Program Science: The New Focus in Prevention

Much attention has been paid to improving knowledge translation and “implementation science” in the context of public health. Within this agenda there is an implicit concern that scientific knowledge is not being efficiently or effectively applied in the design and implementation of public health programs. Accordingly, there are widespread efforts to review, synthesize and disseminate scientific evidence for public health managers and practitioners. However, the usual approaches to knowledge translation are focused on single interventions addressing narrowly defined public health issues. While this approach to knowledge translation is generally appropriate for addressing clinical practice issues, the multi-dimensionality of many public health issues generally requires the integration of knowledge from multiple domains to design and implement effective programs. For example, in the field of HIV and STI prevention, the feasibility and potential impact of a particular intervention is often context-specific, due to the diversity of the epidemiologic, socio-cultural and economic conditions. Moreover, it is unlikely that a single intervention will be sufficient, thus requiring the implementation of a mix of interventions that is appropriate for a given context. To address these complexities, we propose the concept of “program science” as an improved approach to knowledge translation. Whereas “implementation science” is primarily concerned with ensuring the implementation of discrete interventions, “program science” is also concerned with: 1) the strategic focus of prevention programs, 2) achievement of an optimum intervention mix and, 3) approaches to maximize the scale and efficiency of programs. The conceptual and practical implications of this approach will be discussed.