Advances in Bridging Research and Practice: Introduction to the Second Special Issue on the Interactive System Framework for Dissemination and Implementation

Department of Psychology and Center for School Based Mental Health Programs, Miami University, Oxford, OH, USA, .
American Journal of Community Psychology (Impact Factor: 1.74). 08/2012; 50(3-4). DOI: 10.1007/s10464-012-9545-3
Source: PubMed
ABSTRACT
The need for new ways to bridge the gap between research and practice is clear; the use of evidence-based prevention programs and implementation with fidelity in practice are strikingly limited. The Interactive Systems Framework for Dissemination and Implementation (ISF) was created to help bridge research and practice by specifying the systems and processes required to support dissemination and implementation of evidence-based programs, processes, practices, and policies. The ISF identifies three key systems necessary for this process which include the Synthesis and Translation System, the Support System, and the Delivery System. The ISF was featured in a special issue of the American Journal of Community Psychology in 2008. This special issue extends that work by including both researchers who have applied an ISF lens to aspects of their current work and researchers who have proactively applied the ISF in a process that goes across the various systems of the ISF, i.e., Synthesis and Translation, Support, and Delivery. Content areas include: children's mental health, teen pregnancy prevention, HIV prevention, violence prevention, heart disease and stroke prevention, breast cancer prevention, and substance abuse prevention. In this introductory article, we provide a brief description of the history of the ISF and a summary of the articles in the special issue.

Full-text

Available from: Catherine A Lesesne, May 05, 2014
ORIGINAL PAPER
Advances in Bridging Research and Practice: Introduction
to the Second Special Issue on the Interactive System Framework
for Dissemination and Implementation
Paul Flaspohler
Catherine A. Lesesne
Richard W. Puddy
Emilie Smith
Abraham Wandersman
Published online: 9 August 2012
Ó Society for Community Research and Action 2012
Abstract Theneedfornewwaystobridgethegapbetween
research and practice is clear; the use of evidence-based
prevention programs and implementation with fidelity in
practice are strikingly limited. The Interactive Systems
Framework for Dissemination and Implementation (ISF) was
created to help bridge research and practice by specifying the
systems and processes required to support dissemination and
implementation of evidence-based programs, processes,
practices, and policies. The ISF identifies three key systems
necessary for this process which include the Synthesis and
Translation System, the Support System, and the Delivery
System. The ISF was featured in a special issue of the
American Journal of Community Psychology in 2008. This
special issue extends that work by including both researchers
who have applied an ISF lens to aspects of their current work
and researchers who have proactively applied the ISF in a
process that goes across the various systems of the ISF, i.e.,
Synthesis and Translation, Support, and Delivery. Content
areas include: children’s mental health, teen pregnancy pre-
vention, HIV prevention, violence prevention, heart disease
and stroke prevention, breast cancer prevention, and sub-
stance abuse prevention. In this introductory article, we
provide a brief description of the history of the ISF and a
summary of the articles in the special issue.
Keywords Interactive Systems Framework
Dissemination Implementation Capacity building
Technical Assistance Public Health
The need for new ways to bridge the gap between research
and practice is clear; the use of evidence-based prevention
programs and implementation with fidelity in practice are
strikingly limited. For example, the U.S. Department of
Education (2011) evaluation of the use of evidence-based
prevention programs in substance abuse and school crime
reported that only 7.8 % of school programs met a standard
of being research-based. Of these research-based programs,
44 % met standards for being implemented with fidelity.
Therefore, approximately 3.5 % of all the school-based
prevention programs in the study were both research-based
and implemented with fidelity. This study illustrates the
proverbial gap between research and practice and the clear
need for better ways to bridge the two.
Historically, funders, scientists and practitioners have
been aware of the need to bridge research and practice dating
as far back to the 1862 Morrill Act, which was designed to
create land-grant colleges and universities to better educate
the population to avail themselves of knowledge of agri-
culture and mechanics. Early models of dissemination in
business, agriculture, pharmaceuticals, and the behavioral
sciences recognized the need for agents and systems of
The findings and conclusions in this special issue on the Interactive
Systems Framework for Dissemination and Implementation are those
of the author(s) and do not necessarily represent the official position
of the Centers for Disease Control and Prevention.
P. Flaspohler (&)
Department of Psychology and Center for School Based Mental
Health Programs, Miami University, Oxford, OH, USA
e-mail: flaspopd@muohio.edu
C. A. Lesesne
ICF International, Atlanta, GA, USA
R. W. Puddy
Centers for Disease Control and Prevention, Atlanta, GA, USA
E. Smith
Pennsylvania State University, University Park, PA, USA
A. Wandersman
University of South Carolina, Columbia, SC, USA
123
Am J Community Psychol (2012) 50:271–281
DOI 10.1007/s10464-012-9545-3
Page 1
change that fostered diffusion and adoption of innovations
(Fairweather and Davidson 1986; Havelock 1973; Rogers
2003). In 2008, the Interactive Systems Framework for
Dissemination and Implementation (ISF) was created to
help bridge research and practice by specifying the systems
and processes required to support dissemination and
implementation of evidence-based programs, processes,
practices, and policies (Wandersman et al. 2008). The ISF
identifies three key systems necessary for this process which
include the Synthesis and Translation System, the Support
System, and the Delivery System. In the 4 years that have
passed since the publication of the first special issue on the
ISF in AJCP, many researchers and practitioners have
applied the key concepts and themes found in the ISF to their
current work. The articles in the second special issue on the
ISF serve as an extension and complement to the original
work. In this introduction to the issue, we outline the roots
and history of the ISF, highlight progress in dissemination/
implementation resulting from the ISF, and provide a brief
overview of the articles contained in this special issue.
The History of the ISF
In a presidential address to the Society for Community
Research and Action, Wandersman (2003) called for the
development of a field of community science which has as a
major goal—to improve the quality of life in our commu-
nities by improving the quality of the practice of treatment,
prevention, health promotion, and education. Community
Science is an interdisciplinary field, which develops and
researches community-centered models that enable com-
munities to use evidence-based interventions more effec-
tively and efficiently. The limitations of concentrating only
on research-to-practice models were described and the need
for broader models was requested. The ISF emerged, in part,
from Wandersman’s call to define and develop a Commu-
nity Science and to find more effective means of under-
standing and supporting the transfer of innovation between/
among practitioners, consumers, researchers, and policy
makers. At the same time, the Division of Violence Pre-
vention (DVP) at the Centers for Disease Control and Pre-
vention (CDC) was challenged by the knowledge that there
were evidence-based approaches for the prevention of
problems such as youth violence and child maltreatment,
but these effective approaches were not being widely
adopted or implemented with quality.
In recognition of the need for stronger collaboration and
support between research and practice, the CDC’s DVP,
the University of South Carolina, and Miami University
initiated a 3 year dissemination/implementation planning
project (Saul et al. 2008). The effort resulted in the creation
of the ISF framework and the initial adoption and expanded
application of the ISF within CDC projects and program-
matic efforts. For example, DVP used the ISF to identify
challenges for each of the three systems and accompanying
research ideas to address the challenges, as well as, actions
taken in response to the planning process to illustrate how a
funder can use the ISF to bridge science and practice (Saul
et al. 2008). In another CDC example, the Division of
Reproductive Health at CDC used the framework proac-
tively in the Promoting Science Based Approaches to Teen
Pregnancy Prevention Project (Lesesne et al. 2008). The
framework was introduced to a broader audience in the
American Journal of Community Psychology special issue
on the ISF in 2008 (Wandersman et al. 2008) that included
authors from several disciplines and interest in multiple
content areas. Awareness and early interest in the ISF
occurred quickly as demonstrated by several events
including presentations at: the 2009 NIH Conference on the
Science of Dissemination and Implementation, at the
American Evaluation Association-CDC Summer Evalua-
tion Institute (Wandersman and House 2010), Biennial
meetings of the Society for Community Research and
Action (Flaspohler et al. 2007; Wandersman et al. 2005)
the Annual Convention of the American Psychological
Association (Flaspohler et al. 2005b), the Annual Confer-
ence of the Society for Prevention Research (Flaspohler
et al. 2005a), and globally in Japan, Brazil, and New
Zealand (university lectures by Wandersman).
The strengths of the first special issue about the ISF
include clearly framing the components of the research to
science process and early demonstration projects built upon
the model (which were more often retrofits of the model). The
current issue extends that work by including both researchers
who have applied an ISF lens to aspects of their current work
and researchers who have proactively applied the ISF in a
process that goes across the various systems of the ISF, i.e.,
Synthesis and Translation, Support, and Delivery. Content
areas include: children’s mental health, teen pregnancy pre-
vention, HIV prevention, violence prevention, heart disease
and stroke prevention, breast cancer prevention, and sub-
stance abuse prevention. The goal in all cases is to build
capacity and better understand the needs, barriers, and
resources necessary for the adoption of evidence-based
practices with fidelity and quality implementation.
The 2008 special issue on the ISF has been widely dis-
seminated and helped establish an important place for
community psychology in the arena of bridging research and
practice. Since its publication, the ISF has been cited over
150 times in a wide range of journals across disciplines
including: The Journal of the American Medical Associa-
tion, The American Journal of Public Health, The American
Journal of Evaluation, Prevention Science, Psychology of
Women Quarterly, and The Journal of Epidemiology and
Public Health. While the ISF was a new framework and thus
272 Am J Community Psychol (2012) 50:271–281
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many submissions to the original special issue were sup-
porting and/or applying the ISF to existing or past efforts in
public health, there was considerable resonance with the
systems, types of capacity, and need for system interaction to
optimize dissemination and implementation opportunities.
At the same time, the growing recognition of the need for
better understanding of dissemination and implementation
resulted in the development of a number of other frameworks
around the same time as the ISF’s debut (e.g., Domitrovich
et al. 2008; Fixsen et al. 2005; Layde et al. 2012). As theories
and models are generated, more attention is paid to the
importance of bridging the research-practice gap both in
terms of action and in terms of research funding (see
Chambers, this issue).
Drawing on lessons learned from the Synthesis and
Translation System of the ISF, CDC realized the impor-
tance of making the ISF more accessible to a wider audi-
ence of practitioners in the field and applied its own
synthesis and translation process to the original science
behind the ISF itself. The resulting product is a translated
ASAP (Applying Science, Advancing Practice) publication
(see ‘Appendix 1’) that puts the ISF into user friendly
language and format. If you are unfamiliar with the basic
concepts of the ISF, you are encouraged to review the
original paper describing the ISF (Wandersman et al.
2008), the ASAP synthesis publication (‘‘Appendix 1’),
and the paper by Thigpen et al. (this issue) that describes
the process of developing the ASAP translation product.
The Call for Papers and Response
Nearly a decade has passed since work began on developing
the ISF. In that time, partnerships between researchers,
funders, and community practitioners have led to demon-
stration projects based upon the ISF model. This work is
timely and relevant for community psychologists and allied
disciplines vested in designing programs, policies, and
practices that create or sustain effective action. The chal-
lenge facing many change agents (practitioners and
researchers alike) is how to use the best available evidence
to inform and mobilize communities and systems to opti-
mize the benefit of the programs, policies, and practices.
The ISF provides a framework that can be illuminated and
enhanced by the unique and common perspectives of
funders, researchers, practitioners, and consumers. Our
goals for this 2012 special issue were to provide a forum to
further illuminate the ISF framework through: (1)
Expanding multi-disciplinary interest in research and
application of the ISF through contributions from a wide
variety of fields; (2) Disseminating innovative applications
of ISF-inspired efforts with more depth and reflection on
the framework; and (3) Presenting research, evaluation,
and critiques of the framework, its three main system
components in action, the interaction between the systems,
and/or the contextual features that surround the ISF.
When the call for papers for the second special issue on
the ISF was released, over 30 inquiries were submitted,
signaling continued interest in its uptake. Furthermore, part
of the success and attraction of the ISF was that it intro-
duced the concept of systems being critical to the nature of
the work of dissemination and implementation. The systems
concept was brought to life and emphasized as one of the
distinguishing features of the ISF. Taken as a whole, these
articles provide insight into new and fertile directions to
focus both research and action in the social and behavioral
sciences. If programs and services are developed to promote
the greater good (or deliver outcomes that should benefit
individuals, groups, and societies) and we know that there is
a gap between research-proven practices and the achieve-
ment of their presumed good in the ‘real world,’ then a
systems approach to bridge this gap should lead to benefits
to society. In this next section, we present the organization
of the special issue and provide some perspective on the
contributions and limitations of the special issue.
Illuminations
The majority of articles presented in this issue focus pri-
marily on the Support System (e.g., the trainers, consultants
that help foster implementation), the Delivery System (e.g.,
the staff and organizations involved in service provision),
and the interaction between these two systems. In short, most
contributors focused primarily on understanding and
enhancing implementation of evidence-based programs and
services through conceptualizing, assessing, and evaluating
Support System functions, attributes of the Delivery System,
or both. Efforts to conceptualize and test functions of Sup-
port Systems and their impact on Delivery Systems represent
a great leap forward in addressing questions in the research-
practice gap and illuminating how the ISF framework does
and does not facilitate our ability to accomplish these aims.
These articles are presented first in the special issue.
The Delivery System
A number of articles focus on attributes of the Delivery
System (broadly defined) that are associated with suc-
cessful implementation. For example, Chinman et al. (this
issue) provide a baseline analysis showing that initial
practitioner capacity predicts the quality and performance
of prevention programs. By testing the first link in the
chain of causation, Chinman et al. are moving toward
testing the full causal links between an innovation, efforts
to build capacity to effectively use the innovation, delivery
Am J Community Psychol (2012) 50:271–281 273
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of the innovation, and ultimately the achievement of
intended consumer-level outcomes associated with the
innovation. Similarly, Halgunseth et al. (this issue) use the
ISF as a model for understanding how general capacity
influences implementation of the evidence-based Good
Behavior Game (Embry 2002) in after-school settings.
Gregory et al. (this issue) examine how sensitivity to
organizational culture, cultural competence, and motiva-
tional interviewing affect building capacity for and deliv-
ering prevention programs and services. These articles
contribute to increasing our understanding of how to con-
ceptualize, measure, and build characteristics that influence
implementation and dissemination that might be applicable
across many interventions.
The next two articles pay particular attention to the
roles, structures, and attributes of community coalitions
and their relationship and functioning within the ISF
framework. Saldana and Chamberlain (this issue) describe
the Community Development Teams approach, wherein
interdisciplinary coalitions are created to support imple-
mentation of Multidimensional Treatment Foster Care.
Firesheets et al. (this issue) describe collaboration between
a professional support system and grassroots community
coalitions (labeled community support systems).
The Support System
The Support System is the focus of a number of articles.
Several are concerned with implementation of a particular
program or service. For example, Smythe-Leistico et al.
(this issue) describe support for implementation of a kin-
dergarten transition project. Duffy et al. (this issue)
examine a Support System for teen-pregnancy prevention.
The authors describe a state-level initiative to implement
teen pregnancy prevention using the Getting To Outcomes
(GTO) approach. They examine the impact of training and
technical assistance on the level of implementation of
pregnancy prevention programs. Rhoades et al. (this issue)
demonstrate how a state-level Support System in Penn-
sylvania has used empirical evidence to inform general and
program-specific capacity building that support interactions
among researchers, funders, and practitioners. Rhoades
et al. expand on the ISF model incorporating funders and
policy-makers as engaged stakeholders. Using the expan-
ded ISF as a model for the wide-scale dissemination and
support of evidence-based practices (EBPs), Pennsylvania
has created an infrastructure to address the primary barriers
to moving from lists of EBPs to achieving population-level
public health improvement.
Several articles address the interaction between the
Support System and the Delivery System. Florin et al. (this
issue) describe how the ISF was applied in Rhode Island
(RI) communities implementing the SAMSHA Strategic
Prevention Framework by developing a Training and
Technical Assistance Resources Center to support Delivery
System members in their efforts to reduce substance abuse
in RI communities. Florin et al. examined relationships
between training and technical assistance and Strategic
Prevention Framework implementation and outcomes—
connecting the activities of the Support System to the
practice outcomes of the Delivery System. Ray et al. (this
issue) describe how the strategic combination of training of
trainer (TOT) models with proactive technical assistance
may lead to more optimal outcomes than simply TOT
models alone—thus informing better practices in the
transfer of knowledge, skills, and capacity to the Delivery
System. Flaspohler et al. (this issue) describe the goals and
activities of a system for supporting the implementation of
evidence-based practices in schools. This article provides a
concrete example of actions used to build both general and
innovation-specific implementation capacity involving
‘ready and willing schools; the processes used to build
capacity using training and consultation; and the efforts to
monitor program fidelity. This article bridges the Support
System and the Delivery System. Wandersman et al. (this
issue) focus on the Support System interaction with the
Delivery System as well. They propose an evidence-based
approach to tools, training, technical assistance, and quality
assurance/quality improvement. The article describes the
Getting To Outcomes (GTO) accountability approach as a
structure to enhance the science and practice of innovation
support; the comprehensive approach includes planning,
implementation, evaluation, and sustainability.
There is a strong emphasis on implementation
throughout the special issue. A synthesis and translation of
implementation science is presented by Meyers et al. in
two articles: (1) a synthesis of 25 implementation frame-
works (Quality Implementation Framework) (Meyers et al.
this issue) focuses on specific actions that can be employed
to foster high quality implementation, and (2) a translation
of the results of the synthesis (Quality Implementation
Tool) and its use for improving quality of implementation
(Meyers et al. this issue). Rapkin et al. (this issue) suggest
the advantages of using the ISF to frame a rigorous
approach to evaluation that incorporates quality improve-
ment principles into the dissemination of evidence-based
strategies to promote early detection of breast cancer
through screening.
The Framework
Several articles examine the ISF as a whole. For example,
Collins et al. (this issue) compare the ISF with the CDC’s
Division of HIV/AIDS Prevention dissemination model
drawing specific attention to similarities and differences,
but ultimately illustrates how the two models are
274 Am J Community Psychol (2012) 50:271–281
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complementary with each contributing substantially to
addressing the gap between identifying effective programs
and ensuring their widespread adoption in the field. A final
set of articles are examples of how the ISF has been used as
a whole as either a tool or a framework for the development
or improvement of dissemination efforts. For example,
Taylor, Weist, and DeLoach (this issue) describe the way
that the ISF was used to frame discussion of how to support
dissemination and implementation of evidence-based
trauma services in New Orleans schools after Hurricane
Katrina. Lane et al. (this issue) describe how the ISF was
used to frame the evaluation of report recommendations
from the Institute of Medicine to prevent and control
hypertension. Lewis et al. (this issue) describe how the ISF
guided the development of a synthesis/translation tool
intended to promote the use of evidence-based teen preg-
nancy prevention and the multi-layered support systems
and strategies used to support the innovation in practice
settings.
Plenty of Room for Continued Refinement
The contributions in this special issue demonstrate
advancement in the thinking and the empirical investiga-
tion of the ISF and ISF-like systems of moving research
into practice; however, there remains a paucity of research
using rigorous designs to test the implied causal pathways
from system to system explicated in the ISF. Although
Chinman et al. (this issue) and Lane et al. (this issue) may
soon have more data and ability to rigorously test aspects
of the framework, we are not there yet.
Also, there were not contributions in the issue that truly
reflected the dynamic interaction of the Delivery System
through the Support System to inform the Synthesis and
Translation system. Efforts to identify practice-based
innovations worthy of further research and, if effective,
refined Support System to bolster these innovations in
practice—were not submitted. Methods such as the sys-
tematic screening and assessment methodology (Leviton
and Gutman 2010) used to identify innovative practices
developed by the Delivery System were absent from this
issue. Perhaps this reflects the audience of the journal or a
lack of resonance with the ISF among those aiming to build
practice-driven/practice-based innovations.
Most of the articles presented here are about the
movement of research-proven programs into new settings.
There is very little about movement of practice in the
opposite direction. Our best examples of movement in this
direction might be the pieces that describe necessary fac-
tors and conditions in the Delivery System (on the ground)
that are associated with achievement of outcomes (e.g.,
Firesheets et al.; Chinman et al.; Flaspohler et al.; Saldana
et al.; and Gregory et al.). The ISF came from explicit
recognition that understanding both research to practice
models (focused in development and dissemination of
rigorously evaluated interventions) and community- cen-
tered models (which emphasize community control and
participation in developing locally driven solutions to high-
priority problems) provide valuable insight for strength-
ening dissemination and implementation. It is worth noting
the absence of submissions to the second special issue on
the ISF that emphasize community-centered or community
developed strategies or programs.
Coalitions like those described here in various manu-
scripts have become critical agents in promoting commu-
nity and school-based prevention, but they do not always fit
cleanly into the ISF systems. They are not necessarily
engaged directly in the delivery of services or serve in
support roles, but play a gatekeeping role—facilitating
access between the support and delivery systems or acting
as paraprofessional support providers. This point is shared
by many examples of multi-layered Support Systems and
Delivery Systems. More needs to be known about how to
create effective interfaces among the ISF systems, specif-
ically among the Support System and coalitions.
The articles in this second special issue on the ISF are
located between a foreword by Chambers (this issue) who
describes how the ISF can assist the NIH in reaching out
from the clinical/medical innovations perspective to the
world of clinical practice and a commentary by Noonan,
Wilson, & Mercer (this issue) who describe how the ISF
can further assist CDC in bridging applied research and
public health practice. The two perspectives are energizing
in that the ISF continues to provide a systems structure to
be built upon conceptually and empirically to help bridge
research and practice.
Acknowledgments We would like to thank the following people for
reviewing submissions for this Special Issue: Gregory Aarons,
Melanie Barwick, Gary Blau, David Chambers, Matthew Chinman,
Christian Connell, Joe Durlak, Rochelle Fritz, Joel Gaffney, Jennifer
Gibson, Corinne Graffunder, Linda C. Halgunseth, Anna Hung,
Pamela Imm, David Julian, Hal A. Lawson, Melissa A. Maras,
Elizabeth A. Mellin, Trisha Mueller, Sandra Naoom, Rita Noonan,
Larry Pasti, Nathaniel Riggs, Jean Schenshul, Vanessa Watts, Kathi
Wilson.
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Appendix 1
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    • "Identify existing D&I resources and toolkits.Information on D&I models and frameworks was obtained from work published by investigators from the CDC Prevention Research Center at Washington University in St. Louis[44,45]. Key models from diffusion theory[14,46,47]and referenced by the Implementation Science Division of the National Cancer Institute484950515253were presented. Methods and approaches in stakeholder engagement were adapted from work supported through the NIH CTSA program[35,54,55]. "
    [Show abstract] [Hide abstract] ABSTRACT: Currently, national training programs do not have the capacity to meet the growing demand for dissemination and implementation (D&I) workforce education and development. The Colorado Research in Implementation Science Program (CRISP) developed and delivered an introductory D&I workshop adapted from national programs to extend training reach and foster a local learning community for D&I. To gauge interest and assess learning needs, a pre-registration survey was administered. Based on feedback, a 1.5-day workshop was designed. Day 1 introduced D&I frameworks, strategies, and evaluation principles. Local and national D&I experts provided ignite-style talks on key lessons followed by panel discussion. Breakout sessions discussed community engagement and applying for D&I grants. A workbook was developed to enhance the training and provided exercises for application to an individual's projects. Day 2 offered expert-led mentoring sessions with selected participants who desired advanced instruction. Two follow-up surveys (immediate post-workshop, 6 months) assessed knowledge gained from participation and utilization of workshop content. Ninety-three workshop registrants completed an assessment survey to inform workshop objectives and curriculum design; 43 % were new and 54 % reported a basic understanding of the D&I field. Pre-registrants intended to use the training to "apply for a D&I grant" (73 %); "incorporate D&I into existing projects" (76 %), and for quality improvement (51 %). Sixty-eight individuals attended Day 1; 11 also attended Day 2 mentoring sessions. In the 1-week post-workshop survey (n = 34), 100 % strongly agreed they were satisfied with the training; 97 % strongly agreed the workshop workbook was a valuable resource. All Day 2 participants strongly agreed that working closely with faculty and experts increased their overall confidence. In the 6-month follow-up evaluation (n = 23), evidence of new D&I-related manuscripts and grant proposals was found. Training materials were published online ( www.ucdenver.edu/implementation/workshops ) and disseminated via the National Institutes of Health (NIH) Clinical and Translational Science Awards Consortium. To sustain reach, CRISP adapted the materials into an interactive e-book ( www.CRISPebooks.org ) and launched a new graduate course. Local D&I training workshops can extend the reach of national training programs.
    Full-text · Article · Dec 2015 · Implementation Science
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    • "The adoption and implementation of evidence-based care guidelines and quality improvement (QI) practices into everyday practice is limited; hence, scientific advances rarely reach their population potential in a timely manner123456789101112. One underlying reason is that most prior research focused on developing and evaluating interventions but not on the distinct methods used to support such interventions' uptake into practice131415. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting. Methods/design: This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics' ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the "how" and "why" underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in "real-world" practices. Discussion: Having a better understanding of how different strategies support implementation efforts could positively impact the field of implementation science, by comparing practical, generalizable methods for implementing clinical innovations in community health centers. Bridging this gap in the literature is a critical step towards the national long-term goal of effectively disseminating and implementing effective interventions into community health centers. Trial registration: ClinicalTrials.gov, NCT02325531.
    Full-text · Article · Oct 2015 · Implementation Science
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    • "Fortunately, 65% of daily teen smokers report that they want to quit (13, 14). The prevalence and consequences of teen smoking coupled with the new evidence on cessation program effectiveness, indicates an unequivocal need for effective, widely disseminated youth smoking cessation interventions (7, 15). "
    [Show abstract] [Hide abstract] ABSTRACT: The not-on-tobacco program is an evidence-based teen smoking cessation program adopted by the American Lung Association (ALA). Although widely disseminated nationally via ALA Master Trainers, in recent years, adoption and implementation of the N-O-T program in West Virginia (WV) has slowed. WV, unfortunately, has one of the highest smoking rates in the US. Although it is a goal of public health science, dissemination of evidence-based interventions is woefully understudied. The present manuscript reviews a theoretical model of dissemination of the not-on-tobacco program in WV. Based on social marketing, diffusion of innovations, and social cognitive theories, the nine-phase model incorporates elements of infrastructure development, accountability, training, delivery, incentives, and communication. The model components as well as preliminary lessons learned from initial implementation are discussed.
    Full-text · Article · Aug 2014 · Frontiers in Public Health
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