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Shato T, Kepper MM, McLoughlin GM, Tabak RG, Glasgow RE, Brownson RC. Designing for dissemination among public health and clinical practitioners in the USA. J Clin Transl Sci 2023; 8:e8. [PMID: 38384897 PMCID: PMC10877519 DOI: 10.1017/cts.2023.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/07/2023] [Accepted: 12/03/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction The slow adoption of evidence-based interventions reflects gaps in effective dissemination of research evidence. Existing studies examining designing for dissemination (D4D), a process that ensures interventions and implementation strategies consider adopters' contexts, have focused primarily on researchers, with limited perspectives of practitioners. To address these gaps, this study examined D4D practice among public health and clinical practitioners in the USA. Methods We conducted a cross-sectional study among public health and primary care practitioners in April to June 2022 (analyzed in July 2022 to December 2022). Both groups were recruited through national-level rosters. The survey was informed by previous D4D studies and pretested using cognitive interviewing. Results Among 577 respondents, 45% were public health and 55% primary care practitioners, with an overall survey response rate of 5.5%. The most commonly ranked sources of research evidence were email announcements for public health practitioners (43.7%) and reading academic journals for clinical practitioners (37.9%). Practitioners used research findings to promote health equity (67%) and evaluate programs/services (66%). A higher proportion of clinical compared to public health practitioners strongly agreed/agreed that within their work setting they had adequate financial resources (36% vs. 23%, p < 0.001) and adequate staffing (36% vs. 24%, p = 0.001) to implement research findings. Only 20% of all practitioners reported having a designated individual or team responsible for finding and disseminating research evidence. Conclusions Addressing both individual and modifiable barriers, including organizational capacity to access and use research evidence, may better align the efforts of researchers with priorities and resources of practitioners.
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Affiliation(s)
- Thembekile Shato
- Prevention Research Center, Brown School, Washington
University in St. Louis, St. Louis, MO,
USA
- Department of Surgery (Division of Public Health Sciences), Washington
University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Maura M. Kepper
- Prevention Research Center, Brown School, Washington
University in St. Louis, St. Louis, MO,
USA
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University,
Philadelphia, PA, USA
- Implementation Science Center for Cancer Control, Brown School and School
of Medicine, Washington University in St. Louis, St.
Louis, MO, USA
| | - Rachel G. Tabak
- Prevention Research Center, Brown School, Washington
University in St. Louis, St. Louis, MO,
USA
| | - Russell E. Glasgow
- Department of Family Medicine and ACCORDS Research Center,
University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington
University in St. Louis, St. Louis, MO,
USA
- Department of Surgery (Division of Public Health Sciences), Washington
University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
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Purtle J, Moucheraud C, Yang LH, Shelley D. Four very basic ways to think about policy in implementation science. Implement Sci Commun 2023; 4:111. [PMID: 37700360 PMCID: PMC10496363 DOI: 10.1186/s43058-023-00497-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Policy is receiving increasing attention in the field of implementation science. However, there remains a lack of clear, concise guidance about how policy can be conceptualized in implementation science research. Building on Curran's article "Implementation science made too simple"-which defines "the thing" as the intervention, practice, or innovation in need of implementation support-we offer a typology of four very basic ways to conceptualize policy in implementation science research. We provide examples of studies that have conceptualized policy in these different ways and connect aspects of the typology to established frameworks in the field. The typology simplifies and refines related typologies in the field. Four very basic ways to think about policy in implementation science research. 1) Policy as something to adopt: an evidence-supported policy proposal is conceptualized as "the thing" and the goal of research is to understand how policymaking processes can be modified to increase adoption, and thus reach, of the evidence-supported policy. Policy-focused dissemination research is well-suited to achieve this goal. 2) Policy as something to implement: a policy, evidence-supported or not, is conceptualized as "the thing" and the goal of research is to generate knowledge about how policy rollout (or policy de-implementation) can be optimized to maximize benefits for population health and health equity. Policy-focused implementation research is well-suited to achieve this goal. 3) Policy as context to understand: an evidence-supported intervention is "the thing" and policies are conceptualized as a fixed determinant of implementation outcomes. The goal of research is to understand the mechanisms through which policies affect implementation of the evidence-supported intervention. 4) Policy as strategy to use: an evidence-supported intervention is "the thing" and policy is conceptualized as a strategy to affect implementation outcomes. The goal of research is to understand, and ideally test, how policy strategies affect implementation outcomes related to the evidence-supported intervention. CONCLUSION Policy can be conceptualized in multiple, non-mutually exclusive ways in implementation science. Clear conceptualizations of these distinctions are important to advancing the field of policy-focused implementation science and promoting the integration of policy into the field more broadly.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Corrina Moucheraud
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, Global Center for Implementation Science, New York University School of Global Public Health, Global Mental Health and Stigma Program, 708 Broadway, New York, NY, 10003, USA
| | - Donna Shelley
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Purtle J, Stadnick NA, Wynecoop M, Bruns EJ, Crane ME, Aarons G. A policy implementation study of earmarked taxes for mental health services: study protocol. Implement Sci Commun 2023; 4:37. [PMID: 37004117 PMCID: PMC10067193 DOI: 10.1186/s43058-023-00408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Insufficient funding is frequently identified as a critical barrier to the implementation and sustainment of evidence-based practices (EBPs). Thus, increasing access to funding is recognized as an implementation strategy. Policies that create earmarked taxes-defined as taxes for which revenue can only be spent on specific activities-are an increasingly common mental health financing strategy that could improve the reach of EBPs. This project's specific aims are to (1) identify all jurisdictions in the USA that have implemented earmarked taxes for mental health and catalogue information about tax design; (2) characterize experiences implementing earmarked taxes among local (e.g., county, city) mental health agency leaders and other government and community organization officials and assess their perceptions of the acceptability and feasibility of different types of policy implementation strategies; and (3) develop a framework to guide effect earmarked tax designs, inform the selection of implementation strategies, and disseminate the framework to policy audiences. METHODS The project uses the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to inform data collection about the determinants and processes of tax implementation and Leeman's typology of implementation strategies to examine the acceptability and feasibility strategies which could support earmarked tax policy implementation. A legal mapping will be conducted to achieve aim 1. To achieve aim 2, a survey will be conducted of 300 local mental health agency leaders and other government and community organization officials involved with the implementation of earmarked taxes for mental health. The survey will be followed by approximately 50 interviews with these officials. To achieve aim 3, quantitative and qualitative data will be integrated through a systematic framework development and dissemination process. DISCUSSION This exploratory policy implementation process study will build the evidence base for outer-context implementation determinants and strategies by focusing on policies that earmarked taxes for mental health services.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708, Broadway, New York, NY, 10003, USA.
| | - Nicole A Stadnick
- Department of Psychiatry, Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Megan Wynecoop
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708, Broadway, New York, NY, 10003, USA
| | - Eric J Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74Th St, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N 13Th St, Philadelphia, PA, 19122, USA
- Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, 425 E 61St St, New York, NY, 10065, USA
| | - Gregory Aarons
- Department of Psychiatry, Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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Pilar M, Purtle J, Powell BJ, Mazzucca S, Eyler AA, Brownson RC. An Examination of Factors Affecting State Legislators' Support for Parity Laws for Different Mental Illnesses. Community Ment Health J 2023; 59:122-131. [PMID: 35689717 PMCID: PMC9188272 DOI: 10.1007/s10597-022-00991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/24/2022] [Indexed: 01/09/2023]
Abstract
Mental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators' support for state parity laws for four mental illnesses- major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA.
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Amy A Eyler
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
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Ashcraft LE, Moon DJ, Merlin JS, Eack SM, Rogal SS. Quantifying implementation strategy and dissemination channel preferences and experiences for pain management in primary care: a novel implementer-reported outcome. Implement Sci Commun 2022; 3:128. [PMID: 36494841 PMCID: PMC9733293 DOI: 10.1186/s43058-022-00378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Precision implementation science requires methods to evaluate and select implementation strategies. This study developed and evaluated a novel measure of concordance between current and preferred dissemination channels (DC) and implementation strategies (IS) to guide efforts to improve the adoption of evidence-based management strategies for chronic pain. METHODS We conducted a one-time electronic survey of Pennsylvania primary care practitioners (PCPs) about current vs. preferred chronic pain management DC and IS use. Survey items were selected based on preliminary data, the Model for Dissemination of Research, and the Evidence-Based Recommendations for Implementing Change taxonomy of implementation strategies. We used Cohen's kappa (κ) to assess the agreement between participant-level current and preferred DC/IS. We calculated % preferred minus % experienced for each DC/IS and assessed the equality of proportions to determine whether this difference significantly departed from zero. We categorized DC and IS based on the degree of use and preference, to evaluate alignment. RESULTS The current sample included 101 Pennsylvania PCPs primarily in urban (94.06%), non-academic (90.10%) settings who self-identified as mostly female (66.34%) and white (85.15%). The greatest difference between preferred and experienced DCs, or "need," was identified by participants as workshops, clinical experts, seminars, and researchers. Similarly, participants reported the greatest IS gaps as multidisciplinary chronic pain workgroups, targeted support for clinicians, and a chronic pain clinical champion. Participating PCPs had moderate DC concordance (kappa = 0.45, 95% CI = 0.38-0.52) and low IS concordance (kappa = 0.18, 95% CI = 0.13-0.23). DC and IS concordance were both greater than that expected by chance. We further identified well-aligned DC and IS, including professional organizations, briefs, and guidelines. CONCLUSION We identified a novel implementer-reported outcome of dissemination channel and implementation strategy concordance that allows implementation scientists to quantify the magnitude of the gap between the current and preferred experience of implementers. This quantitative measure can help with the selection and evaluation of dissemination channels and implementation strategies. Future research should leverage this measure to understand the degree to which preference concordance influences clinical outcomes and performance.
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Affiliation(s)
- Laura Ellen Ashcraft
- grid.410355.60000 0004 0420 350XCenter for Health Equity Research and Promotion, Corporal Michael Crescenz VA Medical Center, Philadelphia, PA USA ,grid.21925.3d0000 0004 1936 9000School of Social Work, University of Pittsburgh, Pittsburgh, PA USA
| | - Deborah J. Moon
- grid.21925.3d0000 0004 1936 9000School of Social Work, University of Pittsburgh, Pittsburgh, PA USA
| | - Jessica S. Merlin
- grid.21925.3d0000 0004 1936 9000Division of General Internal Medicine, School of Medicine, CHAllenges in Managing and Preventing Pain (CHAMPP) clinical research center, University of Pittsburgh, Pittsburgh, PA USA
| | - Shaun M. Eack
- grid.21925.3d0000 0004 1936 9000School of Social Work, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Shari S. Rogal
- grid.21925.3d0000 0004 1936 9000Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA USA ,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare Center, Pittsburgh, PA USA
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Support for COVID-19-Related Substance Use Services Policy Changes: a New York State-Wide Survey. J Behav Health Serv Res 2022; 49:262-281. [PMID: 35112221 PMCID: PMC8810146 DOI: 10.1007/s11414-021-09784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 12/05/2022]
Abstract
This study aims to describe which substance use service (SUS) organizations and who within these organizations support the maintenance of policies targeted at improving substance use treatment services. An online survey assessing respondent, organizational and program demographics, and knowledge and support regarding policy changes was distributed to all certified SUS and harm reduction programs in NYS. Bivariate and latent class analyses were used to identify patterns and associations to policy choices. Across the 227 respondents, there was a support for maintaining expansion of insurance coverage, virtual behavioral health/counseling and medication initiation/maintenance visits, reductions in prior authorizations, and access to prevention/harm reduction services. Three classes of support for policies were derived: (1) high-supporters (n = 49; 21%), (2) low-supporters (n = 66; 29%), and (3) selective-supporters. Having knowledge of policy changes was associated with membership in the high-supporters class. Implications regarding the role of knowledge in behavioral health policies dissemination structures, decision-making, and long-term expansion of SUS are discussed.
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Snell-Rood C, Jaramillo ET, Hamilton AB, Raskin SE, Nicosia FM, Willging C. Advancing health equity through a theoretically critical implementation science. Transl Behav Med 2021; 11:1617-1625. [PMID: 33904908 PMCID: PMC8367016 DOI: 10.1093/tbm/ibab008] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
While implementation science is driven by theory, most implementation science theories, models, and frameworks (TMF) do not address issues of power, inequality, and reflexivity that are pivotal to achieving health equity. Theories used in anthropology address these issues effectively and could complement prevailing implementation science theories and constructs. We propose three broad areas of theory that complement and extend existing TMF in implementation science to advance health equity. First, theories of postcoloniality and reflexivity foreground attention to the role of power in knowledge production and to the ways that researchers and interventionists may perpetuate the inequalities shaping health. Second, theories of structural violence and intersectionality can help us to better understand the unequal burden of health disparities in the population, thereby encouraging researchers to think beyond single interventions to initiate partnerships that can impact overlapping health vulnerabilities and influence the upstream causes of vulnerability. Finally, theories of policy and governance encourage us to examine the social-political forces of the "outer context" crucial for implementation and sustainability. The incorporation of critical theories could enhance implementation science and foster necessary reflexivity among implementation scientists. We contend that a theoretically critical implementation science will promote better science and, more importantly, support progress toward health equity.
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Affiliation(s)
- Claire Snell-Rood
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Elise Trott Jaramillo
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, Albuquerque, NM, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah E Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesca M Nicosia
- Institute for Health & Aging, University of California, Integrative Health, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, Albuquerque, NM, USA
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Damari B, Sharifi V, Asgardoon MH, Hajebi A. Iran's Comprehensive Mental and Social Health Services (SERAJ Program): A Pilot Protocol. IRANIAN JOURNAL OF PSYCHIATRY 2021; 16:116-123. [PMID: 34054991 PMCID: PMC8140297 DOI: 10.18502/ijps.v16i1.5387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: The Iranian Mental Health Survey (IranMHS) indicated that almost 1 in 4 people had one or more psychiatric disorders (23.6%); however, two-thirds of patients did not benefit from health interventions, many provided services were inadequate and imposed a high burden on Iranian families. Therefore, the development of a national program on providing comprehensive social and mental health services, entitled “SERAJ”, became necessary. The present study aims to develop and outline the protocol for the pilot implementation of SERAJ. Method: This study is an action research with the collaborative mode. To compile the protocol, a broad review of the literature, interviews with experts and stakeholders, and focused group discussions were conducted. Results: The pilot implementation should be divided into 4 phases: (1) preparing documentation and work team, (2) preparing the prerequisites for providing pilot services, (3) providing pilot services, and (4) implementation and evaluation. Conclusion: SERAJ considered both preventive and treatment measures for mental and social health disorders and their risk factors. Moreover, the entire population can have access to primary and secondary services. Therefore, SERAJ is more comprehensive than the current situation in the country's mental health services. We suggest piloting and evaluating SERAJ in three districts of Iran.
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Affiliation(s)
- Behzad Damari
- Department of Governance and Health, Neuroscience Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Asgardoon
- Department of Governance and Health, Neuroscience Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Student Society for Immunodeficiencies, Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Hajebi
- Research Center for Addiction and Risky Behaviors (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
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Ashcraft LE, Quinn DA, Brownson RC. Strategies for effective dissemination of research to United States policymakers: a systematic review. Implement Sci 2020; 15:89. [PMID: 33059748 PMCID: PMC7560305 DOI: 10.1186/s13012-020-01046-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/14/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Research has the potential to influence US social policy; however, existing research in this area lacks a coherent message. The Model for Dissemination of Research provides a framework through which to synthesize lessons learned from research to date on the process of translating research to US policymakers. METHODS The peer-reviewed and grey literature was systematically reviewed to understand common strategies for disseminating social policy research to policymakers in the United States. We searched Academic Search Premier, PolicyFile, SocINDEX, Social Work Abstracts, and Web of Science from January 1980 through December 2019. Articles were independently reviewed and thematically analyzed by two investigators and organized using the Model for Dissemination of Research. RESULTS The search resulted in 5225 titles and abstracts for inclusion consideration. 303 full-text articles were reviewed with 27 meeting inclusion criteria. Common sources of research dissemination included government, academic researchers, the peer reviewed literature, and independent organizations. The most frequently disseminated research topics were health-related, and legislators and executive branch administrators were the most common target audience. Print materials and personal communication were the most common channels for disseminating research to policymakers. There was variation in dissemination channels by level of government (e.g., a more formal legislative process at the federal level compared with other levesl). Findings from this work suggest that dissemination is most effective when it starts early, galvanizes support, uses champions and brokers, considers contextual factors, is timely, relevant, and accessible, and knows the players and process. CONCLUSIONS Effective dissemination of research to US policymakers exists; yet, rigorous quantitative evaluation is rare. A number of cross-cutting strategies appear to enhance the translation of research evidence into policy. REGISTRATION Not registered.
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Affiliation(s)
- Laura Ellen Ashcraft
- University of Pittsburgh School of Social Work, 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
| | - Deirdre A Quinn
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, University Drive C, Building 30, Pittsburgh, PA, 15240, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA
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What Is Dissemination and Implementation Science?: An Introduction and Opportunities to Advance Behavioral Medicine and Public Health Globally. Int J Behav Med 2020; 27:3-20. [PMID: 32060805 DOI: 10.1007/s12529-020-09848-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There has been a well-documented gap between research (e.g., evidence-based programs, interventions, practices, policies, guidelines) and practice (e.g., what is routinely delivered in real-world community and clinical settings). Dissemination and implementation (D&I) science has emerged to address this research-to-practice gap and accelerate the speed with which translation and real-world uptake and impact occur. In recent years, there has been tremendous development in the field and a growing global interest, but much of the introductory literature has been U.S.-centric. This piece provides an introduction to D&I science and summarizes key concepts and progress of the field for a global audience, provides two case studies that highlight examples of D&I research globally, and identifies opportunities and innovations for advancing the field of D&I research globally.
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11
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Nelson KL, Purtle J. Factors associated with state legislators' support for opioid use disorder parity laws. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102792. [PMID: 32540516 PMCID: PMC7483853 DOI: 10.1016/j.drugpo.2020.102792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the United States, state behavioral health parity laws play a crucial role in ensuring equitable insurance coverage and access to substance use disorder treatment and services for people that need them. State legislators have the exclusive authority to adopt these laws. The purpose of this study was to identify legislator beliefs independently associated with "strong support" for opioid use disorder (OUD) parity. METHODS Data were from a 2017 cross-sectional, state-stratified, multi-modal survey of state legislators (N = 475). The dependent variable was "strong support" for OUD parity. Primary independent variables were beliefs about state parity laws. Bivariate analyses and mixed effects logistic regression were conducted. RESULTS Legislators who "strongly supported" OUD parity were significantly more likely than legislators who did not "strongly support" OUD parity to be female (64.1% vs. 46.5%, p<.001) , Democrat (76.2% vs. 29.3%, p<.001), and have liberal, compared to conservative, ideology (85.6% vs. 27.1%, p<.001). After adjusting for legislator demographics and state-level covariates, beliefs such as agreeing that state parity laws do not increase health insurance premium costs (aOR=6.77, p<.01) and that substance use disorder treatments can be effective (aOR=5.00, p<.001) remained associated with "strong support" for OUD parity. These state legislators' beliefs were more strongly associated with "strong support" for OUD parity than political party, ideology, and other demographic and state-level characteristics. CONCLUSIONS Dissemination materials and communication strategies to cultivate support for OUD parity laws among state legislators should focus on the fiscal impacts of parity laws and the effectiveness of substance use disorder treatments.
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Affiliation(s)
- Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States; Urban Health Collaborative, Drexel University, Philadelphia, PA, United States.
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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12
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Purtle J, Lê-Scherban F, Nelson KL, Shattuck PT, Proctor EK, Brownson RC. State mental health agency officials' preferences for and sources of behavioral health research. Psychol Serv 2020; 17:93-97. [PMID: 31192673 PMCID: PMC6908783 DOI: 10.1037/ser0000364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
State mental health agencies (SMHAs) are integral to public behavioral health service systems. As such, senior-level officials within SMHAs are important targets for advocacy and dissemination of behavioral health research findings. Evidence-informed decision making in SMHAs can potentially be enhanced by developing summaries of behavioral health research (e.g., policy briefs) that reflect SMHA officials' information preferences, but knowledge about these preferences is lacking. An exploratory study was conducted with the aims of characterizing senior-level SMHA officials' preferences for behavioral health research and describing where they turn for this research when making policy decisions. A cross-sectional, web-based survey of senior-level SMHA officials (1 per state) was conducted in March-May 2017 (n = 43, response rate = 84%). The features of behavioral health research that SMHA officials identified as "very important" most frequently were research being relevant to state residents (93.0%), providing data on cost-effectiveness (86.0%) and budget impact (81.4%), and being presented concisely (81.0%). The primary sources that SMHA officials turned to for behavioral research when making policy decisions were professional organizations (79.1%), SMHA agency staff (60.5%), and university researchers (55.8%). Compared with state legislators' responses to the same survey questions, results suggest that senior-level SMHA officials and legislators have similar preferences for behavioral health research but turn to different sources for this research. Advocates and researchers who seek to promote evidence-informed decision making in SMHAs should consider developing policy briefs that are concise, provide state-level prevalence data about behavioral conditions, and contain economic evaluation data, and they should disseminate these materials to multiple sources. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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PURTLE JONATHAN, LÊ‐SCHERBAN FÉLICE, WANG XI, SHATTUCK PAULT, PROCTOR ENOLAK, BROWNSON ROSSC. State Legislators' Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels. Milbank Q 2019; 97:1200-1232. [PMID: 31710152 PMCID: PMC6904266 DOI: 10.1111/1468-0009.12431] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Policy Points When communicating with state legislators, advocates for state behavioral health parity laws should emphasize that the laws do not increase insurance premiums. Legislators' opinions about the impacts of state behavioral health parity laws and the effectiveness of behavioral health treatment have more influence on support for the laws than do their political party affiliation or state-level contextual factors. Reducing legislators' stigma toward people with mental illness could increase their support for state behavioral health parity laws CONTEXT: Comprehensive state behavioral health parity legislation (C-SBHPL) is an evidence-based policy that improves access and adherence to behavioral health treatments. However, adoption of C-SBHPL by state legislators is low. Little is known about how C-SBHPL evidence might be most effectively disseminated to legislators or how legislators' fixed characteristics (eg, ideology), mutable characteristics (eg, beliefs about the policy's impact), and state-level contextual factors might influence their support for behavioral health policies. The purpose of our study is (1) to describe the associations between legislators' fixed and mutable characteristics, state-level contextual factors, and support for C-SBHPL; and (2) to identify the mutable characteristics of legislators independently associated with C-SBHPL support. METHODS We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C-SBHPL, and the independent variables included legislators' fixed and mutable characteristics and state-level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression. FINDINGS Thirty-nine percent of the legislators strongly supported C-SBHPL. After adjustment, the strongest predictors of C-SBHPL support were beliefs that C-SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C-SBHPL. State-level contextual factors did not moderate associations between mutable characteristics and support for C-SBHPL. CONCLUSIONS Legislators' mutable characteristics are stronger predictors of C-SBHPL support than are most of their fixed characteristics and all state-level contextual factors, and thus should be targeted by dissemination efforts.
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Affiliation(s)
| | | | - XI WANG
- PolicyLab, Children's Hospital of Philadelphia
| | - PAUL T. SHATTUCK
- Dornsife School of Public HealthDrexel University
- A.J. Drexel Autism InstituteDrexel University
| | - ENOLA K. PROCTOR
- Center for Mental Health Services ResearchBrown School at Washington University in St. Louis
| | - ROSS C. BROWNSON
- Prevention Research Center in St. LouisBrown at Washington University in St. Louis
- Division of Public Health Sciences and Alvin J. Siteman Cancer CenterWashington University School of Medicine, Washington University in St. Louis
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Purtle J, Lê-Scherban F, Wang X, Brown E, Chilton M. State Legislators' Opinions About Adverse Childhood Experiences as Risk Factors for Adult Behavioral Health Conditions. Psychiatr Serv 2019; 70:894-900. [PMID: 31272336 PMCID: PMC6773502 DOI: 10.1176/appi.ps.201900175] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) increase risk of adult behavioral health conditions. State legislators are an important audience to target with evidence about ACEs because they make policy decisions that can prevent ACE exposure and enhance resilience. This study sought to describe state legislators' opinions about ACEs as risk factors for adult behavioral health conditions and identify how opinions vary between legislators with different characteristics. METHODS A multimodal survey was conducted in 2017 (response rate, 16.4%; N=475). Dependent variables were the extent to which legislators thought that four ACEs-sexual abuse, physical abuse, witnessing domestic violence, and childhood neglect-increase risk of adult behavioral health conditions. Independent variables were legislator characteristics (e.g., ideology and gender). Rao-Scott chi-square tests and multivariable logistic regression were conducted. RESULTS Childhood sexual abuse was identified as a major risk factor by the largest proportion of respondents (77%), followed by childhood physical abuse (59%), witnessing domestic violence (39%), and childhood neglect (38%). The proportion identifying each ACE as a major risk factor was significantly higher among Democrats than among Republicans, liberals than among conservatives, and women than among men. For example, 56% of liberals identified witnessing domestic violence as a major risk factor, compared with 29% of conservatives (p<.001). CONCLUSIONS Opinions about ACEs as risk factors for adult behavioral health conditions varied between legislators with different characteristics, especially liberals and conservatives. To enhance the policy impact of evidence about ACEs, advocates might consider developing multiple versions of ACE evidence summaries that are tailored on the basis of these characteristics.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Félice Lê-Scherban
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Xi Wang
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Emily Brown
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Mariana Chilton
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
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Purtle J, Dodson EA, Nelson K, Meisel ZF, Brownson RC. Legislators' Sources of Behavioral Health Research and Preferences for Dissemination: Variations by Political Party. Psychiatr Serv 2018; 69:1105-1108. [PMID: 29983112 PMCID: PMC6251498 DOI: 10.1176/appi.ps.201800153] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to characterize primary sources of behavioral health research and dissemination preferences of state legislators and assess differences by political party. METHODS A 2017 cross-sectional survey of state legislators (N=475) assessed where legislators seek, and the most important features of, behavioral health research. Bivariate analyses and multivariate logistic regression were conducted. RESULTS Advocacy organizations (53%), legislative staff (51%), and state agencies (48%) were identified most frequently as sources of behavioral health research. Universities were identified by significantly more Democrats than Republicans (34% versus 19%; adjusted odds ratio=1.79). Data about budget impact and cost-effectiveness were most frequently rated as very important, but by significantly fewer Democrats than Republicans (77% versus 87% and 76% versus 89%, respectively). CONCLUSIONS To reach legislators and satisfy their information preferences, behavioral health researchers should target diverse audiences, partner with intermediary organizations, and craft messages that include economic evaluation data.
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Affiliation(s)
- Jonathan Purtle
- Dr. Purtle and Ms. Nelson are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia. Dr. Dodson and Dr. Brownson are with the Prevention Research Center in St. Louis, Brown School of Social Work, Washington University in St. Louis. Dr. Brownson is also with the Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis. Dr. Meisel is with the Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Elizabeth A Dodson
- Dr. Purtle and Ms. Nelson are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia. Dr. Dodson and Dr. Brownson are with the Prevention Research Center in St. Louis, Brown School of Social Work, Washington University in St. Louis. Dr. Brownson is also with the Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis. Dr. Meisel is with the Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Katherine Nelson
- Dr. Purtle and Ms. Nelson are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia. Dr. Dodson and Dr. Brownson are with the Prevention Research Center in St. Louis, Brown School of Social Work, Washington University in St. Louis. Dr. Brownson is also with the Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis. Dr. Meisel is with the Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Zachary F Meisel
- Dr. Purtle and Ms. Nelson are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia. Dr. Dodson and Dr. Brownson are with the Prevention Research Center in St. Louis, Brown School of Social Work, Washington University in St. Louis. Dr. Brownson is also with the Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis. Dr. Meisel is with the Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ross C Brownson
- Dr. Purtle and Ms. Nelson are with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia. Dr. Dodson and Dr. Brownson are with the Prevention Research Center in St. Louis, Brown School of Social Work, Washington University in St. Louis. Dr. Brownson is also with the Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis. Dr. Meisel is with the Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Audience segmentation to disseminate behavioral health evidence to legislators: an empirical clustering analysis. Implement Sci 2018; 13:121. [PMID: 30231934 PMCID: PMC6148796 DOI: 10.1186/s13012-018-0816-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background Elected officials (e.g., legislators) are an important but understudied population in dissemination research. Audience segmentation is essential in developing dissemination strategies that are tailored for legislators with different characteristics, but sophisticated audience segmentation analyses have not been conducted with this population. An empirical clustering audience segmentation study was conducted to (1) identify behavioral health (i.e., mental health and substance abuse) audience segments among US state legislators, (2) identify legislator characteristics that are predictive of segment membership, and (3) determine whether segment membership is predictive of support for state behavioral health parity laws. Methods Latent class analysis (LCA) was used. Data were from a multi-modal (post-mail, e-mail, telephone) survey of state legislators fielded in 2017 (N = 475). Nine variables were included in the LCA (e.g., perceptions of behavioral health treatment effectiveness, mental illness stigma). Binary logistic regression tested associations between legislator characteristics (e.g., political party, gender, ideology) and segment membership. Multi-level logistic regression assessed the predictive validity of segment membership on support for parity laws. A name was developed for each segment that captured its most salient features. Results Three audience segments were identified. Budget-oriented skeptics with stigma (47% of legislators) had the least faith in behavioral health treatment effectiveness, had the most mental illness stigma, and were most influenced by budget impact. This segment was predominantly male, Republican, and ideologically conservative. Action-oriented supporters (24%) were most likely to have introduced a behavioral health bill, most likely to identify behavioral health issues as policy priorities, and most influenced by research evidence. This was the most politically and ideologically diverse segment. Passive supporters (29%) had the greatest faith in treatment effectiveness and the least stigma, but were also least likely to have introduced a behavioral health bill. Segment membership was a stronger predictor of support for parity laws than almost all other legislator characteristics. Conclusions State legislators are a heterogeneous audience when it comes to behavioral health. There is a need to develop and test behavioral health evidence dissemination strategies that are tailored for legislators in different audience segments. Empirical clustering approaches to audience segmentation are a potentially valuable tool for dissemination science. Electronic supplementary material The online version of this article (10.1186/s13012-018-0816-8) contains supplementary material, which is available to authorized users.
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