NIH: Dissemination and Implementation Research in Health

Sponsor: The National Institutes of Health (NIH)

Dissemination and implementation research intends to bridge the gap between public health, clinical research, and everyday practice by building a knowledge base about how health information, interventions, and new clinical practices are transmitted and translated for public health and health care service use in specific settings. Unfortunately, there continues to be great variation in how these terms are used. Dissemination and implementation have both been used to represent the complete process of bringing "evidence" into practice, originally defined as "diffusion." While using the terms dissemination and implementation to cover such a wide area can be very helpful in facilitating discussion, it does not allow for the division of this very complex diffusion process into smaller, more easily addressed research questions that can develop a robust knowledge base. We are inviting applications that will begin to break down the complexity of bridging research and practice.

For the purpose of this FOA, we make a distinction between "dissemination" and "implementation."

Dissemination is the targeted distribution of information and intervention materials to a specific public health or clinical practice audience. The intent is to spread knowledge and the associated evidence-based interventions. Implementation is the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings. This distinction needs to be made because interventions developed in the context of efficacy and effectiveness trials are rarely transferable without adaptations to specific settings. Therefore, research is needed to examine the process of transferring interventions into local settings, settings that may be similar to but also somewhat different from the ones in which the intervention was developed and tested.

Dissemination Research

We are currently missing critical information about how, when, by whom, and under what circumstances research evidence spreads throughout the agencies, organizations, and front line workers providing public health and clinical services. As a necessary prerequisite for unpacking how information can lead to treatment or service changes, we need to understand how and why information on mental health, drug abuse, and other disease treatments may or may not reach many different stakeholders. We need to understand what underlies the creation, transmission, and reception of information on evidence-based psychopharmacological, behavioral, and psychosocial interventions. Successful dissemination of health information (including information about underutilized interventions) may occur quite differently depending on whether the audience consists of consumers, caregivers, practitioners, policymakers, employers, administrators, or other stakeholder groups. Moving the field forward will require studies identifying mechanisms and approaches to package and convey the evidence-based information necessary to improve public health and clinical care services.

Implementation Research

Previous efforts in dissemination research have often assumed that interventions can be transferred into any service setting without modification and that a unidirectional flow of information (e.g., publishing a guideline) is sufficient to achieve practice change. "Success" of the transfer has been largely assessed based on structural measures (such as counts of personnel or contacts) or patient outcome measures that do not specifically assess how the intervention was implemented or whether the implementation remained faithful to the original conceptualization and intent of the intervention. We need the field to develop a knowledge base about "how" interventions are transported to real-world practice settings, which is likely to require more than the dissemination of information about the interventions. This research announcement encourages theory-driven studies to test conceptual frameworks around the implementation process that move away from an exclusively "top-down" approach to a greater emphasis on the resources of local care settings and the needs of multiple stakeholders.

Dissemination and Implementation research needs to involve both interdisciplinary cooperation and trans-disciplinary collaboration, utilizing theories, empirical findings, and methods from a variety of fields not traditionally associated with health research. Relevant fields include: information science, clinical decision-making, organizational and management theory, finance, individual and systems-level behavioral change, public health, business administration, statistics, anthropology, learning theory, and marketing. Meaningful research will include collaboration with stakeholders from multiple public health and/or clinical practice settings as well as consumers of services and their families/social networks.

Research Issues: Listed below are examples of topics supported by this program announcement for dissemination and implementation research. The list is illustrative, not exhaustive. It is expected that investigators responding to this FOA will identify other important research areas.

Analysis of factors influencing the creation, packaging, transmission and reception of valid health research knowledge, ranging from psychological and socio-cultural factors affecting individual practitioners, consumers, primary caregivers and other stakeholder groups to investigations addressing large service delivery systems and funding sources.

Experimental studies to test the effectiveness of individual and systemic dissemination strategies, focusing on outcomes related to the direct outcomes of the strategies (e.g., acquisition of new knowledge, maintenance of knowledge, attitudes about the dissemination strategies, use of knowledge in practice decision-making).

Studies of systemic interventions to impact organizational structure, climate, culture, and processes to enable dissemination and implementation of clinical information and effective clinical interventions.

Studies of efforts to implement prevention, early detection, and diagnostic interventions, as well as treatments or clinical procedures of demonstrated efficacy into existing care systems to measure the extent to which such procedures are utilized, and adhered to, by providers and consumers.

Studies of the capacity of specific care delivery settings (primary care, schools, community health settings, etc.) to incorporate dissemination or implementation efforts within current organizational forms.

Studies that focus on the development and testing of theoretical models for dissemination and implementation processes.

Studies on the fidelity of implementation efforts, including the identification of components of implementation that will enable fidelity to be assessed meaningfully.

Development of outcome measures and suitable methodologies for dissemination and implementation approaches that accurately assess the success of an approach to move evidence into practice (i.e., not just clinical outcomes).

Longitudinal and follow-up studies on the factors that contribute to the sustainability of research-based improvements in public health and clinical practice.

Studies testing the utility of alternative dissemination strategies for service delivery systems targeting rural, minority, and/or other underserved populations.

Studies on how target audiences are defined, and how evidence is packaged for specific target audiences.

Amount: Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary. Although the financial plans of the IC(s) provide support for this program, awards pursuant to this funding opportunity are contingent upon the availability of funds and the receipt of a sufficient number of meritorious applications.

A project period of up to two years and a budget for direct costs of up to two $25,000 modules, or $50,000 per year, may be requested (i.e., a maximum of $100,000 over two years in four modules of $25,000 each). Commensurate Facilities and Administrative (F&A) costs are allowed.

Deadline:

05/24/2007
09/01/2007
01/24/2008
05/01/2008
09/24/2008
01/02/2009
05/22/2009
09/01/2009

For further information, please visit: http://grants1.nih.gov/grants/guide/pa-files/PAR-06-520.html