Dissemination Science: Designing for impact, and implications for SCTC

1. Dissemination Science: Designing for impact, and implications for SCTC Douglas Luke, PhD May 1, 2014

2. Goals • Problem: Discovery to delivery gap • Solution: Designing for Dissemination & Impact • Examples from tobacco control • Tobacco control guides • SCTC

3. Problem: Discovery to Delivery Gap

4. Scurvy! http://greas.ca/publication/pdf/melaniebarwickenglish.pdf

5. The Promise of D&I Science …there is still an enormous gap between what we know can maximize the quality of health care and what is currently being delivered in practice and community settings. …to optimize public health we must not only understand how to create the best interventions, but how to best ensure that they are effectively delivered within clinical and community practice. NIH, OBSSR

6. http://www.thepermanentejournal.org/files/Fall2010PDFS/PerinatalResearchUnit.pdfhttp://www.thepermanentejournal.org/files/Fall2010PDFS/PerinatalResearchUnit.pdf

8. Dissemination also takes too much time in tobacco control

10. Consequence of Dissemination & Implementation Gap • Poor quality health care • Ineffective and patchwork policies • Suffering, morbidity are prolonged • Nation doesn’t benefit from billions of US tax dollars spent on research to develop & test effective care and evidence-based policies

11. Low Tax No Statewide Smoke-free State TC Disparities Source: Campaign for Tobacco Free Kids High Tax Statewide Smoke-free

12. Dissemination & Implementation Gaps in Tobacco Control • Dissemination • Awareness of evidence-based guidelines (e.g., Best Practices) is high among national and state TC leaders, but low among local and regional TC practitioners • Lack of useful implementation guides and training that translate science into program and policy development • Implementation • Half of states have no comprehensive smokefree policies • Many states have been slow to implement aggressive pricing policies

13. What is dissemination? An active approach of spreading evidence-based information to the target audience via determined channels using planned strategies – Brownson, et al., 2013, AJPH

14. Historical context (abbreviated) • Seminal article in 1943 on diffusion of hybrid seed corn in two Iowa communities • Key findings • Adoption as key dependent variable, change agents, importance of different communication channels

15. Diffusion of innovations • Diffusion = the process through which an innovation is communicated through certain channels over time among the members of a social system • Most influential theory guiding dissemination science (Rogers) • Early development emphasized temporal patterns and actor characteristics

16. Models for dissemination • Many dissemination models exist • Tabak and colleagues have identified 37 (Tabak, et al., 2012, AJPM)

17. Solution: Designing for Dissemination to Enhance Impact

18. Dissemination and Impact Pipeline Model Scientific Activity Scientific Dissemination

19. Dissemination and Impact Pipeline Model Policymakers Community & Advocacy Partners Scientific Activity Scientific Dissemination Public Health Impact Practitioners & Clinicians Legal Audiences Funders

20. Dissemination and Impact Pipeline Model Policymakers Community & Advocacy Partners Scientific Activity Scientific Dissemination Public Health Impact Practitioners & Clinicians Legal Audiences Funders Media

21. Dissemination and Impact Pipeline Model Policymakers Community & Advocacy Partners Scientific Activity Scientific Dissemination Public Health Impact Practitioners & Clinicians Push Legal Audiences Funders Media Pull

22. Barriers to Effective Dissemination (on the ‘Push’ side) • What factors get in the way of pushing science into effective policy & practice? • Putting dissemination ‘at the end’ • Lack of funding and infrastructure • Reliance on single dissemination modes • Reliance on outmoded dissemination approaches and models • Lack of training, general media ‘savviness’ • Lack of appropriate incentives • Professional jealousy • For tobacco control: Interference and misinformation from the tobacco industry

23. Principles of Designing for Dissemination & Impact • Be active - passive dissemination does not work • Be repetitive - single messages do not work • Use multiple channels - single channels are less effective • Involve stakeholders early - otherwise information may not be heard and used • Be a translator – tailor information to specific audiences Adapted from Tabak, et al., 2012, AJPM; and Mueller, et al., 2008, JPHMP)

24. Figure 2. A framework for dissemination of evidence-based policies Define EBPs Active Dissemination Policy content Audience Research Passive Dissemination Policy process Attributes affecting dissemination: relative advantage, complexity, cost 5. Maintenance 1. Innovation Development • Build the rationale for evidence-based policies • Development of the Community Guide and other sources on policy interventions • Build source credibility 2. Awareness • Begin active knowledge transfer • Identify target audience factors • Identify communication channels 3. Adoption • Uptake of the policy by the target audience(s) • Target adoption to attitudes and values of intended audience • Identify barriers to adoption • Improve the skills of adopters • Provide training and technical assistance 4. Implementation • Ongoing implementation and continued use of the innovation • Ensure policy enforcement Policy outcomes

25. Necessary Skills & Training • Health communications • Infographics and visual design • Marketing and science journalism • Social media • Organizational behavior • Dissemination & implementation science

26. Examples

27. Example: Tobacco Control Guides • Responding to practitioners’ need for translating Best Practices into practical program and policy implementation February 2014 April 2014 February 2014 Available at: http://cphss.wustl.edu/Projects/Pages/Tobacco-Control-Guides

28. Tobacco Control Guides Incorporating audience guidance and feedback Audiences: Advocacy, Practitioners, Legal, Science

29. Tobacco Control Guides Tailoring scientific information for practitioner audience

30. Tobacco Control Guides Telling stories

31. Tobacco Control Guides Repeating information and using visual displays to emphasize the ‘take home message.’

32. Tobacco Control Guides Using infographics to provide rich information and support story telling

33. Tobacco Control Guides Using pictures and graphics to enhance the attractiveness of the report, and to frame the content

34. It’s Not All on You… • Distinguishing between dissemination skills and strategies on the one hand… • And a dissemination system on the other hand • You (as the scientist) do not need to be the primary or exclusive disseminator • Good tobacco control science comes first… • But you should be connected to the dissemination system so that your work is communicated accurately

35. SCTC and Dissemination for Impact • Importance of dissemination for SCTC • Central position in evaluation logic model • Builds on history of strong dissemination partnerships • Getting off to a strong start • Workgroups, core projects, developmental projects • Diversity of dissemination products & activities (e.g., website, reports, training materials, DVDs, tailored products)

36. For more information… Douglas Luke, PhD dluke@.wustl.edu