Diffusion Theory and Knowledge Dissemination, Utilization, and Integration in Public Health

Helen Diller Comprehensive Cancer Center, and Department of Epidemiology and Biostatistics, School of Medicine University of California, San Francisco, California 94143-0981, USA.
Annual Review of Public Health (Impact Factor: 6.47). 05/2009; 30(1):151-74. DOI: 10.1146/annurev.publhealth.031308.100049
Source: PubMed


Legislators and their scientific beneficiaries express growing concerns that the fruits of their investment in health research are not reaching the public, policy makers, and practitioners with evidence-based practices. Practitioners and the public lament the lack of relevance and fit of evidence that reaches them and barriers to their implementation of it. Much has been written about this gap in medicine, much less in public health. We review the concepts that have guided or misguided public health in their attempts to bridge science and practice through dissemination and implementation. Beginning with diffusion theory, which inspired much of public health's work on dissemination, we compare diffusion, dissemination, and implementation with related notions that have served other fields in bridging science and practice. Finally, we suggest ways to blend diffusion with other theory and evidence in guiding a more decentralized approach to dissemination and implementation in public health, including changes in the ways we produce the science itself.

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Available from: Lawrence W Green, Oct 05, 2015
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    • "Dissemination has been defined as " an active approach of spreading evidence-based interventions to the target audience via determined channels using planned strategies " [10]. There is a need to speed up the pipeline from discovery to application (e.g., discovery of a new smoking cessation technique to widespread use across clinical and public health settings) [7]. Potential solutions to bring research to practice include involving stakeholders [11] [12] [13] [14] [15] [16] in the research process (e.g., design, data gathering, and analysis) and/or evaluation process (also referred to as practice-based research [17]) and "
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    DESCRIPTION: Objectives. In public health and clinical settings insufficient dissemination of evidence-based practices limits the reach of new discoveries to broad populations. This study aimed to describe characteristics of the dissemination process by researchers across three countries (Brazil, United Kingdom, and United States), explore how designing for dissemination practices has been used, and analyze factors associated with dissemination. Methods. A similar online survey was used to query researchers across the three countries; data were pooled to draw cross-country conclusions. Findings. This study identified similarities and differences between countries. Importance of dissemination to nonresearcher audiences was widely recognized as important; however, traditional academic venues were the main dissemination method. Several factors were associated with self-rated dissemination effort in the pooled sample, but these predictive factors (e.g., support and resources for dissemination) had low prevalence. Less than one-third of researchers rated their level of effort for dissemination as excellent. Respondents reported limited support and resources to make it easier for researchers who might want to disseminate their findings. Conclusion. Though intentions show the importance of dissemination, researchers across countries lack supports to increase dissemination efforts. Additional resources and training in designing for dissemination along with improved partnerships could help bridge the research-practice gap.
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    • "Models of the research and policy processes are, as noted by previous theorists of EBP, rarely made explicit in evaluations of applied research. Where implicit, a simple ‘pipeline’ model is usually assumed (i.e., that the more research is carried out and the higher the quality, the bigger the effect on policy and practice) [38-41]. "
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    ABSTRACT: Despite 40 years of research into evidence-based policy (EBP) and a continued drive from both policymakers and researchers to increase research uptake in policy, barriers to the use of evidence are persistently identified in the literature. However, it is not clear what explains this persistence - whether they represent real factors, or if they are artefacts of approaches used to study EBP. Based on an updated review, this paper analyses this literature to explain persistent barriers and facilitators. We critically describe the literature in terms of its theoretical underpinnings, definitions of 'evidence', methods, and underlying assumptions of research in the field, and aim to illuminate the EBP discourse by comparison with approaches from other fields. Much of the research in this area is theoretically naive, focusing primarily on the uptake of research evidence as opposed to evidence defined more broadly, and privileging academics' research priorities over those of policymakers. Little empirical data analysing the processes or impact of evidence use in policy is available to inform researchers or decision-makers. EBP research often assumes that policymakers do not use evidence and that more evidence - meaning research evidence - use would benefit policymakers and populations. We argue that these assumptions are unsupported, biasing much of EBP research. The agenda of 'getting evidence into policy' has side-lined the empirical description and analysis of how research and policy actually interact in vivo. Rather than asking how research evidence can be made more influential, academics should aim to understand what influences and constitutes policy, and produce more critically and theoretically informed studies of decision-making. We question the main assumptions made by EBP researchers, explore the implications of doing so, and propose new directions for EBP research, and health policy.
    Health Research Policy and Systems 07/2014; 12(1):34. DOI:10.1186/1478-4505-12-34 · 1.86 Impact Factor
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    • "One of the main areas of investigation has been (and is still) focused on the study of its correlates and determinants. Among the many proposed causal explanations of research mobilisation, there is the 'credibility' hypothesis, which posits that the mobilisation and utilisation of research evidence depends, at least in part, on the credibility of its source: the knowledge producer (Cousins and Leithwood, 1993; Green et al, 2009). The argument implicitly goes like this: knowledge exchange shares characteristics with market transactions, since knowledge users (for example, policy makers) behave like consumers of market products in that they grant importance to the trustworthiness of the knowledge producers, especially when knowledge asymmetry is high – that is, when a social actor has more knowledge than another in a given situation, likely giving him an advantage. "
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    ABSTRACT: This study provides an empirical test of the assumption that the credibility of the messenger is one of the factors that influence knowledge mobilisation among policy makers. This general hypothesis was tested using a database of 321 social scientists from the province of Quebec that combines survey and bibliometric data. A regression model was used to study the association between indicators of faculty members' credibility and the number of times they have presented research evidence to public or partly government-owned organisations over an 18-month period. Overall, empirical results provide new evidence supporting the credibility hypothesis.
    Evidence & Policy A Journal of Research Debate and Practice 01/2014; 10(1). DOI:10.1332/174426413X662699
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