NIH funding opportunities (3) - Dissemination and Implementation Research in Health (R01, R03, R21)

The description below was taken from the R01 version of this FOA. Note Institute-specific areas of interest.

For many years, health researchers may have assumed that tools and interventions deemed efficacious within clinical or community-based trials would be readily adopted and implemented; however, compelling evidence suggests that this has not been the case. Even when added information, tools and interventions have been tested within real-world effectiveness studies, the development of knowledge to support their broader dissemination and implementation (e.g. cost and financing of the intervention, provider training, availability of resources, integration into healthcare systems, delivery to vulnerable or difficult-to-reach populations, monitoring the quality of intervention delivery) has often remained outside the scope of these large-scale clinical trials. This has also been the case for the dissemination and implementation of policies and guidelines, such as from the U.S. Preventive Services Task Force, or the Community Guide to Preventive Services. Study of strategies to most effectively, equitably, and efficiently implement health policies and guidelines is encouraged, as are studies that evaluate policy and other contextual factors that influence the success of implementation or dissemination efforts.

Dissemination and implementation research intends to bridge the gap between clinical research, everyday practice, and public health by building a knowledge base about how health information, interventions, and new clinical practices, guidelines and policies are transmitted and translated for public health and health care service use in specific settings. Unfortunately, there continues to be great variation in how these terms are used.

For the purpose of this FOA, we make a distinction between “dissemination research” and “implementation research”, as follows:

Dissemination research is the scientific study of targeted distribution of information and intervention materials to a specific public health or clinical practice audience. The intent is to understand how best to spread and sustain knowledge and the associated evidence-based interventions. We are currently missing critical information about how, when, by whom, and under what circumstances evidence spreads throughout the agencies, organizations, front line workers and consumers of public health and clinical services. As a necessary prerequisite for unpacking how information can lead to intervention or service changes, we need to understand how and why information on physical and behavioral health, preventive services, disease management, decision making, and other interventions may or may not reach many different stakeholders. We need to understand what underlies the creation, transmission, and reception of information on evidence-based pharmacological, behavioral, psychosocial, genomic, policy and systems interventions. Successful dissemination of health information may occur quite differently depending on whether the audience consists of consumers, caregivers, practitioners, policymakers, employers, administrators, or other or multiple stakeholder groups. Moving the field forward will require studies identifying mechanisms and approaches to package and convey the evidence necessary to improve public health, community and clinical care services in ways relevant to local settings.
Implementation research is the scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical and community settings in order to improve patient outcomes and benefit population health. Implementation Research seeks to understand the behavior of healthcare professionals and support staff, healthcare organizations, healthcare consumers and family members, and policymakers in context as key influences on the adoption, implementation and sustainability of evidence-based interventions and guidelines such as those from the Community Guide to Preventive Services, U.S. Preventive Services Task Force, and clinical and professional societies. Implementation research studies should not assume that empirically-supported interventions can be integrated into any service setting and for patient groups and populations without attention to local context, nor that a unidirectional flow of information (e.g., publishing a recommendation, trial, or guideline) is sufficient to achieve practice change. Relevant studies should develop a knowledge base about “how” interventions are integrated within real-world practice settings and patient populations, which will likely require more than the distribution of information about the interventions. This research announcement encourages studies to test models, theories and conceptual frameworks of the implementation process that move away from an exclusively “top-down” approach to a greater emphasis on the resources of local care settings and the needs of multiple stakeholders, including approaches such as team science, community based participatory research, action research and related frameworks that engage stakeholders and end users throughout the process.
Dissemination and Implementation (D&I) Research: Studies typically involve both interdisciplinary cooperation and trans-disciplinary collaboration, utilizing theories, empirical findings, and methods from a variety of fields not traditionally associated with health research. Relevant fields include but are not limited to: information science, clinical decision-making, organizational and management theory, economics, individual and systems-level behavioral change, public health, business and public administration, statistics, anthropology, learning theory, engineering, and marketing. D&I research will often include significant and ongoing collaboration with stakeholders from multiple public health and/or clinical practice settings as well as consumers of services and their families/social networks. This FOA will support a variety of sound methodological approaches including (but not limited to) observational, experimental, quasi-experimental, and simulation modeling approaches that produce relevant evidence on outcomes, costs, and/or unanticipated consequences. The goal is to conduct dissemination and implementation studies utilizing research designs that are both rigorous and relevant. Wherever possible, studies of dissemination or implementation strategies should build knowledge both on the overall effectiveness of the strategies, as well as “how and why” they work. Data on mechanisms of action, moderators, and mediators of dissemination and implementation strategies will greatly aid decision-making on which strategies work for which interventions, in which settings, and for which populations.

For additional resources on dissemination and implementation research, including information on D&I training opportunities, funded studies, key references, past workshops and conferences, visit:

Specific Objectives and Scope of this FOA

This FOA invites research grant applications that will identify, develop, test, evaluate and/or refine strategies to disseminate and implement evidence-based practices (e.g. behavioral interventions; prevention, early detection, diagnostic, treatment and disease management interventions; quality improvement programs) into public health, clinical practice, and community settings. In addition, studies to advance dissemination and implementation research methods and measures are encouraged.

Examples of relevant research directions include but are not limited to:

Studies of strategies to implement health promotion, prevention, screening, early detection, and diagnostic interventions, as well as effective treatments, clinical procedures or guidelines into existing care systems.
Studies of the implementation of multiple evidence-based practices within community or clinical settings to meet the needs of complex patients and diverse systems of care.
Studies of the local adaptation of evidence-based practices in the context of implementation that systematically identify intervention components that surpass or fall short of expected intervention effects.
Longitudinal and follow-up studies on the factors that contribute to the sustainability of evidence-based interventions in public health and clinical practice.
Studies testing the effectiveness and cost-effectiveness of dissemination or implementation strategies to reduce health disparities and improve quality of care among rural, minority, low literacy and numeracy, and other underserved populations.
Studies of the de-implementation of clinical and community practices that are not evidence-based, have been prematurely widely adopted, yield sub-optimal benefits for patients, or are harmful or wasteful.
Studies of the relationship of context and local capacity of clinical and community settings to adoption, implementation and sustainability of evidence-based practices.
Prospective or retrospective studies of the adoption, implementation and sustainability of health policies and their interaction with programs and contextual factors.
Studies of influences on the creation, packaging, transmission and reception of valid health research knowledge.
Studies of systems interventions to impact organizational structure, climate, culture, and processes to enable dissemination and implementation of clinical/public health information and effective clinical/public health interventions.
Studies that focus on the development and testing of theoretical and evaluation models for D&I processes.
Development of D&I relevant outcome and process measures and suitable methodologies for dissemination and implementation approaches.
Studies of the dissemination of varied strategies to promote effective patient and caregiver communication, leading to improved healthcare delivery and outcomes.
Studies of the dissemination and implementation of effective and cost-effective strategies for incorporating genomic medicine, sequence-based diagnostics and therapeutics in clinical care.
Studies testing the implementation and use of genomic information, family history risk information, and/or pharmacogenetic information for improved diagnosis and treatment.

In order to take advantage of existing resources and knowledge in the field, investigators are encouraged to consider the relationship of the following key characteristics of dissemination and implementation (D&I) research to their applications, which may include but are not limited to:

Use and testing or refinement of conceptual models appropriate for D&I
Understanding of the complexity of health interventions, including those with multiple components and those for low resource settings and for populations traditionally underrepresented in research, for which D&I may not be a simple process
Understanding the incentives and/or barriers to the D&I of novel tools and practices to improve public health
Incorporating the identification of mediators, moderators, and mechanisms of action, where applicable, that explain the impact of dissemination or implementation strategies
Consideration and characterization of the multi-level context and environment in which the proposed research will be conducted
Development and/or use of applicable outcomes, measures and analyses related to the models used and the project specific aims. Applicants are encouraged to review available resources where possible and use more harmonized and standard measures, rather than developing their own measures for each study.
Attention to issues of resources expended, programs costs, cost-effectiveness or other economic outcomes
Incorporation of stakeholder relevant outcomes of research (including relevant outcomes for patients, families, providers, administrators, policymakers).

Collaborative Research: In addition, given the range of expertise that may be needed for conducting dissemination and implementation research, applicants are encouraged to form trans-disciplinary teams of scientists and practice stakeholders to work together to develop and/or test conceptual models of dissemination and implementation that may be applicable across diverse community and practice settings and patient populations, and design studies that will accurately and transparently assess the outcomes of dissemination and implementation efforts.

Deadlines: standard dates apply

URLs:

Filed Under: Funding Opportunities

NIH funding opportunities (3) – Dissemination and Implementation Research in Health (R01, R03, R21)