Interventions in Organizational and Community Context

A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

Published in: Administration and Policy in Mental Health and Mental Health Services Research, v. 35, No. 1-2, Mar. 2008, p. 21-37

Posted on RAND.org on December 31, 2007

by Peter Mendel, Lisa S. Meredith, Michael Schoenbaum, Cathy D. Sherbourne, Kenneth B. Wells

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The effective dissemination and implementation of evidence-based health interventions within community settings is an important cornerstone to expanding the availability of quality health and mental health services. Yet it has proven a challenging task for both research and community stakeholders. This paper presents the current framework developed by the UCLA/RAND NIMH Center to address this research-to-practice gap by: (1) providing a theoretically-grounded understanding of the multi-layered nature of community and healthcare contexts and the mechanisms by which new practices and programs diffuse within these settings; (2) distinguishing among key components of the diffusion process--including contextual factors, adoption, implementation, and sustainment of interventions--showing how evaluation of each is necessary to explain the course of dissemination and outcomes for individual and organizational stakeholders; (3) facilitating the identification of new strategies for adapting, disseminating, and implementing relatively complex, evidence-based healthcare and improvement interventions, particularly using a community-based, participatory approach; and (4) enhancing the ability to meaningfully generalize findings across varied interventions and settings to build an evidence base on successful dissemination and implementation strategies.

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