Translating research for health policy june 2014


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Translating research for health policy june 2014

  1. 1. Translating Research For Health Policy: Researchers’ Perceptions And Use Of Social Media 1. David Grande1,*, 2. Sarah E. Gollust2, 3. Maximilian Pany3, 4. Jane Seymour4, 5. Adeline Goss5, 6. Austin Kilaru6 and 7. Zachary Meisel7 +Author Affiliations 1. 1 David Grande ( is an assistant professor of medicine at the University of Pennsylvania, in Philadelphia. 2. 2 Sarah E. Gollust is an assistant professor in the Division of Health Policy and Management, School of Public Health, University of Minnesota, in Minneapolis. 3. 3 Maximilian Pany is an undergraduate student at Swarthmore College, in Pennsylvania. 4. 4 Jane Seymour is a graduate student in public health at the University of Pennsylvania. 5. 5 Adeline Goss is a student at the Perelman School of Medicine, University of Pennsylvania. 6. 6 Austin Kilaru is a student at the Perelman School of Medicine, University of Pennsylvania. 7. 7 Zachary Meisel is an assistant professor of emergency medicine at the University of Pennsylvania. 1. ↵*Corresponding author Next Section Abstract As the United States moves forward with health reform, the communication gap between researchers and policy makers will need to be narrowed to promote policies informed by evidence. Social media represent an expanding channel for communication. Academic journals, public health agencies, and health care organizations are increasingly using social media to communicate health information. For example, the Centers for Disease Control and Prevention now regularly tweets to 290,000 followers. We conducted a survey of health policy researchers about using social media and two traditional channels (traditional media and direct outreach) to disseminate research findings to policy makers. Researchers rated the efficacy of the three dissemination methods similarly but rated social media lower than the other two in three domains: researchers’ confidence in their ability to use the method, peers’ respect for its use, and how it is perceived in academic promotion. Just 14 percent of our participants reported tweeting, and 21 percent reported blogging about their research or related health policy in the past year. Researchers described social media as being incompatible with research, of high risk professionally, of uncertain efficacy, and an unfamiliar technology that they did not know how to use. Researchers will need evidence-based strategies, training, and institutional resources to use social media to communicate evidence.  Social Media  Research The translation of research evidence into clinical practice is often slow. Considerable attention has been paid to delays in this translation process, such as the delay in adopting
  2. 2. the use of beta-blockers for acute myocardial infarction after evidence supporting their use became available.1 The National Research Council recently expressed concern about a similar issue: whether scientific evidence is being adequately communicated to policy makers and adopted in public policy.2 The scientific evidence produced by health policy and health services researchers provides a foundation of knowledge for public policy related to health care and population health. To maximize the return on public investments in research, the findings from this research need to be communicated effectively to policy makers and other health care stakeholders. Moreover, the demand for evidence is likely to grow as the nation embarks on implementation of the Affordable Care Act and addresses the challenges in health care related to cost, quality, and access that lie ahead. Researchers and policy makers confront substantial barriers to effective communication. For example, the two groups have different incentives, social networks, time frames, vocabularies, and values.3 ⇓–5 Academic researchers work in an environment that values traditional scholarly productivity, has a long time horizon for knowledge generation, and is largely based within the social networks of academe.5 In contrast, policy makers require relevant, timely research that is accessible and delivered by trusted individuals with whom they have established relationships.6 ⇓⇓⇓⇓–11 Policy makers value scientific evidence, but it is just one item to be considered in a setting full of competing influences.12 Researchers vary in the degree to which they actively disseminate their work, such as writing policy briefs or working with public relations specialists to generate press coverage.13 Social media represent an expanding tool that could facilitate communication of scientific evidence to policy makers. Technologies such as Twitter have created new communication networks and channels that can deliver information in targeted and efficient ways.14 For example, a health legislative aide can follow on Twitter trusted individuals who have strong reputations for culling and translating policy-relevant findings from research journals. Similarly, bloggers can translate new research into formats that policy makers might find more accessible than traditional journal articles.15 These tools complement traditional dissemination methods such as issuing press releases, because they may better target specialized audiences, quickly link to related content (for example, policy briefs), create opportunities to sustain communication beyond a single day of press coverage, and facilitate direct relationships with key information intermediaries or policy makers. Academic journals are increasingly using Twitter, as are major health agencies, health officials, and health care organizations. As an example, Twitter’s website indicated 73,000 followers for Health Affairs and 182,000 for the New England Journal of Medicine as of April 22, 2014; the Centers for Disease Control and Prevention regularly disseminates public health information to 290,000 followers on Twitter.
  3. 3. Taking advantage of the promise of social media for translation and dissemination will require engagement by researchers and their institutions. However, little is known about researchers’ attitudes toward social media and their capacity to use these media.16 In this article we present findings about the attitudes of health services and health policy researchers toward social media compared to more traditional communication channels. We also measured researchers’ use of social media. Previous SectionNext Section Study Data And Methods Study Population And Recruitment We conducted a mixed-methods survey that included an experimental component. The survey was administered in person in June 2013 as a structured and semistructured interview, containing both closed- ended and open-ended questions. Our respondents were 215 health services and health policy researchers recruited from a random sample of 325 people who had preregistered for the 2013 AcademyHealth Annual Research Meeting, the largest gathering of US health policy researchers. We limited our sample to researchers whose primary affiliation was with an academic institution. To invite each of the 325 people to be interviewed at the meeting, we sent them a recruitment letter introducing the study, along with $2. The letter stated that “the study will examine strategies to improve knowledge dissemination from academic researchers to policy makers.” We sent follow-up e-mail to schedule interviews with responders, and we contacted nonresponders up to two additional times by e-mail. Participants were entered in a raffle for a $200 retail gift card. Survey Instrument We designed the instrument to compare researchers’ attitudes toward different methods of disseminating research and to measure the frequency of the researchers’ dissemination behaviors. We measured attitudes in the following three ways. Vignette-Based Randomized Experiment: We presented each respondent with a vignette in which we described a researcher who published a study with implications for health policies on childhood obesity in a peer-reviewed journal. We randomly assigned each participant one of three versions of the vignette, in which the researcher disseminated her findings through traditional media, social media, or direct outreach to policy makers. The experimental design and vignettes are described in online Appendix A1.17 We asked participants to rate the activity presented in the vignette across five domains: the efficacy of the researcher’s mode of dissemination, their confidence about disseminating their own work in that mode, their peers’ respect for that mode of dissemination, how much the academic promotion process values the mode, and their overall impression of the researcher described in the vignette. We asked participants to rate each domain on a scale from 1 to 10, except for overall impression. In that case, we asked participants to rate the researcher using a feeling thermometer (a rating between 50 and 100 degrees meant that the respondent felt warm toward the researcher, while a rating between 0 and 50 degrees meant that the respondent felt cool toward the researcher).18 Rating Of Efficacy Of Dissemination Methods: On a scale of 1 to 10, we asked each participant to rate the efficacy of eight channels to “communicate specifically with policy makers and other decision makers.” Two of the eight channels were scholarly (editorials or commentaries in peer-reviewed journals and original research articles), one was traditional
  4. 4. media (articles in newspapers about a research study), two were direct outreach to policy makers (directly contacting policy makers and issuing policy briefs from an academic center or institute), and three were social media (Twitter, Facebook, and blogs on journal websites). In the vignette experiment we provided a contextual narrative that included characteristics of the researcher, her research publication, and its successful dissemination. However, in this section of the survey, participants rated the dissemination method without additional context. Open-Ended Qualitative Questions: We asked participants how researchers should be using social media, if at all, to disseminate their work. Frequency Of Respondents’ Dissemination Activities: In addition, we measured respondents’ reported frequency of dissemination behaviors. We did this by asking if at any time in the previous year they had engaged in dissemination activities using scholarly channels (“published an editorial in a journal where you made policy recommendations”), traditional media channels (“news media covered a study you published,” were “interviewed by a news reporter about an issue related to your area of expertise”), direct outreach to policy makers (“published a policy brief,” “had direct contact with a policymaker,” “directly contacted an interest group or community group”), and social media channels (“blogged, used Twitter, or Facebook to communicate about research or health policy expertise”). We conducted cognitive pretesting of the survey instrument on a convenience sample of five health services researchers and adapted the instrument accordingly. Survey Administration The in-person structured interviews were conducted in a designated area at the AcademyHealth Annual Research Meeting. Trained research assistants conducted the interviews and recorded participants’ responses in writing for the close-ended questions and with a digital audio recorder for the open-ended questions. We obtained consent prior to all interviews. Of the 325 researchers in the sample, 215 participated, for a response rate of 66 percent. Twenty-eight participants were unable to complete the interview during the meeting; instead, they were interviewed by telephone. The study was approved by the University of Pennsylvania’s Institutional Review Board. Analysis We used analysis of variance to compare both mean scores across the three experimental groups—participants exposed to vignettes that described dissemination through social media, traditional media, or direct outreach to policy makers—for each of the domains that we measured and mean academic rank. We used multivariate linear regression models to test for interactions between experimental-group assignment and academic rank on the key outcomes. We used chi-square tests of association to test for significant ( ) differences in reported dissemination behaviors by academic rank. For open-ended questions, we entered deidentified transcripts of responses into the structured qualitative software QSR NVivo, version 10.0. We used an inductive process to identify the main themes that emerged in the qualitative text, first comparing emerging themes across a small sample of text using a consensus approach and then applying the resulting themes to the full sample.19 Limitations Our research had several limitations. First, we recruited participants from a sample of university health services and health policy researchers attending the AcademyHealth Annual Research Meeting. The researchers attending the meeting may not be representative of university researchers overall. In fact, these researchers’ applied focus and policy interests should bias them toward more, not less, interest in translation to policy settings. However, our participants were drawn from a random sample (not a convenience sample)
  5. 5. of people who had preregistered for the meeting. Therefore, we are relatively confident that the sample is representative of this population. Second, we relied on self-reports to measure behavior. This method could be vulnerable to some recall bias as well as to social desirability bias, depending on the behavior. Third, as is the case with all survey research, our results could be vulnerable to nonresponse bias. This is true in spite of our high response rate of 66 percent. Previous SectionNext Section Study Results Exhibit 1 describes the characteristics of the 215 participants. There were no significant differences in participants’ demographic characteristics across the three experimental groups. View this table:  In this window  In a new window Exhibit 1 Survey Participants’ Characteristics, By Experimental Group, 2013 Vignette Ratings Participants rated two of the dissemination methods—traditional media and direct outreach to policy makers—favorably across the five domains we measured (Exhibit 2). Dissemination through social media received neutral scores in the domains of confidence, peer respect, and academic promotion. It also ranked below the other two methods in the domain of overall impression but was evaluated almost as favorably as the other two in efficacy. View this table:  In this window  In a new window Exhibit 2 Survey Participants’ Attitudes Toward Dissemination Methods, 2013 As a secondary outcome, we tested for differences in the ratings of the three dissemination methods by academic rank. We found a significant difference by academic rank in how participants rated the efficacy of the methods, with senior faculty considering social media less favorably than junior faculty (Exhibit 3). However, we found no significant differences in the other domains (Appendices A2, A3, and A4).17 View larger version:  In this page  In a new window  Download as PowerPoint Slide Exhibit 3
  6. 6. Survey Participants’ Attitudes About The Efficacy Of Dissemination Methods, By Academic Rank, 2013 SOURCE Authors’ analysis of survey data. NOTES Participants in all three experimental groups ranked efficacy using a scale of 1 (not at all effective) to 10 (very effective). The interaction between academic rank and efficacy was significant ( ). Ratings Of Efficacy Of Dissemination Methods We asked all participants, regardless of their experimental-group assignment, to rate the efficacy of various dissemination methods. Respondents rated more traditional dissemination methods (direct outreach to policy makers, traditional media, and policy briefs) favorably and social media methods (Twitter, journal blogs, and Facebook) unfavorably (Exhibit 4). Higher academic rank was associated with less favorable attitudes toward Twitter ( ), blogs on journal websites ( ), and newspaper articles ( ). View larger version:  In this page  In a new window  Download as PowerPoint Slide Exhibit 4 Survey Participants’ Attitudes About The Efficacy Of Dissemination Methods In Communicating With Policy Makers And Other Decision Makers, 2013 SOURCE Authors’ analysis of survey data. NOTE Participants ranked the efficacy of each dissemination channel to communicate research to “policy makers and other decision makers” using a scale of 1 (not at all effective) to 10 (very effective). Because the participants had been differentially exposed to a randomly assigned vignette, we tested for priming effects—that is, whether exposure to different vignettes earlier in the survey (based on random assignment to an experimental group) influenced the reported attitudes in questions that appeared later in the survey. We found none. Reported Dissemination Activities In The Past Year Sixty-five percent or more of the participants reported using traditional media (being interviewed by a reporter or having the news media cover their research) or directly contacting a policy maker to disseminate information in the previous year (Exhibit 5). However, just 14 percent reported tweeting and 21 percent reported blogging about their research or related health policy. View larger version:  In this page  In a new window  Download as PowerPoint Slide Exhibit 5
  7. 7. Survey Participants’ Reported Dissemination Activities In The Previous Year, 2013 SOURCE Authors’ analysis of survey data. Higher academic rank was associated with higher rates of publishing policy briefs ( ), contacting interest or community groups ( ), having the news media cover a research study ( ), and being interviewed by a reporter ( ). Qualitative Results Using open-ended questions, we explored participants’ views about the role that social media should have in disseminating academic research. We identified four key themes, each of which is discussed in more detail below. First, many researchers believe that the culture of social media is frequently at odds with that of research. Second, researchers believe that using social media entails substantial professional risk. Third, researchers have low confidence in their ability to use social media. And fourth, researchers are uncertain about how effective social media are at disseminating research. Clash Of Cultures: Participants were critical of two aspects of social media: the media’s technical limitations and the quality of communication. Participants emphasized that it would be hard to communicate the nuances of research findings through social media. One participant said, “I would not use something that’s so succinct that it could allow for misinterpretation.” Another participant was even more skeptical: “There are variations in findings, and sometimes those variations and also the precision of the estimates get lost. …There’s a real challenge in doing that, in getting at the nuances of your study.” Many respondents were very critical of the perceived subjectivity in the social media environment. One researcher said, “Anyone could write a 140-word Twitter statement [that] may or may not be true, and there’s the risk…that you can just get confused with the junk that’s out there.” Professional Risk: Many participants had strong beliefs that researchers—and, by extension, their institutions—are critical of social media. One participant cautioned junior faculty members, saying, “When you’re still under the tenure gun, having a controversy around you because of something you say on social media could be a huge barrier in terms of perceptions of you.” Another participant raised the concern that using social media could look like advocacy and self-promotion, which is inconsistent with academic norms: “I think there’s a fine line between being a researcher and being an issue advocate and also similarly [between] being a researcher who wants to get their message out and being a self-promoter who wants to just have their face everywhere.” Low Confidence: Many researchers feared that they would make a mistake on social media and get themselves in trouble. One participant said: “I have no idea how to do it. I’m afraid to do it because I don’t want to say or do the wrong thing that would…get me in trouble.” Others felt unable to keep up with changing social media technology. One researcher commented: “By the time I understood Facebook, Facebook had become old. Now Twitter is new. By the time I understand Twitter, it will have become old and something else will come up.” Some participants concluded that they needed help in using social media to disseminate their research: “I need to hire [a] spokesperson or a health journalist to help…write the lay dissemination document outside of the journal publication, that [is] intended to be disseminated in social media.”
  8. 8. Uncertainty About Efficacy: Some participants seemed open to using social media but were not sure if doing so would be effective. One said, “It seems natural that this is probably the broadest way to disseminate findings, but I don’t know.” Another said, “I think the field is relatively young, and we need to do a lot more studies around what’s the evidence that [social media are] effective at policy translation and dissemination.” We compared perceptions of social media between self-reported users and nonusers of the media. Users were more likely to believe that social media are efficacious and ought to be used as an adjunct to more traditional communication channels. These participants described using social media as a way to disseminate a broader range of studies (even those not published in what one participant referred to as a “top” journal) and to reach a broader audience (the general public and policy makers), compared to using traditional media. Users did not question whether social media were effective, but they wanted proven strategies to optimize the efficacy of their use of the media. They described professional concerns about using social media that were similar to those of nonusers but often articulated specific strategies to address those concerns, such as using social media only for professional purposes, exercising extra editorial caution before posting any content, and following appropriate communication channels within their universities. Social media users often mentioned wanting their universities, professional organizations, and the journals they write for to provide clearer standards about appropriate uses of social media. Previous SectionNext Section Discussion As new challenges such as implementation of the Affordable Care Act emerge in public health and health care, the need to translate evidence into health policy increases. The barriers to disseminating evidence and incorporating it into policy are high. However, social media are an increasingly common communication tool that could play an important role.16 In our survey of university-based health services and health policy researchers, we identified three key findings. First, researchers are concerned about using social media and the media’s compatibility with academic research. They have concerns about how their peers and institutions perceive social media. Many researchers also believe that the culture of social media is incompatible with that of science and research, describing social media as crowded with opinion and “junk.” They were concerned about allowing their scientific results to be presented in close proximity to opinion pieces and about being perceived as advocates or as self-promoting. Second, many researchers were nonetheless optimistic about the efficacy of social media in disseminating evidence, when we gave them an example of how the media could be used. Some of the ambivalent views that we observed in the direct ratings of social media and the qualitative results about the efficacy of the media to communicate scientific findings may result from participants’ lack of familiarity with how the technology works. This was evident in responses to open-ended questions. For example, many respondents believed that they could not communicate anything beyond the 140-character limit on Twitter, despite the widespread practice of embedding within tweets links to more substantive content. Many participants acknowledged that the nature of communication is changing and that eventually researchers will need to catch up. Junior faculty members were more optimistic than their senior colleagues about the efficacy and scope of social media. This finding may be an effect of age that results from differential knowledge and adoption of social media technology. Alternatively, senior faculty members may have greater access to direct policy communication channels because of their stature and reputation.
  9. 9. Third, a large majority of researchers are not using social media to communicate research findings. This is in contrast to very high rates of use of older communication channels such as traditional media or direct contact with policy makers. Our findings have two major implications. First, the lack of evidence about social media’s ability to deliver research findings to decision makers is one of the barriers to the adoption of these media. Participants in our study wanted evidence about whether they should use the media and how to use them effectively. Research is needed to clarify whether or not social media are an efficacious way to communicate evidence to decision makers and, if they are, to identify the optimal strategies to ensure that the evidence presented in social media will be used by decision makers. The recent interest by the National Institutes of Health20 and the Patient-Centered Outcomes Research Institute21 in the science of dissemination holds promise for furthering this work. However, an explicit focus on social media channels should be a priority in this research agenda. Second, researchers will ultimately need training and technological support and infrastructure to use social media effectively. Researchers’ academic institutions might be able to provide some of the necessary resources. Previous SectionNext Section Conclusion Public investments in research on health and health care are substantial. It is essential to maximize the returns on those investments by making research a key component of the process of developing, implementing, and refining health policies. Historically, the communication gap between researchers and policy makers has been large.3 Social media are a new and relatively untested tool, but they have the potential to create new communication channels between researchers and policy makers that can help narrow that gap. Determining how health researchers can best use and adapt this new technology to communicate evidence to policy makers should be a priority for universities, research funders, and scientists. Previous SectionNext Section Acknowledgments The results are to be presented as an abstract at the AcademyHealth Annual Research Meeting, San Diego, California, June 8, 2014. This research was supported by the Robert Wood Johnson Foundation Health and Society Scholars Program and the Summer Undergraduate Minority Research Program at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania. Sarah Gollust received a research grant from American International Group. The authors are grateful to Kristin Rosengren, Michael Gluck, Lisa Simpson, and the AcademyHealth Translation and Dissemination Institute for support and assistance with this project. The authors thank Joanne Levy, Janet Weiner, and the students in the Summer Undergraduate Minority Research Program at the Leonard Davis Institute of Health Economics for their assistance with data collection. The authors also thank Dan Polsky for guidance and input. [Published online June 6, 2014.] Previous Section NOTES 1. ↵ 1. Krumholz HM, 2. Radford MJ, 3. Wang Y, 4. Chen J, 5. Heiat A, 6. Marciniak TA
  10. 10. . National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project. JAMA. 1998;280(7):623–9. CrossRefMedlineSearch Google Scholar 2. ↵ 1. Prewitt K, 2. Schwandt TA, 3. Straf ML , editors. Using science as evidence in public policy. Washington (DC): National Academies Press; 2012. Search Google Scholar 3. ↵ 1. Brownson RC, 2. Royer C, 3. Ewing R, 4. McBride TD . Researchers and policymakers: travelers in parallel universes. Am J Prev Med. 2006;30(2):164–72. CrossRefMedlineSearch Google Scholar 4. ↵ 1. Mitton C, 2. Adair CE, 3. McKenzie E, 4. Patten SB, 5. Waye Perry B . Knowledge transfer and exchange: review and synthesis of the literature. Milbank Q.2007;85(4):729–68. CrossRefMedlineSearch Google Scholar 5. ↵ 1. Coburn AF . The role of health services research in developing state health policy. Health Aff (Millwood). 1998;17(1):139–51. Abstract 6. ↵ 1. Innvaer S, 2. Vist G, 3. Trommald M, 4. Oxman A . Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy. 2002;7(4):239–44. Abstract/FREE Full Text 7. ↵ 1. Contandriopoulos D, 2. Lemire M,
  11. 11. 3. Denis JL, 4. Tremblay E . Knowledge exchange processes in organizations and policy arenas: a narrative systematic review of the literature. Milbank Q. 2010;88(4):444–83. CrossRefMedlineSearch Google Scholar 8. ↵ 1. Lavis JN, 2. Robertson D, 3. Woodside JM, 4. McLeod CB, 5. Abelson J . How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q. 2003;81(2):221–48. CrossRefMedlineSearch Google Scholar 9. ↵ 1. Lavis JN, 2. Ross SE, 3. Hurley JE, 4. Hohenadel JM, 5. Stoddart GL, 6. Woodward CA, 7. et al. Examining the role of health services research in public policymaking. Milbank Q. 2002;80(1):125– 54. CrossRefMedlineSearch Google Scholar 10. ↵ 1. Jewell CJ, 2. Bero LA . “Developing good taste in evidence”: facilitators of and hindrances to evidence-informed health policymaking in state government. Milbank Q. 2008;86(2):177–208. CrossRefMedlineSearch Google Scholar 11. ↵ 1. Sorian R, 2. Baugh T . Power of information: closing the gap between research and policy. Health Aff (Millwood). 2002;21(2):264–73. Abstract/FREE Full Text 12. ↵ 1. Dodson EA, 2. Stamatakis KA, 3. Chalifour S, 4. Haire-Joshu D, 5. McBride T,
  12. 12. 6. Brownson RC . State legislators’ work on public health-related issues: what influences priorities? J Public Health Manag Pract. 2013;19(1):25–9. CrossRefMedlineSearch Google Scholar 13. ↵ 1. Brownson RC, 2. Jacobs JA, 3. Tabak RG, 4. Hoehner CM, 5. Stamatakis KA . Designing for dissemination among public health researchers: findings from a national survey in the United States. Am J Public Health. 2013;103(9):1693–9. CrossRefSearch Google Scholar 14. ↵ 1. Merchant RM, 2. Elmer S, 3. Lurie N . Integrating social media into emergency-preparedness efforts. N Engl J Med. 2011;365(4):289–91. CrossRefMedlineSearch Google Scholar 15. ↵ 1. Batts SA, 2. Anthis NJ, 3. Smith TC . Advancing science through conversations: bridging the gap between blogs and the academy. PLoS Biol.2008;6(9):e240. CrossRefMedlineSearch Google Scholar 16. ↵ 1. Keller B, 2. Labrique A, 3. Jain KM, 4. Pekosz A, 5. Levine O . Mind the gap: social media engagement by public health researchers. J Med Internet Res.2014;16(1):e8. CrossRefSearch Google Scholar 17. ↵To access the Appendix, click on the Appendix link in the box to the right of the article online. 18. ↵ 1. Wilcox C, 2. Sigelman L, 3. Cook E . Some like it hot: individual differences in responses to group feeling thermometers. Public Opin Q.1989;53(2):246–57.
  13. 13. Abstract/FREE Full Text 19. ↵ 1. Bradley EH, 2. Curry LA, 3. Devers KJ . Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res.2007;42(4):1758–72. CrossRefMedlineSearch Google Scholar 20. ↵ 1. Glasgow RE, 2. Vinson C, 3. Chambers D, 4. Khoury MJ, 5. Kaplan RM, 6. Hunter C . National Institutes of Health approaches to dissemination and implementation science: current and future directions. Am J Public Health. 2012;102(7):1274–281. CrossRefMedlineSearch Google Scholar 21. ↵ 1. Selby JV, 2. Beal AC, 3. Frank L . The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda.JAMA. 2012;307(15):1583–4. CrossRefMedlineSearch Google Scholar