Integrating Research, Practice, and Policy: What We
See Depends on Where We Stand
Jon F. Kerner
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I
n this special issue of the Journal of Public Health
Management and Practice, the editors have taken on the
important challenge of characterizing the current landscape of
knowledge translation research and practice in public health.
This includes the diffusion of scientific and program evaluation
evidence into public health practice and policy, the dissemination
and implementation of evidence-based interventions in public
health practice, and the complex issues associated with the
meaning and methods of dissemination and implementation
research. Three of the most important challenges for moving the
field of dissemination and implementation science and research
dissemination and implementation practice forward are the
confusion of terminology, the meaning of evidence, and
partnerships across the research, practice, and policy divides.
Because many in the research, practice, and policy-making
sectors do not see their role in closing the gap among research,
practice, and policy, new and expanded incentives need to be put
in place to encourage these collaborations. Partnerships between
research, practice, and policy can help inform decisions in all
three sectors to help achieve a better balance between evidence
based on science and evidence based on personal experience.
KEY WORDS: knowledge translation, research-practice-policy
integration
In this special issue of the Journal of Public Health
Management and Practice, the editors have taken on the
important challenge of attempting to characterize the
current landscape of knowledge translation research
and practice in public health. This includes diffusion of
scientific and program evaluation evidence into public
health practice and policy, the dissemination and im-
plementation of evidence-based interventions in public
J Public Health Management Practice, 2008, 14(2), 193–198
Copyright C 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
health practice, and the complex issues associated with
the meaning and methods of dissemination and im-
plementation research. Although the concepts of diffu-
sion and dissemination date back more than a century,1
much of that work was done outside the context of
health (eg, in agriculture). It is only in the past two
decades that recognizing the gap between research dis-
covery and program delivery and how to address it has
been articulated in the context of health.2
A key reason why addressing the discovery-delivery
gap in health has become so pressing of late is the grow-
ing recognition within the United States that our failure
to address the slow and uneven spread of innovations
from health research into practice and policy is a signif-
icant contributor to health disparities. Thus, it is those
who have the most (ie, the 4 Ws—the Worried, White,
Wealthy, and Well) rather than those who need the most
who are usually first in line to benefit from the Nation’s
investment in health research.3
Of all the many challenges and opportunities that
are addressed in this special issue, three of the most im-
portant for moving the field of dissemination and im-
plementation science and research dissemination and
implementation practice forward are the confusion of
terminology, the meaning of evidence, and partner-
ships across the research, practice, and policy divides.
● What’s in a Name?
A key challenge is one of language and mean-
ing. The terms translational and translation research,
The findings and conclusions in this article are those of the author and do not
necessarily represent the views of the National Cancer Institute, The National
Institutes of Health, and the US Department of Health and Human Services.
Corresponding Author: Jon F. Kerner, PhD, Division of Cancer Control &
Population Sciences, National Cancer Institute, 6130 Executive Blvd, EPN 6142,
Bethesda, MD 20892 (kernerj@mail.nih.gov).
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Jon F. Kerner, PhD, is Deputy Director for Research Dissemination and Diffusion,
Division of Cancer Control & Population Sciences, National Cancer Institute, National
Institutes of Health, Bethesda, Maryland.
193
194 ❘ Journal of Public Health Management and Practice
knowledge translation and transfer, dissemination, dif-
fusion and implementation (to name but a few) are used
interchangeably to mean sometimes similar and some-
times different things in the literature.4,5 Within the
US National Institutes of Health (NIH), there are some
who hold that translational research not only applies to
basic discovery-to-intervention development types of
research but also extends to development-to-delivery
research. Others, this author included, argue that it
is important to distinguish translational research from
dissemination and implementation research, because,
in part, the context of the former is so different from the
context of the latter. Thus, the context of translational
research is relatively homogeneous (eg, academic med-
ical centers) and relatively resource rich. In contrast,
the contexts for translating intervention innovations,
particularly in public health practice, are more hetero-
geneous in terms of both implementation resources and
infrastructure to support dissemination and implemen-
tation of innovations.6
In this special issue, Rabin et al7 address the chal-
lenge of language and meaning and argue that a com-
mon language is essential. When different disciplines
and organizations begin to work on the development
of a field, that field is characterized by inconsistent ter-
minology. They note that the same terms can mean dif-
ferent things and different terms can refer to the same
thing both within and across countries. They also ac-
knowledge that given the relative nascence of dissem-
ination and implementation research, at least in the
health context, it is premature to resolve all of the exist-
ing inconsistencies. Their glossary represents a starting
point for resolving language differences in the field.
At a recent international think tank on implemen-
tation and translational research held outside Stock-
holm, Sweden,8 presenters from the health, social work,
and education sectors demonstrated that inconsisten-
cies of terminology and meaning exist not only within
the health sector but also across and within these other
research/practice contexts where translating evidence
into practice is both a priority and a conundrum. From
these presentations and subsequent discussions, an in-
ternational team of conference participants represent-
ing multiple research and practice sectors are in the
early stages of planning a multiphase effort to first
develop lexicons of dissemination and implementa-
tion research terms within and across research/practice
sectors and countries, and then use these lexicons to
help set priorities for future international and multi-
sector dissemination and implementation research and
practice.
Rather than viewing this first step as creating an
agreed-upon scientific “Esperanto” for dissemination
and implementation, this effort will involve partici-
pants from several research/practice sectors and mul-
tiple countries to identify both common concepts and
terms across sectors and unique concepts and terms
within sectors. As such, the output of this first phase
may be viewed as a “Rosetta Stone,” allowing re-
searchers and practitioners from multiple sectors and
countries to communicate with each other about shared
research and practice priorities for the dissemination
and implementation of evidence-based practices and
policies.
● Is Evidence, Like Beauty, in the Eye of
the Beholder?
Different perspectives regarding the nature and quality
of evidence, and a lack of agreement on what constitutes
“best” evidence,9 suggest that for practitioners and pol-
icy makers alike, evidence like beauty is in the eye of the
beholder. Such a person-specific and context-specific
perspective implies that new models and strategies
for integrating explicit knowledge from research with
tacit and contextual knowledge from practice and pol-
icy experience (knowledge integration)10 may hold some
promise over and above the relatively unidirectional
approach of framing the translation challenge as always
emphasizing the value of objective evidence gained
from research over subjective evidence gained from
practitioner and patient experience (knowledge transfer).
In a collaboration between the National Cancer In-
stitute (NCI), the Centers for Disease Control and
Prevention Breast and Cervical Cancer Early Detec-
tion Program (BCCEDP), the American Cancer Soci-
ety (ACS), and the US Department of Agriculture’s
(USDA’s) County Cooperative Extension Service, these
multisector research and practice partners initiated the
Team-Up: Cancer Screening Saves Lives demonstra-
tion project. Team-Up focused on the dissemination
and implementation of evidence-based breast and cer-
vical cancer screening promotion programs in six states
with multiple counties that had historically high rates of
breast and cervical cancer mortality. A central research
dissemination resource for this collaborative demon-
stration program was the Cancer Control PLANET
(Plan, Link, Act, Network with Evidence-based Tools)
Web portal.11 PLANET is the first comprehensive Web
portal to provide access to evidence-based cancer con-
trol planning data and resources that can help cancer
control planners, health educators, program staff, and
researchers design, implement, and evaluate evidence-
based cancer control programs.
A key issue that emerged during the Cancer Con-
trol PLANET training of Team-Up cancer screening
service promotion program teams was the concern
expressed by CDC BCCEDP–funded program staff,
 Integrating Research, Practice, and Policy ❘ 195

TABLE 1 ● An informed decision-making model for selecting interventions to disseminate and/or implement
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Types of programs

Research-tested Evaluated Program based on

intervention intervention Evidence-informed personal experience/
Type of evidence review programa programb programc tacit knowledged
Systematic evidence reviewse 1 2 NA NA
Individual efficacy/effectiveness study 2 3 4 NA
Individual program evaluation/pilot study NA 5 6 8
Program description/process report NA 7 8 9
Abbreviation: NA, not applicable.
a Tested in a peer review grant, outcome evaluation published in a peer-reviewed journal.
b Outcome evaluation published in a peer-reviewed journal.
c Based on the published literature.
d No reference to published literature.
e For example, Guide to Community Preventive Services, Guide to Clinical preventive Services, Cochrane Reviews.

USDA County Cooperative Extension agents, and ACS
volunteers as to the contextual relevance of the inter-
vention approaches and research-tested intervention
programs available from the Cancer Control PLANET.
This concern led the NCI to develop an evidence matrix
to help program staff working with cancer control re-
searchers make informed decisions about selecting the
most evidence-based program that was also a “good
fit” within the county service delivery context in which
breast and cervical cancer screening was taking place.
Table 1 displays this matrix.
As Table 1 suggests, there are many types of interven-
tion programs and intervention approaches from which
to choose, with different levels of evidence applied to
each. Exemplar questions that program staff and policy
makers often face when deciding how best to address a
public health problem are as follows. (1) which program
or intervention approach has the strongest evidence of
efficacy and effectiveness? (2) Which program or ap-
proach has the best fit for the service delivery context
in which we are operating? (3) Which program or ap-
proach can most easily be adapted to improve the fit
in our service delivery context or to meet the needs of
our target populations? (4) How much flexibility do we
have to adapt the program or the approach without seri-
ously undermining the impact on outcomes? (5) Which
program or intervention approach can we afford to im-
plement within the resource base of our service delivery
context? Researchers may be inclined to focus more on
the first question while practitioners may be sensitive
to the more practical questions 2 to 5.
Recognizing that the answers to some of these ques-
tions may be in conflict with the answers to others, it
should be recognized that for every context there is
balance that must be reached between, for example,
implementing an intervention with fidelity to ensure
positive outcomes, and adaptation to help increase the
contextual fit and implementation feasibility in real-
world settings. At the Stockholm Think Tank, a lively
debate took place about the issue of implementation
fidelity versus program adaptation. One camp argued
that implementing the interventions with fidelity was
the best way, perhaps the only way, to ensure com-
parable outcomes. Adapting the intervention to help
with contextual fit could be considered later, as long
as core intervention elements were preserved intact.
The other camp pointed out that unless program im-
plementers were able to adapt the intervention a priori
to address contextual and population fit, and perhaps
imbue a sense of program ownership of the evidence-
based intervention being implemented, there would be
a much lower likelihood of initiating implementation
in the first place.
Moreover, identifying core elements from efficacy
or effectiveness research study findings is rarely pos-
sible because the size and expense of factorial designs
needed to sort out core program elements from those
that could be changed or discarded usually mean that
these types of research studies are neither proposed
nor funded. Absent available dissemination and im-
plementation research data to test these competing hy-
potheses, this is a good example of one of many dissem-
ination and implementation issues that can and should
be addressed through D&I research. The NIH has, for
the past several years, provided an important funding
opportunity for researchers and practitioners working
together to try to address issues like this example.12
To help Team-Up program staff sort through the ma-
trix of program types and levels of evidence reflected
in Table 1, the NCI focused on finding a range of pro-
gram options available to them, assessing the contex-
tual, population, and resource fit of the available pro-
grams, and selecting the program that had the most
rigorous level of evidence supporting its efficacy or
196 ❘ Journal of Public Health Management and Practice
effectiveness that also fit their needs. A key theme in
this training and discussion was the idea that if research
should influence practice, so should practice influence
research.13 Thus, depending on the extent to which pro-
grams are chosen from the lower right corner of the ma-
trix (eg, #’s 7–9), perhaps because of better contextual fit,
it was suggested that program staff find and work with
intervention researchers to conduct rigorous efficacy
or effectiveness research evaluations of the programs
so that lessons learned from these intervention efforts
can further contribute to the evidence base from which
future implementation choices can be made. Similarly,
to the extent interventions are selected from the upper
left corner of the matrix (eg, #’s 1–3) for implementa-
tion, again it would be ideal if dissemination and im-
plementation researchers would seek out and partner
with program implementation staff to jointly study the
factors that enhance implementation of evidence-based
interventions. New and expanded resources are needed
to create and support these research-practice partner-
ships and to develop communities of evidence-based
practice.
● Partnerships: Who Will Work With Whom?
There are many levels at which partnerships to close
the discovery-delivery gap, if expanded and supported,
could greatly facilitate the pace and extent to which the
lessons learned from science could be better integrated
with the lessons learned from practice and policy. At
the national level, the federal government spends tens
of billions of dollars on research and hundreds of bil-
lions of dollars on service delivery but spends “decimal
dust” on linking the lessons learned from each with the
other.6 One key problem is that US government agen-
cies are “siloed,” making it difficult to overcome admin-
istrative and structural barriers to build bridges across
the divide between research and practice.
For example, within the US Department of Health
and Human Services (DHHS), the NIH have admin-
istrative and management procedures in place which
make it relatively easy for one institute or center at the
NIH to partner with another institute or center on a
shared research funding initiative. However, if an NIH
institute or center wants to partner with another DHHS
agency more focused on delivering services than re-
search (eg, the CDC, the HRSA), pooling funds and ex-
pertise is much more challenging. This does not prevent
collaboration, but rather makes it more time consum-
ing and more expensive to work collaboratively than
to work alone. Moreover, as budgets have flattened or
been reduced recently both with respect to supporting
health research and the delivery of health services, shar-
ing resources and expertise in the face of doing more
with less to meet agency-specific priorities makes col-
laboration that much more difficult.
On the policy side, how decisions are made about
service delivery programs and where to integrate the
lessons learned from science into the decision-making
process is extremely complex. For example, Figure 1
provides a schematic of all the Legislative and Execu-
tive Branch units in the US government that were in-
volved with child and family services as of 1993, based
on a report issued in 1995.14
In the Legislative Branch alone, there were 10 com-
mittees and 20 subcommittees of the US House of Rep-
resentatives and 9 committees and 13 subcommittees
of the US Senate that exercised control over the pro-
grams and policies for children and family services.
The elected members and the committee staff of all
these committees and subcommittees would then inter-
act with 10 departments within the Executive Branch,
working with staff of multiple agencies within many
of these 10 departments. Taken together, 88 separate
US government entities had responsibility for 76 major
federal programs for children and families. Thus, two
key questions when considering how to integrate sci-
ence with policy decision making would be where and
with whom to start?
On the legislative side, each committee and sub-
committee is made up of elected officials (and their
staff) who, in addition to holding a substantive inter-
est in the service context that is the purview of the
committee/subcommittee of which they are a member,
are equally and perhaps more concerned about play-
ing a leadership role in policy legislation that emerges
from that committee/subcommittee as well as how
that role will be viewed in the home district that they
were elected to represent. With respect to the execu-
tive branch agencies affected by this policy legislation,
both their funding levels and program priorities can
be determined in part or in full by the policy deci-
sions made through legislation. So to the extent they
have program and/or policy discretion, they may be
quite sensitive to how the members of the different leg-
islative committees and subcommittees view their deci-
sions. Finally both members of legislative and executive
branch agencies may be as much or more concerned
about “self-promotion” as they are about promoting
the health and social welfare of the constituents they
were elected or appointed to serve. How best to in-
tegrate science into the program and policy decision
making that takes place in this complex system is not
obvious, nor easy to evaluate.
Similar to the complexity of research, practice, and
policy partnerships at the federal level, state and lo-
cal health departments, state governors and legisla-
tors, county executives and boards of health, and city
mayors and city councils all are potential partners with

FIGURE 1 ● Executive Branch Departments and Congressional Committees That Control Programs for Children and
Families and How They Relate to Each Other.
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Reproduced with permission from Dunkle.14
researchers and research institutions to work together
to make sure the lessons learned from health research
benefit all populations and communities. Moreover,
given that resources from government, nongovernment
organizations, and the private sector all contribute to,
and often compete with each other at all levels, to sup-
port public health, a key question is what incentives
can be put in place to overcome turf issues, competi-
tion for “brand” recognition, and administrative and
organizational barriers to research, practice, and policy
partnerships?
The recognition by a number of national govern-
ment and nongovernment organizations that by work-
ing together the whole could be greater than the sum
of its parts led to a national effort to support the devel-
opment and implementation of comprehensive cancer
control plans in all 50 states and among tribes and terri-
tories within the United States. This national effort led
to 50 state and several tribe and territorial comprehen-
sive cancer control plans being successfully developed.
In addition, a growing number of successful efforts to
Integrating Research, Practice, and Policy ❘ 197
find the resources to implement these plans were ini-
tiated. This extensive array of collaborations serves as
a call to action to public, private, and nonprofit orga-
nizations, governments at all levels, and individuals to
renew their commitments to reducing the burden of
cancer15 as well as other chronic diseases.
● Summary
In this special issue, the challenges and opportunities
for learning from dissemination and implementation
research and translating these findings into new re-
search dissemination and implementation practices are
reviewed. This issue is of growing concern for the re-
search, practice, and policy communities, because all
Americans are stakeholders in ensuring that the return
on our public sector investment in research is high and
equitably distributed with respect to improved public
health, clinical care services, and positive health out-
comes. Given that many in the research, practice, and
198 ❘ Journal of Public Health Management and Practice
policy sectors do not see themselves as having a central
role in closing the gap among research, practice, and
policy, new and expanded incentives need to be put in
place to encourage these collaborations.
As long as the majority of scientists and scientific
funding agencies do not see that they not only are
stakeholders in the dissemination and implementa-
tion of evidence-based interventions and policy ap-
proaches but can also increase the number of research
applications and funding of science to inform research
dissemination, the slow pace of translating research
into practice will continue to suppress the return on
our Nation’s investment in health research. Similarly,
unless the practice community comes to value the
important role they must play in helping shape inter-
vention science to achieve a greater balance between
internal and external validity,16 many intervention in-
novations emerging from health research will continue
to be viewed by the practice community as impractical
and irrelevant. Consequently, public health and clini-
cal care will continue to be delivered with suboptimal
or at best inconsistent quality. Finally, many competing
political pressures influence policy makers, in deciding
where to target resources and how to evaluate program
success. To the extent that new and expanded partner-
ships between research, practice, and policy can help
inform these important policy decisions, a better bal-
ance between evidence based on science and evidence
based on personal experience can be achieved.
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