Making sense of translation in health research
It feels like translation is the new buzz word in research, or at least that’s how it could be taken in the Australian context. Over the last couple of years and particularly the last 12 months, the term ‘translation” has been thrown into everything in an effort to show that researchers and research funders are involved in making a difference to the lives of the public, who ultimately fund the research.
With over 90 terms used for research translation, e.g knowledge translation, knowledge transfer and exchange, implementation and so on, it can be difficult to determine what is really meant by the term, and even how to go about achieving translation.
A close look at the state of translation in Australia, amongst research funders, higher education institutions and other research organisations, highlights this confusion even further. There are mixed uses of ‘research translation’ and ‘translational research’, two terms with different meanings. Some funders, and research institutions have embedded the terminology within their strategic plans, and long term visions but have not defined the term within the context of their use. Perhaps even more frustrating is the emergence of this terminology without explanation or understanding of what is required to meet research translation obligations.
The World Health Organisation defines knowledge translation as….. “The synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health.”
Australia’s national health funding agency, the National Health and Medical Research Council (NHMRC), has embedded the term “translation” and “translational” within its strategic plan, on fifty-two occasions. They have developed several funding sources to meet their translation goals, partnership grants, trip fellowships, and centres of research excellence, however the focus is firmly on academic translation, through publication and conferences, and commercialisation. In addition, they have developed the highly revered research translation faculty as a mechanism to determine the evidence practice gaps to guide areas for future research.
Although the NHMRC is providing funds to deliver high quality evidence through research in areas where there are big gaps in evidence to practice, they are not providing funding in a way that will bridge this gap. Current research funding mechanisms continue to develop new knowledge, but the use of that knowledge appears to be an interesting possibility without the skills, rewards, and funding to make it happen.
The development of clinical guidelines has been touted by the NHMRC as bridging the research to practice gap however, the uptake and use of clinical guidelines still requires a translation effort to ensure relevance and sustainable use of the guideline. In fact, the literature on clinical guideline uptake has found that only 8% of clinical guidelines get used in practice. Yet again this is an example of how the creation and publication of evidence based best practice, developed in isolation and presented in a limiting format with little consideration of evidence use, barriers to uptake and implementation processes, leaves a gaping hole in the use of that knowledge.
Both locally and globally there are some good examples of research translation, but there is plenty of room to do more. There is increasing discussion and chatter regarding a greater emphasis on the possible return on investment. Recent publications around research wastage (http://www.thelancet.com/series/research) and income for outcome (http://www.nature.com/nature/journal/v511/n7510_supp/full/511S72a.html) have highlighted the need to provide better value for money and return on investment from research funding. At present the average time for findings to get into practice is 17 years, and even then only 14 % of research gets used. Should we be doing more or is it acceptable to suggest that the other 86% is likely to be blue sky research?
With the introduction of the Medical Research Future Fund there will come increasing public pressure to ensure that the money spent results in tangible outcomes implemented into service delivery models. Of course we will continue to develop new drugs, better clinical methodologies and surgical procedures with increased funding, but what about the other advances in health, and in service delivery, and in the practice of care?
Many things need to change to make true translation efforts a success. Our own Chief Scientist has weighed in on the translation issue and it’s time to listen and take action.
“Translational research is a priority, and the more our international competitors invest in it while we lag behind, the more challenges face us in the future. But as I argued earlier, funding is not enough. We need to change the way we recognize research, the way we engage between silos and the way we encourage future scientists. For translational research in Australia to be fully effective, we need more than funding, we need cultural change. And we need to ask whether, given our commendable research strengths, Australia can afford not to fund translational research” Ian Chubb, Chief Scientist of Australia