Estratégia de disseminação de enfermagem

Um Quadro para a Divulgação de Práticas de Promoção de Saúde Baseadas em Evidências.

Navegue neste artigo.

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

Citação sugerida para este artigo: Harris JR, Cheadle A, Hannon PA, Forehand M, Lichiello P, Mahoney E, Snyder S, Yarrow J. Um quadro para a divulgação de práticas de promoção da saúde baseadas em evidências. Anterior Crônico Dis 2012; 9: 110081. DOI: dx. doi. org/10.5888/pcd9.110081.

A adoção mais ampla de práticas de promoção da saúde baseadas em evidências depende do desenvolvimento e teste de abordagens efetivas de disseminação. Para auxiliar no desenvolvimento dessas abordagens, criamos um quadro prático extraído da literatura sobre disseminação e nossas experiências de disseminação de práticas baseadas em evidências. Os principais elementos do nosso quadro são 1) uma estreita parceria entre pesquisadores e uma organização disseminadora que se apropria do processo de disseminação e 2) uso de princípios de marketing social para trabalhar em estreita colaboração com potenciais organizações de usuários. Apresentamos 2 exemplos que ilustram o quadro: EnhanceFitness, para atividade física entre idosos e American Cancer Society Workplace Solutions, para prevenção de doenças crônicas entre trabalhadores. Também discutimos 7 papéis práticos que os pesquisadores desempenham na divulgação e pesquisa relacionada: triagem através da evidência, realização de pesquisa formativa, avaliação da prontidão das organizações de usuários, equilíbrio de fidelidade e reinvenção, monitoramento e avaliação, influenciando o contexto externo e testando abordagens de disseminação.

Introdução.

Embora a comunidade de saúde pública tenha desenvolvido muitas práticas baseadas em evidências para promover comportamentos saudáveis, a adoção dessas práticas tem sido casual (1,2). Em resposta, os Centros para o Controle e Prevenção de Doenças (CDC) e os Institutos Nacionais de Saúde (NIH) pediram mais atenção à disseminação de práticas baseadas em evidências e à pesquisa sobre como aumentar a eficácia da disseminação (3-5).

Vários quadros conceituais foram desenvolvidos para organizar a extensa literatura sobre difusão e disseminação de práticas baseadas em evidências. Especialmente relevantes para a divulgação de práticas de promoção da saúde baseadas em evidências são os de Greenhalgh et al (6) e Wandersman et al (7). A Greenhalgh, focada em práticas de nível de sistema em grandes organizações de cuidados de saúde, analisou a literatura sobre disseminação e difusão e desenvolveu um quadro conceitual para organizá-la. A Wandersman se concentrou mais diretamente nas práticas de promoção da saúde que poderiam ser implementadas em pequenas e grandes organizações; sua estrutura de sistemas interativos (ISF) destaca os papéis dos principais atores no processo de disseminação. Outro quadro recentemente desenvolvido que sintetiza vários frameworks existentes (incluindo o de Greenhalgh) é o quadro consolidado para pesquisa de implementação (CFIR) (8). Finalmente, o framework RE-AIM, embora desenvolvido para avaliação, é amplamente utilizado para fornecer princípios de organização para a disseminação de práticas baseadas em evidências (9).

Esses quadros são úteis para gerar hipóteses para pesquisas futuras, mas não existe um quadro prático para desenvolver e testar abordagens de disseminação. Esse quadro servirá como um guia para a divulgação de organizações comunitárias e ajudará os pesquisadores a desenvolver e testar abordagens para a disseminação de práticas baseadas em evidências.

Descrevemos um quadro prático de divulgação desenvolvido no Centro de Pesquisa de Promoção da Saúde (HPRC) da Universidade de Washington, um Centro de Pesquisa de Prevenção financiado pelo CDC para realizar pesquisas sobre prevenção e controle comunitário de doenças crônicas. Para ilustrar o quadro, utilizamos 2 abordagens de disseminação que desenvolvemos e testamos e discutimos as funções práticas que os pesquisadores desempenham na pesquisa de disseminação e disseminação.

HPRC Dissemination Framework.

As práticas baseadas em evidências que podem ser disseminadas usando nossa estrutura proposta (Figura) incluem mudanças ambientais, políticas, programas e sistemas. Exemplos de práticas baseadas em evidências incluem mudanças ambientais testadas pela pesquisa (por exemplo, aumento da disponibilidade de alimentos saudáveis ​​nas escolas e locais de trabalho), políticas (por exemplo, cobertura do seguro do empregador para o tratamento da cessação do tabagismo), programas (por exemplo, programas de exercicios de envelhecimento saudável, como Matéria de equilíbrio [10] e Ativo para a Vida [11]), e os sistemas mudam (por exemplo, horários expandidos para clínicas de mamografia).

Figura. O quadro de divulgação mostra os recursos (pesquisadores e organizações disseminadoras) que afetam uma organização de usuários através de uma abordagem de disseminação desenvolvida de forma colaborativa, usando princípios de marketing social. A estrutura funciona em um contexto externo de elementos modificáveis ​​e não modificáveis. [Uma descrição de texto desta figura também está disponível.]

O framework HPRC reconhece que as práticas podem se espalhar passivamente ou ativamente. A & # 8220; difusão & # 8221; A flecha ilustra que algumas práticas baseadas em evidências se espalham passivamente e são adotadas sem suporte adicional ou instigação de fora da organização de usuários (12). A flecha de abordagem de disseminação maior mostra que a difusão por via-se, muitas vezes, não é uma maneira eficaz de divulgar práticas baseadas em evidências e que são necessários esforços específicos para incentivar a implementação generalizada. O quadro se concentra no processo de disseminação ativa.

A estrutura HPRC tem 3 atores principais: pesquisadores e organizações disseminadoras (Figura, esquerda) e organizações de usuários (Figura, à direita). Os pesquisadores procuram criar novos conhecimentos para ajudar a divulgar as melhores práticas. As organizações disseminadoras ("disseminators") usam esse conhecimento para liderar os esforços de disseminação. As organizações de usuários colocam as melhores práticas no lugar. Os divulgadores podem ser organizações sem fins lucrativos que comercializam uma prática baseada em evidências (por exemplo, através de licenças ou vendas de um programa de promoção da saúde de marca) ou fundações ou agências governamentais que financiam organizações de usuários para apoiar adoção e pesquisadores para avaliar a implementação de práticas baseadas em evidências (eg , financiamentos concedidos pela Administração sobre o Envelhecimento para incentivar a adoção de práticas baseadas em evidências).

Pesquisadores e disseminadores criam uma parceria colaborativa mutuamente benéfica. A parceria pode ser iniciada por qualquer das partes e, em nossa experiência, é mais eficaz quando a equipe de pesquisa e o disseminador estão tentando alcançar as mesmas organizações de usuários e estão dispostos a aprender sobre os recursos e metas do outro. Com base nessa aprendizagem, tanto os pesquisadores quanto o disseminador estão melhor equipados para projetar e testar abordagens de disseminação que atendam aos objetivos e capacidade do disseminador. Os pesquisadores trabalham em estreita colaboração com os disseminadores para refinar e testar a abordagem de disseminação para torná-lo mais adequado para organizações de usuários. Embora os pesquisadores possam servir de disseminadores, os disseminadores têm pelo menos 2 vantagens na divulgação das melhores práticas: 1) podem se concentrar na disseminação, e não nos objetivos de pesquisa e no financiamento, e assim se concentrar nos sistemas de suporte necessários para alcançar a escala necessária para fazer uma diferença em nível populacional; e 2) eles podem estar mais próximos em cultura e valores para organizações de usuários do que pesquisadores e, portanto, mais capazes de promover as melhores práticas e adaptá-las às necessidades locais.

A divulgação bem sucedida de práticas baseadas em evidências em uma organização de usuários envolve uma cascata de etapas (Figura). Os passos incluem a adoção, implementação e manutenção. A cascata também reconhece os elementos fixos da organização de usuários & # 8212; ou seja, o estado da organização antes da disseminação & # 8212; e está pronta para apoiar a adoção, implementação e manutenção, incluindo a disponibilidade de recursos humanos e financeiros. A terminologia é paralela às etapas de adoção, implementação e manutenção no framework RE-AIM (9). A saída desta cascata é a mudança nas práticas organizacionais e nos comportamentos pessoais que resultam em melhorias de saúde e outros benefícios (por exemplo, aumento da produtividade) para os membros da organização (por exemplo, seus trabalhadores) ou para os consumidores a que atende.

Entre as caixas que mostram os pesquisadores e os disseminadores à esquerda e as organizações de usuários à direita estão as "conexões e seções bidirecionais". Esta flecha destaca a necessidade de entender as organizações de usuários e todas as etapas potenciais no processo de implementação, desde fatores de prontidão até como motivar a adoção e facilitar a implementação e manutenção. Acreditamos que esses vínculos e aprendizagens devem ser informados pelos princípios do marketing social, que se concentram nas necessidades e capacidades das organizações de usuários. Aplicando esses princípios, o disseminador começa com uma análise de mercado (13). Esta análise avalia os benefícios potenciais das práticas baseadas em evidências & # 8212; tanto para a organização de usuários quanto para seus membros e consumidores visando a mudança de comportamento & # 8212; e potenciais barreiras à adoção (tanto organizacional quanto individual). A análise avalia 5 áreas-chave (13):

Consumidores: as necessidades dos consumidores organizacionais e individuais da (s) prática (s). Concorrência: as alternativas salientes que servem de competição para a (s) prática (s). Empresa: a capacidade da empresa (em nossa estrutura, a capacidade combinada dos pesquisadores e divulgadores) para apoiar a disseminação da (s) nova (s) prática (s). Colaboradores: os pontos fortes dos colaboradores & # 8212; potenciais redes de suporte ou outros parceiros & # 8212; que podem oferecer informações sobre os constrangimentos das configurações do mundo real e facilitar a disseminação da mesma maneira que um revendedor ajuda a distribuir produtos aos consumidores. Contexto: o contexto sociopolítico, descrito como o contexto externo modificável e não modificável & # 8201; em nossa estrutura. Contexto modificável & # 8212; tais como redes organizacionais, financiamento e suporte a políticas (por exemplo, reembolso para a participação no programa) & # 8212; está dentro da esfera de influência dos disseminadores e pesquisadores. O contexto não modificável inclui o clima econômico e político geral.

Ao realizar uma análise completa do mercado, o divulgador estará preparado para decidir quais segmentos de organizações de usuários potenciais a serem direcionados e como melhor posicionar a (s) prática (s) baseada em evidências para esses segmentos segmentados (14). O processo de segmentação pode começar no nível organizacional (identificando grupos únicos de organizações de usuários que estão particularmente bem equipados para adotar a prática) ou a nível individual (identificando grupos únicos de indivíduos que o disseminador acredita que devem adotar o comportamento (s) ) que a prática promove). Na segmentação, o disseminador identifica o (s) segmento (s) específico (s) para o qual deseja desenvolver uma abordagem de disseminação. Uma vez que o alvo é identificado, a abordagem de disseminação deve ser posicionada para comunicar os benefícios das práticas promovidas de forma clara e concisa, enfatizando os benefícios específicos que devem ressoar com o segmento alvo. Ao nível da organização de usuários, por exemplo, o posicionamento pergunta: quais necessidades organizacionais específicas serão atendidas com esta prática, mais do que com outras práticas e por quê?

Em resumo, o framework HPRC propõe que, para disseminar eficazmente as práticas baseadas em evidências, os pesquisadores devem 1) colaborar com um disseminador e 2) trabalhar com organizações de usuários para aprimorar a prática e a abordagem da disseminação, orientada pelos princípios do marketing social.

Dois Exemplos de Disseminação.

Desenvolveu e testou a versão baseada em cadeira de EF para adultos idosos frágeis. Desenvolveu uma versão on-line do treinamento do instrutor de EF para reduzir os custos associados ao treinamento e alcançar um amplo grupo de instrutores. Testado EnhanceMobility; uma adaptação de EF para pessoas com demência.

Examinou os empregadores na comunidade-alvo de empregadores de médio porte em indústrias de baixos salários para avaliar suas necessidades e recursos. Entrevistou os membros da equipe da ACS para avaliar suas necessidades de preparação e treinamento para apoiar os empregadores usando ACS WPS.

Aprovado o CDC Arthritis Program aprovado pelo EF. A aprovação adquirida para a EF é um dos 5 programas de prevenção de doenças baseados em evidências incluídos na Administração sobre o envelhecimento (AoA) Choices for Independence grants, 2009.

Trabalhou para aprovar as leis estaduais que exigem políticas de não fumadores no local de trabalho, conforme recomendado pela ACS WPS. Trabalhou para aprovar os mandatos legislativos estaduais para o seguro de seleção de câncer colorretal conforme recomendado pela ACS WPS.

Selecionado como um programa Choices para o financiamento do AoA (26 estados). Parte de uma iniciativa de US $ 7,5 milhões no sul da Flórida.

Trabalhou para aumentar o financiamento a nível estadual para o abandono da cessação do tabaco para trabalhadores de baixa renda e sem seguro. Combinado ACS WPS com outra prática no local de trabalho da ACS apoiada pelos governos estaduais no Colorado, no Novo México e em Washington.

A partir de 2010, oferecido em 523 locais da comunidade em 32 estados, e serviu 23.241 participantes; 10.282 em 2010.

A partir de 2010, 1.385 empregadores haviam participado da ACS WPS, atingindo mais de 2,5 milhões de trabalhadores.

Nesta seção, apresentamos 2 exemplos para ilustrar o quadro de disseminação (Caixa 1). A EnhanceFitness (EF) promove a atividade física entre adultos mais velhos, e as Soluções para o Local de Trabalho da Sociedade Americana do Câncer (ACS) promovem a prevenção de doenças crônicas entre os trabalhadores. Em cada exemplo, em itálico, os termos-chave da Caixa 1.

EnhanceFitness.

EF, uma prática baseada em evidências, é um programa de exercícios grupais de baixo custo, altamente adaptável para adultos mais velhos. A EF foi originalmente projetada e testada por uma parceria de pesquisa que incluía o Northshore Senior Centre em Bothell, Washington; Group Health Cooperative, uma organização de manutenção da saúde; e HPRC. Em seu teste original, EF aumentou a atividade física entre os participantes e ajudou-os a manter um nível de funcionamento mais elevado que o da população de comparação (15).

Por mais de uma década, Senior Services, uma organização sem fins lucrativos baseada na comunidade em King County, Washington, atuou como organização disseminadora da EF (16). Durante vários anos, a HPRC e os Serviços para idosos usaram vínculos e aprendizagens para refinar e adaptar EF para atender às necessidades das organizações de usuários, incluindo centros para idosos e populações especiais, como adultos idosos frágeis e pessoas com demência. Como sua abordagem de disseminação, as licenças de serviços seniores EF para centros seniores e outras organizações de usuários, que pagam uma taxa de licenciamento, e usa a receita de licenciamento para auxiliar a implementação por essas organizações de usuários. Com suporte pela taxa de licenciamento, os Serviços para idosos oferecem aulas de certificação de instrutores para EF em sites em todo o país, fornecem assistência técnica, treinamento e materiais de marketing, e coleta e analisa a fidelidade do programa e os dados de fitness.

Para modificar o contexto externo para aumentar o reconhecimento e a credibilidade da EF, Senior Services e HPRC obtiveram a aprovação da EF de organizações nacionais, incluindo o CDC Arthritis Program e Administration on Aging. O HPRC também se associou a iniciativas de financiamento local que ofereçam apoio à EF. Os resultados da divulgação até à data mostram que a EF atinge diversos participantes em todo o país. De mais de 23.000 participantes, 28% são membros de minorias raciais / étnicas, 38% são mais velhos do que 80 anos, 60% dos que relatam receita têm renda baixa ou muito baixa, 2% falam ou não são ingleses e 4% são imigrantes ou refugiados.

Soluções no local de trabalho da American Cancer Society.

A ACS WPS oferece aos empregadores um pacote de práticas baseadas em evidências destinadas a promover a saúde no local de trabalho e prevenir doenças crônicas entre os trabalhadores. A Divisão Great West da ACS & # 8217; HPRC desenvolveu conjuntamente a ACS WPS e, em seguida, realizou um teste piloto com 8 grandes empregadores no noroeste do Pacífico (17). O teste piloto mostrou um aumento significativo nesses empregadores # 8217; implementação das práticas WPS da ACS. Após o estudo piloto, o Escritório Nacional de Casa da ACS assumiu o papel de organização disseminadora nacional da ACS WPS. Usando vínculos e aprendizagens, o HPRC e a ACS estão aprimorando e adaptando o ACS WPS para atender às necessidades dos empregadores, as principais organizações de usuários. O HPRC e a ACS trabalham com uma variedade de empregadores, incluindo empregadores de pequeno e médio porte e aqueles em indústrias de baixos salários. Como sua abordagem de disseminação, a ACS implanta funcionários locais e regionais que atuam como agentes de mudança (especialistas técnicos externos que trabalham dentro de uma organização de usuários) (2). Após uma avaliação formal dos empregadores # 8217; implementação de práticas de promoção da saúde no local de trabalho baseadas em evidências, a equipe da ACS realiza uma análise de lacunas e apresenta aos empregadores informações e assistência técnica destinadas a aumentar a adoção e implementação das práticas recomendadas. A ACS treinou aproximadamente 15% de sua equipe em todo o país nos princípios e processos que suportam o WPS da ACS e está identificando maneiras de modificar o WPS da ACS para aumentar sua eficácia e torná-lo sustentável para a equipe da ACS. Para modificar o contexto externo, a ACS e a HPRC trabalharam para aprovar as leis estaduais e o financiamento que apoiam as práticas recomendadas pela ACS WPS. Eles também adaptaram outro dos pacotes de promoção de saúde no local de trabalho do ACS & # 8217; de acordo com os princípios da ACS WPS e um subconjunto de suas práticas. Os resultados da divulgação até à data mostram que a ACS WPS atende diversos empregadores em todo o país. HPRC e ACS continuam a medir o efeito da ACS WPS nos locais de trabalho & # 8217; implementação das práticas recomendadas.

Discussão.

A estrutura HPRC para pesquisa de disseminação e disseminação baseia-se na literatura e foi moldada por nossa experiência bem sucedida no desenvolvimento e disseminação de práticas de prevenção de doenças crônicas. Como mostram os dois exemplos, trabalhamos com organizações privadas como divulgadores nacionais, usando abordagens de disseminação baseadas em teoria e alcançando alcance nacional de práticas baseadas em evidências. O pacote de práticas baseadas em evidências do Workplace Solutions inclui mudanças ambientais, políticas, programas e mudanças de sistemas, por isso acreditamos que esse quadro é aplicável a todas essas áreas e ao amplo campo da pesquisa translacional (5,18).

Quadro HPRC e literatura existente sobre disseminação.

O framework HPRC incorpora elementos da estrutura Greenhalgh e paralelos elementos-chave da estrutura Wandersman (ISF); Cada uma dessas estruturas é baseada em uma revisão de uma grande quantidade de literatura. Os principais recursos de disseminação em nosso quadro são estreitamente paralelos aos do sistema de recursos de Greenhalgh, nomeadamente os papéis principais para uma agência de mudança ("organização disseminada" em nossa terminologia) e "fornecedores de conhecimento" (pesquisadores). Também de Greenhalgh, adotamos a idéia de que o processo de implementação em uma organização é específico da organização e envolve uma série complexa de etapas. Os pesquisadores, portanto, precisam trabalhar em estreita colaboração com disseminadores e organizações de usuários na concepção de abordagens de disseminação (Figura).

Os sistemas no Wandersman ISF framework também paralelamente elementos-chave da estrutura HPRC. O Sistema de Apoio à Prevenção de ISF, que auxilia no processo de disseminação, corresponde aos nossos "recursos de divulgação" (7). E o nosso processo de pesquisadores que trabalham com disseminadores e organizações de usuários para aperfeiçoar a estratégia de prática e disseminação é uma aproximação aproximada do Sistema de Síntese e Tradução de ISF.

Kreuter e Bernhardt (19) destacam uma necessidade adicional de disseminação efetiva de produtos de saúde pública e # 8212; sistemas de marketing e distribuição. Para produtos comerciais, esses sistemas incluem transferência para distribuidores, distribuição para lojas de consumidores, gerenciamento de estoque, vendas, assistência técnica, atendimento ao cliente e reparos. Em nossa estrutura, implicamos a necessidade de sistemas de marketing e distribuição em nosso uso de princípios de marketing, mas esses sistemas merecem atenção especial dos disseminadores. Embora algumas agências de saúde sem fins lucrativos que atuem como disseminadores tenham sistemas de marketing e distribuição em escala nacional (por exemplo, AARP, ACS e YMCA), a maioria não precisa e precisa trabalhar com parceiros comerciais para alcançar a escala necessária para fazer a diferença em um nível de população.

Funções para pesquisadores.

Na estrutura HPRC, pesquisadores e disseminadores formam uma parceria para aumentar sua capacidade de difundir práticas baseadas em evidências. O contributo dos investigadores para a parceria inclui 7 papéis práticos (Caixa 2): 1) triagem através da evidência, 2) realização de pesquisa formativa, 3) avaliação da prontidão das organizações de usuários, 4) equilíbrio de fidelidade e reinvenção, 5) monitoramento e avaliação, 6) influenciando o contexto externo, e 7) testando abordagens de disseminação. A caixa 2 descreve o contexto em que essas funções se aplicam e as contribuições relacionadas que os pesquisadores podem fazer.

Para maximizar a aplicabilidade do mundo real das abordagens de disseminação, os pesquisadores devem testá-los em colaboração com disseminadores. Ao testar abordagens de disseminação, pesquisadores e disseminadores devem estar atentos sobre quais abordagens de disseminação estão sendo comparadas. Greenhalgh (6) sugere que os maiores ganhos de conhecimento virão de comparar mudanças incrementais em uma abordagem de disseminação comprovada para testar o efeito das mudanças. Ela contrasta esse teste incremental com testes de todos ou nenhuns, em que muitas vezes é difícil discernir que parte da abordagem levou a mudanças significativas na adoção e implementação. Os pesquisadores também devem considerar cuidadosamente o design do estudo. Os projetos experimentais são teoricamente possíveis, mas as abordagens de disseminação muitas vezes devem ser adaptadas a subgrupos de organizações ou mesmo a organizações individuais (à medida que nossa estrutura enfatiza), dificultando a obtenção de uma abordagem padrão e replicável que possa ser testada usando um projeto experimental. Os projetos quase experimentais podem ser mais práticos.

Conclusão.

Propomos um quadro prático para projetar e testar abordagens de disseminação para práticas baseadas em evidências. O quadro descreve funções complementares para pesquisadores, disseminadores e organizações de usuários na disseminação ampla de práticas baseadas em evidências. Utilizamos o framework para divulgar as promoções baseadas em evidências para a atividade física de adultos mais velhos e programas de saúde no local de trabalho a nível nacional. Outros pesquisadores e profissionais podem encontrar o quadro útil para aumentar a adoção de práticas baseadas em evidências.

Agradecimentos.

A pesquisa apoiando a informação neste artigo foi patrocinada pelo Centro de Pesquisa de Promoção da Saúde da Universidade de Washington, um dos Centros de Pesquisa de Prevenção de CDC (contrato de cooperação HPRC nº U48DP001911). O apoio ao financiamento adicional veio do Escritório de Pesquisa de Saúde Pública do CDC através do seu programa de Centros de Excelência em Marketing e Saúde da Saúde (concessão 5-P01-CD000249-03).

Informação sobre o autor.

Autor Correspondente: Judith Yarrow, Escola de Saúde Pública da Universidade de Washington, HPRC, 1107 NE 45th St, Ste 200, Seattle, Washington 98105.

Afiliações de autor: Jeffrey R. Harris, Allen Cheadle, Peggy A. Hannon, Patricia Lichiello, Universidade de Washington, Centro de Pesquisa em Promoção da Saúde, Seattle, Washington; Mark Forehand, Michael G. Foster School of Business, Universidade de Washington, Seattle, Washington; Eustacia Mahoney, Sociedade Americana do Câncer, Seattle, Washington; Susan Snyder, Senior Services, Seattle, Washington.

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Índice.

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Disseminação dos resultados da pesquisa: o que os pesquisadores deveriam fazer? Uma revisão sistemática de escopo de estruturas conceituais.

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

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

Aceito: 22 de novembro de 2010.

Publicado: 22 de novembro de 2010.

Fundo.

Abordar as deficiências na disseminação e transferência de conhecimento baseado em pesquisa para a prática clínica de rotina é alto na agenda política tanto no Reino Unido como internacionalmente.

No entanto, há falta de clareza entre as agências de financiamento quanto ao que representa a disseminação. Além disso, as expectativas e orientações fornecidas aos pesquisadores variam de uma agência para outra. Neste contexto, realizamos um escopo sistemático para identificar e descrever os quadros conceituais / organizadores que poderiam ser usados ​​pelos pesquisadores para orientar sua atividade de disseminação.

Pesquisamos doze bases de dados eletrônicas (incluindo MEDLINE, EMBASE, CINAHL e PsycINFO), as listas de referência de estudos incluídos e de sites de agências de financiamento individuais para identificar possíveis estudos para inclusão. Para ser incluído, os documentos tiveram que apresentar um quadro ou plano explícito projetado para ser usado por pesquisadores ou que poderia ser usado para orientar a atividade de disseminação. Os documentos que mencionaram a disseminação (mas não forneceram nenhum detalhe) no contexto de um quadro mais amplo de tradução de conhecimento foram excluídos. As referências foram selecionadas de forma independente por pelo menos dois revisores; Discordâncias foram resolvidas com discussão. Para cada documento incluído, a origem, a data de publicação, uma descrição dos principais elementos do quadro e se houve uma referência implícita / explícita à teoria foram extraídos. Foi realizada uma síntese narrativa.

Trinta e três quadros preencheram nossos critérios de inclusão, 20 dos quais foram projetados para ser usados ​​por pesquisadores para orientar suas atividades de disseminação. Vinte e oito estruturas incluídas foram sustentadas pelo menos em parte por uma ou mais das três abordagens teóricas diferentes, a saber, a comunicação persuasiva, a difusão da teoria das inovações e o marketing social.

Conclusões.

Atualmente, existem vários quadros teoricamente informados disponíveis para pesquisadores que podem ser usados ​​para ajudar a orientar seu planejamento e atividade de disseminação. Dada a ênfase atual em aumentar a incorporação do conhecimento sobre os efeitos das intervenções na prática rotineira, os financiadores poderiam considerar encorajar os pesquisadores a adotar uma abordagem teoricamente informada para a disseminação da pesquisa.

Fundo.

Os recursos de saúde são finitos, por isso é imperativo que a prestação de cuidados de saúde de alta qualidade seja assegurada através da implementação bem-sucedida de tecnologias de saúde econômicas. No entanto, há um reconhecimento crescente de que o potencial total de evidências de pesquisa para melhorar a prática em ambientes de saúde, seja em relação à prática clínica, seja a prática gerencial e tomada de decisão, ainda não é realizado. Abordar as deficiências na disseminação e transferência de conhecimento baseado na pesquisa para a prática clínica de rotina é importante na agenda política, tanto no Reino Unido [1 - 5] como internacionalmente [6].

À medida que o interesse na pesquisa para o intervalo de prática aumentou, também a terminologia utilizada para descrever as abordagens empregadas [7, 8]. A difusão, a disseminação, a implementação, a transferência de conhecimento, a mobilização do conhecimento, a ligação e o intercâmbio, e a pesquisa em prática, são usadas para descrever conceitos e práticas sobrepostas e inter-relacionadas. Nesta revisão, usamos o termo divulgação, que consideramos um elemento-chave no contínuo de pesquisa para a prática (tradução de conhecimento). Nós definimos a disseminação como um processo planejado que envolve a consideração do público-alvo e as configurações em que os resultados da pesquisa devem ser recebidos e, quando apropriado, comunicar e interagir com públicos de políticas e serviços de saúde mais amplos de forma a facilitar a aceitação da pesquisa na tomada de decisões processos e práticas.

A maioria das agências de financiamento da pesquisa em saúde aplicada espera e exige algum compromisso ou esforço por parte dos donos para disseminar os resultados de suas pesquisas. No entanto, parece haver uma falta de clareza entre as agências de financiamento quanto ao que representa a divulgação [9]. Além disso, embora a maioria considere a disseminação como uma responsabilidade compartilhada entre esses financiamentos e aqueles que conduzem a pesquisa, as expectativas e orientações fornecidas aos pesquisadores variam de uma agência para outra [9].

Anteriormente, ressaltamos a necessidade de os pesquisadores considerar cuidadosamente os custos e os benefícios da disseminação e suscitaram preocupações sobre a natureza e a variação no tipo de orientação emitida pelos órgãos de financiamento aos seus donos e requerentes [10]. Neste contexto, realizamos uma análise sistemática do escopo com os dois objetivos a seguir: identificar e descrever os quadros conceituais / organizacionais projetados para ser usados ​​por pesquisadores para orientar suas atividades de disseminação; e para identificar e descrever quaisquer estruturas conceituais / organizacionais relacionadas ao continuum de tradução do conhecimento que forneçam detalhes suficientes sobre os elementos de disseminação que os pesquisadores poderiam usá-lo para orientar suas atividades de disseminação.

Foram pesquisados ​​os seguintes bancos de dados para identificar possíveis estudos para inclusão: MEDLINE e MEDLINE em processo e outras citações não indexadas (1950 a junho de 2010); EMBASE (1980 a junho de 2010); CINAHL (1981 a junho de 2010); PsycINFO (1806 a junho de 2010); EconLit (1969 a junho de 2010); Resúmenes de serviços sociais (1979 a junho de 2010); Política e Prática Social (1890 a junho de 2010); Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, banco de dados de resumos de revisões de efeitos, banco de dados de avaliação de tecnologia de saúde, NHS Economic Evaluation Database (Cochrane Library 2010: Issue 1).

Os termos de pesquisa foram identificados através da discussão da equipe de pesquisa, escaneando a literatura de fundo e navegando no dicionário de sinônimos. Não houve restrições metodológicas, linguísticas ou de data. Os detalhes das estratégias de pesquisa específicas do banco de dados são apresentados Arquivo Adicional 1, Apêndice 1.

As pesquisas de citação de cinco artigos [11 - 15] identificados antes das pesquisas no banco de dados foram realizadas no Science Citation Index (Web of Science), MEDLINE (OvidSP) e Google Scholar (fevereiro de 2009).

Uma vez que esta revisão foi realizada como parte de um projeto mais amplo com o objetivo de avaliar a atividade de disseminação de pesquisadores britânicos aplicados e de saúde pública [16], pesquisamos os sites de 10 principais financiadores do Reino Unido de serviços de saúde e pesquisa em saúde pública. Estes eram a British Heart Foundation, a Cancer Research UK, o Chief Scientist Office, o Departamento de Política de Saúde, o Conselho de Pesquisa Econômica e Social (ESRC), a Joseph Rowntree Foundation, o Medical Research Council (MRC), o NIHR Health Programa de Avaliação de Tecnologia, Programa de Prestação de Serviços e Organização do NIHR e Wellcome Trust. Pretendemos identificar quaisquer estruturas, guias ou planos de divulgação / comunicação disponíveis para conceder candidatos ou titulares.

Também interrogamos os sites de quatro agências chave com um registro estabelecido no campo da disseminação e transferência de conhecimento. 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?

Onde você começa?

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; e.

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:

Visão baseada em recursos da empresa.

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.

Discussão.

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.

Agradecimentos.

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.

Referências.

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

Fundo.

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.

Conclusões.

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.

Fundo.

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.

Discussão.

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.

Agradecimentos.

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.

Índice.

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.

Instruções.

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. Por exemplo,

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? Como? 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: