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증거 기반 건강 증진 프랙티스 확산을위한 기본 틀.

이 기사 탐색.

Jeffrey R. Harris, MD, MPH, MBA; Allen Cheadle, PhD; Peggy A. Hannon, Ph. D, MPH; Mark Forehand, PhD; Patricia Lichiello, MA; 유스타시아 마호니 (Eustacia Mahoney); Susan Snyder, MS; Judith Yarrow, MA.

이 논문의 인용 인용문 : Harris JR, Cheadle A, Hannon PA, Forehand M, Lichiello P, Mahoney E, Snyder S, Yarrow J. 증거 기반 건강 증진 관행을 보급하기위한 프레임 워크. Prev Chronic Dis 2012; 9 : 110081. DOI : dx. doi. org/10.5888/pcd9.110081.

증거 기반의 건강 증진 관행의 보급 확대는 효과적인 보급 방법을 개발하고 시험하는 것에 달려있다. 이러한 접근법을 개발하는 데 도움이되도록 우리는 보급에 관한 문헌과 증거 기반 실천을 널리 알린 경험을 토대로 실제적인 틀을 만들었습니다. 우리 프레임 워크의 주요 요소는 1) 연구자와 보급 과정의 소유권을 가져 오는 보급 기관 간의 긴밀한 파트너십과 2) 잠재 사용자 조직과 긴밀히 협력하기위한 사회적 마케팅 원칙의 사용입니다. 이 프레임 워크를 설명하는 2 가지 예를 제시합니다. 고령자의 신체 활동을 향상시키는 EnhanceFitness와 근로자의 만성 질병 예방을위한 American Cancer Society Workplace Solutions. 또한 연구원이 보급 및 관련 연구에서 수행하는 7 가지 실질적인 역할에 대해 논의합니다. 즉 증거 정리, 조형 연구, 사용자 조직의 준비 상태 평가, 충실도 재조정, 모니터링 및 평가, 외부 상황에 대한 영향 및 배포 방법 테스트입니다.

소개.

공중 보건 공동체가 건강한 행동을 촉진하기위한 많은 근거 기반 관행을 개발했지만, 이러한 관행의 채택은 무의미하다. 이에 대한 질병 통제 및 예방 센터 (CDC)와 국립 보건원 (NIH)은 증거 기반 관행의 보급과 보급 효과를 높이는 방법에 대한 연구 (3-5)에 더 많은 관심을 기울여야한다고 촉구했다.

증거에 기반한 관행의 확산과 보급에 관한 광범위한 문헌을 체계화하기 위해 몇 가지 개념적 틀이 개발되었다. 근거 중심의 건강 증진 관행의 보급과 특히 관련된 것은 Greenhalgh et al (6)과 Wandersman et al (7)의 관행이다. Greenhalgh는 대형 보건 의료 조직의 시스템 수준 사례에 초점을 맞추어 보급 및 보급에 관한 문헌을 검토하고이를 구성하기위한 개념적 틀을 개발했습니다. Wandersman은 소규모 및 대규모 조직 모두에서 구현 될 수있는 건강 증진 실무에보다 직접적으로 집중했습니다. 그의 인터랙티브 시스템 프레임 워크 (ISF)는 보급 프로세스에서 주요 행위자의 역할을 강조합니다. 기존의 여러 프레임 워크 (Greenhalgh의 프레임 워크 포함)를 합성하는 또 다른 최근 개발 된 프레임 워크는 CFIR (Implementation Research)을위한 통합 된 프레임 워크입니다 (8). 마지막으로 RE-AIM 프레임 워크는 평가를 위해 개발되었지만 증거 기반 관행의 보급을위한 조직 원칙을 제공하기 위해 널리 사용된다 (9).

이러한 프레임 워크는 향후 연구를위한 가설을 생성하는 데 유용하지만 배포 방법을 개발하고 테스트하기위한 실제 프레임 워크가 없습니다. 이러한 틀은 지역 사회 기반 조직을위한 보급의 지침이되며 연구자가 근거 중심 관행의 보급에 대한 접근법을 개발하고 시험 할 수 있도록 도와 줄 것이다.

우리는 만성 질환의 지역 사회 기반 예방 및 통제에 관한 연구를 수행하기 위해 CDC가 자금을 지원하는 예방 연구 센터 인 워싱턴 대학 건강 증진 연구 센터 (HPRC)에서 개발 된 보급을위한 실질적인 틀을 설명합니다. 이 프레임 워크를 설명하기 위해 우리는 우리가 개발하고 테스트 한 2 가지 보급 방법을 사용하여 연구자가 보급 및 보급 연구에서 수행하는 실제적인 역할에 대해 논의합니다.

HPRC 보급 프레임 워크.

제안 된 체계 (그림)를 사용하여 전파 할 수있는 증거 기반 실천은 환경 변화, 정책, 프로그램 및 시스템을 포함합니다. 근거 기반의 사례로는 연구 조사 된 환경 변화 (예 : 학교 및 직장에서 건강에 좋은 음식의 이용 가능성 증가), 정책 (예 : 담배 중단을위한 고용주 보험 적용 범위), 프로그램 (예 : 건강한 노화 운동 프로그램, (예 : Mammering of Balance [10], Active for Life [11]), 시스템 변경 (예 : 유방 조영술 클리닉의 경우 시간 확장) 등이 있습니다.

그림. 보급 프레임 워크는 소셜 마케팅 원칙을 사용하여 공동으로 개발 된 보급 방법을 통해 사용자 조직에 영향을 미치는 리소스 (연구원 및 보급 단체)를 보여줍니다. 프레임 워크는 수정 가능하고 수정할 수없는 요소의 외부 컨텍스트에서 작동합니다. [이 그림의 텍스트 설명도 가능합니다.]

HPRC 프레임 워크는 관행이 수동적으로 또는 능동적으로 확산 될 수 있음을 인정합니다. & # 8220; 확산 & # 8221; 화살표는 증거 기반 사례가 수동적으로 확산되고 사용자 조직 외부에서 추가 지원이나 선동없이 채택된다는 것을 보여줍니다 (12). 더 큰 보급 접근법의 화살표는 보급만으로는 증거에 기반한 관행을 전파하는 효과적인 방법이 아니며 광범위한 시행을 장려하기 위해 특별한 노력이 필요함을 보여줍니다. 이 기본 틀은 능동적 인 보급 과정에 초점을 맞추고있다.

HPRC 프레임 워크에는 연구자 및 보급 조직 (그림, 왼쪽)과 사용자 조직 (그림, 오른쪽)의 3 가지 주체가 있습니다. 연구원은 모범 사례의 보급을 돕기 위해 새로운 지식을 창출하려고합니다. 보급 기관 (“dememinators”)은 보급 노력을 이끌 기 위해 그 지식을 사용합니다. 사용자 조직은 모범 사례를 적용합니다. 배포자는 근거 기반의 관행 (예 : 브랜드 건강 증진 프로그램의 라이센스 또는 판매를 통해)을 판매하는 비영리 단체 또는 사용자 조직에 근거하여 입양을 지원하는 기금 또는 정부 기관 및 증거 기반 사례의 구현을 평가하는 연구자 일 수 있습니다 (예 : , 근거 기반 관행의 채택을 장려하기 위해 고령화에 관한 행정부가 제공 한 자금 지원).

연구원 및 배포자는 상호 유익한 협력 파트너십을 구축합니다. 파트너 관계는 당사자 중 한 사람에 의해 시작될 수 있으며 경험상 연구 팀과 배포자가 동일한 사용자 조직에 도달하려고 할 때 가장 효과적이며 서로의 자원과 목표에 대해 배우고 자 할 때 가장 효과적입니다. 이 학습을 바탕으로 연구자와 보급 자 모두 보급 자의 목표와 역량에 맞는 보급 방법을 설계하고 테스트 할 수있는 능력이 뛰어납니다. 연구원은 배포자 접근법을 사용자 조직에보다 적합하게 만들기 위해이를 보급 및 테스트하는 데 보급 업체와 긴밀히 협력합니다. 연구원은 보급자 역할을 할 수 있지만, 보급자에게는 모범 사례 보급에 최소한 2 가지 이점이 있습니다. 1) 연구 목표 및 기금보다는 보급에 집중할 수 있으므로, 보급에 필요한 규모에 도달하는 데 필요한 지원 시스템에 중점을 둘 수 있습니다. 인구 수준에서의 차이; 2) 그들은 연구자보다 문화와 가치면에서 사용자 조직에 더 가까울 수 있으므로 모범 사례를보다 잘 홍보하고 지역의 필요에 맞게 적응할 수 있습니다.

사용자 조직에서 증거 기반 사례를 성공적으로 보급하는 데는 계단식 단계가 필요합니다 (그림). 단계에는 채택, 구현 및 유지 관리가 포함됩니다. 캐스케이드는 사용자 조직의 고정 요소를 인정합니다. & # 8212; 즉, 보급되기 전 조직의 상태 & # 8212; 인간 및 재원의 이용 가능성을 포함하여 채택, 구현 및 유지 관리를 지원할 준비가되었는지를 확인해야합니다. 이 용어는 RE-AIM 프레임 워크 (9)에서 채택, 구현 및 유지 보수 단계와 유사합니다. 이 캐스 캐 이드의 결과는 조직의 관행과 개인 행동의 변화로 조직 구성원 (예 : 직원) 또는 서비스를 제공하는 고객에 대한 건강 및 기타 이점 (예 : 생산성 향상)이 향상됩니다.

왼쪽의 연구원과 보급자를 보여주는 상자와 오른쪽의 사용자 조직을 보여주는 상자 사이에는 양방향 †링크 및 학습 화살표가 있습니다. 이 화살표는 준비 과정에서 채택 동기를 부여하는 방법 및 구현 및 유지 관리를 용이하게하는 방법에 이르기까지 사용자 조직 및 구현 프로세스의 모든 잠재적 단계를 이해해야 할 필요성을 강조합니다. 우리는 이러한 연계와 학습이 사용자 조직의 필요와 능력에 중점을 둔 소셜 마케팅의 원칙에 따라 정보를 제공 받아야한다고 생각합니다. 이러한 원칙을 적용하면, 보급자는 시장 분석으로 시작됩니다 (13). 이 분석은 증거 기반 관행의 잠재적 이익을 평가합니다. 사용자 조직과 행동 변화를 목표로하는 회원 및 소비자에게 모두 적용됩니다. & # 8212; 그리고 채택의 장벽 (조직과 개인 모두). 분석 결과 5 가지 핵심 영역 (13)이 평가되었습니다.

소비자 : 관행의 조직 및 개인 소비자의 요구. 경쟁 (Competition) : 연습을위한 경쟁으로 작용하는 중요한 대안. 회사 : 새로운 관행의 보급을 지원하기위한 회사의 역량 (우리의 프레임 워크에서 연구원과 보급 자의 합친 역량). 공동 작업자 : 공동 작업자의 강점 & # 8212; 잠재적 인 지원 네트워크 또는 다른 파트너 & # 8212; 실제 환경의 제약 조건에 대한 정보를 제공하고 유통 업체가 제품을 소비자에게 배포하는 것과 거의 같은 방식으로 보급을 촉진 할 수 있습니다. 컨텍스트 : 수정 가능하고 변경 불가능한 '외부 컨텍스트'로 묘사되는 사회 정치적 맥락. 우리의 프레임 워크에서. 수정 가능한 컨텍스트 & # 8212; 재정 지원 및 정책 지원 (예 : 프로그램 참여 환급) & # 8212; 보급 자나 연구원의 영향권 내에있다. 수정 불가능한 맥락은 전반적인 경제 및 정치 환경을 포함합니다.

전체 시장 분석을 수행함으로써, 보급자는 잠재적 인 사용자 조직의 어떤 부문을 목표로 삼고이 목표로 삼은 부분에 대한 증거 기반 실천을 최적으로 배치하는 방법을 결정할 준비가됩니다 (14). 세분화 프로세스는 조직 수준 (실습을 채택하기에 특히 잘 갖추어 진 사용자 조직의 고유 한 그룹 식별) 또는 개별 레벨 (배포자가 행동을 채택해야하는 개인의 고유 한 그룹 식별 (s ). 타겟팅에서 보급자는 보급 방법을 개발하고자하는 특정 세그먼트를 식별합니다. 일단 표적이 확인되면 보급 접근법은 표적 구획과 공감할 것으로 기대되는 특정 이익을 강조하면서 촉진 된 관행의 이익을 명확하고 간결하게 전달할 수있는 위치에 있어야한다. 예를 들어, 포지셔닝은 사용자 조직의 수준에서이 관행에 대해 구체적으로 어떤 조직 요구가 충족 될 것이며, 다른 관행에 비해 구체적으로 요구되는 이유는 무엇이며, 그 이유는 무엇입니까?

요약하면, HPRC 프레임 워크는 증거 기반 사례를 효과적으로 보급하기 위해 연구원은 1) 보급 자와 협력하고 2) 소셜 마케팅의 원칙에 따라 보급에 대한 관행과 접근 방식을 개선하기 위해 사용자 조직과 협력해야합니다.

두 가지 보급 예.

연약한 노인들을위한 EF의 의자 기반 버전을 개발하고 테스트했습니다. EF 강사 교육의 온라인 버전을 개발하여 교육 관련 비용을 줄이고 광범위한 강사 풀에 도달 할 수 있습니다. 테스트 된 EnhanceMobility; 치매를 가진 사람들을위한 EF의 적응.

저임금 산업 분야의 중견 고용주를 대상으로 한 조사에서 고용주는 자신의 필요와 자원을 평가합니다. ACS 직원을 인터뷰하여 ACS WPS를 사용하는 고용주를 지원할 준비와 교육 필요성을 평가했습니다.

EF의 CDC 관절염 프로그램 승인 획득. EF가 2009 년 노령화 (AoA) 선택에 포함 된 5 가지 증거 기반 질병 예방 프로그램 중 하나 인 독립성 보조금 승인을 획득했습니다.

ACS WPS에서 권장 한 직장 금연 정책을 시행하는 주법을 통과시키기 위해 노력했습니다. ACS WPS에서 권장하는대로 대장 암 검진을위한 보험에 대한 주 정부의 입법 명령을 통과시키기 위해 노력했습니다.

AoA 기금 (26 개 주)의 선택 프로그램으로 선정되었습니다. 사우스 플로리다에서 750 만 달러짜리 프로젝트의 일환.

저소득층, 보험이없는 근로자를위한 담배 중단 중단에 대한 주 차원의 기금 조성을 위해 노력했습니다. 콜로라도, 뉴 멕시코 및 워싱턴주의 주정부가 지원하는 ACS WPS와 다른 ACS 작업장 연습을 결합한 것.

2010 년 현재, 32 개 주에 523 개 지역에서 제공되며 23,241 명의 참가자에게 봉사했습니다. 2010 년 10,282 건

2010 년 현재, 1,385 명의 사용자가 ACS WPS에 참가하여 250 만명 이상의 근로자에게 서비스를 제공했습니다.

이 절에서는 보급 체계를 설명하기 위해 2 가지 예를 제시한다 (Box 1). EnhanceFitness (EF)는 고령자의 신체 활동을 촉진하고 미국 암 협회 (ACS) Workplace Solutions (WPS)은 근로자의 만성 질병 예방을 촉진합니다. 각 예에서 상자 1의 핵심 용어를 기울임 꼴로 표시합니다.

EnhanceFitness.

EF는 근거 중심의 실습으로, 노년층을위한 저비용, 적응력이 높은 집단 운동 프로그램입니다. EF는 원래 워싱턴의 보셀 (Bothell)에있는 노스 쇼어 시니어 센터 (Northshore Senior Center)를 포함하는 연구 파트너십에 의해 설계되고 테스트되었습니다. 그룹 건강 협동 조합, 건강 관리 조직; 및 HPRC. 최초의 임상 시험에서 EF는 참가자들 사이의 신체 활동을 증가 시켰고 비교 집단보다 더 높은 수준의 기능을 유지하도록 도왔습니다 (15).

워싱턴 주 킹 카운티에있는 비영리 단체 기반 조직인 Senior Services는 EF (16)의 보급 기관으로 10 년 이상 근무 해 왔습니다. 몇 년 동안, HPRC 및 고령자 서비스는 노인 센터 및 허약 한 노인 및 치매를 가진 사람들과 같은 특수 인구를 포함한 사용자 조직의 요구를 충족시키기 위해 EF를 수정하고 적용하기위한 연계 및 학습을 사용했습니다. 선임 서비스는 유포 비용을 지불하는 노인 센터 및 기타 사용자 조직에 EF를 배포하고 이러한 사용자 조직의 구현을 돕기 위해 라이선스 수익을 사용합니다. 라이선스 비용으로 지원되는 Senior Services에서는 전국의 EF 강사 인증 강좌를 제공하고 기술 지원, 교육 및 마케팅 자료를 제공하고 프로그램 충실도 및 피트니스 데이터를 수집 및 분석합니다.

고위 진료 기관과 HPRC는 EF의 인정과 신뢰성을 높이기 위해 외부 상황을 수정하기 위해 CDC 관절염 프로그램 및 노화 방지 관리를 비롯한 국가 기관의 EF 승인을 획득했습니다. HPRC는 또한 EF를 지원하는 지역 자금 조달 계획에 파트너가되었습니다. 지금까지의 보급 결과는 EF가 전국적으로 다양한 참가자들에게 도달한다는 것을 보여줍니다. 23,000 명 이상의 참가자 중 28 %가 소수 민족이며, 38 %가 80 세 이상이며 소득이 저소득이거나 소득이 매우 낮고 소득이 매우 낮거나 소득이 낮은 사람이 2 %, 영어가 제한적이거나없는 사람들이 4 %, 이민자가 4 %입니다. 또는 피난민.

미국 암 협회 직장 솔루션.

ACS WPS는 작업장에서의 건강 증진과 근로자들 사이의 만성 질병 예방을 목적으로 한 증거 기반 실무 패키지를 고용주에게 제공합니다. ACS의 Great West Division과 HPRC는 ACS WPS를 공동으로 개발 한 후 태평양 북서부의 8 개 대규모 고용주와 파일럿 테스트를 실시했습니다 (17). 파일럿 테스트에서는 고용주가 크게 증가한 것으로 나타났습니다. & # 8217; ACS WPS 실천의 구현. 예비 연구 후에, ACS National Home Office는 ACS WPS의 국가 보급 기관 역할을 맡았습니다. 연계와 학습을 사용하여 HPRC와 ACS는 주 사용자 조직인 사용자의 요구를 충족시키기 위해 ACS WPS를 정제하고 조정합니다. HPRC와 ACS는 중소 규모 사업주와 저임금 산업 분야의 고용주와 함께 작업합니다. 보급 방법으로서 ACS는 변경 대리인 (사용자 조직 내부에서 일하는 외부 기술 전문가) (2)으로 활동하는 지역 및 지 역 직원을 배치합니다. 고용주에 대한 공식 평가 후 & # 8217; 증거 기반 직장 건강 증진 관행의 시행에 따라 ACS 직원은 갭 분석을 실시하고 권장 관행의 채택 및 시행을 목적으로하는 정보 및 기술 지원을 고용주에게 제시합니다. ACS는 ACS WPS를 지원하는 원칙과 프로세스에 대해 직원의 약 15 %를 교육했으며 ACS WPS를 수정하여 ACS WPS의 효과를 높이고 ACS 직원이 지속 할 수 있도록하는 방법을 확인하고 있습니다. 외부 상황을 수정하기 위해 ACS와 HPRC는 ACS WPS에서 권장하는 지원 관행 및 주법을 지원하기 위해 노력했습니다. 그들은 또한 ACS의 주정부가 자금을 지원하는 직장 ​​건강 증진 패키지 중 다른 것을 ACS WPS 원칙과 그 실무의 일부를 포함하도록 채택했습니다. 현재까지의 보급 결과는 ACS WPS가 전국적으로 다양한 고용주에게 도달 함을 보여줍니다. HPRC와 ACS는 작업장에서 ACS WPS의 효과를 계속 측정합니다. & # 8217; 권장 관행의 구현.

토론.

보급 및 보급 연구를위한 HPRC 프레임 워크는 문헌에 기반을두고 있으며 만성 질병 예방 실천을 개발하고 보급하는 성공적인 경험으로 형성되었습니다. 2 가지 사례에서 볼 수 있듯이, 우리는 이론을 바탕으로 한 보급 접근법을 사용하는 국가 보급 자로서 사기업과 협력하여 증거 기반 실천에 대한 전국적인 접근을 달성했습니다. Workplace Solutions 패키지에는 환경 변화, 정책, 프로그램 및 시스템 변경이 포함되어 있으므로이 프레임 워크는 모든 영역과 광범위한 번역 연구 분야에 적용됩니다 (5,18).

HPRC 프레임 워크 및 보급에 관한 기존 문헌.

HPRC 프레임 워크는 Greenhalgh 프레임 워크의 요소를 통합하고 Wandersman (ISF) 프레임 워크의 핵심 요소와 유사합니다. 이러한 각 프레임 워크는 많은 양의 문헌을 검토 한 결과입니다. 우리 프레임 워크의 핵심 보급 자원은 Greenhalgh의 자원 시스템, 즉 변경 기관 (우리 기관 용어를 포함하는 조직)과 지식 제공자 (연구원)의 핵심 역할과 매우 유사합니다. 또한 Greenhalgh에서 우리는 조직에서의 구현 프로세스가 조직마다 다르고 복잡한 일련의 단계가 필요하다는 아이디어를 채택합니다. 따라서 연구원은 배포 방법 (그림)을 디자인 할 때 배포자와 사용자 조직과 긴밀하게 협력해야합니다.

Wandersman ISF 프레임 워크의 시스템은 HPRC 프레임 워크의 핵심 요소와도 병행합니다. ISF 예방 지원 시스템 (ISF Prevention Support System)은 보급 과정에서 도움을 주며 우리의 보급 자원에 해당합니다 (7). 그리고 보급자 및 사용자 조직과 협력하여 실무 및 보급 전략을 개선하기위한 연구원의 프로세스는 ISF 예방 종합 및 번역 시스템의 근사치입니다.

Kreuter와 Bernhardt (19)는 공중 보건 제품의 효과적인 보급에 대한 추가적인 필요성을 강조했다. 마케팅 및 유통 시스템. 상업용 제품의 경우 이러한 시스템에는 유통 업체로의 이전, 소비자 매장으로의 유통, 재고 관리, 판매, 기술 지원, 고객 서비스 및 수리가 포함됩니다. 우리의 프레임 워크에서 우리는 마케팅 원칙을 사용할 때 마케팅 및 배포 시스템에 대한 필요성을 암시하지만 이러한 시스템은 배포자로부터 특별한 관심을받을 자격이 있습니다. 보급자로 일하는 일부 비영리 보건 기관이 전국 규모 (예 : AARP, ACS 및 YMCA)의 마케팅 및 유통 시스템을 보유하고 있지만 대부분은 시너지 효과를 내기 위해 필요한 규모에 도달하기 위해 상업적 파트너와 협력 할 필요가 없으며 필요할 수도 있습니다. 인구 수준.

연구자를위한 역할.

HPRC 프레임 워크에서 연구자와 보급자는 증거 기반 실천을 확산시키는 능력을 향상시키기위한 파트너십을 형성합니다. 파트너십에 대한 연구원의 기여도는 1) 증거를 통한 분류, 2) 조형 연구 수행, 3) 사용자 조직의 준비 가능성 평가, 4) 충실도와 재구성 균형의 균형, 5) 모니터링 및 평가, 6) 외부 환경에 영향을 미치고, 7) 보급 방법을 시험한다. Box 2는 이러한 역할이 적용되는 맥락과 연구원이 수행 할 수있는 관련 기여에 대해 개략적으로 설명한다.

전파 접근법의 실제 적용 가능성을 극대화하기 위해 연구자는 보급 자와 협력하여 이들을 시험해야합니다. 보급 방법을 시험 할 때, 연구자와 보급자는 보급 방법이 비교되고 있는지에 대해 신중해야한다. Greenhalgh (6)은 입증 된 보급 방식의 점진적 변화를 비교하여 변화의 효과를 테스트함으로써 가장 큰 지식을 얻을 수 있다고 제안합니다. 그녀는이 증분 테스트를 모든 또는없는 테스트와 대조합니다. 이 테스트에서는 접근 방식의 어떤 부분이 채택 및 구현에서 중요한 변화를 가져 왔는지 식별하기가 어려울 수 있습니다. 연구원은 또한 신중하게 연구 설계를 고려해야합니다. 실험적 설계가 이론적으로 가능하지만 보급 방법은 조직의 하위 그룹 또는 개별 조직에 맞게 조정해야하므로 실험 설계를 사용하여 테스트 할 수있는 표준적이고 복제 가능한 접근 방식을 사용하기가 어렵습니다. 준 실험적 설계가 더 실용적 일 수 있습니다.

결론.

우리는 증거 기반 실천을위한 보급 접근법을 설계하고 시험하기위한 실용적 틀을 제안했다. 이 프레임 워크는 증거 기반 관행을 광범위하게 보급하는 연구자, 보급 자 및 사용자 조직에 대한 보완적인 역할을 설명합니다. 우리는 노령 성인 신체 활동 및 직장 건강 프로그램에 대해 전국적으로 증거 기반 홍보를 보급하기 위해 프레임 워크를 사용했습니다. 다른 연구자 및 실무자는 증거 기반 실무의 채택을 증가시키는 데 유용한 프레임 워크를 찾을 수 있습니다.

감사 인사.

이 기사의 정보를 뒷받침하는 연구는 워싱턴 DC 건강 증진 연구 센터 (CDC 예방 연구 센터 (HPRC 협력 협약 번호 U48DP001911) 중 하나)가 후원했습니다. 추가 자금 지원은 건강 마케팅 및 건강 커뮤니케이션 프로그램의 우수 센터 (grant 5-P01-CD000249-03)를 통해 공공 건강 연구의 CDC 사무소에서 이루어졌습니다.

작가 정보.

해당 저자 : Judith Yarrow, 워싱턴 대학 공중 보건 대학, HPRC, 1107 NE 45th St, Ste 200, Seattle, Washington 98105.

저자 소속 : Jeffrey R. Harris, Allen Cheadle, Peggy A. Hannon, Patricia Lichiello, 워싱턴 대학, 건강 증진 연구 센터, 시애틀, 워싱턴; 마크 포핸드, 마이클 지 포스터 스쿨 of 비즈니스, 워싱턴 대학, 시애틀, 워싱턴; Eustacia Mahoney, 미국 암 협회, 시애틀, 워싱턴; Susan Snyder, 워싱턴 시애틀 시니어 서비스.

구현 과학.

게시하려면 어디에서 선호합니까? 10 분간의 설문 조사에 대해 알려주십시오. 처음 1000 건의 응답을위한 자선 기부!

목차.

이 기사에는 공개 피어 리뷰 보고서를 사용할 수 있습니다.

연구 결과의 보급 : 연구자는 무엇을해야합니까? 개념적 프레임 워크에 대한 체계적인 범위 지정 검토.

Paul M Wilson 1 저자, Mark Petticrew 2, Mike W Calnan 3, Irwin Nazareth 4.

© Wilson et al; 라이센시 BioMed Central Ltd. 2010.

수락 : 2010 년 11 월 22 일.

게시일 : 2010 년 11 월 22 일

배경.

연구 기반 지식의 일상적인 임상 실습으로의 보급 및 전달의 결함을 해결하는 것은 영국 및 국제적으로 정책 안건에서 높습니다.

그러나 보급을 대표하는 기관에 대한 자금 지원 간에는 명확성이 부족합니다. 또한 연구자에게 제공되는 기대치와 지침은 기관마다 다릅니다. 이 배경에 대해 우리는 연구원이 보급 활동을 안내하는 데 사용할 수있는 개념적 / 체계화 된 프레임 워크를 식별하고 설명하기 위해 체계적인 범위 지정을 수행했습니다.

우리는 12 개의 전자 데이터베이스 (MEDLINE, EMBASE, CINAHL, PsycINFO 포함), 포함 된 연구의 참고 목록 및 개별 자금 제공 기관 웹 사이트를 검색하여 포함 가능성이있는 연구를 확인했습니다. 포함시키기 위해 논문은 연구자가 사용하도록 설계하거나 보급 활동을 안내하는 데 사용될 수있는 명시적인 프레임 워크 또는 계획을 제시해야했습니다. 광범위한 지식 번역 프레임 워크의 맥락에서 보급 (그러나 세부 사항을 제공하지 않음)을 언급 한 논문은 제외되었습니다. 참고 문헌은 적어도 두 명의 검토자가 독립적으로 심사했습니다. 불일치는 토론에 의해 해결되었습니다. 포함 된 각 논문의 출처, 발행일, 프레임 워크의 주요 요소에 대한 설명, 이론에 대한 암시 적 / 명시 적 언급이 추출되었는지 여부 등을 추출했다. 내러티브 합성이 수행되었다.

33 개의 프레임 워크가 포함 기준을 충족 시켰으며 그 중 20 개는 연구원이 보급 활동을 안내하는 데 사용하도록 고안되었습니다. 28 개의 프레임 워크는 설득력있는 의사 소통, 혁신 이론의 보급, 사회적 마케팅이라는 세 가지 이론적 접근 방식 중 하나 이상에 의해 적어도 부분적으로 뒷받침되었다.

결론.

현재 연구자가 보급 계획 및 활동을 안내하는 데 사용할 수있는 이론적으로 유용한 프레임 워크가 많이 있습니다. 현재 일상적인 업무에 대한 개입의 효과에 대한 지식의 이해를 높이는 데 중점을 두어 연구자가 연구 보급에 이론적으로 정보에 입각 한 접근 방식을 채택하도록 장려 할 수있다.

배경.

의료 자원은 유한하므로 비용 효율적인 건강 기술을 성공적으로 구현하여 고품질 의료 서비스를 제공하는 것이 필수적입니다. 그러나 임상 실무 또는 관리 실무 및 의사 결정과 관련하여 의료 환경에서의 실습을 향상시키는 연구 증거의 잠재력이 아직 실현되지 않았다는 인식이 점차 커지고 있습니다. 연구 기반 지식의 일상적인 임상 실습에 대한 보급 및 전달의 결함을 해결하는 것은 영국 [1-5] 및 국제적으로 [6] 정책 의제에서 높다.

격차를 줄이기위한 연구에 대한 관심이 높아짐에 따라 채택 된 접근법을 설명하는 데 사용 된 용어도있다 [7, 8]. 확산, 보급, 구현, 지식 이전, 지식 동원, 연계 및 교환, 그리고 실천에 대한 연구는 모두 중첩되고 상호 연관된 개념과 관행을 설명하는 데 사용됩니다. 이 검토에서, 우리는 보급이라는 용어를 사용했는데, 이는 우리가 연구 (지식 번역)의 연속체에서 핵심 요소로 간주하는 것입니다. 우리는 목표 청중 및 연구 결과가 접수 될 수있는 환경을 고려한 계획 프로세스로 정의하고 의사 결정에 대한 연구 유입을 용이하게하는 방식으로 광범위한 정책 및 보건 서비스 청중과 의사 소통 및 상호 작용할 수 있습니다 프로세스와 실습.

적용되는 보건 연구 기관의 대부분은 보조금 보유자가 연구 결과를 널리 알리려는 노력이나 노력을 요구합니다. 그러나 보급을 대변하는 기관에 대해 자금 지원 기관간에 명확성이 부족한 것처럼 보입니다 [9]. 더욱이, 대부분의 사람들이 연구비를 지원하는 사람들과 연구자들간에 공유 책임이 있다고 생각하지만, 연구자에게 제공되는 기대치와 지침은 기관마다 다릅니다 [9].

우리는 이전에 연구가들이 보급의 비용과 이익을 신중하게 고려할 필요성을 강조했으며, 보조금 소지자와 지원자에게 자금 조달 기관이 발표 한 지침 유형의 본질과 변화에 대한 우려를 제기했다. 이러한 배경에서, 우리는 다음 두 가지 목적을 가진 체계적인 범위 검토를 수행했다 : 연구자가 보급 활동을 안내하기 위해 사용하도록 고안된 개념적 / 조직적 프레임 워크를 식별하고 설명한다. 연구자가 보급 활동을 안내하기 위해 연구자가 사용할 수있는 보급 요소에 대해 충분한 세부 정보를 제공하는 지식 변환 연속체와 관련된 개념적 / 체계화 된 프레임 워크를 식별하고 설명하는 것.

포함될 잠재적 연구를 확인하기 위해 다음 데이터베이스가 검색되었습니다 : MEDLINE 및 MEDLINE In-Process 및 기타 색인없는 인용 (1950 년에서 2010 년 6 월); EMBASE (1980 년에서 2010 년 6 월까지); CINAHL (1981 ~ 2010 년 6 월); PsycINFO (2010 년 6 월 ~ 1806 년); EconLit (1969 년에서 2010 년 6 월); 사회 복지 초록 (1979 년 ~ 2010 년 6 월); 사회 정책 및 실천 (2010 년 6 월 1890 년); Cochrane Database of Systematic Reviews, Cochrane 중앙 대조구 등록, Cochrane Methodology Register, 효과 검토 요약서 데이터베이스, 건강 기술 평가 데이터베이스, NHS 경제 평가 데이터베이스 (Cochrane Library 2010 : Issue 1).

검색 용어는 연구 팀의 토론, 배경 문헌 검색 및 데이터베이스 시소러스 검색을 통해 확인되었습니다. 방법론, 언어 또는 날짜 제한이 없었습니다. 데이터베이스 특정 검색 전략에 대한 자세한 내용은 추가 파일 1, 부록 1을 참조하십시오.

사이언스 인용 색인 (Web of Science), MEDLINE (OvidSP) 및 Google Scholar (2009 년 2 월)에서 데이터베이스 검색 이전에 식별 된 5 개의 기사 [11-15]에 대한 인용 검색이 수행되었습니다.

이 검토는 영국의 적용 및 공공 보건 연구원 [16]의 보급 활동을 평가하기위한 광범위한 프로젝트의 일환으로 수행되었으므로 영국의 10 개 주요 의료 서비스 제공자 및 공중 보건 연구 기관의 웹 사이트를 검색했습니다. 영국 심장 재단, 영국의 Cancer Research, 수석 과학자 사무실, 건강 정책 연구 프로그램, 경제 사회 연구위원회 (ESRC), Joseph Rowntree 재단, MRC (Medical Research Council), NIHR Health 기술 평가 프로그램, NIHR 서비스 제공 및 조직 프로그램 및 Wellcome Trust. 우리는 신청자 또는 소지자에게 부여 할 수있는 보급 / 커뮤니케이션 프레임 워크, 가이드 또는 계획을 확인하고자했습니다.

우리는 또한 보급 및 지식 이전 분야에서 확립 된 기록으로 네 개의 핵심 기관의 웹 사이트를 조사했습니다. These were the Agency for Healthcare Research and Quality ( AHRQ ) , the Canadian Institutes of Health Research (CIHR), the Canadian Health Services Research Foundation (CHSRF), and the Centre for Reviews and Dissemination (CRD).

As a number of databases and websites were searched, some degree of duplication resulted. In order to manage this issue, the titles and abstracts of records were downloaded and imported into EndNote bibliographic software, and duplicate records removed.

References were screened independently by two reviewers; those studies that did not meet the inclusion criteria were excluded. Where it was not possible to exclude articles based on title and abstract alone, full text versions were obtained and their eligibility was assessed independently by two reviewers. Where disagreements occurred, the opinion of a third reviewer was sought and resolved by discussion and arbitration by a third reviewer.

To be eligible for inclusion, papers needed to either present an explicit framework or plan designed to be used by a researcher to guide their dissemination activity, or an explicit framework or plan that referred to dissemination in the context of a wider knowledge translation framework but that provided enough detail on the dissemination elements that a researcher could then use it. Papers that referred to dissemination in the context of a wider knowledge translation framework, but that did not describe in any detail those process elements relating to dissemination were excluded from the review. A list of excluded papers is included in Additional File 2 , Appendix 2.

For each included paper we recorded the publication date, a description of the main elements of the framework, whether there was any reference to other included studies, and whether there was an explicit theoretical basis to the framework. Included papers that did not make an explicit reference to an underlying theory were re-examined to determine whether any implicit use of theory could be identified. This entailed scrutinising the references and assessing whether any elements from theories identified in other papers were represented in the text. Data from each paper meeting the inclusion criteria were extracted by one researcher and independently checked for accuracy by a second.

A narrative synthesis [ 17 ] of included frameworks was undertaken to present the implicit and explicit theoretical basis of included frameworks and to explore any relationships between them.

Identification of conceptual frameworks .

Characteristics of conceptual frameworks designed to be used by researchers.

Conceptual frameworks designed for use by researchers.

Author, Year, Aims.

Develop a model to aid understanding about how new medical information in general and technology assessments in particular reaches practising physician and affects their practice.

The source of communication.

The channels of communication.

The communication message.

The characteristics of the audience receiving the communication.

The setting in which the communication is received.

Explicitly based on McGuire's five attributes of persuasive communication.

Also sets framework in the context specifically the innovation-decision process.

Reference to other included frameworks.

Communication effectiveness determined by five attributes. Appears to be first application of McGuire's matrix to the context of medical technology assessment. Argues that formal information dissemination followed by informal interaction with influential and knowledgeable colleagues likely to have most impact.

Presents a framework to be used by researchers seeking to promote the findings of a systematic review.

Implementation of strategy.

Feed back and evaluation.

Revised version acknowledges McGuire's five attributes of persuasive communication. Implicit in original version that is explicitly derived from Winkler.

2009 version also sets framework in the context of Diffusion of innovations specifically the innovation-decision process.

Reference to other included frameworks.

Greenhalgh in 2009 version.

Hughes in 2009 version.

Lavis in 2009 version.

Framework for disseminating the findings of systematic reviews. Originally postulated that dissemination effectiveness influenced by the sources of communications, media used, and audiences targeted.

Later versions acknowledge other elements of persuasive communications and expand into a three phase 'plan, develop, and implement process that assumes interaction with target audiences and consideration of setting in which messages received.

National Center for the Dissemination of Disability Research (NCDDR)[ 19 , 38 ]

To provide a knowledge base for strengthening the ways in which research results can be accessed and used by those who need them.

source (i. e. , agency, organization, or individual responsible for creating the new knowledge or product, and/or for conducting dissemination activities)

content (message that is disseminated, that is, the new knowledge or product itself, as well as any supporting information or materials)

medium ( i. e ., ways in which the knowledge or product is described, 'packaged,' and transmitted)

user ( or intended user, of the information or product to be disseminated)

Not explicitly stated but four (source, message, audience, channel) of McGuire's five attributes of persuasive communication evident.

Also mentions Diffusion of Innovations; specifically the innovation-decision process.

Reference to other included frameworks.

Review of literature suggests that some combination of four major dimensions of knowledge utilization that can help to strengthen dissemination efforts.

A detailed practical ten step-by-step guide for researchers later produced.

Review the process of dissemination by those who carry it out, those who disseminate it and those who, potentially, make use of it. Examine current approaches to dissemination, considered their effectiveness, highlight obstacles to successful integration of research into practice, and suggest a range of strategies to assist successful dissemination and implementation of research findings.

Provide accessible summaries of research.

Keep the research report brief and concise.

Publish in journals or publications which are user friendly.

Use language and styles of presentation which engage interest.

Target the material to the needs of the audience.

Extract the policy and practice implications of research.

Tailor dissemination events to the target audience and evaluate them.

Use a combination of dissemination methods.

Understand external factors.

Not explicitly stated but four (setting, message, audience, channel) of McGuire's five attributes of persuasive communication evident.

Reference to other included frameworks.

Commissioned by the Joseph Rowntree Foundation, a framework based on non-systematic literature review and survey of key informants and organisations (including CRD).

Authors suggest that active dissemination of research is often under resourced by research commissioners and researchers and that insufficient time and money are set aside when the original funding is considered.

Five factors identified as contributing to effective dissemination: relevance, quality, accessibility, ownership and timing. List for researchers of factors that can help them disseminate research successfully.

Report also outlines suggestions for commissioners, policy makers and practitioners for improving the effectiveness of research dissemination.

To help educational development projects engaged in the dissemination of new products, materials and good practice in learning and teaching to create an effective dissemination strategy.

What is dissemination?

What do we want to disseminate?

Who are our stakeholders and what are we offering them?

When do we disseminate?

What are the most effective ways of disseminating?

Who might help us disseminate?

How do we prepare our strategy?

How do we turn our strategy into an action plan?

How do we cost our dissemination activities?

How do we know we have been successful?

Not explicitly stated but three (message, audience, channel) of the McGuire's five attributes of persuasive communication evident.

Reference to other included frameworks.

Practical question based guide for educational development projects.

States that it is based on experiences from over 100 educational development projects, in particular, the Fund for the Development of Teaching and Learning (FDTL) and the Teaching, Learning Technology Programme (TLTP) and Innovations Fund.

Presents an integrated dissemination model for social work and case study example to illustrate the practical application of the model.

Assess market opportunities.

and identify target system.

Engage target system.

Field test the intervention.

Disseminate the intervention broadly.

Gather system feedback and provide ongoing consultation.

Reference to other included frameworks.

Describes an integrated dissemination model for social work and provides an example to illustrate its practical application (OutPatient Treatment In ONtario Services - OPTIONS project)

Argues that diffusion of innovations and social marketing address the important question of how to put the products of research where they will do the most good: into the hands of practicing clinicians.

Examine examples of effective dissemination strategies, provide insights and suggest pointers for researchers, research students and others who may be involved in dissemination.

Source of the message.

Medium selected to present the message.

Not explicitly stated but four (message, source, audience, channel) of McGuire's five attributes of persuasive communication.

Reference to other included frameworks.

Practical guide aimed at nursing researchers. Refers to early descriptions of the CRD approach [ 39 ].

Author argues that current commitment evidence-based practice will have limited impact on practice and patient care until a similar commitment to dissemination is evident at both corporate and individual levels.

To develop a framework that researchers and other knowledge disseminators who are embarking on knowledge translation can use to increase their familiarity with the intended user groups.

The researcher-user relationship.

Reference to other included frameworks.

Novel framework derived from a review of the research utilisation literature and from the authors' own experience.

Emphasises the importance of understanding user context. Each 'domain' provides researchers with a set of questions that can be used to aid the prioritisation of audiences and to develop and tailor relevant messages across user groups.

Provide an organizing framework for a knowledge transfer strategy and an overview of our understanding of the current knowledge for each of the five elements of the framework.

What should be transferred to decision makers?

To whom should it be transferred?

By whom should research knowledge be transferred?

How should research knowledge be transferred?

With what effect should research knowledge be transferred?

Not explicitly stated but four (message, audience, source, channel) of McGuire's five attributes of persuasive communication.

Reference to other included frameworks.

Organising framework and overview of literature relating to knowledge transfer strategies. Question format implicitly mirrors Lasswell's famous description of the act of communications as 'Who says what in which channel to whom with what effect' [ 37 ].

Describe a conceptual framework for the dissemination and utilisation of information, long with examples of its use.

Exposure strategies are those dissemination methods that focus on the goal of increased knowledge.

Experience strategies focus on the goal of increased positive attitudes towards the new knowledge.

Expertise strategies focus on the goal of increased competence.

Embedding strategies target consumers tend to be personally focused.

Diffusion of innovations in that research has concluded knowledge is not a 'thing to be sent and received. Rather disseminating new findings or information involves communicating through 'certain channels over time among members of a social system'

Reference to other included frameworks.

Authors suggest most dissemination practices are not organized or planned to achieve comprehensive impact. Role of framework is to help researchers understand dissemination and utilization as a series of active learning strategies and to direct these at particular knowledge goals and the needs of particular users.

Paper also presents examples of '4E' use.

Economic and Social Research Council [ 26 ]

Provide advice on planning and prioritising activities and includes a template you can use to structure your own strategy. Aimed at research directors but is applicable to any communications exercise and should be useful to a wider group of researchers.

Developing messages and branding.

Not explicitly stated but four (message, audience, source as branding, channel) of McGuire's five attributes of persuasive communication.

Reference to other included frameworks.

A detailed practical step-by-step guide on planning and prioritising research communication.

Involves all key elements of McGuire's persuasive communication matrix but also addresses more practical issues such as timing and availability of resources.

Available at: esrc. ac. uk/ESRCInfoCentre/CTK/communications-strategy/default. aspx.

Canadian Health Services Research Foundation [ 25 ]

List of Key elements that should be included in a dissemination plan. Provide a good overview of some of the most critical things that should be considered.

Key messages (contextualised)

Dissemination activities, tools, timing and responsibilities.

Not explicitly stated but all (message, audience, setting, source, channel) of McGuire's five attributes of persuasive communication.

Reference to other included frameworks.

Brief overview of key elements that should be considered as part of a collaborative research planning process. Involves all key elements of McGuire's persuasive communication matrix but also addresses more practical issues such as timing and availability of resources.

Aims to assist project coordinators and team leaders to generate an effective flow of information and publicity about the objectives and results of their work, the contributions made to European knowledge and scientific excellence, the value of collaboration on a Europe-wide scale, and the benefits to EU citizens in general.

Defining key messages.

Establishing target audiences.

Selecting the appropriate modes of communication.

Tailoring information to the intended outlets.

Building good relationships with the media.

Maximising the exposure of messages.

Tapping useful Commission and other external resources.

Not explicitly stated but three (message, audience, channel) of McGuire's five attributes of persuasive communication.

Reference to other included frameworks.

Practical guide aimed at researchers in EU Sixth (now seventh) Framework Programme projects. Provides an outline of good practices to assist researchers to generate an effective flow of information and publicity about the objectives and results of their work.

Focuses primarily on research communication via mass media channels.

Designed to assist the Agency for Healthcare Research and Quality (AHRQ) Patient Safety grantees with disseminating their research results.

What is going to be disseminated?

Who will apply it in practice?

Through whom can you reach end users?

How you convey the research outcomes?

How you determine what worked?

Where do you start?

Not explicit but four (message, audience, source, channel) of McGuire's five attributes of persuasive communication derived from Lavis.

Reference to other included frameworks.

Practical guide including six major elements aimed at AHRQ patient safety researchers. Basic premise is to provide a structure to what can be a nebulous concept yet which researchers are increasingly expected to respond. Emphasises importance of engaging end users in planning process.

Provide a six step framework for understanding international approaches to physical activity diffusion and dissemination.

Describe the innovation, its rationale and evidence base, and its relevance in an international context;

Describe the target audience for dissemination and the sequence, timing, and formatting of dissemination strategies;

Define the international communication channels for the innovation;

Determine the role of key policymakers and sustainable partnerships that are needed to implement the innovation at different levels (local, state, national, international);

Identify the barriers and facilitators of the innovation in the international context; 과.

Conduct research and evaluation to understand the dissemination process.

Application of Diffusion of Innovations in a public health context.

Not explicitly stated but three (audience, channel, setting) of McGuire's five attributes of persuasive communication.

Reference to other included frameworks.

Authors emphasise that dissemination one part of diffusion process. Much of framework based on expert opinion and experiences.

Four case studies presented to illustrate aspects of framework. Authors suggest that these share some common elements, including strong advocacy, good communications between key individuals and institutions, and the presence of shared values and population-level approaches.

To provide a framework that is intended to help non-profit organizations plan, conduct, and evaluate efforts to transfer and exchange knowledge with others.

Define the target audience.

Preparing the message (Clear, Concise, Consistent, Compelling, Continuous)

Selection of transfer method (s)

Evaluation of expected effects.

Not explicitly stated but.

four (message, source, audience, channel) of McGuire's five attributes of persuasive communication.

Reference to other included frameworks.

Five key elements to consider when planning knowledge transfer and exchange activity. States elements derived from recent literature, including Lavis.

To analyse the barriers to knowledge transfer that are often inherent in the format of the information communicated. Proposes a more user-friendly, enriched format to facilitate the translation of evidence-based information into practice.

Five dimensions for enhancing information delivery:

Comprehensibility of data on clinical benefits and harms.

Applicability and relevance.

Straightforwardness and appeal.

Reference to other included frameworks.

Describes five dimensions for enhancing information delivery and argues that little attention is focussed on the way clinical information is constructed and communicated and how it can be made more relevant, acceptable and eventually 'got through' to practitioners.

Social marketing techniques may help the promotion of evidence-based knowledge. This would entail systematically analysing and addressing barriers to clarity and acceptability of information, and offering a comprehensive and critical look at its validity, biases and relevance. However, paper does not fully describe or apply the key features of a social marketing approach.

Provide a conceptual framework to identify barriers and facilitators and design strategies to knowledge translation strategies to be used by organisations doing research.

Knowledge creation considers the characteristics of researchers and research.

considers resources and strategies.

Research utilization considers the characteristics of decision makers and context of decision making;

Question transfer considers research priorities and funders.

Context of organization considers the leadership system, policies, values, and culture of the organisation doing research.

Reference to other included frameworks.

Practical Tehran University of Medical Sciences (TUMS) framework developed from review of literature.

Authors' suggest universities depend primarily on the passive dissemination of knowledge.

They suggest the following strategies can make knowledge translation more effective in universities: defining and setting up of a system to assess the knowledge translation cycle; implementation and use of information technology; identification and encouragement of face-to-face interactions between researchers and decision makers; exchanging knowledgeable individuals among centres; creating mutual trust, a common language and culture for the creation of organizational knowledge; using important motivational tools in the university; using multidimensional methods for knowledge transfer.

To identify what the cultural divides are between researchers and policymakers and how social scientists have bridged these differences by careful attention to several pragmatic practices for increasing research use in policymaking.

Conceptualize policy work, not as disseminating information, but as developing relationships.

Take the initiative to contact policymakers.

or policy intermediaries.

Learn about the target policymaking audience.

Communicate research findings in ways that meet policymakers' information needs.

Use clear, careful language when dealing with myths about vulnerable populations.

Familiarize yourself with the policymaking process.

Provide a timely response to the questions driving the policy debate.

Learn how to approach policy work as an educator rather than an advocate.

Show respect for policymakers' knowledge and experience.

Be patient and self-rewarding in defining success.

Reference to other included frameworks.

Based around notion that the underutilisation of research is down to a communication gap between researchers and policymakers, who have differing goals, information needs, values, and language that are best thought of as a cultural divide.

Ten recommendations derived from qualitative interviews on the barriers and facilitators to research communication with social scientists working in family policy.

Present a conceptual framework and.

propose a eight point strategy for improving the dissemination of best practices by national quality improvement campaigns.

Provide simple, evidence - based recommendations.

Align messages with strategic goals of adopting organization.

Use a nodal organizational structure.

Engage a coalition of credible campaign sponsor.

Establish threshold of participating organizations.

Provide practical implementation tools.

Create networks to foster learning opportunities.

Monitor progress and evaluate impact.

Builds on Diffusion of Innovations but with a focus on active dissemination; planned efforts to persuade targeted groups to adopt an innovation.

Reference to other included frameworks.

Authors recognise that dissemination impact depends on contextual factors, including the nature of the innovation itself, external environmental incentives, and features of the adopting organizations. They argue that although important contextual considerations are outside the control of disseminators, greater use of their strategy is likely to promote more potent campaign efforts, more effective dissemination, and ultimately greater take-up of evidence-based practices.

Theoretical underpinnings of dissemination frameworks.

Thirteen of the twenty included dissemination frameworks were either explicitly or implicitly judged to be based on the Persuasive Communication Matrix [ 35 , 36 ]. Originally derived from a review of the literature of persuasion which sought to operationalise Lasswell's seminal description of persuasive communications as being about 'Who says what in which channel to whom with what effect' [ 37 ]. McGuire argued that there are five variables that influence the impact of persuasive communications. These are the source of communication, the message to be communicated, the channels of communication, the characteristics of the audience (receiver), and the setting (destination) in which the communication is received.

Included frameworks were judged to encompass either three [ 21 , 27 , 29 ], four [ 15 , 20 , 23 , 26 , 28 , 31 , 38 ], or all five [ 11 , 18 , 25 ] of McGuire's five input variables, namely, the source, channel, message, audience, and setting. The earliest conceptual model included in the review explicitly applied McGuire's five input variables to the dissemination of medical technology assessments [ 11 ]. Only one other framework (in its most recent version) explicitly acknowledges McGuire [ 17 ]; the original version acknowledged the influence of Winkler et al . on its approach to conceptualising systematic review dissemination [ 18 ]. The original version of the CRD approach [ 18 , 39 ] is itself referred to by two of the other eight frameworks [ 20 , 23 ]

Diffusion of Innovations theory [ 40 , 41 ] is explicitly cited by eight of the dissemination frameworks [ 11 , 17 , 19 , 22 , 24 , 28 , 29 , 34 ]. Diffusion of Innovations offers a theory of how, why, and at what rate practices or innovations spread through defined populations and social systems. The theory proposes that there are intrinsic characteristics of new ideas or innovations that determine their rate of adoption, and that actual uptake occurs over time via a five-phase innovation-decision process (knowledge, persuasion, decision, implementation, and confirmation). The included frameworks are focussed on the knowledge and persuasion stages of the innovation-decision process.

Two of the included dissemination frameworks make reference to Social Marketing [ 42 ]. One briefly discusses the potential application of social and commercial marketing and advertising principles and strategies in the promotion of non-commercial services, ideas, or research-based knowledge [ 22 ]. The other briefly argues that a social marketing approach could take into account a planning process involving 'consumer' oriented research, objective setting, identification of barriers, strategies, and new formats [ 30 ]. However, this framework itself does not represent a comprehensive application of social marketing theory and principles, and instead highlights five factors that are focussed around formatting evidence-based information so that it is clear and appealing by defined target audiences.

Three other distinct dissemination frameworks were included, two of which are based on literature reviews and researcher experience [ 14 , 32 ]. The first framework takes a novel question-based approach and aims to increase researchers' awareness of the type of context information that might prove useful when disseminating knowledge to target audiences [ 14 ]. The second framework presents a model that can be used to identify barriers and facilitators and to design interventions to aid the transfer and utilization of research knowledge [ 32 ]. The final framework is derived from Two Communities Theory [ 43 ] and proposes pragmatic strategies for communicating across conflicting cultures research and policy; it suggests a shift away from simple one-way communication of research to researchers developing collaborative relationships with policy makers [ 33 ].

Characteristics of conceptual frameworks relating to knowledge translation that could be used by researchers to guide their dissemination activities.

Conceptual frameworks relating to knowledge translation that could be used by researchers to guide their dissemination activities.

Author, Year, Aims.

To facilitate the use of research in clinical settings by providing findings that are relevant and ready to use, in a form that maintains the richness of full research reports yet is still understandable to the general reader.

Qualities of Research.

(described as topic selection based on literature reviews and surveys of clinicians with criteria focussed on relevance, applicability and the perceived gaps between evidence and practice)

Characteristics of the communication (including use of non-technical language, emphasis on implications for practice and strategies for implementation).

Facilitation of utilisation (provision of enquiry centre for implementation advice and to respond to requests for further information and feedback channel for researchers and practitioners)

Reference to other included frameworks.

Describes an approach devised by the National Center for Nursing Research to make research results accessible to practising nurses via a topic focused conference and monograph series.

Presents a coordinated implementation model that that seeks to shed light on dissemination processes and on best how to flow research findings into practice.

Dissemination elements within wider implementation model:

The communication channels.

The implementation setting.

Full model derived from models of social influence, diffusion of innovations, adult learning theory and social marketing.

Four (source, setting, message, channel) of McGuire's five attributes of persuasive communication evident (explicitly derived from Winkler)

Reference to other included frameworks.

Argues that use of research in practice may depend more on a change in researchers behaviour than it does on practitioners-research findings most likely to find their way into practice when they are synthesised, contextualised, packaged to the needs of the end user.

Wider model recognises the external influencing factors on the overall practice environment including, economic resources, legislation and regulation, education, personnel as well as public (media) and patient pressures.

To construct a comprehensive framework of research dissemination and utilisation.

that exist among five stages of innovation (knowledge, persuasion, decision, implementation and confirmation) and four types of characteristics (innovation, organization, environment and individual) as progression from research dissemination to research utilization occurs.

Explicit application of Rogers diffusion of innovations innovation-decision process.

Reference to other included frameworks.

Application of Rogers's innovation-decision process to health research dissemination and utilisation. Framework integrates concepts of research dissemination (knowledge, persuasion), evidence-based decision making (decision) and research utilisation (implementation) within the innovations decision process of diffusion of innovations theory.

Argues that the extent to which an individual or organisation becomes knowledgeable about new ideas is somewhat dependent on the dissemination strategies employed by health researchers.

Present a conceptual and analytic frameworks that integrate several approaches to understanding and studying dissemination processes within public health systems focussed on cardiovascular health promotion.

Four categories of factors shown to affect the success of dissemination efforts:

Characteristics of the dissemination.

Factors associated with users.

Relationships between producers and users.

Derived from Diffusion of Innovations-goes on to describe five approaches to dissemination (science push, problem solving, organisational, knowledge transfer and interaction)

Reference to other included frameworks.

Authors state that dissemination and capacity exist within a broader social, political, economic context operating at micro, meso and macro levels.

The framework posits that contextual factors act as mediators shaping the behaviours and values of individuals and organizations, innovations, and influencing the process and outcome of capacity building and dissemination.

Review of the literature on the spread and sustainability of innovations in health service delivery and organisation.

Develop and apply (in four case studies) a unifying conceptual model based on the evidence.

Planned dissemination elements within wider model:

Address needs and perspectives of potential adopters.

Tailor different strategies to different groups.

Use appropriate messages.

Use appropriate communication channels.

Undertake rigorous evaluation.

Application of Diffusion of Innovations in a health service delivery and organisation context.

Not explicitly stated but.

four (message, setting, audience, channel) of McGuire's five attributes of persuasive communication.

Reference to other included frameworks.

Formal dissemination programs, defined as active and planned efforts to persuade target groups to adopt an innovation are more effective if the program's organizers (1) take full account of potential adopters' needs and perspectives, with particular attention to the balance of costs and benefits for them; (2) tailor different strategies to the different demographic, structural, and cultural features of different subgroups; (3) use a message with appropriate style, imagery, metaphors, and so on; (4) identify and use appropriate communication channels; and (5) incorporate rigorous evaluation and monitoring of defined goals and milestones.

Review tobacco control dissemination experience to draw guidance for physical activity promotion.

Push: strengthening science.

push by proving, improving, and communicating effective interventions for wide population use;

Pull: boosting demand, or market pull for interventions among consumers, and healthcare purchasers and policymakers.

Capacity: building the capacity of relevant systems and institutions to deliver them.

Diffusion of Innovations used to assess how tobacco control lessons diffuse and apply to the field of physical activity.

Reference to other included frameworks.

Author's state dissemination encompasses the planned facilitation and acceleration of diffusion of innovations, transfer and utilization of knowledge, and implementation of the resulting adaptations in local circumstances.

Author suggest lessons from tobacco control include the need for a funded mandate; the mass media to frame the public policy debate and to help undermine negative behaviour; the comprehensiveness of interventions at national and local levels to mutually reinforce each other; the need for systematic evaluation; the need for policy and funding to support programs; the need for coordinated programs to support individuals.

Outline the main attributes of.

Diffusion of Innovations and key concepts to consider in the dissemination and diffusion of innovations to promote physical activity.

Advocacy: identifying and engaging key stakeholders.

Increased funding to build the evidence base to supply diffusion and dissemination strategies and to allow investigators to gain experience with type of role.

Implement surveillance systems to track use of evidence-based interventions.

Application of Diffusion of Innovations in a public health context.

RE-AIM framework can be used to determine the success and impact of dissemination efforts.

Reference to other included frameworks.

Diffusion of innovations theory can be applied to accelerate the rate of diffusion specifically to promote physical activity interventions.

Authors present two case studies and argue that their success illustrates the need for dedicated field staff, product production, marketing, and distribution.

To determine the extent of research transfer in natural sciences and engineering among Canadian university researchers;

to examine any differences between various disciplines with regard to the extent of transfer; to examine the determinants of research transfer.

Four categories of resources (along with the attributes of research knowledge) likely to enable researchers to transfer knowledge:

회사에 대한 리소스 기반 뷰.

Resource-based view of the firm-researchers.

have resources and capabilities which are deployed and.

mobilized in their knowledge transfer activities.

Reference to other included frameworks.

Based on a survey of 1,554 researchers, presents a model of how researchers in natural sciences and engineering transfer knowledge outside the academic community.

Two determinants found to be consistently influential: linkages between researchers and research users, and focus of the research projects on end user needs. Other determinants influencing knowledge transfer varied from one research field to another.

Describe a participatory approach to knowledge translation developed during a program of research concerning equitable care for diverse populations.

Two dimensions process (translation) and content.

Process (translation involving: credible messengers, accountability, reciprocity, respect, and research champions)

Content (ongoing cycle of data collection, analysis and synthesis of knowledge)

Reference to other included frameworks.

A collaborative model of knowledge translation between researchers and practitioners in clinical settings-derived from a non systematic review of literature and from experiences drawn from a programme of research funded by the Canadian Institutes of Health Research.

Authors state at the core of the approach is a collaborative relationship between researchers and practitioners, which underpins the knowledge translation cycle, and occurs simultaneously with data collection/analysis/synthesis.

To provide a new tool for researchers and healthcare decision makers that integrates existing concepts relevant to translating research into practice.

Program or intervention (consideration of elements from the perspective of the organization and staff to be targeted)

External environment (consideration of)

Implementation and sustainability infrastructure necessary for success (consideration of)

Recipients (Characteristics of both organisational and patient recipients of interventions need to be considered to maximize.

States that aspects of the model derived from diffusion of innovations, social ecology, the PRECEDE/PROCEED model, and the quality improvement/implementation literature. Impact measures derived from RE-AIM.

Reference to other included frameworks.

Practical, Robust Implementation and Sustainability Model (PRISM) considers how the program or intervention design, the external environment, the implementation and sustainability infrastructure, and the recipients influence program adoption, implementation, and maintenance.

Designed to help researchers (and organisations) conceptualize, implement, and evaluate healthcare improvement programs.

To present a knowledge transfer model and illustrate how its use can lead to competitive advantage.

Comprehensive employee skills assessment.

Identify the type of knowledge to be transferred (tacit or explicit)

Select appropriate media required for knowledge transfer.

Appropriate generation of corporate university (defined as a strategic commitment to organisational learning and development of intellectual capital)

Knowledge-based view of the firm.

Reference to other included frameworks.

The authors propose that the type of knowledge to be transferred and the appropriate media to transfer that knowledge, determine the education and training needs required to achieve competitive advantage.

To identify dimensions that could be used to describe and differentiate models of partnerships, and illustrate how these dimensions could be applied using three recent case studies in Australia.

Decision maker involvement.

in research versus researcher involvement in decision making.

Investigator versus decision maker driven research.

Value of decision maker involvement at various stages of the research process.

Discrete projects versus programs versus ongoing reciprocity.

Formal versus informal linkages.

Active versus passive involvement.

Concentrated and specific versus.

diffuse and heterogeneous linkages.

Reference to other included frameworks.

Dimensions derived from a brief narrative review of the partnership literature within health services research and on a selection of theoretical and conceptual references from other fields, particularly organization science.

Authors argue building capacity for knowledge exchange demands an evidence-base of its own. They suggest their seven dimensions of partnerships provide a basis for research examining the usefulness of particular partnership models and their applicability and effectiveness in different contexts.

Reviews knowledge transfer frameworks to gain a better understanding of the processes involved in knowledge transfer and presents a five domain model of the knowledge transfer processes to help researchers, practitioners and decision makers plan and evaluate initiatives for transferring knowledge into action.

Problem: Identifying and communicating about the problem which the knowledge needs to address.

Context: Analysing the context which surrounds the producers and users of knowledge.

Knowledge: Developing and selecting the knowledge to be transferred.

Intervention: Selecting specific knowledge transfer activities or.

Use: Considering how the knowledge will be used in practice.

Practical framework developed from on commonalities from 28 published models including the Diffusion of Innovations.

Reference to other included frameworks.

Authors emphasise that knowledge transfer is an interactive, multidirectional rather than linear process.

Report outlines a series of domain specific questions for research users and producers to use to think about and incorporate knowledge transfer processes in to their routine practice.

Theoretical underpinnings of dissemination frameworks.

Only two of the included knowledge translation frameworks were judged to encompass four of McGuire's five variables for persuasive communications [ 45 , 47 ]. One framework [ 45 ] explicitly attributes these variables as being derived from Winkler et al [ 11 ]. The other [ 47 ] refers to strong direct evidence but does not refer to McGuire or any of the other included frameworks.

Diffusion of Innovations theory [ 40 , 41 ] is explicitly cited in eight of the included knowledge translation frameworks [ 13 , 45 – 49 , 52 , 56 ]. Of these, two represent attempts to operationalise and apply the theory, one in the context of evidence-based decision making and practice [ 13 ], and the other to examine how innovations in organisation and delivery of health services spread and are sustained in health service organisations [ 47 , 57 ]. The other frameworks are exclusively based on the theory and are focussed instead on strategies to accelerate the uptake of evidence-based knowledge and or interventions.

Two of the included knowledge translation frameworks [ 50 , 53 ] are explicitly based on resource or knowledge-based Theory of the Firm [ 58 , 59 ]. Both frameworks propose that successful knowledge transfer (or competitive advantage) is determined by the type of knowledge to be transferred as well as by the development and deployment of appropriate skills and infrastructure at an organisational level.

Two of the included knowledge translation frameworks purport to be based upon a range of theoretical perspectives. The Coordinated Implementation model is derived from a range of sources, including theories of social influence on attitude change, the Diffusion of Innovations, adult learning, and social marketing [ 45 ]. The Practical, Robust Implementation and Sustainability Model was developed using concepts from Diffusion of Innovations, social ecology, as well as the health promotion, quality improvement, and implementation literature [ 52 ].

Three other distinct knowledge translation frameworks were included, all of which are based on a combination of literature reviews and researcher experience [ 44 , 51 , 54 ].

Conceptual frameworks provided by UK funders.

Of the websites of the 10 UK funders of health services and public health research, only the ESRC made a dissemination framework available to grant applicants or holders (see Table 1 ) [ 26 ]. A summary version of another included framework is available via the publications section of the Joseph Rowntree Foundation [ 60 ]. However, no reference is made to it in the submission guidance they make available to research applicants.

All of the UK funding bodies made brief references to dissemination in their research grant application guides. These would simply ask applicants to briefly indicate how findings arising from the research will be disseminated (often stating that this should be other than via publication in peer-reviewed journals) so as to promote or facilitate take up by users in the health services.

토론.

This systematic scoping review presents to our knowledge the most comprehensive overview of conceptual/organising frameworks relating to research dissemination. Thirty-three frameworks met our inclusion criteria, 20 of which were designed to be used by researchers to guide their dissemination activities. Twenty-eight included frameworks that were underpinned at least in part by one or more of three different theoretical approaches, namely persuasive communication, diffusion of innovations theory, and social marketing.

Our search strategy was deliberately broad, and we searched a number of relevant databases and other sources with no language or publication status restrictions, reducing the chance that some relevant studies were excluded from the review and of publication or language bias. However, we restricted our searches to health and social science databases, and it is possible that searches targeting for example the management or marketing literature may have revealed additional frameworks. In addition, this review was undertaken as part of a project assessing UK research dissemination, so our search for frameworks provided by funding agencies was limited to the UK. It is possible that searches of funders operating in other geographical jurisdictions may have identified other studies. We are also aware that the way in which we have defined the process of dissemination and our judgements as to what constitutes sufficient detail may have resulted in some frameworks being excluded that others may have included or vice versa. Given this, and as an aid to transparency, we have included the list of excluded papers as Additional File 2 , Appendix 2 so as to allow readers to assess our, and make their own, judgements on the literature identified.

Despite these potential limitations, in this review we have identified 33 frameworks that are available and could be used to help guide dissemination planning and activity. By way of contrast, a recent systematic review of the knowledge transfer and exchange literature (with broader aims and scope) [ 61 ] identified five organising frameworks developed to guide knowledge transfer and exchange initiatives (defined as involving more than one way communications and involving genuine interaction between researchers and target audiences) [ 13 – 15 , 62 , 63 ]. All were identified by our searches, but only three met our specific inclusion criteria of providing sufficient dissemination process detail [ 13 – 15 ]. One reviewed methods for assessment of research utilisation in policy making [ 62 ], whilst the other reviewed knowledge mapping as a tool for understanding the many knowledge creation and translation resources and processes in a health system [ 63 ].

There is a large amount of theoretical convergence among the identified frameworks. This all the more striking given the wide range of theoretical approaches that could be applied in the context of research dissemination [ 64 ], and the relative lack of cross-referencing between the included frameworks. Three distinct but interlinked theories appear to underpin (at least in part) 28 of the included frameworks. There has been some criticism of health communications that are overly reliant on linear messenger-receiver models and do not draw upon other aspects of communication theory [ 65 ]. Although researcher focused, the included frameworks appear more participatory than simple messenger-receiver models, and there is recognition of the importance of context and emphasis on the key to successful dissemination being dependent on the need for interaction with the end user.

As we highlight in the introduction, there is recognition among international funders both of the importance of and their role in the dissemination of research [ 9 ]. Given the current political emphasis on reducing deficiencies in the uptake of knowledge about the effects of interventions into routine practice, funders could be making and advocating more systematic use of conceptual frameworks in the planning of research dissemination.

Rather than asking applicants to briefly indicate how findings arising from their proposed research will be disseminated (as seems to be the case in the UK), funding agencies could consider encouraging grant applicants to adopt a theoretically-informed approach to their research dissemination. Such an approach could be made a conditional part of any grant application process; an organising framework such as those described in this review could be used to demonstrate the rationale and understanding underpinning their proposed plans for dissemination. More systematic use of conceptual frameworks would then provide opportunities to evaluate across a range of study designs whether utilising any of the identified frameworks to guide research dissemination does in fact enhance the uptake of research findings in policy and practice.

There are currently a number of theoretically-informed frameworks available to researchers that could be used to help guide their dissemination planning and activity. Given the current emphasis on enhancing the uptake of knowledge about the effects of interventions into routine practice, funders could consider encouraging researchers to adopt a theoretically informed approach to their research dissemination.

Declarations.

감사 인사.

This review was undertaken as part of a wider project funded by the MRC Population Health Sciences Research Network (Ref: PHSRN 11). The views expressed in this paper are those of the authors alone.

Electronic supplementary material.

Competing interests.

Paul Wilson is an Associate Editor of Implementation Science. All decisions on this manuscript were made by another senior editor. Paul Wilson works for, and has contributed to the development of the CRD framework which is included in this review. The author(s) declare that they have no other competing interests.

Authors' contributions.

All authors contributed to the conception, design, and analysis of the review. All authors were involved in the writing of the first and all subsequent versions of the paper. All authors read and approved the final manuscript. Paul Wilson is the guarantor.

Authors’ Affiliations.

참조.

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Disseminating research findings: what should researchers do? A systematic scoping review of conceptual frameworks.

배경.

Addressing deficiencies in the dissemination and transfer of research-based knowledge into routine clinical practice is high on the policy agenda both in the UK and internationally.

However, there is lack of clarity between funding agencies as to what represents dissemination. Moreover, the expectations and guidance provided to researchers vary from one agency to another. Against this background, we performed a systematic scoping to identify and describe any conceptual/organising frameworks that could be used by researchers to guide their dissemination activity.

We searched twelve electronic databases (including MEDLINE, EMBASE, CINAHL, and PsycINFO), the reference lists of included studies and of individual funding agency websites to identify potential studies for inclusion. To be included, papers had to present an explicit framework or plan either designed for use by researchers or that could be used to guide dissemination activity. Papers which mentioned dissemination (but did not provide any detail) in the context of a wider knowledge translation framework, were excluded. References were screened independently by at least two reviewers; disagreements were resolved by discussion. For each included paper, the source, the date of publication, a description of the main elements of the framework, and whether there was any implicit/explicit reference to theory were extracted. A narrative synthesis was undertaken.

Thirty-three frameworks met our inclusion criteria, 20 of which were designed to be used by researchers to guide their dissemination activities. Twenty-eight included frameworks were underpinned at least in part by one or more of three different theoretical approaches, namely persuasive communication, diffusion of innovations theory, and social marketing.

결론.

There are currently a number of theoretically-informed frameworks available to researchers that can be used to help guide their dissemination planning and activity. Given the current emphasis on enhancing the uptake of knowledge about the effects of interventions into routine practice, funders could consider encouraging researchers to adopt a theoretically-informed approach to their research dissemination.

배경.

Healthcare resources are finite, so it is imperative that the delivery of high-quality healthcare is ensured through the successful implementation of cost-effective health technologies. However, there is growing recognition that the full potential for research evidence to improve practice in healthcare settings, either in relation to clinical practice or to managerial practice and decision making, is not yet realised. Addressing deficiencies in the dissemination and transfer of research-based knowledge to routine clinical practice is high on the policy agenda both in the UK [1-5] and internationally [6].

As interest in the research to practice gap has increased, so too has the terminology used to describe the approaches employed [7,8]. Diffusion, dissemination, implementation, knowledge transfer, knowledge mobilisation, linkage and exchange, and research into practice are all being used to describe overlapping and interrelated concepts and practices. In this review, we have used the term dissemination, which we view as a key element in the research to practice (knowledge translation) continuum. We define dissemination as a planned process that involves consideration of target audiences and the settings in which research findings are to be received and, where appropriate, communicating and interacting with wider policy and health service audiences in ways that will facilitate research uptake in decision-making processes and practice.

Most applied health research funding agencies expect and demand some commitment or effort on the part of grant holders to disseminate the findings of their research. However, there does appear to be a lack of clarity between funding agencies as to what represents dissemination [9]. Moreover, although most consider dissemination to be a shared responsibility between those funding and those conducting the research, the expectations on and guidance provided to researchers vary from one agency to another [9].

We have previously highlighted the need for researchers to consider carefully the costs and benefits of dissemination and have raised concerns about the nature and variation in type of guidance issued by funding bodies to their grant holders and applicants [10]. Against this background, we have performed a systematic scoping review with the following two aims: to identify and describe any conceptual/organising frameworks designed to be used by researchers to guide their dissemination activities; and to identify and describe any conceptual/organising frameworks relating to knowledge translation continuum that provide enough detail on the dissemination elements that researchers could use it to guide their dissemination activities.

The following databases were searched to identify potential studies for inclusion: MEDLINE and MEDLINE In-Process and Other Non-Indexed Citations (1950 to June 2010); EMBASE (1980 to June 2010); CINAHL (1981 to June 2010); PsycINFO (1806 to June 2010); EconLit (1969 to June 2010); Social Services Abstracts (1979 to June 2010); Social Policy and Practice (1890 to June 2010); Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database (Cochrane Library 2010: Issue 1).

The search terms were identified through discussion by the research team, by scanning background literature, and by browsing database thesauri. There were no methodological, language, or date restrictions. Details of the database specific search strategies are presented Additional File 1, Appendix 1.

Citation searches of five articles [11-15] identified prior to the database searches were performed in Science Citation Index (Web of Science), MEDLINE (OvidSP), and Google Scholar (February 2009).

As this review was undertaken as part of a wider project aiming to assess the dissemination activity of UK applied and public health researchers [16], we searched the websites of 10 major UK funders of health services and public health research. These were the British Heart Foundation, Cancer Research UK, the Chief Scientist Office, the Department of Health Policy Research Programme, the Economic and Social Research Council (ESRC), the Joseph Rowntree Foundation, the Medical Research Council (MRC), the NIHR Health Technology Assessment Programme, the NIHR Service Delivery and Organisation Programme and the Wellcome Trust. We aimed to identify any dissemination/communication frameworks, guides, or plans that were available to grant applicants or holders.

We also interrogated the websites of four key agencies with an established record in the field of dissemination and knowledge transfer. These were the Agency for Healthcare Research and Quality ( AHRQ ) , the Canadian Institutes of Health Research (CIHR), the Canadian Health Services Research Foundation (CHSRF), and the Centre for Reviews and Dissemination (CRD).

As a number of databases and websites were searched, some degree of duplication resulted. In order to manage this issue, the titles and abstracts of records were downloaded and imported into EndNote bibliographic software, and duplicate records removed.

References were screened independently by two reviewers; those studies that did not meet the inclusion criteria were excluded. Where it was not possible to exclude articles based on title and abstract alone, full text versions were obtained and their eligibility was assessed independently by two reviewers. Where disagreements occurred, the opinion of a third reviewer was sought and resolved by discussion and arbitration by a third reviewer.

To be eligible for inclusion, papers needed to either present an explicit framework or plan designed to be used by a researcher to guide their dissemination activity, or an explicit framework or plan that referred to dissemination in the context of a wider knowledge translation framework but that provided enough detail on the dissemination elements that a researcher could then use it. Papers that referred to dissemination in the context of a wider knowledge translation framework, but that did not describe in any detail those process elements relating to dissemination were excluded from the review. A list of excluded papers is included in Additional File 2, Appendix 2.

For each included paper we recorded the publication date, a description of the main elements of the framework, whether there was any reference to other included studies, and whether there was an explicit theoretical basis to the framework. Included papers that did not make an explicit reference to an underlying theory were re-examined to determine whether any implicit use of theory could be identified. This entailed scrutinising the references and assessing whether any elements from theories identified in other papers were represented in the text. Data from each paper meeting the inclusion criteria were extracted by one researcher and independently checked for accuracy by a second.

A narrative synthesis [17] of included frameworks was undertaken to present the implicit and explicit theoretical basis of included frameworks and to explore any relationships between them.

Our searches identified 6,813 potentially relevant references (see Figure ​ Figure1). 1 ). Following review of the titles and abstracts, we retrieved 122 full papers for a more detailed screening. From these, we included 33 frameworks (reported in 44 papers) Publications that did not meet our inclusion criteria are listed in Additional File 2, Appendix 2.

Characteristics of conceptual frameworks designed to be used by researchers.

Table ​ Table1 1 summarises in chronological order, twenty conceptual frameworks designed for use by researchers [11,14,15,18-34]. Where we have described elements of frameworks that have been reported across multiple publications, these are referenced in the Table.

Theoretical underpinnings of dissemination frameworks.

Thirteen of the twenty included dissemination frameworks were either explicitly or implicitly judged to be based on the Persuasive Communication Matrix [35,36]. Originally derived from a review of the literature of persuasion which sought to operationalise Lasswell's seminal description of persuasive communications as being about 'Who says what in which channel to whom with what effect' [37]. McGuire argued that there are five variables that influence the impact of persuasive communications. These are the source of communication, the message to be communicated, the channels of communication, the characteristics of the audience (receiver), and the setting (destination) in which the communication is received.

Included frameworks were judged to encompass either three [21,27,29], four [15,20,23,26,28,31,38], or all five [11,18,25] of McGuire's five input variables, namely, the source, channel, message, audience, and setting. The earliest conceptual model included in the review explicitly applied McGuire's five input variables to the dissemination of medical technology assessments [11]. Only one other framework (in its most recent version) explicitly acknowledges McGuire [17]; the original version acknowledged the influence of Winkler et al . on its approach to conceptualising systematic review dissemination [18]. The original version of the CRD approach [18,39] is itself referred to by two of the other eight frameworks [20,23]

Diffusion of Innovations theory [40,41] is explicitly cited by eight of the dissemination frameworks [11,17,19,22,24,28,29,34]. Diffusion of Innovations offers a theory of how, why, and at what rate practices or innovations spread through defined populations and social systems. The theory proposes that there are intrinsic characteristics of new ideas or innovations that determine their rate of adoption, and that actual uptake occurs over time via a five-phase innovation-decision process (knowledge, persuasion, decision, implementation, and confirmation). The included frameworks are focussed on the knowledge and persuasion stages of the innovation-decision process.

Two of the included dissemination frameworks make reference to Social Marketing [42]. One briefly discusses the potential application of social and commercial marketing and advertising principles and strategies in the promotion of non-commercial services, ideas, or research-based knowledge [22]. The other briefly argues that a social marketing approach could take into account a planning process involving 'consumer' oriented research, objective setting, identification of barriers, strategies, and new formats [30]. However, this framework itself does not represent a comprehensive application of social marketing theory and principles, and instead highlights five factors that are focussed around formatting evidence-based information so that it is clear and appealing by defined target audiences.

Three other distinct dissemination frameworks were included, two of which are based on literature reviews and researcher experience [14,32]. The first framework takes a novel question-based approach and aims to increase researchers' awareness of the type of context information that might prove useful when disseminating knowledge to target audiences [14]. The second framework presents a model that can be used to identify barriers and facilitators and to design interventions to aid the transfer and utilization of research knowledge [32]. The final framework is derived from Two Communities Theory [43] and proposes pragmatic strategies for communicating across conflicting cultures research and policy; it suggests a shift away from simple one-way communication of research to researchers developing collaborative relationships with policy makers [33].

Characteristics of conceptual frameworks relating to knowledge translation that could be used by researchers to guide their dissemination activities.

Table ​ Table2 2 summarises in chronological order the dissemination elements of 13 conceptual frameworks relating to knowledge translation that could be used by researchers to guide their dissemination activities [13,44-55].

Theoretical underpinnings of dissemination frameworks.

Only two of the included knowledge translation frameworks were judged to encompass four of McGuire's five variables for persuasive communications [45,47]. One framework [45] explicitly attributes these variables as being derived from Winkler et al [11]. The other [47] refers to strong direct evidence but does not refer to McGuire or any of the other included frameworks.

Diffusion of Innovations theory [40,41] is explicitly cited in eight of the included knowledge translation frameworks [13,45-49,52,56]. Of these, two represent attempts to operationalise and apply the theory, one in the context of evidence-based decision making and practice [13], and the other to examine how innovations in organisation and delivery of health services spread and are sustained in health service organisations [47,57]. The other frameworks are exclusively based on the theory and are focussed instead on strategies to accelerate the uptake of evidence-based knowledge and or interventions.

Two of the included knowledge translation frameworks [50,53] are explicitly based on resource or knowledge-based Theory of the Firm [58,59]. Both frameworks propose that successful knowledge transfer (or competitive advantage) is determined by the type of knowledge to be transferred as well as by the development and deployment of appropriate skills and infrastructure at an organisational level.

Two of the included knowledge translation frameworks purport to be based upon a range of theoretical perspectives. The Coordinated Implementation model is derived from a range of sources, including theories of social influence on attitude change, the Diffusion of Innovations, adult learning, and social marketing [45]. The Practical, Robust Implementation and Sustainability Model was developed using concepts from Diffusion of Innovations, social ecology, as well as the health promotion, quality improvement, and implementation literature [52].

Three other distinct knowledge translation frameworks were included, all of which are based on a combination of literature reviews and researcher experience [44,51,54].

Conceptual frameworks provided by UK funders.

Of the websites of the 10 UK funders of health services and public health research, only the ESRC made a dissemination framework available to grant applicants or holders (see Table ​ Table1) 1 ) [26]. A summary version of another included framework is available via the publications section of the Joseph Rowntree Foundation [60]. However, no reference is made to it in the submission guidance they make available to research applicants.

All of the UK funding bodies made brief references to dissemination in their research grant application guides. These would simply ask applicants to briefly indicate how findings arising from the research will be disseminated (often stating that this should be other than via publication in peer-reviewed journals) so as to promote or facilitate take up by users in the health services.

토론.

This systematic scoping review presents to our knowledge the most comprehensive overview of conceptual/organising frameworks relating to research dissemination. Thirty-three frameworks met our inclusion criteria, 20 of which were designed to be used by researchers to guide their dissemination activities. Twenty-eight included frameworks that were underpinned at least in part by one or more of three different theoretical approaches, namely persuasive communication, diffusion of innovations theory, and social marketing.

Our search strategy was deliberately broad, and we searched a number of relevant databases and other sources with no language or publication status restrictions, reducing the chance that some relevant studies were excluded from the review and of publication or language bias. However, we restricted our searches to health and social science databases, and it is possible that searches targeting for example the management or marketing literature may have revealed additional frameworks. In addition, this review was undertaken as part of a project assessing UK research dissemination, so our search for frameworks provided by funding agencies was limited to the UK. It is possible that searches of funders operating in other geographical jurisdictions may have identified other studies. We are also aware that the way in which we have defined the process of dissemination and our judgements as to what constitutes sufficient detail may have resulted in some frameworks being excluded that others may have included or vice versa. Given this, and as an aid to transparency, we have included the list of excluded papers as Additional File 2, Appendix 2 so as to allow readers to assess our, and make their own, judgements on the literature identified.

Despite these potential limitations, in this review we have identified 33 frameworks that are available and could be used to help guide dissemination planning and activity. By way of contrast, a recent systematic review of the knowledge transfer and exchange literature (with broader aims and scope) [61] identified five organising frameworks developed to guide knowledge transfer and exchange initiatives (defined as involving more than one way communications and involving genuine interaction between researchers and target audiences) [13-15,62,63]. All were identified by our searches, but only three met our specific inclusion criteria of providing sufficient dissemination process detail [13-15]. One reviewed methods for assessment of research utilisation in policy making [62], whilst the other reviewed knowledge mapping as a tool for understanding the many knowledge creation and translation resources and processes in a health system [63].

There is a large amount of theoretical convergence among the identified frameworks. This all the more striking given the wide range of theoretical approaches that could be applied in the context of research dissemination [64], and the relative lack of cross-referencing between the included frameworks. Three distinct but interlinked theories appear to underpin (at least in part) 28 of the included frameworks. There has been some criticism of health communications that are overly reliant on linear messenger-receiver models and do not draw upon other aspects of communication theory [65]. Although researcher focused, the included frameworks appear more participatory than simple messenger-receiver models, and there is recognition of the importance of context and emphasis on the key to successful dissemination being dependent on the need for interaction with the end user.

As we highlight in the introduction, there is recognition among international funders both of the importance of and their role in the dissemination of research [9]. Given the current political emphasis on reducing deficiencies in the uptake of knowledge about the effects of interventions into routine practice, funders could be making and advocating more systematic use of conceptual frameworks in the planning of research dissemination.

Rather than asking applicants to briefly indicate how findings arising from their proposed research will be disseminated (as seems to be the case in the UK), funding agencies could consider encouraging grant applicants to adopt a theoretically-informed approach to their research dissemination. Such an approach could be made a conditional part of any grant application process; an organising framework such as those described in this review could be used to demonstrate the rationale and understanding underpinning their proposed plans for dissemination. More systematic use of conceptual frameworks would then provide opportunities to evaluate across a range of study designs whether utilising any of the identified frameworks to guide research dissemination does in fact enhance the uptake of research findings in policy and practice.

There are currently a number of theoretically-informed frameworks available to researchers that could be used to help guide their dissemination planning and activity. Given the current emphasis on enhancing the uptake of knowledge about the effects of interventions into routine practice, funders could consider encouraging researchers to adopt a theoretically informed approach to their research dissemination.

Competing interests.

Paul Wilson is an Associate Editor of Implementation Science. All decisions on this manuscript were made by another senior editor. Paul Wilson works for, and has contributed to the development of the CRD framework which is included in this review. The author(s) declare that they have no other competing interests.

Authors' contributions.

All authors contributed to the conception, design, and analysis of the review. All authors were involved in the writing of the first and all subsequent versions of the paper. All authors read and approved the final manuscript. Paul Wilson is the guarantor.

Supplementary Material.

Appendix 1: Database search strategies . This file includes details of the database specific search strategies used in the review.

Appendix 2: Full-text papers assessed for eligibility but excluded from the review . This file includes details of full-text papers assessed for eligibility but excluded from the review.

감사 인사.

This review was undertaken as part of a wider project funded by the MRC Population Health Sciences Research Network (Ref: PHSRN 11). The views expressed in this paper are those of the authors alone.

Advances in Patient Safety.

Dissemination Planning Tool: Exhibit A from Volume 4.

Programs, Tools, and Products.

목차.

Advances in Patient Safety: From Research to Implementation.

This tool was developed to help researchers evaluate their research and develop appropriate dissemination plans, if the research is determined to have "real world" impact. Creation and testing of the tool is described in Development of a Planning Tool to Guide Research Dissemination . ( PDF version - 157.95 KB ) ( Microsoft Word version - 115 KB ). Advances in Patient Safety: From Research to Implementation. Rockville, MD: Agency for Healthcare and Research Quality; 2005.

By Deborah Carpenter, Veronica Nieva, Tarek Albaghal, and Joann Sorra (Westat)

Purpose.

AHRQ is increasingly interested in research that has "real world" impact in the practice of health care. This tool will help you, the Patient Safety Researcher, develop a plan for disseminating your research findings and products to potential users in the health care system. This tool is designed to prompt your thinking about the processes that you would use to disseminate your findings or products, beyond publishing and presenting in peer-reviewed venues.

This tool will ask you to identify the aspects of your research that are ready for dissemination, and to think about who could benefit from your findings or products. It will also encourage you to consider various ways to reach these users—establishing direct links as well as working through intermediary organizations, or tapping into existing networks.

Components of a Dissemination Plan.

Developing a dissemination plan will facilitate the translation of your research into practice. Your dissemination plan will include six major elements:

Go to Figure 1 for graphic illustration.

명령.

Select one research finding or product that you expect to be particularly important in improving patient safety, and that is ready for dissemination. You may want to complete the tool separately if you have several findings or products to disseminate.

For each component of a dissemination plan, you will answer a few key questions about the selected finding or product. At the end, you will integrate your responses into an overall strategy and workplan.

Don't be discouraged if at first you cannot answer every question in this planning tool; the questions serve as prompts to consider these elements in the future as your dissemination effort evolves. Consider this a working document to help you think through the steps you will need to take to get the word out about your research finding or product. This may take a few iterations! You may want to work back and forth between questions as your thinking develops. You may do a first pass at the tool, and revisit it after a few days. You may also want to ask for input from others.

I. Specifying Research Findings and Products: What You Intend to Disseminate.

Draw the boundary around your research finding or product as broadly or as narrowly as you wish, depending on your dissemination aims. Be specific. The more concrete you can be in defining your finding or product, the easier it will be to complete the tool. 예를 들어,

You may want to disseminate 1) an event reporting system as a large product or 2) separately disseminate the taxonomy, measuring tools, or data analytic methods that you developed as smaller aspects of the reporting system. You may want to disseminate a best practice guideline, a curriculum that you developed around the practice, or research findings on outcomes resulting from adoption of these guidelines.

Describe the research finding or product you wish to disseminate. You may want to start by listing your major findings and products, then select one major finding or product for dissemination. For example—A decision support device, an educational curriculum, data collection tool, etc. What problems related to safety in patient care does your research finding or product address?

What makes your research finding or product stand out?

For example—Is it an innovative way to tackle an existing problem? Does it identify a new problem? Does it support or contradict current practices?

Issues to consider in selection what to disseminate:

Think about the pros and cons of disseminating portions of the research vs. all related products and findings. Different end users (e. g. policymakers and health care providers) may be interested in different aspects of the research. Is your research finding ready for dissemination? How strong is the evidence on your research findings? How generalizable are your findings? How does your research finding/product conform to current procedures? What additional research (for a finding) or testing (for a product) would be needed before launching a dissemination effort?

II. Identifying End Users.

List the end users for your research finding or product. Be as specific as possible. You may want to specify health care settings as well as types of clinicians or administrators.

For example—ICU nurses, family physicians, hospital administrators, blood bankers, medical schools, doctors' offices. Describe how your research finding or product is useful to your end users. Why would they want to use your finding or product? For example—does it increase efficiency? Improve quality of care? Provide legal protection? What recent or future events might help or hinder end user interest in your finding or product? Have you involved these end users in your research project? 방법? How can you involve them at this point? For example—Have nurses evaluate the use of an infusion pump. What barriers might your end users face in trying to implement your finding or product? What suggestions might you have for overcoming these barriers?

III. Working with Dissemination Partners.

Think about opinion leaders in your professional community who might be interested in spreading the word about your research. Informal networks and colleagues may be useful dissemination partners. Organizational dissemination partners could include quality improvement organizations, professional groups of your target audience, accreditation or licensing boards, or health care delivery associations. List individuals, organizations, and informal networks who might partner with you in translating and communicating your research findings or products to your end users. Note how they are important to reaching particular end users.

How does your research finding or product fit with and advance the mission and goals of these parties? Why would they want to work with you? What recent/future events might help or hinder their willingness to work with you? What characteristics of your finding or product would appeal to each of these potential dissemination partners? How can you develop an ongoing relationship with these potential dissemination partners? How would you work with them so that your research finding or product is included in their communication channels, and/or tailored to their health delivery systems?

Issues to consider about dissemination partners:

How will you reach the professional opinion leaders? Do you work with anyone who can link you up with them? How will you work with organizational partners? Do you have a personal contact, have you reviewed their Web sites, their standard publications, and annual reports? What materials might you prepare for their use? Do you need different partners to reach different end users? How can you use partners existing informal networks to reach end users?

IV. Communicating Your Message.

Effective dissemination relies on the use of varied channels—e. g., publications and reports, Web sites and other electronic communications, meetings and conferences, person-to-person communications, formal collaborations or information networks.

Consider what methods and channels you might use to bring your research finding or product directly to your end users or partners. Consider also how your dissemination partners communicate regularly with their constituencies—your end users. How you might use their channels to disseminate your finding or product?

You should consider all of these channels to ensure that the widest possible audience is exposed to your research finding or product and in ways that are both accessible and easy-to-use. Cost and cost-effectiveness are obviously important considerations in choosing the right medium.

Your end users could obtain information about research findings, products, or innovations in health care through various means. Optimally, you will need to use a combination of methods to reach end users.

Academic journals Book chapters Technical reports Trade magazines Regular newspapers Special interest newsletters Radio or TV interviews Interest group listservs Web sites.

Academic detailing Clinical specialty associations Informal professional networks Professional conferences Professional meetings (e. g., grand rounds) Workshops and other CME/CNE training Participating in improvement collaboratives or test beds.

How do you think your end users obtain information about health care innovations? Which of the methods above would be effective channels to reach them? What combinations of methods could reinforce your message? Which of these methods could you realistically use to reach your end users? Which methods do your potential dissemination partners use to communicate with your end users? Which ones could be used as channels for your research finding or product? What difficulties might end users have with the methods of communication used, and how could you plan to overcome those difficulties?

What materials might you provide to potential dissemination partners about your research? How can you frame your research results to make them relevant to your partners' agenda? How will you tailor your materials and message to adapt to their ways of communicating with your end users?

V. Evaluating Success.

How will you know if you have met your dissemination goals? What are your success criteria? Are there measurable indicators for these criteria?

For example—Number of physicians reached, responses to advertisements, number of Web site hits, number of inquiries received. How will you involve end users in evaluating the dissemination activities?

For example—Obtaining feedback on how easy the research product was to use, what was needed to translate research findings into practice in their setting. How will you involve end users in evaluating the dissemination activities?

Issues to consider in evaluating success of the dissemination effort:

What are ways that you can measure the success of your dissemination effort? How will you keep in contact with users and potential users? How will you provide feedback to your users and dissemination partners? How will you incorporate their feedback in your future research, product design, and ongoing development?

Developing A Summary.

After you have considered the components of your dissemination plan, use the last page to write a summary of 100-200 words that outlines your basic plan, based on the structure in this planning tool, by completing the following statements.

My research finding or product is _________________________________________________. (Description.) It can be used to _______________________________________________________________. ( Value statement of advantages over current practice.) My primary end users are _______________________________________________________. ( Who is in a position to use the information?) I plan to involve users in my dissemination efforts by __________________________________. (How can I make sure my message is clear?) I can use the following individuals, organizations and networks __________________________________________________to help. (Who has influence with target users? ) The ways that I will communicate the results include:

__________________________________________. (Communication mechanisms.) Potential obstacles that I face in disseminating my research include.

_____________________________________________________________. (List potential difficulties.) I can mitigate these obstacles by ________________________________________________. (Plan to overcome the difficulties.) I plan to evaluate the dissemination plan by ___________________________________________________________________. (Indicators to be used; plans for involving end users and partners.)

I plan to encourage feedback from end users and dissemination partners by.

_______________________________________________________ and provide feedback to them by.

_______________________________________________________ (Obtaining and providing feedback.)

My Dissemination Strategy—Summary.

VI. Dissemination Work Plan.

Immediate action items, schedule, and persons responsible:

Longer term action items, schedule, and persons responsible: