An Overview of Research and Evaluation Designs for Dissemination and Implementation

Abstract

The wide variety of dissemination and implementation designs now being used to evaluate and improve health systems and outcomes warrants review of the scope, features, and limitations of these designs. This article is one product of a design workgroup that was formed in 2013 by the National Institutes of Health to address dissemination and implementation research, and whose members represented diverse methodologic backgrounds, content focus areas, and health sectors. These experts integrated their collective knowledge on dissemination and implementation designs with searches of published evaluations strategies. This article emphasizes randomized and nonrandomized designs for the traditional translational research continuum or pipeline, which builds on existing efficacy and effectiveness trials to examine how one or more evidence-based clinical/prevention interventions are adopted, scaled up, and sustained in community or service delivery systems. We also mention other designs, including hybrid designs that combine effectiveness and implementation research, quality improvement designs for local knowledge, and designs that use simulation modeling.

Keywords: adaptation; adoption; fidelity; implementation trial; scale up; sustainment.

Figure 1. Traditional Translational Pipeline

*These dissemination and implementation stages include systematic monitoring, evaluation, and adaptation as required.

Figure 2

Focus of Research in a Head-to-Head Randomized implementation Trial with Identical Clinical/Preventive Intervention and Different Implementation Strategies

Figure 3

Randomize 40 Counties in CA to Independent County (IND) or Community Development Team (CDT) Implementation Strategy and Time (Cohort) Using a Randomized Roll-Out Design; 11 Counties in OH were Separately Randomized in a Fourth Cohort to the Same Implementation Strategies.

Figure 4. Roll-Out Randomized Designs

Symbol “O” refers to implementation as usual, “X*” and “Y*” are introductions on new implementation strategies, and “X” and “Y” are continuation of these strategies over extended periods of time.