Expanding Implementation Research to Prevent Chronic Diseases in Community Settings

Abstract

Chronic disease prevention continues to be inadequate, overall and in achieving health equity, in spite of the many evidence-based practices and policies (EBPPs) available to address risk behaviors such as unhealthful eating, lack of physical activity, and tobacco use. Although clinical settings are needed for EBPPs that involve medical procedures such as immunization or early detection, dissemination of EBPPs can be effective in a variety of settings such as schools and childcare centers, worksites, social service organizations, and religious organizations. More implementation research is needed to meet challenges of effective application of EBPPs in such community settings, in which primary missions, capacity, cultures, and values do not focus on health services delivery. To address health equity, consideration of social and economic contexts of people reached in these settings is essential. This review presents lessons learned from past studies to guide future implementation research and practice across diverse settings and geographies.

Keywords: chronic disease; community settings; dissemination and implementation science; prevention.

FIGURE 1. Opportunities for implementation research to prevent chronic diseases outside of health settings

Context includes the characteristics and needs of individuals who are members of or are served by these settings; the organizational structure and operational characteristics; and the external policy and funding environment. Health equity is both a process, i.e., removing economic and social obstacles to health such as poverty or discrimination, and a goal, i.e., when everyone has a fair and just opportunity to be as healthy as possible (16).