CONCEPTUAL AND METHODOLOGICAL ISSUES IN RESEARCH DISSEMINATION

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CONCEPTUAL AND METHODOLOGICAL ISSUES IN RESEARCH
DISSEMINATION
Russ Glasgow, Ph.D. Kaiser Permanente Colorado
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KAISER PERMANENTE COLORADOCLINICAL RESEARCH UNIT

• MISSION STATEMENT
• To develop, conduct, and translate high-quality
  research into practice
• and to promote evidence-based
• practices and service-oriented, cost-effective
  medical care.

http//kpco-cru.org
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OVERVIEW

• Terminology
• Challenges to Dissemination of EBBM
• Methodological and Evaluation Issues
• Suggested Focal Points for Future

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TERMS AND DEFINITIONS

• Diffusion - the passive process by which a
  program is absorbed into more widespread use
• Dissemination - the active promotion or support
  of a program to encourage its widespread adoption
• Replication - moving a tested prototype program
  to additional sites or target population

Glasgow, et al. (2004) Cancer 101 (Suppl
5)1239-1250 NCI (2002) Designing for
Dissemination Conference, Summary Report
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TRANSLATION
The transfer of evidenced-based knowledge into
routine or representative practice
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INTEGRATION
The informed combination of evidence-based knowle
dge and local contextual knowledge into community
applications.
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TERMS AND DEFINITIONS (cont.)

• Efficacy - research conducted under tightly
  controlled conditions to establish causality
  under optimal conditions
• Effectiveness - research conducted under
  generalizable or real-world conditions to
  determine results under typical conditions

Flay, et al (1986) Efficacy and effectiveness
trialsPreventive Medicine 15451-474
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CHALLENGES TO DISSEMINATION

• Hard to determine applicability to local setting
• Insufficient detail or specificity in protocol
• Protocol does not fit local expertise, patients,
  resources, time or culture
• Protocol not delivered as in EB study

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SIMPLE QUESTIONS FOR DISSEMINATION

• Who comes? (Reach and Representativeness)
• What Outcomes are Produced? (Effectiveness)
  (Intended and Unintended)
• Where Will Program Work? (Adoption and
  Representativeness)
• How Consistently is Program Delivered?
  (Implementation)
• How Long Will Effects Last? (Maintenance)

Dzewaltowski, Glasgow, Klesges, Estabrooks, Brock
(2004) Ann Beh Med 28(2)235-245
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MORE COMPLEX ISSUES FOR DISSEMINATION

• What parts of the protocol are less applicable or
  not consistently implemented?
• How does success come about at multiple levels?
• How much does it cost, what types of costs, and
  how does the value produced compare to
  alternative uses?
• What factors influence adaptation,
  implementation, and institutionalization?

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THE 3 Rs OF DISSEMINATION RESEARCH
Representativeness who participates at patient,
setting, and staff levels
Robustness are results replicable across
subgroups of - settings (large vs small high
vs low resource) - patients (high vs. low
literacy race/ ethnicity)
Re-Invention how is program modified and
adopted over time?
Rotheram-Borus, et al (2004) Interventions that
are CURRESIn Facilitating pathways
Care, treatment, and preventionNew York,
Springer. Rogers, E.M. (2003) Diffusion of
Innovations (5th Edition) New York Free Press
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GENERALIZATIONACROSS

• Patients
• Setting Conditions
• Clinicians
• Outcomes including economic
• Time
• Treatment nuances

Cronbach, et al. (1972) The dependability of
behavioral measurements Theory of
Generalizability for scores and profiles. New
York John Wiley Sons Shadish, et al. (2002)
Experimental and quasi-experimental design for
generalized Causal inference. Boston Houghton
Mifflin
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TERMINOLOGY PART 2

• ADOPTION the percent and representativeness of
  invited settings and clinicians who participate
  in a program
• REACH the percent and representativeness of
  patients or consumers who participate in a
  program
• RETURN-ON INVESTMENT relatively short-term
  results (often in dollars) or benefits of a
  program relative to cost inputs
• INSTITUTIONALIZATION longer-term sustainability
  of a program (after formal research is over) so
  that becomes part of the ongoing culture

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ISSUES FOR THE FIELD

• Fidelity vs. Customization to Local Setting
• Adaptive and Tailored EB Programs vs.
  Standardized, Generic, Static Ones
• Importance and Evaluation of Participatory
  Planning, Delivery, and Evaluation Methods

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SOME MODELS FOR TRANSLATION RESEARCH
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If we want more evidence-based practice, we need
more practice-based evidence. L. W. Green, 2004