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Dissemination Science: Designing for impact, and implications for SCTC. Douglas Luke, PhD. May 1, 2014. Goals. Problem: Discovery to delivery gap Solution: Designing for Dissemination & Impact Examples from tobacco control Tobacco control guides SCTC. Problem: Discovery to Delivery Gap.

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slide1

Dissemination Science:

Designing for impact, and implications for SCTC

Douglas Luke, PhD

May 1, 2014

slide2

Goals

  • Problem: Discovery to delivery gap
  • Solution: Designing for Dissemination & Impact
  • Examples from tobacco control
    • Tobacco control guides
    • SCTC
slide4

Scurvy!

http://greas.ca/publication/pdf/melaniebarwickenglish.pdf

slide5

The Promise of D&I Science

…there is still an enormous gap between what we know can maximize the quality of health care and what is currently being delivered in practice and community settings.

…to optimize public health we must not only understand how to create the best interventions, but how to best ensure that they are effectively delivered within clinical and community practice.

NIH, OBSSR

slide6

http://www.thepermanentejournal.org/files/Fall2010PDFS/PerinatalResearchUnit.pdfhttp://www.thepermanentejournal.org/files/Fall2010PDFS/PerinatalResearchUnit.pdf

slide10

Consequence of Dissemination & Implementation Gap

  • Poor quality health care
  • Ineffective and patchwork policies
  • Suffering, morbidity are prolonged
  • Nation doesn’t benefit from billions of US tax dollars spent on research to develop & test effective care and evidence-based policies
slide11

Low Tax

No Statewide Smoke-free

State TC Disparities

Source: Campaign for Tobacco Free Kids

High Tax

Statewide Smoke-free

slide12

Dissemination & Implementation Gaps in Tobacco Control

  • Dissemination
    • Awareness of evidence-based guidelines (e.g., Best Practices) is high among national and state TC leaders, but low among local and regional TC practitioners
    • Lack of useful implementation guides and training that translate science into program and policy development
  • Implementation
    • Half of states have no comprehensive smokefree policies
    • Many states have been slow to implement aggressive pricing policies
slide13

What is dissemination?

An active approach of spreading evidence-based information to the target audience via determined channels using planned strategies

– Brownson, et al., 2013, AJPH

slide14

Historical context (abbreviated)

  • Seminal article in 1943 on diffusion of hybrid seed corn in two Iowa communities
    • Key findings
      • Adoption as key dependent variable, change agents, importance of different communication channels
slide15

Diffusion of innovations

    • Diffusion = the process through which an innovation is communicated through certain channels over time among the members of a social system
  • Most influential theory guiding dissemination science (Rogers)
    • Early development emphasized temporal patterns and actor characteristics
slide16

Models for dissemination

  • Many dissemination models exist
    • Tabak and colleagues have identified 37 (Tabak, et al., 2012, AJPM)
slide18

Dissemination and Impact Pipeline Model

Scientific

Activity

Scientific

Dissemination

slide19

Dissemination and Impact Pipeline Model

Policymakers

Community & Advocacy

Partners

Scientific

Activity

Scientific

Dissemination

Public Health

Impact

Practitioners & Clinicians

Legal

Audiences

Funders

slide20

Dissemination and Impact Pipeline Model

Policymakers

Community & Advocacy

Partners

Scientific

Activity

Scientific

Dissemination

Public Health

Impact

Practitioners & Clinicians

Legal

Audiences

Funders

Media

slide21

Dissemination and Impact Pipeline Model

Policymakers

Community & Advocacy

Partners

Scientific

Activity

Scientific

Dissemination

Public Health

Impact

Practitioners & Clinicians

Push

Legal

Audiences

Funders

Media

Pull

slide22

Barriers to Effective Dissemination (on the ‘Push’ side)

  • What factors get in the way of pushing science into effective policy & practice?
    • Putting dissemination ‘at the end’
    • Lack of funding and infrastructure
    • Reliance on single dissemination modes
    • Reliance on outmoded dissemination approaches and models
    • Lack of training, general media ‘savviness’
    • Lack of appropriate incentives
    • Professional jealousy
    • For tobacco control: Interference and misinformation from the tobacco industry
slide23

Principles of Designing for

Dissemination & Impact

  • Be active - passive dissemination does not work
  • Be repetitive - single messages do not work
  • Use multiple channels - single channels are less effective
  • Involve stakeholders early - otherwise information may not be heard and used
  • Be a translator – tailor information to specific audiences

Adapted from Tabak, et al., 2012, AJPM; and Mueller, et al., 2008, JPHMP)

slide24

Figure 2. A framework for dissemination of evidence-based policies

Define EBPs

Active Dissemination

Policy content

Audience Research

Passive

Dissemination

Policy process

Attributes affecting dissemination: relative advantage, complexity, cost

5. Maintenance

1. Innovation Development

  • Build the rationale for evidence-based policies
  • Development of the Community Guide and other sources on policy interventions
  • Build source credibility

2. Awareness

  • Begin active knowledge transfer
  • Identify target audience factors
  • Identify communication channels

3. Adoption

  • Uptake of the policy by the target audience(s)
  • Target adoption to attitudes and values of intended audience
  • Identify barriers to adoption
  • Improve the skills of adopters
  • Provide training and technical assistance

4. Implementation

  • Ongoing implementation and continued use of the innovation
  • Ensure policy enforcement

Policy outcomes

slide25

Necessary Skills & Training

  • Health communications
  • Infographics and visual design
  • Marketing and science journalism
  • Social media
  • Organizational behavior
  • Dissemination & implementation science
slide27

Example: Tobacco Control Guides

  • Responding to practitioners’ need for translating Best Practices into practical program and policy implementation

February 2014

April 2014

February 2014

Available at: http://cphss.wustl.edu/Projects/Pages/Tobacco-Control-Guides

slide28

Tobacco Control Guides

Incorporating audience guidance and feedback

Audiences: Advocacy, Practitioners, Legal, Science

slide29

Tobacco Control Guides

Tailoring scientific information for practitioner audience

slide30

Tobacco Control Guides

Telling stories

slide31

Tobacco Control Guides

Repeating information and using visual displays to emphasize the ‘take home message.’

slide32

Tobacco Control Guides

Using infographics to provide rich information and support story telling

slide33

Tobacco Control Guides

Using pictures and graphics to enhance the attractiveness of the report, and to frame the content

slide34

It’s Not All on You…

  • Distinguishing between dissemination skills and strategies on the one hand…
  • And a dissemination system on the other hand
  • You (as the scientist) do not need to be the primary or exclusive disseminator
    • Good tobacco control science comes first…
    • But you should be connected to the dissemination system so that your work is communicated accurately
slide35

SCTC and Dissemination for Impact

  • Importance of dissemination for SCTC
    • Central position in evaluation logic model
    • Builds on history of strong dissemination partnerships
  • Getting off to a strong start
    • Workgroups, core projects, developmental projects
    • Diversity of dissemination products & activities (e.g., website, reports, training materials, DVDs, tailored products)
slide36

For more information…

Douglas Luke, PhD

dluke@.wustl.edu

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