Cynthia Vinson

National Institutes of Health Approaches to Dissemination and Implementation Science: Current and Future Directions

To address the vast gap between current knowledge and practice in the area of dissemination and implementation research, we address terminology, provide examples of successful applications of this research, discuss key sources of support, and highlight directions and opportunities for future advances. There is a need for research testing approaches to scaling up and sustaining effective interventions, and we propose that further advances in the field will be achieved by focusing dissemination and implementation research on 5 core values: rigor and relevance, efficiency, collaboration, improved capacity, and cumulative knowledge.

The U.S. training institute for dissemination and implementation research in health

BackgroundThe science of dissemination and implementation (D&I) is advancing the knowledge base for how best to integrate evidence-based interventions within clinical and community settings and how to recast the nature or conduct of the research itself to make it more relevant and actionable in those settings. While the field is growing, there are only a few training programs for D&I research; this is an important avenue to help build the field’s capacity. To improve the United States’ capacity for D&I research, the National Institutes of Health and Veterans Health Administration collaborated to develop a five-day training institute for postdoctoral level applicants aspiring to advance this science.MethodsWe describe the background, goals, structure, curriculum, application process, trainee evaluation, and future plans for the Training in Dissemination and Implementation Research in Health (TIDIRH).ResultsThe TIDIRH used a five-day residential immersion to maximize opportunities for trainees and faculty to interact. The train-the-trainer-like approach was intended to equip participants with materials that they could readily take back to their home institutions to increase interest and further investment in D&I. The TIDIRH curriculum included a balance of structured large group discussions and interactive small group sessions.Thirty-five of 266 applicants for the first annual training institute were accepted from a variety of disciplines, including psychology (12 trainees); medicine (6 trainees); epidemiology (5 trainees); health behavior/health education (4 trainees); and 1 trainee each from education & human development, health policy and management, health services research, public health studies, public policy and social work, with a maximum of two individuals from any one institution. The institute was rated as very helpful by attendees, and by six months after the institute, a follow-up survey (97% return rate) revealed that 72% had initiated a new grant proposal in D&I research; 28% had received funding, and 77% had used skills from TIDIRH to influence their peers from different disciplines about D&I research through building local research networks, organizing formal presentations and symposia, teaching and by leading interdisciplinary teams to conduct D&I research.ConclusionsThe initial TIDIRH training was judged successful by trainee evaluation at the conclusion of the week’s training and six-month follow-up, and plans are to continue and possibly expand the TIDIRH in coming years. Strengths are seen as the residential format, quality of the faculty and their flexibility in adjusting content to meet trainee needs, and the highlighting of concrete D&I examples by the local host institution, which rotates annually. Lessons learned and plans for future TIDIRH trainings are summarized.

Translating research into improved outcomes in comprehensive cancer control.

A key question in moving comprehensive cancer control (CCC) plans into action is, to what extent should the knowledge gained from investments in cancer prevention and control research influence the actions taken by states, tribes, and territories during implementation? Underlying this ‘should’ is the assumption that evidence-based approaches (i.e., a public health or clinical intervention or policy that has resulted in improved outcomes when scientifically tested), when implemented in a real-world setting, will increase the likelihood of improved outcomes. This article elucidates the barriers and opportunities for integrating science with practice across the cancer control continuum. However, given the scope of CCC and the substantial investment in generating new knowledge through science, it is difficult for any one agency, on its own, to make a sufficient investment to ensure new knowledge is translated and implemented at a national, state, or local level. Thus, if greater demand for evidence-based interventions and increased resources for adopting them are going to support the dissemination initiatives described herein, new interagency partnerships must be developed to ensure that sufficient means are dedicated to integrating science with service. Furthermore, for these collaborations to increase both in size and in frequency, agency leaders must clearly articulate their support for these collaborative initiatives and explicitly recognize those collaborative efforts that are successful. In this way, the whole (in this context, comprehensive cancer control) can become greater than the sum of its parts.

Implementation science in cancer prevention and control: a decade of grant funding by the National Cancer Institute and future directions

BackgroundThe National Cancer Institute (NCI) has supported implementation science for over a decade. We explore the application of implementation science across the cancer control continuum, including prevention, screening, treatment, and survivorship.MethodsWe reviewed funding trends of implementation science grants funded by the NCI between 2000 and 2012. We assessed study characteristics including cancer topic, position on the T2–T4 translational continuum, intended use of frameworks, study design, settings, methods, and replication and cost considerations.ResultsWe identified 67 NCI grant awards having an implementation science focus. R01 was the most common mechanism, and the total number of all awards increased from four in 2003 to 15 in 2012. Prevention grants were most frequent (49.3%) and cancer treatment least common (4.5%). Diffusion of Innovations and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) were the most widely reported frameworks, but it is unclear how implementation science models informed planned study measures. Most grants (69%) included mixed methods, and half reported replication and cost considerations (49.3%).ConclusionsImplementation science in cancer research is active and diverse but could be enhanced by greater focus on measures development, assessment of how conceptual frameworks and their constructs lead to improved dissemination and implementation outcomes, and harmonization of measures that are valid, reliable, and practical across multiple settings.

Translating Cancer Control Research Into Primary Care Practice: A Conceptual Framework:

Effective dissemination, implementation, and adoption of research-tested lifestyle risk factor interventions within primary care are critical to reduce cancer morbidity and mortality. The objective of this study is to identify short- and long-term action steps within primary care research and practice to bridge the discovery-to-delivery gap in cancer prevention and control. Experts in primary care research and practice from the United States and Canada participated in this qualitative project. Concept mapping was used to synthesize expert input on actions to improve research-practice integration in cancer prevention and control. Results were used to facilitate an action-planning meeting among primary care researchers and practitioners. Five areas were identified as critical to improving the integration of research and practice in cancer prevention and control: (1) stakeholder collaborations, (2) organizational culture and structure, (3) learning infrastructure, (4) incentives and funding, and (5) data and accountability systems. Addressing the discovery-to-delivery gap in primary care requires collaboration among researchers and practitioners throughout the knowledge production cycle. The model developed in this project can be used to stimulate actions at the individual, organizational, and systems level to reduce the burden of cancer related to lifestyle risk factors.

Evolution of Cancer Control P.L.A.N.E.T.: moving research into practice

Evidence-based interventions (EBIs) are not broadly implemented, despite widespread availability of programs, policies, and guidelines. Systematic processes for integrating EBIs with community preference remain challenging for cancer control and prevention, as well as other areas. The Cancer Control P.L.A.N.E.T. (P.L.A.N.E.T) Web portal provides a platform to access data, EBIs, and resources to foster local partnerships and assist public health researchers and practitioners design, implement, and evaluate evidence-based cancer control programs. This article summarizes the evolution of P.L.A.N.E.T. and describes effective and innovative Web 2.0 strategies to increase Web visits, create more interactive platforms for researchers and practitioners to integrate evidence-based resources, community preferences, and the complex context in which programs and policies are implemented. Lessons learned could benefit public health settings and reach low-income, high-risk communities. Researchers, community practitioners, and government partnerships should continue to develop and test innovative ways to address pressing issues in cancer control, health disparities, and health delivery.

Adapting research-tested computerized tailored interventions for broader dissemination and implementation

This paper focuses on the process for adapting existing legacy computerized tailored intervention (CTI) programs and implications for future development of CTI to ensure that interventions can be disseminated and implemented in different settings. A significant amount of work is required to adapt existing CTI for new research applications and public health interventions. Most new CTI are still developed from scratch, with minimal re-use of software or message content, even when there are considerable overlaps in functionality. This is largely a function of the substantial technical, organizational, and content-based barriers to adapting and disseminating CTI. CTI developers should thus consider dissemination and re-use early in the design phase of their systems. This is not intended to be a step-by-step guide on how to adopt or disseminate research-tested CTI, but rather a discussion that highlights issues to be considered for adapting and disseminating evidence-based CTI.

Comprehensive cancer control: progress and accomplishments

The potential for Comprehensive Cancer Control (CCC) across the nation has been realized in the last decade with 69 Coalitions developing and implementing CCC plans. Many partners at all levels—national, state, jurisdictional, tribal and communities—have contributed to this success. This article details the contribution of these partners across these various levels, with a selection of the many activities contributing to this success. Consequently the cancer burden, although still of major importance, continues to be addressed in significant ways. Although there are future challenges, CCC coalitions continue to play an important role in addressing the cancer burden.

Cyberinfrastructure for consumer health.

The rapid evolution of cyberinfrastructure has had a transformative effect on the global health enterprise, blurring the boundaries between research nd practice in biomedicine, health services, and public ealth. Commercial and government-supported entities are combining new technologies with behavioral science to monitor social, behavioral, and medical data with other data sources including GIS in the home and clinic to detect disease before manifestation, and to support compliance, treatment, and health promotion. Nowhere is this more evident than in the U.S., where the publicand private-sector development of health-related platforms, tools, and applications, and the electronic informationinfrastructuretoconnect them,arebeingsupportedbykey policy, regulatory, and market-driven innovations. Fundamental to the theme of this supplement to the American Journal of Preventive Medicine on Cyberinfrastructure for ConsumerHealth are the concepts of cyberinfrastructure and health information technology (HIT). Incorporating concepts that include high-performance computing, parallel computing, and cloud computing, cyberinfrastructure is related to the broader conceptualization of network and information technologies that include systems, tools, devices, and applications based on supercomputing systems, distributed networks, cloud computing, and information management enabled by federal government investment in electronic information infrastructure over the past decades. Consumer health informatics refers to HIT that utilizes data enabled by cyberinfrastructure, or in otherwords the computer, mobile, and Internet platforms necessary for

Research to reality: moving evidence into practice through an online community of practice.

How can a community of practice help further the practical application of cancer control research? In 2011, the National Cancer Institute (NCI) launched an online community of practice, Research to Reality (R2R). R2R aims to infuse evidence-based strategies into communities by engaging researchers and practitioners in a joint approach to research dissemination. To measure community growth and engagement, NCI measures data across 3 program domains: content, interaction, and activity. NCI uses Web analytics, usability testing, and content analyses to manage and evaluate R2R. As of December 2013, R2R had more than 1,700 registered members. More than 500 researchers and practitioners register for the monthly cyber-seminars, and 40% return each month. R2R hosts more than 15,500 page views and 5,000 site visits in an average month. This article describes the process of convening this online community and quantifies our experiences to date.