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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    • "Third, more research is needed to demonstrate (cost-)effectiveness of lifestyle interventions, in particular those aimed at increasing physical activity, eating a healthy diet, and losing weight. In addition, more insight into how health care professionals perceive evidence-based lifestyle interventions and why they adopt or reject them would provide more guidance for intervention developers to design interventions that fit the real-world environment (Glasgow et al., 2012; Green et al., 2009). Finally, it would be valuable to investigate how smoking cessation interventions found their way into Dutch practice, in order to learn from their successes and failures and speed up the dissemination and implementation of evidence-based interventions addressing other important health behaviors. "
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    ABSTRACT: Background: The application of evidence-based lifestyle interventions is suboptimal, but little is known what interventions are actually used. This study aimed to explore the range of lifestyle interventions used in Dutch ambulatory health care settings. Method: We conducted interviews (n = 67) in purposefully selected hospitals, general practices, and community care organizations. Interviews focused on identifying activities to help patients stop smoking, reduce alcohol consumption, increase physical activity, eat a healthy diet, and lose weight. We also asked who developed the interventions. All reported activities were registered and analyzed. Results: Four categories of health promotion activities emerged: giving advice, making referrals, offering counseling, and providing lifestyle interventions organized separately from the care process. In total, 102 lifestyle interventions were reported. Forty-five interventions were developed by researchers, of which 30 were developed by the Dutch Expert Center on Tobacco Control. Providers did not know the source of 31 interventions. Eighteen interventions were developed by the providers themselves, and eight were based on evidence-based guidelines. Conclusions: Health promotion activities seemed to be widely present in Dutch health care, in particular smoking cessation interventions. Although health care providers use many different interventions, replacing nontested for evidence-based interventions is required.
    Full-text · Article · Jan 2016 · Health Promotion Practice
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    • "The standard approach to improving medical practice includes developing and disseminating clinical guidelines . Developing the guidelines involves panels of experts systematically reviewing the literature, achieving consensus, and publishing the results in a medical journal intended for the clinical audience[4]; this approach leaves a great gap between clinical knowledge and clinical practice5678. Various approaches have been tried to narrow this gap, such as providing educational materials, audit/feedback[9], and academic detailing[10], with mixed success; about 30–40% of patients do not receive evidence-based care, and about 20–25% of care given is unnecessary or potentially harmful[8,11]. Clinicians tend to continue to do what is comfortable, and value personal experience and familiar practice routines over scientific evidence[12]. "
    Full-text · Working Paper · Jan 2016
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    • "There is a well-established disconnect between evidence-based practice and the realties of clinical service provision across health professions including physical therapy, occupational therapy, mental health services and speech-language pathology (Boaz, Baeza, & Fraser, 2011; Burke & Gitlin, 2012; Douglas et al., 2014). A myriad of factors contribute to this gap including the sometimes-competing priorities of clinicians and researchers, the external validity of research studies, and the persisting belief systems of clinicians (Green, Ottoson, García, & Hiatt, 2009). This gap furthermore lends itself to inconsistencies in service provision, which ultimately have a negative impact on client outcomes (Stetler, Ritchie, RycroftMalone, Schultz, & Charns, 2009). "
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    ABSTRACT: The Consolidated Framework for Implementation Research (CFIR) was developed to merge research and practice in healthcare by accounting for the many elements that influence evidence-based treatment implementation. These include characteristics of the individuals involved, features of the treatment itself, and aspects of the organizational culture where the treatment is being provided.
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