pubhlth 244 - week 7: dissemination & implementation science

implementation from the outset

• pre-intervention

  • is there a relationship?

• efficacy studies

  • could a program work?

• effectiveness studies

  • does this program work?

• implementation studies

  • what makes the program work in practice settings?

DI science

• EBI

• Dissemination

• Implementation

DI

seeks to understand how to increase the adoption, implementation, & continued use of health-enhancing evidence-based interventions

EBIs

• programs

• practices

• policies

• treatment

dissemination

involves efforts to reach audiences & stakeholders about Eis & strategies to facilitate their adoption

implementation

focuses on planned efforts to support adoption and integration of EBIs into routine practice in community, clinical & public health settings

where to find EBIs?

• community guide

  • evidence-based recommendations & findings from the community preventative services task force

dissemination activities

• designing for dissemination focuses on identifying interested audiences and sharing the EBIs

  • design EBI product + plan for communication, packaging, & distribution

  • identify & engage key audiences who will adopt & sustain EBI

implementation activities

• designing for implementation requires more steps to focus on strategies for effectively implementing in diverse settings

  • engage stakeholders

  • understand problem & set goals

  • find & select EBI

  • adapt EBI

  • implement EBI

  • evaluate EBI

why do some initiatives go “viral”?

• “tipping point” of almost anything can be broken down into 3 things

  • people: connectors, mavens, & salespeople

  • innovation: “stickiness”

  • context: info to get ppl to adopt the innovation so that it “tips” & speads like wildfire

diffusion of innovation for dissemination

• how do you get something to be adopted

s-shaped diffusion curve (“spreading”)

• adpotion of an innovation in a population follows an S-shared curve

  • at first, low % of pop does the behavior

  • as time passes, “infection” starts happening & many more ppl do the behavior

element #1: the innovation (“stickiness”)

• innovations can be an idea, practice, or object

• must be perceived as “new” or “novel”

• should ideally be in line w/ the cultural beliefs & practices of a pop

element #2: communication channels

• 2 distinct communication channels:

• media

• interpersonal

communication channel: media

formal channel (i.e., television, radio, internet, print media)

communication channel: interpersonal

• informal channel (i.e., people)

  • w/ informal communication channels, the concept of homophily (“birds of a feather flock together”) is critical

  • homophily means that any 2 people are very similar in their views, perception, & beliefs within their larger social system

element #3: time

• to understand how diffusion occurs over time it is useful to consider the innovation-decision process

• how quickly, or slowly, people progress through this process is a critical determinant of the rate of diffusion or the time i takes for the innovation to be adopted

  • knowledge

  • persuasion

  • decicion

  • implementation

  • confirmation

element #4: social system (“context”)

• social system:

  • is characterized by norms that define the social structures

  • set boundaries for diffusion & the communication structures spread info about the innovation

  • formal structures

  • informal structures

s-curve influence by type of adopters

• innovators (2.5%)

• early adopters (13.5%)

• early majority (34%)

• late majority (34%)

• laggards (16%)

innovators

• 2.5%

• the “spark” igniting a chain of adoption

• accept risk

• depart from social norms & try new things

• well-respected by their peers then their adoption may become “contagious”

early adopters

• 13.5%

• hold central positions within their communication structures

• generally well respected & even admired by others in their social system

• many early adopters are opinion leaders whose opinions & behavior can start the tipping/diffusion effect

early majority

• 34%

• take relatively longer period of time to pass through the innovation-decision process compared to innovators & early adopters

• more carefully consider the advantages & disadvantages

• large group, so once they adopt then things start spreading like “wildfire”

late majority

• 34%

• comprises people who may require a longer time to pass through the innovation-decision process

• often reluctant to adopt the innovation, and tend have less access to a variety of information sources

• relatively homogeneous social networks

• typically skeptical about change

laggards

• 16%

• represent the last category of potential adopters

• tend to be extremely traditional

• have faw ties to the key opinion leaders of a social system

• may have very limited access to information

• slowest to accept change

• may never adopt the innovation

consolidated framework for implementation research (CFIR)

determination of the characteristics we look for in a potential adoption

rapid growing field

• need for validated measures (e.g., outer and inner settings)

• need to promote consistent use of comparable measures

• must incentivize and support academics to partner with real-world stakeholders from a range of community settings

• need to understand what promotes “de-implementation” of inappropriate, costly, and/or harmful practices

• increasing potential of policy implementation research

re-aim framework

• reach

• effectiveness

• adoption

• implementation

• maintenance