SYNTHESIS AND DISSEMINATION OF RESEARCH FINDINGS: A CRITICAL NEXT STEP IN THE EVOLUTION OF HEALTH PROMOTION 

The importance of translating research findings into practical guidelines, and distributing these guidelines to those who will use them has received increased attention in scholarly circles in recent months. Supporting this type of work is one of the important components of Health Promotion FIRST (Funding Integrated Synthesis, Research and Training),¹ the legislation we have been advocating. Why is this so important, what is being done now, and what needs to be done? 

Why Is It Important? 

More than $70 billion dollars² is spent globally on health related research each year, but the benefit of that research is muted because much of it never reaches those who can apply the findings. The amount spent on health promotion research is a small fraction of that total but the problem is the same. The results of much health promotion research are hidden in pages of research journals that are rarely if ever read by those who are in a position to set policy or implement health promotion programs. Reference books and textbooks sometimes capture much of the most important findings, but the findings might be 5 or 10 years old by the time they are read. Furthermore, even the most popular books reach only a small portion of the students and professionals in any field. The result is that health promotion remains an art, not a science. The typical practitioner designs and implements programs based not on what he or she knows works best, but on what he or she hopes works best, with ideas gleaned from trial and error and colleagues’ recommendations, despite the fact that hundreds and sometimes thousands of others have implemented similar programs. The typical policy maker in business or government has incomplete information to determine the effectiveness of programs or optimal budget levels. He or she might take a chance based on intuition and invest in programs that are unlikely to produce a return or be conservative and never implement a program while waiting for better evidence. 

What Is Being Done Now? 

A number of organizations have made noble but limited attempts to review and synthesize health promotion research findings. These include efforts by the Cochrane Collaboration³ and the American Journal of Health Promotion,⁴ but these efforts include only hundreds of the tens of thousands of published studies. The federal government coordinates two very impressive efforts, the Guide to Clinical and Preventive Services⁵ and the Guide to Community Services.⁶ These guides provide ongoing reviews of published research on the impact of programs in clinical and community settings. Unfortunately, they provide broad, general recommendations that are useful to scientists, and perhaps to government policy makers, but not to people in workplace, clinical, or community settings who need to make decisions about investing in programs, or to people who design and implement programs. For example, in the ‘‘community’’ Guide, guidelines for workplace, school, home, municipal, state, and regional programming are presented separately when there is a sufficient body of research to allow this, but the user must scan through all the guidelines to find them. Publishing these guides on the web does make them accessible at no cost to any one who has internet access, but it is unlikely that the typical health promotion professional, physician, or corporate benefits manager has ever accessed these sites. For example, audience analysis research on audience use of the clinical and community Guides, revealed that a majority of clinicians still do not use the web as their primary source of information.⁷ 

What Needs to Be Done? 

Despite more than a year of searching for a good model that could be expanded with additional funding, we could find none. Therefore rather than suggest a specific model or plan, Health Promotion FIRST calls for developing a strategic plan on how to best implement a comprehensive synthesis and dissemination program. Such a plan would need to include all the elements below. 

Thorough Understanding of the Many Audiences to Be Reached. One of the first steps would clearly describe all the audiences who would use the information, how they would use it, and how they normally acquire and process January/February 2004, Vol. 18, No. 3 v information. Audiences would include but not be limited to students, scientists, clinicians, and managers that focus on individuals or school, workplace, or family settings, at the municipal, regional, state, and national levels with backgrounds in medicine, nursing, health education, psychology, nutrition, kinesiology, education, public policy, anthropology, sociology, transportation, city planning, and others areas. 

Understanding the Science, Art, and Technology of Communication. A thorough understanding of the science and art of communication and the technology that supports it is prerequisite to any synthesis and dissemination efforts. The field of communication has evolved at a faster pace than almost any area of science. Furthermore, the way we will communicate and learn tomorrow will be different from what we do today. Equally important, different professions and generations communicate in very different ways. 

Continual Monitoring and Review. Once the target audience is articulated and the full range of communication strategies considered, a plan for collecting and reviewing information can be developed. This plan would need to describe how all reliable peer-reviewed sources of health promotion and related research and case studies would be acquired and monitored on an ongoing basis. 

Synthesis and Packaging to Meet the Needs of All the Target Audiences. Each of the target groups would need different information in a different format. For example, scientists would need in-depth systematic reviews that include detailed explanations of study methodology, quantitative results reports, citations for all studies cited, and critiques of methodological limitations. Program managers would need step-by-step instructions tailored to their specific settings on how to design, coordinate, and evaluate programs in each of the intervention areas. Intervention areas would include but not be limited to physical activity, nutrition, stress management, weight control, smoking cessation, medical self care, and alcohol and drug abuse. Clinicians would need protocols for counseling patients in each of the lifestyle areas, guidelines on how and when to refer patients to behavioral specialists, and protocols to train those specialists or locate them in the community. Benefits managers would need summaries of cost effectiveness and cost benefit analyses in each of the areas. Educators would need appropriate summaries to include in textbooks and curriculum plans. 

Distribution to Each Target Audience Through Appropriate Media and Channels. Each target audience accesses information differently. For example, reaching scientists is relatively easy. If scientists are made aware of information that impacts their work and given free access to that information, they are likely to seek it out. Web-based services combined with supplemental publications in the multiple scientific journals read by each of the diverse disciplines involved in health promotion would probably reach a large portion of the scientific community. However, other groups are more difficult to reach. To reach students, health promotion concepts would need to be integrated into the curriculum of each of the disciplines involved in health promotion. This would require proactive work with curriculum committees from each of these disciplines. If these concepts are in the curriculum, textbook authors and publishers are likely to become aware of this and will include these concepts in their textbooks. Reaching practicing professionals would require proactive involvement in continuing education efforts, including helping to plan the contents of professional meetings, and the topics covered by certification exams. 

Awareness of the Impact of Government Programs on Existing Publishers and Education Organizations. All efforts must be designed with full awareness of their impact on existing publishers, web services, educational organizations, and other groups involved in synthesis and dissemination efforts. For example, if government services were to duplicate or compete with the services already provided by these groups, it might result in personnel layoffs, business failures, resentment, and efforts to sabotage these government services. However, if partnerships are formed with these groups in such a way that government funds support and expand their work, this will provide a small economic stimulus and create broader support for these efforts. It may make sense for the government to provide some of these services directly and form partnerships to provide others; the key is to be aware of the full impact of each approach. Implementing a synthesis and dissemination effort of this magnitude will require significant effort and funding, but the total investment will be a fraction of the existing cost of that research and it will multiply the value of that research. 

References 

1. Health Promotion Advocates. Available at: http://www. healthpromotionaladvocates.org. Accessed November 18, 2003. 

2. The International Development Research Center, News Article 33 of 35, Prioritizing International Health: The Global Forum for Health Research. Available at: http://web.idrc.ca/evpen.php?ID55602&ID25DOpTOPIC# Louis%20. Accessed November 18, 2003. 

3. The Cochrane Collaboration. Available at: http://www.cochrane.org. Accessed November 18, 2003. 

4. Anderson D. Understanding the Relationship Between Health Risks and Health-Related Costs. Am J Health Prom. 2004;261–263. Available at: http:// www.HealthPromotionJournal.com/publications/journal.htm.

5. Agency for Health Research and Quality. Guide to Clinical and Preventive Services. Available at: http://www.ahrq.gov/clinic/prevnew.htm. Accessed December 4, 2003. 

6. Centers for Disease Control and Prevention. Guide to Community Service. Available at: http://www.thecommunityguide.org. Accessed November 18, 2003. 

7. Personal communication with staff of Guide to Community Preventive Services. November 17, 2003. 

Michael P. O'Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion