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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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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


Scurvy!

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


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


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


Dissemination also takes too much time in tobacco control


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


Low Tax

No Statewide Smoke-free

State TC Disparities

Source: Campaign for Tobacco Free Kids

High Tax

Statewide Smoke-free


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


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


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


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


  • Models for dissemination

    • Many dissemination models exist

      • Tabak and colleagues have identified 37 (Tabak, et al., 2012, AJPM)


    Solution: Designing for Dissemination to Enhance Impact


    Dissemination and Impact Pipeline Model

    Scientific

    Activity

    Scientific

    Dissemination


    Dissemination and Impact Pipeline Model

    Policymakers

    Community & Advocacy

    Partners

    Scientific

    Activity

    Scientific

    Dissemination

    Public Health

    Impact

    Practitioners & Clinicians

    Legal

    Audiences

    Funders


    Dissemination and Impact Pipeline Model

    Policymakers

    Community & Advocacy

    Partners

    Scientific

    Activity

    Scientific

    Dissemination

    Public Health

    Impact

    Practitioners & Clinicians

    Legal

    Audiences

    Funders

    Media


    Dissemination and Impact Pipeline Model

    Policymakers

    Community & Advocacy

    Partners

    Scientific

    Activity

    Scientific

    Dissemination

    Public Health

    Impact

    Practitioners & Clinicians

    Push

    Legal

    Audiences

    Funders

    Media

    Pull


    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


    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)


    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


    Necessary Skills & Training

    • Health communications

    • Infographics and visual design

    • Marketing and science journalism

    • Social media

    • Organizational behavior

    • Dissemination & implementation science


    Examples


    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


    Tobacco Control Guides

    Incorporating audience guidance and feedback

    Audiences: Advocacy, Practitioners, Legal, Science


    Tobacco Control Guides

    Tailoring scientific information for practitioner audience


    Tobacco Control Guides

    Telling stories


    Tobacco Control Guides

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


    Tobacco Control Guides

    Using infographics to provide rich information and support story telling


    Tobacco Control Guides

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


    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


    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)


    For more information…

    Douglas Luke, PhD

    dluke@.wustl.edu


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