Dissemination Science in School Mental Health: A Framework for Future Research

Evaluating the implementation of a community health worker-delivered intervention integrating asthma care in West Philadelphia public schools

OBJECTIVE

Schools are an important setting because students spend much of their time in school and engage in physical activity during the school day that could exacerbate asthma symptoms. Our objective is to understand the barriers and facilitators to implementing an experimental community health worker-delivered care coordination program for students with asthma within the context of the West Philadelphia Controls Asthma study.

METHODS

Surveys (n = 256) and semi-structured interviews (n = 41) were completed with principals, teachers, nurses, and community health workers from 21 public and charter schools in West Philadelphia between January 2019 and September 2021. Survey participants completed the Evidence Based Practice Attitudes Scale, the Implementation Leadership Scale, and Organizational Climate Index. Semi-structured qualitative interview guides were developed, informed by the Consolidated Framework for Implementation Research.

RESULTS

Participant responses indicate that they perceived benefits for schools and students related to the community health worker-based care coordination program. Several barriers and facilitators to implementing the program were noted, including challenges associated with incorporating the program into school nurse workflow, environmental triggers in the school environment, and challenges communicating with family members. An important facilitator that was identified was having supportive school administrators and staff who were engaged and saw the benefits of the program.

CONCLUSIONS

This work can inform implementation planning for other locales interested in implementing community-based pediatric asthma control programs delivered by community health workers in schools.

Bridging the gap between pregnancy loss research and policy and practice: insights from a qualitative survey with knowledge users

BACKGROUND

The loss of a pregnancy or the death of baby around the time of their birth can have profound impacts on parents, families and staff involved. There is much opportunity to enhance the systematic uptake of evidence-based interventions to enhance service provision, lived experiences and outcomes. Challenges exist to translating pregnancy loss research evidence into policy and practice, however. Pregnancy loss remains a neglected area of research and resourcing and is steeped in stigma. While barriers and facilitators to the use of research evidence by decision-makers in public health and health services are well documented, we aimed to better understand the factors that influence the translation of pregnancy loss research into practice and policy.

METHODS

We conducted a qualitative online survey of pregnancy loss research knowledge users in Ireland, identified through our clinical and academic networks, between January and March 2022. The survey comprised ten questions, with three closed questions, informed by the Knowledge Translation Planning Template©. Questions included who could benefit from pregnancy loss research, perceived barriers and facilitators to the use of research evidence and preferred knowledge translation strategies. We analysed data using reflexive thematic analysis.

RESULTS

We included data from 46 participants in our analysis, from which we generated two central themes. The first-'End the silence; stigma and inequality around pregnancy loss to enhance awareness and understanding, public health and services and supports'-addresses issues related to the stigma, sensitivities and silence, lack of awareness and understanding, and lack of relevance or priority afforded to pregnancy loss. The second theme-'Use a range of tailored, accessible approaches to engage a large, diverse range of knowledge users'-highlights the need to use relevant, accessible, and engaging information, resources or materials in knowledge translation efforts, and a variety of tailored approaches to suit different audiences, including materials, workshops/webinars, media, knowledge brokers and champions or opinion leaders.

CONCLUSIONS

Our analysis provides rich insights into the barriers and facilitators to knowledge translation in the field of pregnancy loss research. We identified key strategies that can be used to inform knowledge translation planning in Ireland, and which have international applicability.

Disseminating online parenting resources through community-academic partnerships

This community-engaged study aimed to understand effective strategies for disseminating online parenting resources (OPRs) in schools. OPRs were disseminated through seven E-Parenting tips and eight Facebook posts. Facebook posts were viewed a total of 12,404 times, and each post reached an average of 505 people each month. Average engagement rate was 2.41% per post. E-Parenting tips yielded 1514 total clicks, and the average clicks per message was 216.29. E-Parenting tips related to internalizing problems (e.g., anxiety, depression) had a higher click rate than E-Parenting tips related to externalizing problems (e.g., oppositional behavior). OPRs disseminated through Facebook posts, and E-Parenting tips resulted in wide reach and engagement. Different media channels should be utilized to disseminate different OPRs to as many parents as possible.

Exploring Intervention Sustainment and Intervention Spread Following a Randomized Clinical Trial of the MOSAIC Program

The randomized trial of the Making Socially Accepting Inclusive Classrooms (MOSAIC) program included intensive coaching from research staff to support teachers' implementation of MOSAIC strategies and resulted in positive student outcomes (Mikami et al., J. Clin. Child Adolesc. Psychol. 51(6):1039-1052, 2022). However, these intensive procedures are costly (in time, money, and resources) and serve as barriers to intervention adoption under typical school conditions. In this study, we explored the extent to which MOSAIC-trained teachers could sustain practices under typical practice conditions (sustainment), the extent to which teachers who did not participate in the trial could adopt the practices under typical practice conditions (spread), and the extent to which strategy use in the follow-up year was associated with participation in MOSAIC-focused professional learning communities (PLCs). Participants were 30 elementary school teachers, including (a) 13 teachers who received intensive coaching on MOSAIC practices during the previous year (MOSAIC group), and (b) seven teachers who participated in the trial in the control condition, plus 10 new teachers interested in MOSAIC (new-to-MOSAIC group). We assessed MOSAIC strategy use over the school year via monthly observations and biweekly teacher self-report surveys. Observation data revealed high sustainment in the MOSAIC group, with teachers showing less than 20% decline in the use of most strategies between the two years of participation. New-to-MOSAIC teachers implemented some core MOSAIC strategies, although not to the extent as those in the MOSAIC group. Higher strategy use was modestly associated with PLC attendance. We discuss implications for encouraging sustainment and intervention spread after initial, intensive supports are withdrawn.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-022-09555-w.

Dissemination Research in Communication Sciences and Disorders: A Tutorial

PURPOSE

The purpose of this tutorial is threefold: (a) to bring attention to the role and value of dissemination research in communication sciences and disorders (CSD), (b) to introduce a model that can be used to guide dissemination research, and (c) to demonstrate strategic steps toward generating research questions and planning methods for dissemination research using an example from the authors' work.

METHOD

This tutorial begins with a discussion of the role of dissemination in clinical research, with emphasis on differentiating the unique value of dissemination within the broader context of dissemination and implementation (D&I) research. The tutorial next presents a model of dissemination from the extant literature and describes how this model can be applied in CSD using examples from the authors' respective programs of clinical research. This is followed by an example that illustrates how the model can be used to determine research questions and guide the development of methods. Finally, the tutorial ends by discussing the potential impact of dissemination research for advancing efforts in CSD for closing the research-to-practice gap.

CONCLUSIONS

Dissemination research is an often overlooked but critical component of D&I efforts. When approached systematically and rigorously, dissemination can make meaningful contributions to clinical research in CSD.

A scoping review of frameworks in empirical studies and a review of dissemination frameworks

BACKGROUND

The field of dissemination and implementation (D&I) research has grown immensely in recent years. However, the field of dissemination research has not coalesced to the same degree as the field of implementation research. To advance the field of dissemination research, this review aimed to (1) identify the extent to which dissemination frameworks are used in dissemination empirical studies, (2) examine how scholars define dissemination, and (3) identify key constructs from dissemination frameworks.

METHODS

To achieve aims 1 and 2, we conducted a scoping review of dissemination studies published in D&I science journals. The search strategy included manuscripts published from 1985 to 2020. Articles were included if they were empirical quantitative or mixed methods studies about the dissemination of information to a professional audience. Studies were excluded if they were systematic reviews, commentaries or conceptual papers, scale-up or scale-out studies, qualitative or case studies, or descriptions of programs. To achieve aim 1, we compiled the frameworks identified in the empirical studies. To achieve aim 2, we compiled the definitions from dissemination from frameworks identified in aim 1 and from dissemination frameworks identified in a 2021 review (Tabak RG, Am J Prev Med 43:337-350, 2012). To achieve aim 3, we compile the constructs and their definitions from the frameworks.

FINDINGS

Out of 6017 studies, 89 studies were included for full-text extraction. Of these, 45 (51%) used a framework to guide the study. Across the 45 studies, 34 distinct frameworks were identified, out of which 13 (38%) defined dissemination. There is a lack of consensus on the definition of dissemination. Altogether, we identified 48 constructs, divided into 4 categories: process, determinants, strategies, and outcomes. Constructs in the frameworks are not well defined.

IMPLICATION FOR D&I RESEARCH

This study provides a critical step in the dissemination research literature by offering suggestions on how to define dissemination research and by cataloging and defining dissemination constructs. Strengthening these definitions and distinctions between D&I research could enhance scientific reproducibility and advance the field of dissemination research.

Disseminating online parenting resources in the community during the COVID-19 pandemic: Lessons learned

Online parenting programs are an effective way to teach behavioral management skills to parents in the absence of in-person resources. This community-engaged study aimed to examine strategies for disseminating online parenting resources in schools. Online resources were disseminated to parents in a Northern California school district. Dissemination strategies were informed by conversations with school principals, teachers, and parents and considered agent, message, and format. A total of 685 parents and teachers clicked on the online resources: 151 parents and 114 teachers attended synchronous classes. The use of dissemination strategies had a compounding influence on the number of synchronous class attendees and clicks. Emails sent by the school district yielded the greatest number of clicks, which was influenced by message content and format. A community-academic partnership (CAP) led to the dissemination of evidence-based online parenting resources to a large population and led to lessons learned that could inform future research involving CAPs.