Furthering Dissemination and Implementation Research: The Need for More Attention to External Validity

Author(s):  
Lawrence W. Green ◽  
Mona Nasser
Author(s):  
Lawrence W. Green ◽  
Mona Nasser

This chapter raises questions about the reliability of much “evidence-based practice” disseminated from the original studies and systematic reviews of those studies, insofar as they were often conducted and reviewed with inadequate attention to external validity. Important issues are raised for dissemination and implementation researchers. Indeed, the pressure on investigators to provide for increasingly rigorous controls on threats to internal validity, and to exclude studies that fall below standards for internal validity, has made many such sources of evidence more suspect in their external validity and less credible to the practitioners or policymakers who would adopt them. Greater attention is needed to ways to incorporate considerations of external validity into studies and in systematic reviews of studies to produce more generalizable evidence, and greater attention to practice-based evidence that can complement the more formal evidence-based practices in the process of implementing and evaluating the dissemination and implementation process


Author(s):  
Ross C. Brownson ◽  
Graham A. Colditz ◽  
Enola K. Proctor

This chapter highlights just a sample of the many rich areas for dissemination and implementation research that will assist us in shortening the gap between discovery and practice, thus beginning to realize the benefits of research for patients, families, and communities. Greater emphasis on implementation in challenging settings, including lower and middle-income countries and underresourced communities in higher income countries will add to the lessons we must learn to fully reap the benefit of our advances in dissemination and implementation research methods. Moreover, collaboration and multidisciplinary approaches to dissemination and implementation research will help to make efforts more consistent and more effective moving forward. Thus, we will be better able to identify knowledge gaps that need to be addressed in future dissemination and implementation research, ultimately informing the practice and policies of clinical care and public health services.


Author(s):  
Ana A. Baumann ◽  
Leopoldo J. Cabassa ◽  
Shannon Wiltsey Stirman

This chapter focuses on adaptations in the context of dissemination and implementation research and practice. Consistent with the existing literature, the authors recommend that adaptations be proactively and iteratively determined, strongly informed by a variety of stakeholders, and that efforts be made to carefully describe and document the nature of the adaptations and evaluate their impact on desired service, health, and implementation outcomes. While this chapter focuses on adaptations to interventions and the context of practice, the authors also note that adaptations may need to be made to implementation strategies. Following the call by Proctor and colleagues for further precision in defining and operationalizing implementation strategies, and based on evidence that scholars are not necessarily reporting what and how they are adapting the interventions, scholars are urged to define and evaluate the adaptations they are making not only to the interventions and context of practice but also to the implementation strategies.


Author(s):  
Cara C. Lewis ◽  
Enola K. Proctor ◽  
Ross C. Brownson

The National Institutes of Health, the Agency for Healthcare Research and Quality, the CDC, and a number of private foundations have expressed the need for advancing the science of dissemination and implementation. Interest in dissemination and implementation research is present in many countries. Improving health care requires not only effective programs and interventions, but also effective strategies to move them into community based settings of care. But before discrete strategies can be tested for effectiveness, comparative effectiveness, or cost effectiveness, context and outcome constructs must be identified and defined in such a way that enables their manipulation and measurement. Measurement is underdeveloped, with few psychometrically strong measures and very little attention paid to their pragmatic nature. A variety of tools are needed to capture health care access and quality, and no measurement issues are more pressing than those for dissemination and implementation science.


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