To help propel this crucial field forward, this book aims to address a number of key issues, including: how to evaluate the evidence base on effective interventions; which strategies will produce the greatest impact; how to design an appropriate study; and how to track a set of essential outcomes.
The passive process by which a growing body of information about an intervention, product, or technology is initially absorbed and acted upon by a small body of highly motivated recipients (Lomas, 1993).
Centers on the conditions which increase or decrease the likelihood that a new idea, product, or practice will be adopted by members of a given culture (Rogers, 1995).
Active process through which the information needs (pull) of target groups working in specific contexts (capacity) are accessed, and information is "tailored" to increase awareness of, acceptance of, and use of the lessons learned from science (Kerner, 2007).
The study of processes and variables that determine and/or influence the adoption of knowledge, interventions or practice by various stakeholders (Lomas, 1997).
The utilization of strategies or approaches to introduce or modify evidence-based interventions within specific settings. This involves the identification of and assistance in overcoming barriers to, the application of new knowledge obtained from a disseminated message or program (Lomas, 1993).
Research that supports the movement of evidence-based interventions and approaches from the experimental, controlled environment into the actual delivery contexts where the programs, tools, and guidelines will be utilized, promoted, and integrated into the existing operational culture (Rubenstein & Pugh, 2006).
Kerner, J Translating Research into Policy and Practice: Who’s Influencing Whom? Presentation at the Annual National Health Policy Conference. Washington, DC. 2007.
Lomas, J Diffusion, dissemination, and implementation: who should do what? Annals of New York Academy of Sciences 1993, 703, 226-235; discussion 235-227.
Lomas, J Improving Research and Uptake in the Health Sector: Beyond the Sound of One Hand Clapping. Centre for Health Economics and Policy Analysis. Policy Commentary 1997, C97-1.
Rogers, E. Diffusion of Innovations (Fourth ed.). 1995. New York: The Free Press.
Rubenstein, L. V., & Pugh, J. Strategies for promoting organizational and practice change by advancing implementation research. Journal of General Internal Medicine 2006, 21 Suppl 2, S58-64.
Evidence-based intervention. n.
The objects of D&I activities are interventions with proven efficacy and effectiveness (i.e., evidence-based). Interventions within D&I research should be defined broadly and may include programs, practices, processes, policies, and guidelines. More comprehensive definitions of evidence-based interventions are available elsewhere. In D&I research, we often encounter with complex interventions (e.g., interventions using community-wide education) where the description of core intervention components and their relationships involve multiple settings, audiences, and approaches.
Adoption. n.
Adoption is the decision of an organization or community to commit to and initiate an evidence-based intervention.
Sustainability. n.
Sustainability describes the extent to which an evidence-based intervention can deliver its intended benefits over an extended period of time after external support from the donor agency is terminated. Most often sustainability is measured through the continued use of intervention components; however, Scheirer and Dearing suggest that measures for sustainability should also include considerations of maintained community- or organizational-level partnerships, maintenance of organizational or community practices, procedures, and policies that were initiated during the implementation of the intervention, sustained organizational or community attention to the issue that the intervention is designed to address, and efforts for program diffusion and replication in other sites. Three operational indicators of sustainability are: (1) maintenance of a program's initial health benefits, (2) institutionalization of the program in a setting or community, and (3) capacity building in the recipient setting or community.
Reinvention/adaptation. n.
For the success of D&I, interventions often need to be reinvented or adapted to fit the local context (i.e., needs and realities). Reinvention or adaptation is defined as the degree to which an evidence-based intervention is changed or modified by a user during adoption and implementation to suit the needs of the setting or to improve the fit to local conditions. The need for adaptation and understanding of context has been called Type 3 evidence (i.e., the information needed to adapt and implement an evidence-based intervention in a particular setting or population). Ideally, adaptation will lead to at least equal intervention effects as is shown in the original efficacy or effectiveness trial. To reconcile the tension between fidelity and adaptation, the core components (or essential features) of an intervention (i.e., those responsible for its efficacy/effectiveness) must be identified and preserved during the adaptation process.
Dissemination strategy. n.
Dissemination strategies describe mechanisms and approaches that are used to communicate and spread information about interventions to targeted users. Dissemination strategies are concerned with the packaging of the information about the intervention and the communication channels that are used to reach potential adopters and target audiences. Passive dissemination strategies include mass mailings, publication of information including practice guidelines, and untargeted presentations to heterogeneous groups. Active dissemination strategies include hands on technical assistance, replication guides, point-of-decision prompts for use, and mass media campaigns. It is consistently stated in the literature that dissemination strategies are necessary but not sufficient to ensure wide-spread use of an intervention.
Models and frameworks can guide the planning, development and evaluation of D&I studies. Tabak and colleagues (see p. 11 for reference) list the following reasons why models and frameworks should be used in D&I. They can:
The clear integration of the selected D&I model or framework into all aspects of the study is critical. A guide to applying models and frameworks to D&I projects is provided by the VA QUERI Enhancing Implementation and further discussed by the VA Implementation Guide.
Ideally, your theory or framework will guide the formulation of your research question, development of your intervention, the evaluation of the intervention, and the interpretation of your findings. For an exercise to do this, you can use Table 1 Try-It activity at the end of this module.
Construct Flexibility (CF): Models were scored on a scale of 1 to 5, where 1 was Broad and 5 was Operational:
Models were scored on a continuum of the following five categories: focus on dissemination only (D only), dissemination more than implementation (D < I), both activities equally (D = I), implementation more than dissemination (D < I), and implementation only (I only).
Models were classified as focusing on a specific level or as cutting across several levels of the socio-ecological framework (outline shown below). Researchers also noted whether models addressed policy.
Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med 2012;43(3):337-350.
Eccles MP, Mittman BS. Welcome to implementation science. Implement Sci 2006;1(1):1.
Tabak RG, Khoong EC, Chambers DA, Brownson, RC. Models in dissemination and implementation research: useful tools in public health services and systems research.Frontiers in PHSSR. 2013;2(1):8.
Centers for Disease and Prevention (CDC) Prevention Research Centers http://www.cdc.gov/prc/stories-prevention-research/stories/dissemination-and-implementation.htm
FRAMEWORK
FRAMEWORK
Canadian Institutes of Health Research (2005). About knowledge translation. Retrieved September 10, 2013, from http://www.cihr-irsc.gc.ca/e/39033.html
FRAMEWORK
FRAMEWORK
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50.
FRAMEWORK
FRAMEWORK
Wandersman A, Duffy J, Flaspohler P, Noonan R, Lubell K, et al. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. American Journal of Community Psychology 2008, 41(3–4), 171-181.
Flaspohler P, Lesesne CA, Puddy RW, Smith E, Wandersman A. Advances in bridging research and practice: introduction to the second special issue on the interactive system framework for dissemination and implementation American Journal of Community Psychology 2012, 50(3-4), 271-281.
FRAMEWORK
FRAMEWORK
Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf. 2008 Apr;34(4):228-43.
FRAMEWORK
FRAMEWORK
Green, LW, and Kreuter, MW, Health Program Planning: An Educational and Ecological Approach, 4th edition (New York: McGraw-Hill) 2001.
http://www.lgreen.net/precede.htm
Aboumatar, H, Ristaino, P, Davis, RO, Thompson, CB, Maragakis, L, Cosgrove, S, Rosenstein, B, and Perl, TM. Infection Prevention Promotion Program Based on the PRECEDE Model: Improving Hand Hygiene Behaviors among Healthcare Personnel. Infect Control Hosp Epidemiol 2012, 33(2):144-151.
FRAMEWORK
FRAMEWORK
The RE-AIM framework is designed to enhance the quality, speed, and public health impact of efforts to translate research into practice in five steps:
Glasgow RE, Vogt TM, Boles SM. 1999. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 1999; 89(9):1922-1927
www.re-aim.org
Allicock M, Johnson LS, Leone L, Carr C, Walsh J, Ni A, Resnicow K, Pignone M, Campbell M. Promoting fruit and vegetable consumption among members of black churches, Michigan and north Carolina, 2008-2010. Prev Chronic Dis. 2013 Mar;10:E33.