In summary, the past 50 years of intervention research have yielded important findings that have yet to be fully disseminated and implemented. There are numerous behavioral interventions for which we have sufficient existing evidence to warrant “scaling up” through the application of rigorous dissemination and implementation processes. At the same time, there are many available frameworks in implementation science that can provide guidance in designing behavioral interventions to facilitate and maximize translation of these programs into practice settings.
Dissemination and implementation of evidence should be critical considerations in the early stages of behavioral intervention design and not simply an afterthought at the completion of the testing phase of an intervention study. It is essential that behavioral intervention researchers obtain both expertise in and partner with dissemination and implementation science investigators to apply relevant theories and methods to guide intervention development. Pragmatic efficacy and effectiveness trials (see Chapter 2) are examples of intervention study designs that may optimize dissemination and implementation potentiality by building in research questions about stakeholder values that may facilitate translation of evidence into a designated practice environment more efficiently and effectively.
With the emergence of a science for implementation, funding agencies and grant reviewers are beginning to explicitly and implicitly expect and/or require that proposals consider the implementation potential of proposed interventions. This represents a paradigm shift in the way in which funders are considering behavioral intervention research.
Implementation science will help to create generalizable knowledge that can be applied across care settings to answer central questions of importance for behavioral intervention researchers. This line of inquiry will yield understandings of why established behavioral interventions may lose their effectiveness over time or when transferred to other settings, why well-tested behavioral interventions may exhibit unintended effects when introduced in new settings, or how an intervention can maximize cost- effectiveness with strategies for effective adoption. The challenges of implementation should be of concern and significance to behavioral intervention researchers.
The emergence of implementation science calls for researchers and practitioners to carefully examine how to refine current practices in developing behavioral interventions and to design new and innovative strategies for their advancement that reflects a better understanding of contextual factors that support or hinder eventual program adoption.
At a minimum, behavioral interventions have to be designed and tested “with the end in mind,” and to do so, implementation theories and models may be helpful to consider. Additionally, the inclusion of stakeholder groups early on to ensure appropriate selection of process and outcome variables may help to advance implementation. Interventions then need to be pilot tested and retested recognizing that implementation efforts require: detailed assessment of contextual characteristics of the settings in which the targeted populations are served; evaluation of the changes in primary and secondary outcomes that are of clinical importance to stakeholders; and a consideration of implementation, maintenance, and cost at both the individual and organizational levels. Implementation science provides working tools in the form of theories, conceptual frameworks, and empirical evidence that can assist in the thinking and action processes of behavioral intervention researchers.