Billions of dollars are invested each year in scientific research, yet too often the benefits stop at journal publications rather than reaching patients, communities or policymakers.
In a recent paper published in Implementation Science Communications, a group of leading implementation scientists at Washington University in St. Louis argues that closing this gap requires a fundamental shift in how universities define and reward impact.
The paper, "So What? Elevating the Impact of Implementation Science," is co-authored by Ross C. Brownson, PhD, the Steven H. and Susan U. Lipstein Distinguished Professor in the School of Public Health; Juliet Iwelunmor, PhD, a professor of medicine in the Division of Infectious Diseases, and Thomas A. Odeny, MD, PhD, an assistant professor of medicine in the Division of Medical Oncology, both at WashU Medicine; Enola K. Proctor, a research professor at the Brown School; and Elvin H. Geng, MD, a professor of medicine in the Division of Infectious Diseases at WashU Medicine.
"For decades, we've been very good at generating evidence," Brownson said. "The question is whether that evidence actually changes what happens in clinics, communities and policy settings."
A changing research climate
The authors draw a clear distinction between traditional academic outputs, such as publications and citation counts, and societal impact. While scholarly outputs remain essential for advancing knowledge, they note that these measures alone reveal little about whether research improves health, reduces inequities, strengthens services or informs policy. In an era of constrained resources, federal funding pressures and widening health disparities, that gap is becoming harder to defend.
At the same time, declining public trust in science and in higher education has intensified pressure on researchers and institutions to demonstrate public benefit beyond academic publication. Higher education must do a better job in showing the return on investment in research, they wrote.
The authors pointed to public health's historic successes - from the eradication of polio to dramatic reductions in vaccine-preventable cancers and sustained declines in infectious disease - as evidence of what's possible when science informs action. Yet large gaps remain between proven interventions and routine implementation in practice and policy.
The consequences of those gaps are substantial. The paper highlighted estimates showing that scaling up just 10 proven, community-level interventions across five East African countries could prevent approximately 75,000 child deaths over time. These interventions include vitamin A supplementation, hand washing and breast feeding. This "know-do" gap, they argue, is among the most pressing and underaddressed challenges in health research today.
Implementation science emerged to confront that challenge by studying how evidence-based programs and policies are adopted, adapted and sustained - or discontinued.
Elevating impact means designing research with use and consequences in mind. However, researchers need to realize that impact is rarely immediate. It often is incremental and easy to miss if researchers focus only on final results. So it's important, the authors found, to track earlier use indicators - such as whether evidence is being noticed, discussed or taken up by practitioners, organizations or decision-makers. Implementation science already offers tools for capturing those signals, including measures of adoption and reach.
The authors also cautioned that impact is not always beneficial. Even well-intentioned interventions can produce unintended consequences, underscoring the need to assess impact carefully and in context.
Policy as a powerful lever
The paper highlighted policy implementation as a powerful and often overlooked driver of impact. Policies shape population health at scale, the authors noted, but turning evidence into law, regulation or funding decisions requires navigating political realities. This often means working within election and budget cycles, responding to demands for locally relevant data and managing competing priorities among policymakers, industry and the public. Ignoring those realities, they said, can stall even well-established, widely supported research.
Researchers can gain traction by strategic engagement with policymakers. Often this involves translating scientific data into real-world stories.
One successful example the authors highlighted is the scale-up of the U.S. President's Emergency Plan for AIDS Relief, a global initiative launched in 2003 that rapidly expanded access to lifesaving HIV treatment by financing and delivering antiretroviral therapy in high-burden countries. That showed what's possible, the researchers argued, when scientific evidence, policy commitment, funding and political will align.
"In fast-moving health crises, waiting decades for evidence to reach practice isn't neutral - it costs lives," said Geng, an expert on HIV prevention and control.
The authors outline four core domains where implementation science can exert the greatest leverage: the speed at which research translates into practice; the sustainability of effective interventions over time; the de-implementation of low-value or harmful practices; and equity - both in outcomes and in the processes by which interventions are deployed.
One domain the authors emphasized is speed: Evidence-based programs often take 15-17 years to reach routine practice, delaying health gains for an entire generation.
Across those domains, the authors offered examples that illustrate how implementation science translates evidence into impact.
- Speed: In HIV care, research demonstrating the benefits of starting antiretroviral therapy immediately after diagnosis helped drive changes in clinical workflows and informed World Health Organization guidance. As a result, many health systems shifted to same-day or near-same-day treatment, dramatically shortening the time from diagnosis to care in high-prevalence countries and the United States.
- Sustainability: Since 1994, Brazil has incorporated community health workers as a core component of primary care. By embedding about 260,000 trained workers within multidisciplinary health teams and assigning them to defined neighborhoods, the approach expanded preventive and basic care to most of Brazil's population, including communities with limited access to physicians.
- De-implementation: The global phaseout of leaded gasoline shows how actively removing harmful materials or practices can yield lasting health and economic benefits.
- Equity: Participatory budgeting demonstrates how involving community members directly in public health funding decisions can reveal unmet needs, strengthen trust and improve outcomes for historically marginalized populations.
Building a culture of impact
The paper calls on universities and research organizations to build a stronger culture of impact, one that supports moving evidence beyond publication and into use. The authors argued that institutions need to provide clear incentives, dedicated support and practical infrastructure to researchers. That can include training, staff support and evaluation systems that recognize when research informs policy, improves practice or reaches communities outside academia.
Building a culture of impact, the authors add, requires attention not only to institutional incentives, but to how research is conceived, developed and communicated with communities from the outset. When community members and practitioners help shape research questions, methods and messages, rather than simply receiving results at the end, they're more likely to trust and use the findings. Working with communities as partners can help ensure that evidence fits practical needs and constraints.
Generating new knowledge alone, the authors argued, no longer meets the moment. Implementation science must put impact at the center of how research is designed, evaluated and rewarded - by scholars and institutions alike. The result could be faster translation of evidence into action, more equitable health outcomes and greater public value from scientific investment.
