Academic-practice partnerships for active living: the Healthy Hawaii Initiative.

Translating research into practice remains a challenge for public health and active living. Several issues have been identified as barriers to effective translation, including increasing the understanding of practice-based evidence, reframing dissemination challenges, placing greater emphasis on public health workforce development, and making research more accessible to policy audiences. Despite continued calls for better collaborations between researchers and practitioners, embedded structural issues exist that decrease collaborative opportunities. These include publication bias favoring studies with high internal validity, often at the expense of external validity; funding opportunities that focus exclusively on either research or practice; training of researchers by other researchers and not by practitioners; difficulties in creating and deepening relationships required to collaborate due to differences in structures and operating principles; and a lack of formal public health training among public health practitioners. Although these issues are common among many areas of public health, the problems are exacerbated by the multidisciplinary nature of the field of active living. There is a divide not only between researchers and practitioners but also across disciplines including transportation, education, parks and recreation, urban planning, and architecture. Although these structural issues make effective practice-based research difficult, they do not make it impossible. This commentary explores the case example of the Healthy Hawaii Initiative (HHI), where overcoming these barriers has been attempted and achieved to some extent. In 1999, the Hawaii state legislature passed legislation mandating that the Department of Health (HDOH) allocate 25% of the state’s tobacco settlement money for disease prevention programs targeting physical activity and nutrition. The state used these funds to create the HHI. Since the inception of the initiative, the HDOH has realized the need to have a strong evaluation of all components of the HHI and partnered with the University of Hawaii’s Department of Public Health Sciences to create the Healthy Hawaii Initiative Evaluation Team (HHIET). The HHIET is comprised of university-based faculty, research staff, and graduate students, who make up the research and evaluation arm of the initiative. The overall goal of the HHI is to increase years of healthy life for all people of Hawaii and reduce existing health disparities among ethnic groups in Hawaii. This goal is addressed by creating sustainable changes that promote healthy lifestyles, in particular through nutrition and physical activity, and by reducing health disparities throughout the state. Interventions are targeted at the individual, social, and environmental levels and use a variety of channels including public education, education of health professionals, school-based programs, and community initiatives. I have had the good fortune of leading the HHIET since the start of the initiative in 2000. The University and HDOH teams have discovered shared goals including making Hawaii a healthier place to live, work, learn, and play. We have also learned how to work together and to acknowledge our sometimes-competing priorities to create a strong partnership. For the university, competing priorities include conducting research studies for peer-reviewed publications. For the HDOH, they often mean answering to the priorities of a variety of stakeholders including elected officials, the Director of Health, and the Centers for Disease Control and Prevention. These different perspectives have helped us to examine what practice-based research is. It needs to be highly relevant to proposed interventions, have strong external validity, and not take years to get results. These were and still are challenging issues that are not typically part of graduate school training. Next, I describe a series of practicebased research studies we have conducted and how they were vastly different from typical randomized trial biomedical research. Our first study examined changing the bell schedule of a local elementary school to offer recess before lunch for some grades. Intuitively, this makes sense. Students can run around without a stomach full of food, and lunch wait time is decreased, because the students can go to lunch when they are ready and not all at the same time. Because of the need to complete the study quickly with limited resources, we were only able to test the program in one school using a pretestposttest design. The intervention worked well in increasing access to recess equipment, decreasing plate waste, and, Jay E. Maddock, PhD, is with the Department of Public Health Sciences, University of Hawaii at Manoa, Manoa, Hawaii.