Ralph Gonzales, MD, MSPH
Why do medical research findings often fail to reach the people who could benefit from them most? And why are health programs proven to work in one setting frequently unable to achieve success in other places? These and other questions are the focus of “implementation science,” a field of study that addresses the wide-ranging challenges of translating research knowledge into real-life practice.
“Implementation science is a relatively new way of describing efforts to improve health by taking advantage of proven — though often underutilized — health interventions and thoughtfully and creatively applying them for general use,” said Ralph Gonzales, MD, a professor in the UCSF School of Medicine and director of the Implementation Science (ImS) program at the University’s Clinical and Translational Science Institute (CTSI).
In practice, implementation science covers diverse activities, including working to change behaviors such as ensuring that clinicians wash their hands regularly, improving care in hospital delivery rooms, and collaborating with community groups to promote disease prevention through youth-focused activities, said Margaret Handley, PhD, MPH, co-director of the ImS program. It also may focus on research in environments defined by complex variables, such as tracking and treating tuberculosis in developing countries, helping women make informed decisions about reproductive health, or linking with community-engaged research.
According to Gonzales, as more researchers learn about implementation science, it’s not uncommon to hear comments like, “Haven’t researchers been doing this all along in areas such as applied science and public health?”
Implementation Science is Inherently Multidisciplinary
There’s more to implementation science, he said. ImS applies theories and principles from diverse fields — economics, behavioral and social sciences, public health, marketing, public policy — and is inherently multidisciplinary. For researchers with years of training in a medical specialty, collaborating with diverse colleagues is not as common, nor as simple, as people might think.
Recognizing that ImS is a key component of translational research, which is ultimately focused on improving health, Gonzales and his team at CTSI are leveraging training and community-building to bridge the gap.
“Training offers researchers the tools, skills and strategies needed to address important contextual factors — including human practices, not all of which are rational or easily predictable — that may be limiting the widespread use of a proven intervention or preventing a project from being sustainable,” said Sara Ackerman, PhD, MPH, a medical anthropologist and the ImS program coordinator.
Margaret Handley, PhD, MPH
The goal is to train researchers to ask the right questions and design interventions that are relevant and acceptable to their audience — whether at the level of individuals, communities, institutions, or policies, she added.
Implementation science training and support opportunities include a one-year, part-time certificate program and a master’s degree program in clinical research with an ImS track. Both are offered through the Training in Clinical Research (TICR) program. In addition, the CTSI Consultation Services program offers expert advice in implementation science methods and principles from UCSF faculty.
Building an Implementation Science Community at UCSF
“Implementation science is a growing discipline, and it’s exciting to be pulling together a diverse community of researchers,” said Handley, who also is a public health-trained epidemiologist and associate adjunct professor in the UCSF School of Medicine. “There are great lessons to be learned from those with a wide range of experience, including thinking about touch points and opportunities for collaboration earlier in the research process. At UCSF, we’re helping investigators develop a skill set early in their careers so that they can come to good ideas more quickly.”
However, she said, there are researchers and clinicians engaged in implementation science-type projects at UCSF who aren’t even aware of it, or they have misconceptions such as the belief that the National Institutes of Health (NIH) doesn’t fund this type of research. With that in mind, an effort is underway to build a community of like-minded scientists to dispel myths, promote and support interdisciplinary collaborations, and help direct investigators to funding opportunities.
UCSF’s CTSI is a member of the Clinical and Translational Science Awards network funded through the National Center for Advancing Translational Sciences at the NIH (Grant Number UL1 TR000004). Under the banner of “Accelerating Research to Improve Health,” CTSI provides a wide range of services for researchers, and promotes online collaboration and networking tools such as UCSF Profiles.
Photos by Susan Merrell