KIN240: Principles of Biobehavioral Health

Knowledge Translation from Bench to Bedside

Importance of Effective Intervention in Health

  • Question: How do we effectively intervene with a given disease/disorder?

  • Challenges:

    • New research often disseminates before peer review.

    • News outlets may misinterpret complex research data.

    • Public skepticism increases if new evidence contradicts pre-existing beliefs.

  • Requirements for Effective Intervention:

    • Clinicians must translate evidence into practical applications.

    • Clinicians need to assess when new treatments should be implemented.

    • Clear communication with patients is crucial.

Topics Discussed

  • Nested Model of Health

  • Health Literacy

  • Knowledge Translation

  • Sources of Information

  • Clinical Trials

  • Sample Size

Healthy People Initiative

  • Goal: To improve national health and wellness over the decade.

  • History: Began in 1979 with Surgeon General Julius Richmond's report, "Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention."

  • Healthy People 2030: Fifth edition outlining key health objectives regarding:

    • Health conditions (e.g., heart disease, cancer, obesity).

    • Health behaviors (including preventive care, drug use, and emergency preparedness).

    • Specific populations (infants, children, individuals with disabilities).

    • Settings and systems (environmental health, healthcare services).

    • Social determinants of health (family and community interactions, economic stability).

Nested Model of Health

  • Concept: Improvements in health require addressing multiple contextual layers.

  • Key Points:

    • Treat immediate health conditions directly.

    • Address surrounding health behaviors to prevent re-emergence of issues.

    • Adapt general health behaviors to fit specific conditions and contexts for varied populations.

    • Recognize that settings and systems greatly affect health interventions.

    • Understand that social determinants influence overall health efforts.

Health Literacy

  • Personal Health Literacy: The ability of an individual to find, understand, and use health-related information.

  • Organizational Health Literacy: The capacity of organizations to help individuals access and utilize health information.

  • Referral to Healthy People 2030: Health literacy highlighted as vital for disease prevention and health promotion.

Importance of Effective Communication

  • Science needs effectively translated into understandable language, or many opportunities for health improvement will be missed.

  • Public receives mixed health messages daily from entertainment-focused sources.

  • General public can face difficulty deciphering health information due to:

    • Complexity of available information.

    • Contradictory health messages.

Literacy Statistics

  • Over 50% of the population can make simple inferences from given information.

  • Only 12% of the adult population has a proficient level of health literacy.

  • Roughly 33% operate at basic literacy levels.

  • Levels of Health Literacy:

    • Below Basic: 14% of the population, can only understand short, straightforward texts.

    • Basic: 22% can perform simple activities with commonplace texts.

    • Intermediate: 53% can summarize and infer from moderately complex texts.

    • Proficient: 12% can integrate multiple sources of information accurately.

Challenges in Organizational Health Literacy

  • Communication barriers impede effective knowledge translation.

  • Use of technical language often leads to misunderstandings, especially when the public lacks background knowledge.

  • Cultural differences can result in misinterpretations of health messages.

Strategies for Improving Organizational Health Literacy

  1. Use of Plain Language: Experts often struggle to simplify complex terminology for public understanding.

  2. Audience Engagement: Efforts should be tailored to the specific health literacy levels of the intended audience to improve understanding.

  3. Action-Oriented Messaging: Focus on desired actions rather than merely conveying information about risk.

Translating Evidence into Practice

Clinical Implementation of Research Findings

  • How are new research findings integrated into public health messaging?

  • Challenges clinicians face include:

    • Lack of training to incorporate research into practice.

    • Variability in research training programs.

  • Knowledge translation requires:

    • Understanding research evidence and its context.

    • Collaboration between medical and research expertise to improve health outcomes.

Sources of Information

  • Systematic Reviews: Summaries of multiple studies that help distill high-quality evidence.

  • Meta-Analyses: Statistical assessments combining findings from numerous studies to provide robust conclusions.

  • Natural Tendencies: Many practitioners rely on lower-quality sources like editorials or blogs that may lack expert scrutiny.

Research Methodology and Clinical Trials

Types of Clinical Trials

  • Phase I Trials: Initial safety assessments; small participant groups (less than 30).

  • Phase II Trials: Efficacy evaluation under controlled settings; a moderate number of participants (30-100).

  • Phase III Trials: Confirmatory studies testing effectiveness in larger groups; participants are randomly assigned to treatment or control groups.

  • Phase IV Trials: Long-term safety evaluations and effectiveness assessments in real-world settings.

Ethical Considerations in Trials

  • Discusses scenarios where placebo or sham controls may be considered unethical, particularly in aggressive diseases.

Conclusion on Clinical Trials and Efficacy

  • Explores the nature of evidence, emphasizing the continuum of strength between various research approaches.

  • Highlights important issues regarding sample size and effect significance.

Additional Resources

  • Citation: Yeh, R. W., et al. (2018). Parachute use to prevent death and major trauma when jumping from aircraft: Randomized controlled trial. BMJ, 363, k5094. Link: https://doi.org/10.1136/bmj.k5094

Knowledge Translation Worksheet

  1. Environmental health is considered a part of which area of the Healthy People 2030 objectives?

  2. What are the 3 innermost layers of the Nested Model of Health (from deep to superficial)?

  3. What are the 3 outermost layers of the Nested Model of Health (from deep to superficial)?

  4. What percent of the population has a Proficient level of personal health literacy?

  5. An individual who can only understand information written in small 1-page or less segments written with common everyday words would have what level of personal health literacy?

  6. What are three ways for improving organizational health literacy?

  7. What is the difference between a systematic review and a meta-analysis?

  8. A position statement written by a panel of experts would be considered what type of information source?

  9. What is the primary purpose of a Phase I clinical trial?

  10. What is the primary purpose of a Phase II clinical trial?

  11. What is the primary purpose of a Phase III clinical trial?

  12. A randomized controlled trial was conducted in a sample of 30 individuals to determine the efficacy of a new drug using a single-arm design. What phase of clinical trial is this likely to be?

  13. A randomized controlled trial compared the effects of a new medical device against a device that looked and felt like the new medical device. What type of control is being used?

  14. What is the reason a non-inferiority control is viewed as superior to a placebo control in the context of a clinical trial?

  15. Vaccine B was tested against the current standard of care Vaccine A as a non-inferiority control. No differences in safety or efficacy were observed between Vaccine B and Vaccine A, yet Vaccine A has been previously shown to have greater efficacy than a placebo control group. What is our interpretation of Vaccine B?

  16. What is the difference between efficacy and effectiveness?