Why dissemination is important

In addition, for comparative effectiveness reviews, the KQs were posted for public comment and finalized by the EPC after review of the comments. Key Informants are the end-users of research, including patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions.

Within the EPC program, the Key Informant role is to provide input into identifying the KQs for research that will inform health care decisions. The EPC solicits input from Key Informants when developing questions for systematic review or when identifying high-priority research gaps and needed new research. Key Informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism.

Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. Technical experts constitute a multidisciplinary group of clinical, content, and methodological experts who provide input regarding methodological issues and scoping the reviews. They are selected to provide broad expertise and perspectives specific to the topic under development.

Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Technical experts provide information to the EPC to identify literature search strategies and recommend approaches to specific issues as requested by the EPC. Technical experts do not do analysis of any kind nor contribute to the writing of the report.

Because of their unique clinical or content expertise, individuals are invited to serve as technical experts and those who present with potential conflicts may be retained. Peer Reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. Peer review comments on the preliminary draft of the report are considered by the EPC in preparation of preparing the final draft of the report.

Peer Reviewers do not participate in writing or editing of the final report or other products. The synthesis of the scientific literature presented in the final report does not necessarily represent the views of individual reviewers.

The dispositions of the peer review comments are documented and will, for comparative effectiveness reviews and technical briefs, be published 3 months after the publication of the evidence report. Peer Reviewers who disclose potential business or professional conflicts of interest may submit comments on draft reports through the public comment mechanism. This project was funded under Contract No.

Department of Health and Human Services. The TOO reviewed contract deliverables for adherence to contract requirements and quality. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U. Content last reviewed December Search small Search. Table of Contents. Terminology and Definitions Transforming scientific evidence for its use in practice, commonly known as research translation , involves many processes and strategies.

Table 1. Definitions of concepts relevant for this review Concept or Construct Definition As It Relates to Health and Health Care Health communication The study and use of communication strategies to inform and influence individual and community decisions that affect health. Dissemination The targeted distribution of information and intervention materials to a specific public health or clinical practice audience. Communication Techniques Government agencies and institutions, advocacy groups, media organizations, researchers, and other interested stakeholders can all carry out communication activities.

Multiple systematic reviews, however, have explicated key communication techniques that are of interest to the field such as: Tailoring the message— Communication designed for an individual based on information from the individual. Using narratives— Communication delivered in the form of a story, testimonial, or entertainment education. Framing the message— Communication that conveys the same messages in alternate ways e.

Table 2. Effect sizes can vary based on length of followup, variables tailored, type of behavior, population studied general vs. Slater, 9 Nonsystematic review Noar et al. Characteristics can be determined by role, demographic, or social psychological variables. Although we have not found a systematic review on this approach, meta-analysis shows its practice is more common in large-scale communication efforts due to its potential effectiveness.

Hinyard and Kreuter, 11 Theoretical review N not reported Winterbottom et al. Dissemination Strategies Dissemination is the targeted distribution of information and intervention materials to a specific public health or clinical practice audience.

Communicating Uncertainty Uncertainty is inherent in health and health care evidence and can limit its use. Multiple systematic evidence reviews and randomized trials have demonstrated that: Qualitative or non-numeric presentations of probability e. Absolute relative risk and relative risk reduction are more understandable than number needed to treat presentations.

KQ 1 What is the comparative effectiveness of communication techniques to promote the use of health and health care evidence by patients and clinicians? How does the comparative effectiveness of communication techniques vary by patients and clinicians? KQ 2 What is the comparative effectiveness of dissemination strategies to promote the use of health and health care evidence for patients and clinicians?

How does the comparative effectiveness of dissemination strategies vary by patients and clinicians? Table 3. Techniques to communicate evidence: Tailoring the message Targeting the message to audience segments Using narratives Framing the message Using a multipronged approach with any of the communication techniques described above e.

Examples of the sources of evidence that we will consider acceptable are: National Guidelines Clearinghouse U. Figure 1. Analytic framework Methods A. Table 4. Table 5. Included communication techniques KQ 1 Communication Potential Approaches Tailoring the message: Tailoring is a multistep and multidimensional process that involves assessing individual characteristics, creating individualized messages using conceptually or empirically based algorithms that are usually computer driven , and then delivering these messages using a variety of appropriate strategies and channels.

The three main tailoring strategies content matching, personalization, and feedback are often used in combination and can occur within a single message. This is more than a personalized letter e. Individualized feedback may have then been provided synchronously e. Once a group is segmented the messages should be designed in a way to be maximally effective for that target group. Targeting can be accomplished by manipulating language, visuals, music, or choice of behavior topic that make the message more interesting, relevant, or appealing to specific subgroups.

The characters and the situations in stories serve as a model for emulation and learning. Personal stories, case studies, anecdotes, testimonials, and experiential sharing e. Messages that emphasize the positive consequences of compliance are referred to as a positive gain frame , whereas a version that stresses the negative consequence of noncompliance is called a negative loss frame.

Studies should explicitly state that the stimuli differed in terms of a gain or loss frame. Enhance your health! A multicomponent approach uses several communication techniques in concurrent combination or in sequence to increase the comprehension and understanding of evidence. Dissemination KQ 2 : Active dissemination strategies involve active efforts to spread evidence-based information via specific strategies and channels. Table 6.

Included dissemination strategies KQ 2 Dissemination Potential Approaches Improve reach of evidence: Distributing evidence widely to many audiences and across many settings increases the reach of information Any information delivered via a human carrier employed by a government-run postal service to a new destination or a for-profit mail delivery service like Fed Ex or United Parcel Service.

Any information delivered via TV, radio, print newspapers, print magazines, or billboards. Motivate recipients to use and apply evidence: Increasing interest in the evidence Champions aka a cheerleader , such as someone who takes ownership of the evidence and visibly promotes it within his or her own organization or across other settings.

Champions help overcome social and political pressures imposed by an organization, role model personal commitment to the program, and involve others in its use. They may or may not actually participate in the work and do not necessarily have any relationship with the organization to which evidence is to be disseminated. They could endorse the intervention, have a role in its development, or advise on strategies.

The idea here is that an opinion leader is endorsing the idea being disseminated. For example, an opinion leader might be the chief executive officer of a company or the head of a department, or an external expert in a particular field applicable to the evidence, or a well-recognized figure like the Surgeon General of the United States Social networks, such as a network of individuals who are friends, colleagues, or know each other.

This might include tracking sheets to be given to patients and risk calculators to be used by clinicians.

It might also include tailored toolkits that explain implementation of evidence in specific settings. Supporting materials do not include brochures, counseling resources, or resources that originate from the practice.

They must originate from the evidence developer and be given to the end-user. Skill training, capacity building, and problem solving including training in any skill that would allow appropriate use of evidence to overcome barriers ; might include training in recognizing the quality of evidence or the circumstances under which it can be reasonably used; and also includes training in various counseling techniques that would facilitate evidence implementation and interactive seminars.

Table 7. Included components of uncertainty in an entire body of evidence and study-specific uncertainty KQ 3 Component Description Sources: Owens et al. Overall strength of evidence The strength of the evidence represents the degree of confidence that the estimates of effects underlying evidence are correct and is used to provide a comprehensive evaluation of the evidence and an assessment of whether additional evidence might change conclusions.

Strength of evidence requires a value judgment based on the risk of bias, consistency, precision, and directness of evidence see definitions below. Risk of bias The risk of bias is the degree to which individual studies are protected from systematic errors or bias.

Biases may result from study design, study conduct, or confounding by other external variables. Consistency The consistency of a body of evidence reflects the degree to which studies present similar findings—in both direction and magnitude of effect. Evidence lacking consistency includes studies with greatly differing or conflicting effect estimates. Lack of consistency is when studies suggest different effect sizes have a different sign or completely different i.

Precision Precision reflects the degree of random error surrounding an effect estimate with respect to a given outcome; such studies express dispersion around a point estimate of risk, such as a confidence interval, which indicates the reproducibility of the estimate. Directness Directness is the degree to which the evidence links the interventions directly to the question of interest. For instance, evidence on the benefits of screening is often not directly available i.

Therefore, recommendations about screening are derived indirectly from evidence that a preclinical disease can be detected and that there is benefit in treating that same disease once symptomatic. Net benefit Net benefit describes the balance or trade-offs in benefits and harms for prevention or treatment services. Net benefit is based on a judgment call by policymakers. Overall there may be net benefit, clinical equipoise benefit that is too close to call at the population level , or net harm.

Applicability Applicability reflects whether an intervention is expected to have the same effect in the population in which it will be used as compared with the effect in the population in which it was studied.

Table 8. Data Abstraction and Data Management For studies that meet inclusion criteria, we will abstract relevant information into evidence tables. Table 9. Data Synthesis Data synthesis and analysis is a core step in developing a systematic review.

Table Definitions of the grades of overall strength of evidence Grade Definition Source: Owens et al. Further research is very unlikely to change our confidence in the estimate of effect. Moderate Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of the effect and may change the estimate.

There are many ways of disseminating research findings. Formal publication of the results of research most commonly takes place in refereed academic journals or books, but this is not always the case. This section of the Framework applies to all forms of dissemination of research findings, refereed and non-refereed, in any medium of communication, including conferences, public performance and public exhibition.

The University of South Australia is committed to promoting an environment of honesty, integrity, accuracy and responsibility in the dissemination of research findings by:. Since there was no debate about the efficacy of employing corticosteroids to reduce neonatal mortality in the developed world, this Global Network trial primarily focused on implementation and effectiveness. Despite increased use of antenatal corticosteroids among women delivering low-birthweight infants in the intervention group, neonatal mortality did not decrease in this group.

Further, study results showed a surprising increase in harm among users of standard corticosteroid dosing [ 15 ]. Appropriately, these findings were responsible for delaying widespread promotion of the drug and stimulating additional research to determine why use of antenatal corticosteroids are associated with improved preterm birth outcomes in developed countries and what additional components should be added to an intervention strategy based upon antenatal corticosteroid use to achieve comparable results in low-resource settings.

Research can also identify interventions which achieve a desired outcome but also cause unintended consequences or compete long-term with the desired outcomes--e. These are two practices, among many others, which may work at cross-purposes with the very effect that is desired. To report only findings with favorable impact and ignore dissemination of findings of harm would be a violation of principles associated with the ethical conduct of research involving human subjects.

Successful programmatic initiatives often begin at the top level, where executive leadership control available dollars, and then move downwards.

Nevertheless, the importance of widespread education, relevant training and community mobilization cannot be overemphasized, and implementation research can be beneficial by focusing on the desired end-point and engaging those in the community whose support is required.

Our research initiatives in India have shown the importance of empowering community health workers as first-line team players in both the education of soon-to-be as well as presently pregnant women. Further, involvement of these village-based health workers in the early identification of women at risk for health complications has proven beneficial. Nevertheless, adequate dissemination of the knowledge gained through our research is necessary to influence scale-up and widespread diffusion to areas in India beyond our research area.

A growing body of peer-reviewed literature offers advice for translating science into evidence-based healthcare behaviors and practices that promote and improve health and can be sustained. Those writing about implementation science agree that success requires recognition that implementation spans multiple stages. Despite variation in the number and description of stages, relevant publications identify similar activities or steps, which are considered essential for integration of research evidence into practice.

Table 1 below provides recommendations and examples of activities that Woolf et al. Table 2 presents useful recommendations that were developed by Glasgow and Emmons to enhance the movement of research into practice. Strategies for integration of research into practice can be complex; thus, it is beneficial to engage methodological support from the outset, to build necessary training requirements into stages of the implementation process, and to create research and service partnerships early.

Neta et al. Application of such an evaluation framework can play an important role in assuring that a program implemented for research on a small scale is appropriate for the larger population. While assuring sustainability of programs that integrate evidence-based health-promoting practices and behaviors is desirable, sustainability does not require a program to be frozen in time.

Rather, a characteristic of sustainable programs is the ability to adapt and change when new knowledge emerges and needs change. Finally, it is recommended that clinical trials addressing effectiveness as a component of translational research retain sufficient flexibility and incorporate intermediate process evaluations, reflective of the changing needs of the end users.

Goldstein E, Grumbach K. Accessed 31 Mar National Institutes of Health. Baby-friendly hospital designation has a sustained impact on continued breastfeeding. Maternal and Child Health Nutrition. Accessed 10 Jan Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health.

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The motives for dissemination identified in 2. Looking at a range of dissemination activities in this way has led to consideration of why dissemination is important. It has also indicated, implicitly, the consequences of not carrying it out effectively.

Another consideration is that the motives and methods for the use and access of information often need to change over time, and even more so with rapidly changing user expectations and technology. This includes both the ways in which information is managed and disseminated by owners and distributors, and accessed and consumed by users. It is clear that the way in which information is supplied can influence both the way users do things as well as impact what they do.

Demands from users can also likely affect the suppliers of information in a similar manner. Share on. Contribution Contact. Create account or Sign in. C Observations The motives for dissemination identified in 2.