The NCCDPHP K2A Framework identifies 3 phases in the overarching processes of moving from scientific discovery to routine public health practice: research, translation, and institutionalization. The research phase 1) includes developing and testing of scientific advances to determine their appropriateness for translation and 2) uses traditional definitions of efficacy, effectiveness, and implementation research. Biomedical or behavioral research and surveillance are needed to validate an approach or verify the efficacy of a program, practice, or policy. These occur before translation, but ideally occur with translation in mind (15). The translation phase incorporates the processes needed to ensure widespread implementation of evidence-based programs, practices, and policies. These processes include making the decision to translate, transforming scientific knowledge into actionable products, developing appropriate supporting structures, and disseminating evidence-based programs, practices, or policies to potential adopters. Implementation in practice depends on the communities, organizations, and practitioners making the decision to adopt and having sufficient supporting structures and resources to effectively move toward action. Effective translation of a program, practice, or policy is likely to follow a similar course, regardless of whether it originates in research or the field, although the specifics of the set of activities within each component will vary depending on the type of intervention. Ideally, successful translation processes lead to the institutionalization phase or maintenance of the program, practice, or policy as an established activity or norm within the community, organization, or social system (16). Processes throughout the translation framework combined with evidence that the efforts are cost-effectively achieving desired public health outcomes can support or inhibit the likelihood of institutionalization (17). In addition, environmental forces such as resource availability (fiscal and technical), quality supporting structures, stakeholder buy-in, and leadership support can affect the longevity of practice changes. Although the WGoT focused most of its attention on the translation phase, we recognize that institutionalization is the ultimate success of translation processes.

Inherent in successful translation is input from the practice community to the professionals involved in intervention research and development. This much-needed input is represented on the translation schematic by the practice-based discovery and practice-based evidence arrows. Field-based discovery highlights the opportunity to conduct efficacy and effectiveness studies on innovative field-based practices that lack data on their intended effects or benefits. Practice-based evidence returns field-based data to the professionals involved in effectiveness and implementation studies or those working to transform knowledge into products (18).

Few formal mechanisms exist for interactions among practitioners delivering interventions and the researchers developing and evaluating those interventions. A notable example of this interaction is the Active for Life initiative funded by the Robert Wood Johnson Foundation, which evaluated the effectiveness of 2 physical activity interventions. As part of that initiative, practitioners delivering the interventions provided feedback on translation issues to program developers. On the basis of the practitioner feedback, program developers reduced the reading level of program materials and produced a shorter version of 1 of the interventions, which facilitated its use in the field (19).

The decision to translate, the intentional decision to use translation processes to move a specific intervention into widespread use, is an essential transition point from the research phase to the translation phase. Integral to intentional translation efforts is a formal determination that the science base is adequate or that public health need suggests that it is time to act (eg, create some form of intervention). Evidence grading systems (20) provide metrics from trials and observational studies to determine when a specific intervention is ready for translation into the field. Although there are multiple decisions throughout the K2A Framework that advance translation, this explicit decision to translate is pivotal to moving purposefully from research to practice. This action is distinct from more passive attempts because it entails a thoughtful decision and active engagement of translation processes (11).

Supporting structures are interrelated elements undergirding all K2A processes. Each phase requires both general and intervention-specific structures such as organizational capacity, champions, staffing, financial resources, training, technical assistance, and intangibles such as leadership and political will (21). Structures to support interventions must be created and sustained to ensure quality practice change and institutionalization.

Evaluation is fundamental to improving translation processes; it provides information on whether evidence-based interventions are reaching the people who need them and it assesses our success in achieving desired health outcomes (22,23). Evaluation as used in the K2A Framework is multifaceted, present throughout the entire translation process, and inherent in each component. The framework does not attempt to dictate how evaluation of translation efforts should be designed or conducted. Although fundamental evaluation questions may evolve for processes across translation, evaluation strategies and methods need to be unique to context and situation. The evaluation bar in the K2A Framework reminds users to incorporate appropriate evaluation activities and measures throughout translation processes.

The entire public health system, from researcher to practitioner, needs to be involved and accountable for putting scientific knowledge into action. Researchers should keep feasibility of implementation clearly in mind when developing interventions so as to avoid developing interventions that are too resource-intensive or require organizational commitment that is unrealistic. For example, a physical activity intervention that requires delivery by physical therapists might not be feasible in senior centers with limited resources. Practitioners should carefully review the literature and other resources such as online clearinghouses when selecting evidence-based interventions to use. If using a home-grown intervention in the field, practitioners should develop evaluation plans, monitor program outcomes, and assist in building the evidence base. Gathering data on these field-based interventions exemplifies the multiple responsibilities for translation and the bidirectional nature of the framework.

One use of the framework in planning is as a reminder of the comprehensive process of translating knowledge into action. We can research or evaluate a specific component of intervention development or translation without treating it as an independent process, because we have a sense of where these findings fit in the overall schema of K2A (24).

In all 3 phases of the K2A Framework, structures and systems must be put into place to support use of evidence-based interventions and practices in the field. Research-related supporting structures such as research grants and training fellowships are vital to the creation of scientific knowledge. Applying that knowledge during the translation and institutionalization phases requires both general and intervention-specific supports. One supporting structure might be the requirement by funding agencies for applicants to use an evidence-base intervention, either a particular intervention or 1 chosen from a menu of acceptable evidence-based interventions. Another supporting structure could include readily available training, technical assistance, and well-researched marketing materials. Organizational capacity, political will, and financial resources are all essential to the success of any intervention, as are intervention-specific dissemination packages, training, and technical assistance (14). Dissemination packages such as how-to guides are of limited use, however, in the absence of organizational capacity. Similarly, technical assistance will produce limited benefits if financial resources or political will to carry out the intervention are absent. Support from state, local, tribal, and federal public health officials is vital to establishing organizational and workforce norms that reinforce motivation to use evidence.