Senior Implementation Research Advisor, CIRCLE Project
The theme for the 12th annual conference (December 4-6, 2019) on the Science of Dissemination and Implementation in Health was Rigor (identifying better methods, measures, and mechanisms for testing theories and models), Relevance (understanding broader community representativeness and balancing generalizability and specificity), and Rapidity (ensuring faster launch and completion and enabling local and ongoing learning and innovation).
Keynote speaker, Amy Edmonson from Harvard Business School, set the tone of the conference with her energetic and upbeat talk on psychological safety – the felt desire for open and honest expression without negative consequences. The three key strategies used by leadership to promote psychological safety align directly with the main principles of implementation research:
- By framing our discussions and work around the idea or goal of learning, we acknowledge that we do not have to start out with perfection; we can course correct.
- By inviting engagement, insisting on dissent, and asking for different perspectives, we are broadening and deepening the discussion, and finally,
- By responding productively to failure, we reinforce that the journey is also part of the goal.
Co-hosted by AcademyHealth and the National Institutes of Health, the conference focused primarily on domestic health issues with a small, but strong global health track that included a lively and thoughtful discussion forum on day two designed to explore approaches to move implementation research forward in low- and middle-income countries. The concepts and learning presented throughout the two-and-a-half day meeting are directly applicable to global maternal and child health implementation research efforts. The key takeaway from the sessions I attended was the importance of theories and frameworks (collectively called models) as a critical element in the dissemination and implementation (D&I) process. The application and presentation of various models throughout the conference, indeed in every session I attended, reinforced their crucial role to ensure rigor, relevance, and rapidity when done as part of an open dialogue among a broad set of stakeholders.
Dissemination and Implementation Models
The session on “Selecting, Adapting, and Operationalizing Theoretical Models for D&I for Proposal Writing and Research” focused on planning for, selecting, combining, adapting, using, and measuring D&I models in health. This session provided practical guidance on how to navigate this complicated, but critical process for anyone interested in contributing to the public health knowledge base.
The presenters led us through a very practical session that helped to clarify what D&I models are and why they are important, including providing clear definitions that distinguish theories from frameworks.
Theories present a systematic way of understanding events or behaviors by providing inter-related concepts, definitions, and propositions that explain or predict events by specifying relationships among variables. They are abstract, broadly applicable, and not content or topic specific.
Frameworks are strategic or action-planning models that provide a systematic way to develop, manage, and evaluate interventions.
Understanding why and how to utilize models serves to strengthen the implementation research efforts of health projects. Models can help to:
- Ensure inclusion of essential implementation strategies
- Enhance the interpretability of study findings
- Provide systematic structure for the development, management, and evaluation of interventions
- Suggest what is important to measure
- Provide explanation why an intervention works (or doesn’t work)
The panel presenters (Borsika Rabin, Rachel Tabak, Russ Glasgow, Ross Brownson, and Bryan Ford from the University of Colorado, Washington University, and University of California San Diego respectively) also discussed how to create a diagram or roadmap to guide the selection of a model. They referred to this as the “plan” stage, where you create a logic model or diagram to identify the most important constructs for the study. Panelists led the audience through a worksheet they developed to facilitate this process.
Following the “plan” stage panelists identified key questions to consider when selecting a D&I Model (there are more than 100 theories, models or frameworks out there to choose from!), and explained strategies to combine and adapt D&I models. Often times, however, these models are created, and then forgotten. The presenters suggested strategies to ensure that D&I models are incorporated into all parts of a project— from early development of D&I research questions to analyses and dissemination of research findings. They emphasized the importance of continually returning to the model while conducting the study to ensure that measures and data collection processes align with the model and its key constructs – this is the “use” phase. During the final stage “measure”, projects should find and select measures of constructs related to the study’s D&I models. Many scholars distinguish dissemination and implementation research from other processes such as quality improvement or monitoring and evaluation by the presence and use of a well-developed model. An interactive web-based tool to help researchers and practitioners work through these phases is available at: https://dissemination-implementation.org. As the Health Research Program’s partners embark on developing and implementing their implementation research strategies for their projects, this is a great resource for selecting, adapting and operationalizing a theoretical model to support implementation.