Wednesday, March 29, 2006

SIDS and other controversies...

The SIDS issue - whether or not to cosleep - is so misunderstood. I think that the Academy of Breastfeeding Medicine (www.bfmed.org) has an excellent statement on the issue.

On this issue, and on many others, there seems to be a constant struggle between three corners of the health triangle: individual patient care, best interest of the public, and the need for simple behavior change messages that allow individuals to help themselves.

Proper counseling for SIDS prevention at the individual level is much more than "back" sleeping or don't cosleep or use of pacifiers. The best interest of the public is served when all factors are properly weighed in a risk/benefit equation, and recommendations include consideration of more than a single issue. Unfortunately, good research can be "translated" poorly, with the resulting messages giving incomplete and even misleading information for individual behavior change.

What can we do to ensure that all three corners of the health triangle are included in thinking? I have only recently been introduced to the concept of translational research, the art and science of combining the evidence from many disciplines, and interpreting it into the language of program, policy and behavior change.

Having worked in many countries, and having worked poorly in many languages and cultures due to poor "translation", and having spoken to skilled interpreters about translation, my conclusion is that we might better aim for "interpretational" research, because it is often necessary to go beyond translation of the words in order to truly achieve full understanding.

Bringing together the evidence from many disciplines and interpreting it into language/messages that, if acted upon, benefit the audience, is the best any interpreter could hope to achieve. Contributing to all parts of the health triangle demands translation, interpretation, and evaluation of impact.

Addressing all three parts of the public health triangle - individual care, public health improvement, and enabling self-care through program, policy and public messages for change - using interpretation and testing of the evidence, may be the best way forward.

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