Section 10: Dissemination, Scale-Up and Sustainability of Pragmatic Research

10.1 Introduction

[NEED INTRO CONTENT]

10.2 Designing for Dissemination, Sustainability & Equity

[NEED CONTENT BASED ON OUTLINE BELOW – this outline from Brownson 2020]

Describe core principles of designing for dissemination (D4D).

Learn about progress in conducting D4D.

Describe D4D methods.

Learn how to incorporate D4D principles in your work to make it more pragmatic.

Key Points:

Oriented primarily for practice audiences

“Big P” Policy D4D has some important differences

The definition of evidence and outcomes

Laws, healthcare reimbursement policies

Kingdon’s politics streams and policy windows

What makes D4D ‘pragmatic’?

Thought Questions:

What are some impacts that your work is having or impacts hoped for in the future?

What makes D4D impactful, pragmatic, and action-oriented?

References

  • Brownson RC, Colditz GA, Enola Knisley Proctor. Dissemination and Implementation Research in Health : Translating Science to Practice. Oxford University Press; 2018.
  • Brownson RC, Fielding JE, Green LW. Building Capacity for Evidence-Based Public Health: Reconciling the Pulls of Practice and the Push of Research. Annu Rev Public Health. 2018;39:27-53. doi:10.1146/annurev-publhealth-040617-014746
  • Brownson RC, Jacobs JA, Tabak RG, Hoehner CM, Stamatakis KA. Designing for dissemination among public health researchers: findings from a national survey in the United States. Am J Public Health. 2013;103(9):1693-1699. doi:10.2105/AJPH.2012.301165
  • Brownson RC, Eyler AA, Harris JK, Moore JB, Tabak RG. Getting the Word Out: New Approaches for Disseminating Public Health Science. J Public Health Manag Pract. 2018;24(2):102-111. doi:10.1097/PHH.0000000000000673
  • Green LW, Ottoson JM, García C, Hiatt RA. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health. 2009;30:151-174. doi:10.1146/annurev.publhealth.031308.100049
  • Knoepke CE, Ingle MP, Matlock DD, Brownson RC, Glasgow RE. Dissemination and stakeholder engagement practices among dissemination & implementation scientists: Results from an online survey. PLoS One. 2019;14(11):e0216971. Published 2019 Nov 13. doi:10.1371/journal.pone.0216971
  • Tabak RG, Stamatakis KA, Jacobs JA, Brownson RC. What predicts dissemination efforts among public health researchers in the United States?. Public Health Rep. 2014;129(4):361-368. doi:10.1177/003335491412900411
  • Slater MD, Kelly KJ, Thackeray R. Segmentation on a shoestring: health audience segmentation in limited-budget and local social marketing interventions. Health Promot Pract. 2006;7(2):170-173. doi:10.1177/1524839906286616
  • Kwan BM, Brownson RC, Glasgow RE, Morrato EH, Luke DA. Designing for Dissemination and Sustainability to Promote Equitable Impacts on Health. Annu Rev Public Health. 2022;43:331-353. doi:10.1146/annurev-publhealth-052220-112457
  • Reno JE, Ong TC, Voong C, et al. Engaging Patients and Other Stakeholders in “Designing for Dissemination” of Record Linkage Methods and Tools. Appl Clin Inform. 2023;14(4):670-683. doi:10.1055/a-2105-6505

Videos

Designing for Dissemination: Beginning with the End in Mind

Principles, Methods, and Systems for Designing for Dissemination, Sustainability, and Equity

10.3 Measuring Impact

[NOTE: THIS CONTENT FROM LUKE 2022, NEED PERMISSION TO USE]

The Translational Science Benefits Model (TSBM) is a framework for assessing the health and societal benefits of clinical and translational science. The framework was developed by a cross-disciplinary team including members of the Institute of Clinical and Translational Sciences (ICTS), Bernard Becker Medical Library at Washington University School of Medicine, and the Center for Public Health Systems Science at the Brown School at Washington University.

The TSBM can help researchers, administrators and policymakers measure the impact of their work in four distinct domains: CLINICAL, COMMUNITY, ECONOMIC, and POLICY.

References

  • Luke DA, Sarli CC, Suiter AM, et al. The Translational Science Benefits Model: A New Framework for Assessing the Health and Societal Benefits of Clinical and Translational Sciences. Clin Transl Sci. 2018;11(1):77-84. doi:10.1111/cts.12495
  • Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health. 2010;100(4):590-595. doi:10.2105/AJPH.2009.185652

Videos

Making a Sustainable and Equitable Impact on Health through Pragmatic Research: The Translational Sciences Benefits Model

Translating for Impact: A Toolkit to Apply the Translational Science Benefits Model to Your Work

10.4 Dissemination Strategies and Methods

[NEED CONTENT]

References

  • Ashcraft LE, Quinn DA, Brownson RC. Strategies for effective dissemination of research to United States policymakers: a systematic review. Implementation Science. 2020;15(1). doi:10.1186/s13012-020-01046-3
  • Brownson RC, Royer C, Ewing R, McBride TD. Researchers and policymakers: travelers in parallel universes. Am J Prev Med. 2006;30(2):164-172. doi:10.1016/j.amepre.2005.10.004
  • Purtle J, Marzalik JS, Halfond RW, Bufka LF, Teachman BA, Aarons GA. Toward the data-driven dissemination of findings from psychological science. Am Psychol. 2020;75(8):1052-1066. doi:10.1037/amp0000721
  • Purtle J, Nelson KL, Bruns EJ, Hoagwood KE. Dissemination Strategies to Accelerate the Policy Impact of Children’s Mental Health Services Research. Psychiatr Serv. 2020;71(11):1170-1178. doi:10.1176/appi.ps.201900527

Videos

Using Stakeholder Engagement to Disseminate Rapid and Responsive Messages

Dissemination to Policymakers

10.5 Scale-Up and Sustainability

[NOTE: CONTENT BELOW FROM SHELTON 2022, NEED PERMISSION IF USING]

Sustained delivery and impact of evidence-based interventions is a considerable challenge across a range of complex real-world public health and healthcare settings. If we are to have an equitable impact on population health, build trust, and make best use of funding and resources, it is critical that we reflect on our existing evidence base and proactively assess and plan for sustainment from the outset.

Adaptations to interventions and strategies may be essential for sustainability, in response to dynamic contexts, changing population needs, and evolving scientific evidence; this may be particularly critical for settings and populations that experience numerous structural barriers to health. Engaging key partners is important for informing meaningful conceptualization and assessment of sustainability, and advancing understanding of the value and return on investment of sustainability for diverse partners and systems.

Existing frameworks can help with assessment to better understand determinants of sustainability across diverse settings, and can inform the development, planning, and evaluation of sustainability strategies to address identified challenges. Pragmatic tools and resources in the field can be used to continuously and explicitly track where and when challenges to sustainability and equity arise along the implementation continuum, with the goal of actively understanding and addressing such gaps.

References

  • Shelton RC, Chambers DA, Glasgow RE. An Extension of RE-AIM to Enhance Sustainability: Addressing Dynamic Context and Promoting Health Equity Over Time. Front Public Health. 2020;8:134. Published 2020 May 12. doi:10.3389/fpubh.2020.00134
  • Shelton RC, Cooper BR, Stirman SW. The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care. Annu Rev Public Health. 2018;39:55-76. doi:10.1146/annurev-publhealth-040617-014731
  • Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8:117. Published 2013 Oct 2. doi:10.1186/1748-5908-8-117
  • Moullin JC, Sklar M, Green A, et al. Advancing the pragmatic measurement of sustainment: a narrative review of measures. Implement Sci Commun. 2020;1:76. Published 2020 Sep 17. doi:10.1186/s43058-020-00068-8
  • Moullin JC, Sklar M, Ehrhart MG, Green A, Aarons GA. Provider REport of Sustainment Scale (PRESS): development and validation of a brief measure of inner context sustainment. Implement Sci. 2021;16(1):86. Published 2021 Aug 30. doi:10.1186/s13012-021-01152-w
  • Balis LE, Strayer TE 3rd, Ramalingam N, Harden SM. Beginning With the End in Mind: Contextual Considerations for Scaling-Out a Community-Based Intervention. Front Public Health. 2018;6:357. Published 2018 Dec 10. doi:10.3389/fpubh.2018.00357
  • Davis M, Beidas RS. Refining contextual inquiry to maximize generalizability and accelerate the implementation process. Implement Res Pract. 2021;2:2633489521994941. Published 2021 Mar 17. doi:10.1177/2633489521994941
  • Pfotenhauer S, Laurent B, Papageorgiou K, Stilgoe AJ. The politics of scaling. Soc Stud Sci. 2022;52(1):3-34. doi:10.1177/03063127211048945
  • Johnson AM, Moore JE, Chambers DA, Rup J, Dinyarian C, Straus SE. How do researchers conceptualize and plan for the sustainability of their NIH R01 implementation projects?. Implement Sci. 2019;14(1):50. Published 2019 May 9. doi:10.1186/s13012-019-0895-1
  • Milat A, Lee K, Conte K, et al. Intervention Scalability Assessment Tool: A decision support tool for health policy makers and implementers. Health Res Policy Syst. 2020;18(1):1. Published 2020 Jan 3. doi:10.1186/s12961-019-0494-2
  • Bulthuis SE, Kok MC, Raven J, Dieleman MA. Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review. Health Policy Plan. 2020;35(2):219-234. doi:10.1093/heapol/czz140
  • Paina L, Peters DH. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan. 2012;27(5):365-373. doi:10.1093/heapol/czr054
  • Zomahoun HTV, Ben Charif A, Freitas A, et al. The pitfalls of scaling up evidence-based interventions in health. Glob Health Action. 2019;12(1):1670449. doi:10.1080/16549716.2019.1670449
  • Koorts H, Eakin E, Estabrooks P, Timperio A, Salmon J, Bauman A. Implementation and scale up of population physical activity interventions for clinical and community settings: the PRACTIS guide. Int J Behav Nutr Phys Act. 2018;15(1):51. Published 2018 Jun 8. doi:10.1186/s12966-018-0678-0
  • Zamboni K, Schellenberg J, Hanson C, Betran AP, Dumont A. Assessing scalability of an intervention: why, how and who? Health Policy and Planning. 2019;34(7):544-552. doi:10.1093/heapol/czz068
  • Woltering L, Fehlenberg K, Gerard B, Ubels J, Cooley L. Scaling – from “reaching many” to sustainable systems change at scale: A critical shift in mindset. Agricultural Systems. 2019;176:102652. doi:10.1016/j.agsy.2019.102652
  • Lane C, McCrabb S, Nathan N, et al. How effective are physical activity interventions when they are scaled-up: a systematic review. Int J Behav Nutr Phys Act. 2021;18(1):16. Published 2021 Jan 22. doi:10.1186/s12966-021-01080-4
  • Hooley C, Salvo D, Brown DS, et al. Scaling-up Child and Youth Mental Health Services: Assessing Coverage of a County-Wide Prevention and Early Intervention Initiative During One Fiscal Year [published correction appears in Adm Policy Ment Health. 2023 May;50(3):534]. Adm Policy Ment Health. 2023;50(1):17-32. doi:10.1007/s10488-022-01220-3
  • Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement Sci. 2016;11:12. Published 2016 Jan 29. doi:10.1186/s13012-016-0374-x

Videos

Advancing Research on Sustainability and Health Equity in Implementation Science

Scaling Up and Out: Increasing the Uptake of Built Environment Approaches in Community Settings

A Systems Approach to Scale-up for Population Health Improvement

Pragmatic Measurement of Sustainment

Scale up Outcomes and Operationalization

The Art of Sustainment in Pragmatic Research

Translating Research Evidence into Practice to Improve Health Equity: Lessons from a Faith Based Physical Activity Intervention

Reconceptualizing Sustainability and Adaptation: From Static to Dynamic

10.6 Key Questions in Sustainability Planning

[CONTENT FROM SHELTON 2022, NEED PERMISSION IF USING]

  • Do I have a clear sense of the evidence-based practice/program and its core components and intended health impact?
  • Have I worked with stakeholders to determine what ‘counts’ as sustainability of the practice/program?
  • Have I started to think about or plan for sustainability during the implementation phase or determine who will be involved in sustainability efforts?
  • Do I have a plan for measuring or assessing or monitoring sustainability over time?
  • Have I considered delivering strategies to better support sustainability?