Are you a clinical/applied researcher? If so, you probably are frustrated by the “research-to-practice” gap: The time it takes to move research findings about new treatments or clinical practices into routine practice. In medicine, it’s been estimated that this gap is about 17 years, and even then, only about 14% of original research is applied clinically. Knowledge translation and implementation science are two newly emerging fields that focus on reducing this research-to-practice gap. Knowledge translation (KT) focuses on summarizing and sharing research in tailored and meaningful ways to people who need to make evidence-informed decisions. These people include clients, families, and caregivers; clinicians; administrators; and policymakers. Implementation science (IS) is the scientific study of methods to promote the integration of research findings into practice settings. Considered priority areas by the American Speech-Language-Hearing Association (ASHA; http://www.asha.org/Research/CPRI/), KT and IS both have been addressed in several initiatives, including (a) a session at the 2014 ASHFoundation Implementation Science Summit; (b) a special supplement on implementation science in a 2015 issue of ASHA’s Journal of Speech, Language, and Hearing Research; (c) as a main Strategic Objective (SO#3) of ASHA’s Strategic Pathway to Excellence—to enhance the generation, publication, knowledge translation, and implementation of clinical research; and (d) formation of the Committee on Clinical Research, Implementation Science, and Evidence-Based Practice in 2015.
Although the language and terminology of KT and IS vary across scientific disciplines, audiences, and geographic locations, both fields focus on addressing the same problem: How do we close the gap between what we know and what we do to improve clinical outcomes? With this in mind, the primary objectives of this article are to (a) discuss how KT and IS can enhance the transfer of research to clinical practice in the communication sciences and disorders (CSD) discipline and (b) invite readers to consider how CSD might build capacity in these relatively new fields by describing the authors’ personal experiences with establishing research careers in KT and IS.
Why KT and IS in CSD?
An ancient proverb states, “What has been will be again; what has been done will be done again; there is nothing new under the sun.” As this quote suggests, some readers may view research in KT and IS as strikingly similar to the work that clinical researchers have been doing since the dawn of treatment efficacy studies. Indeed, treatment efficacy studies are a critical part of clinical research in CSD. However, the authors believe that KT and IS extend beyond treatment efficacy and present an exciting new paradigm shift for researchers in CSD. Clinical/applied researchers are typically motivated by their desire to provide the best possible services for individuals with communication and swallowing disorders. Unfortunately, the traditional path of a best possible treatment making it into the hands of the clinician in the typical clinical setting is like the game of “telephone.” The natural trajectory of any message is to degrade over time and across communication partners unless active strategies are in place to do otherwise. KT and IS not only maintain the scientific integrity of the message (Douglas, Campbell, & Hinckley, 2015) but also offer strategies to accelerate the speed of message transmission and increase the number of people who receive the message.
Many clinical/applied researchers may consider peer-reviewed publication or presentation at a conference the end of the research cycle. From a KT and IS point of view, dissemination of scientific research outcomes s arguably one beginning step in a systematic program of implementation. Using plain, jargon-free language along with multimedia formats, KT and IS communicate information to the end user in a readily accessible manner. In addition, implementing an intervention/practice in a typical setting often involves multiple end users/stakeholders (e.g., clinicians, clients, leaders in the organization, families) whose collaborative participation increases the likelihood of successful implementation.
Establishing Research Careers in KT and IS
Because KT and IS are only recently intersecting with CSD, establishing a research career in these areas is largely uncharted territory. The authors share two possible paths toward such a career. First Author Natalie Douglas completed a research doctorate in CSD and incorporated self-taught IS principles with the mentorship of clinical researchers in speech-language pathology. She was inspired by a seminal monograph synthesizing the IS literature, which was written by researchers at her institution (Fixsen, Naoom, Blasé, Friedman, & Wallace, 2005). As part of her doctoral research, Natalie considered how IS theories, frameworks, and methods could help her study some of the problems she had observed as a clinician working in long-term care settings. Natalie’s mentor encouraged this journey, helping Natalie to pursue a dissertation and, later, to publish her IS research (Douglas et al., 2014). As IS gains momentum within ASHA, Natalie continues to collaborate with other clinical researchers to explore funding sources and other avenues to promote best practices in long-term care environments. She connects with the Global Implementation Initiative through committee work and conference presentations.
Second Author Wenonah Campbell completed a postdoctoral fellowship focused specifically on KT—but not through a CSD program. Instead, she completed her fellowship at CanChild, an interdisciplinary research center in Canada that studies and translates knowledge about children’s health to a range of stakeholders. Guided by concepts and methods from KT and IS, Wenonah worked with her colleagues and a range of stakeholders to develop, evaluate, and implement a new collaborative model for school-based health services (see, e.g., Campbell, Camden, & Missiuna, 2016). Through her involvement with CanChild, Wenonah had the unique opportunity to work on projects that applied KT and IS frameworks. In addition, she gained incredibly rich experiences in the practice of KT—that is, learning how to use KT principles to disseminate research to a wide range of varied audiences. Along the way, Wenonah sought additional training and grant opportunities in KT and IS. She currently teaches a graduate course on KT for rehabilitation science students; this experience helps Wenonah stay current in these emerging fields and contribute to building capacity in the next generation of health researchers.
It is certainly wise to acknowledge the potential risk involved in pursuing a research career in “uncharted territory” of KT and IS; however, the benefits of such a risk far outweigh the uncertainties. Clinical research that has been so rigorously and painstakingly completed by many researchers will not reach a majority of stakeholders—let alone be actively implemented into clinical practice—if it is being represented solely in peer-reviewed publications (that often do not make their way into clinics and labs). The work of a KT and IS researcher is an exciting privilege, and we (the authors) enthusiastically invite you to the journey! The resources below (two References lists and Appendix) provide concrete, relevant ways to include KT and IS into clinical research agendas.
- Take advantage of free KT resources.
- Tailor your research to a specific stakeholder group with knowledge mobilization toolkits.
- Write a KT plan for your current work.
- Learn about options for training and education in KT.
- Volunteer with the Global Implementation Initiative.
- Complete free trainings in IS from leaders in the CSD discipline.
- Start an implementation science journal club, and examine IS research, study protocols, and available training mechanisms.
- Connect with a local Veteran’s Administration that may be conducting IS research.
- Explore funding sources that may support IS work.
Campbell, W. N., Camden, C., & Missiuna, C. (2016, June). Reflections on using a community-based and multisystem approach to transforming school-based intervention for children with developmental motor disorders. Current Developmental Disorders Reports, 3(2), pp. 129–137. doi:10.1007/s40474-016-0081-y.
Douglas, N. F., Campbell, W. N., & Hinckley, J. J. (2015). Implementation science: Buzzword or game changer? Journal of Speech, Language, and Hearing Research, 58(Suppl.), S1827–S1836. Retrieved from http://dx.doi.org/10.1044/2015_JSLHR-L-15-0302.
Douglas, N. F., Hinckley, J. J., Haley, W. E., Andel, R., Chisolm, T. H., & Eddins, A. C. (2014). Perceptions of speech-language pathologists linked to evidence-based practice use in skilled nursing facilities. American Journal of Speech-Language Pathology, 23, 612–624. Retrieved fromhttp://dx.doi.org/10.1044/2014_AJSLP-13-0139.
Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature [FMHI Publication No. 231]. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.
Goldstein, H., & Olszewski, A. (2015). Developing a phonological awareness curriculum: Reflections on an implementation science framework. Journal of Speech, Language, and Hearing Research, 58(Suppl.), S1837–1850. Retrieved from http://dx.doi.org/10.1044/2015_JSLHR-L-14-0351.
Green, L. W., Ottoson, J. M., García, C., & Hiatt, R. A. (2009). Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annual Review of Public Health, 30(1), 151–174. doi:10.1146/annurev.publhealth.031308.100049.
National Center for the Dissemination of Disability Research. (n.d.). Webcast 5: Knowledge Translation at the Canadian Institutes of Health Research. Retrieved fromhttp://www.ncddr.org/webcasts/webcast5.html.
National Implementation Research Network. (n.d.). Implementation defined. Retrieved fromhttp://nirn.fpg.unc.edu/learn-implementation/implementation-defined.
Paul, R. (2015). From the editor: An introduction to the JSLHR Supplement on Implementation Science. Journal of Speech, Language, and Hearing Research, 58(Suppl.), S1717–S1718. Retrieved from http://dx.doi.org/10.1044/2015_JSLHR-L-15-0239.