventions may or may not reach key stakeholders. It is critical, therefore, to ascertain how, when, by whom, and under what circumstances research evidence spreads throughout the agencies, organizations, and front line workers providing public health and clinical services. Implementation research, a close companion of the study of dissemination processes, focuses on methods to promote the integration of research findings and evidence-based interventions into health care practice and policy. A basic assumption is that empirically supported interventions cannot simply be transferred into any service setting without attention to local context, nor that a unidirectional flow of information (e.g., publishing a recommendation, trial, or guideline) is sufficient to achieve practice change.
Aims: The Dissemination Component moves the diabetes translation research agenda forward by identifying mechanisms and approaches to package and convey the evidence-based information necessary to improve public health and clinical care services in ways relevant to local settings and that balance fidelity and adaptation. The Implementation Component helps investigators consider the growing knowledge base about "how" interventions are transported to real-world practice settings, which will likely require more than the distribution of information about the interventions. Our Research Base includes nationally recognized scholars in dissemination and implementation science who have and will continue to make this expertise available.
Leadership: Joan M. O’Connell, PhD, MHS, Associate Professor, Colorado School of Public Health, University of Colorado
Background: Sustainability encompasses the structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based policies and activities, including characteristics of the program that might support its sustainability (e.g., organizational capacity, program adaptability, program evaluation, strategic planning, funding stability, political support, partnerships, etc.).
Aims: The Sustainability Component works to examine the cost effectiveness of prevention and improved disease management in diabetes-related programs and practices. Unfortunately, little is known about these elements of sustainability within the Indian health care system, in general or for diabetes, specifically. The Agency for Health Care Research and Quality, Centers for Medicaid and Medicare, and Centers for Disease Control and Prevention have funded a series of studies by CAIANH to estimate the cost of diabetes care among AI/ANs. Information of this nature is essential to enable the federal government, including IHS, and tribes to allocate scarce resources and to formulate policy that will sustain successful diabetes-related programs and practices.