Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

Abstract

The effective dissemination and implementation of evidence-based health interventions within community settings is an important cornerstone to expanding the availability of quality health and mental health services. Yet it has proven a challenging task for both research and community stakeholders. This paper presents the current framework developed by the UCLA/RAND NIMH Center to address this research-to-practice gap by: 1) providing a theoretically-grounded understanding of the multi-layered nature of community and healthcare contexts and the mechanisms by which new practices and programs diffuse within these settings; 2) distinguishing among key components of the diffusion process-including contextual factors, adoption, implementation, and sustainment of interventions-showing how evaluation of each is necessary to explain the course of dissemination and outcomes for individual and organizational stakeholders; 3) facilitating the identification of new strategies for adapting, disseminating, and implementing relatively complex, evidence-based healthcare and improvement interventions, particularly using a community-based, participatory approach; and 4) enhancing the ability to meaningfully generalize findings across varied interventions and settings to build an evidence base on successful dissemination and implementation strategies.

From research to practice: dissemination of the Contraceptive CHOICE Project

“…There is a gap between research and practice which has led to the increased prioritization of dissemination of research findings within health services [11,15,18]. Yet, we found it difficult to identify published manuscripts where the process of disseminating study results is described in detail.…”

Evaluation Protocol To Assess an Integrated Framework for the Implementation of the Childhood Obesity Research Demonstration Project at the California (CA-CORD) and Massachusetts (MA-CORD) Sites

“…88,90 In complex interventions such as CA-CORD and MA-CORD, the distinction between core and peripheral intervention components is often difficult to determine and may be discerned only through trial and error over time as an intervention is ''scaled up'' and adapted for use in a variety of new contexts. 25,91 Careful monitoring of intervention activities and implementation processes can significantly speed up this process. Specific evaluation activities may vary based on available resources.…”

Integrating Sustainable Mental Health Programs in Primary Care

“…Both top-down government systems supports and bottom-up approaches are required [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. Without these components in place, this not only affects the feasibility to effectively integrate training programs in primary care, but also efforts by policy and decision-makers in restructuring services to deliver comprehensive, cost-effective, and patient-centered care could prove fruitless.…”