In health care, invention is hard, but dissemination is even harder. . . . Even when innovations are implemented successfully in one location, they often [spread] slowly—if at all.

—Berwick (2003)

Developing an evidence-based behavioral intervention is hard, complex work, often requiring years of research and testing. However, this effort is just the beginning of a similarly difficult process of enabling large numbers of people to benefit from a behavioral intervention that has proven effectiveness. Too often, investigators falter at the dissemination phase or moving proven interventions from testing sites to real-world settings. Thus, understanding the specific activities involved in dissemination is important to distill.

What is “dissemination”? Although variably defined, dissemination refers to the active spread of an innovation such as a proven behavioral intervention, usually through specific plans and targeted distribution channels. The National Institutes of Health (NIH) formally defines dissemination as

. . . the purposive distribution of information and intervention materials to a specific public health or clinical practice audience. The intent is to spread information and the associated evidence-based interventions. Research on dissemination addresses how information about health promotion and care interventions is created, packaged, transmitted, and interpreted among a variety of important stakeholder groups. (NIH, 2011)

As shown in Table 21.1, Rogers’s definition also emphasizes the planned nature of dissemination processes. Dissemination of a proven intervention is the phase along the elongated pipeline, as described in Chapter 2 (Figure 2.2), that is specifically focused on not only “getting the word out,” so to speak, but also supporting adoption by organizations, systems of care, community groups, agencies, and/or end users including interventionists and recipients of an intervention. Of importance, however, is to recognize that there is a dynamic relationship between dissemination and implementation. We refer to “implementation” as the fit between a proven intervention and a real-world public health, clinical, and community service

TABLE 21.1 Key Terms Related to the Process of Dissemination




"The use of strategies to adopt and integrate evidence- based health interventions and change practice patterns within specific settings" (Schillinger, 2010).


"The process by which an innovation is communicated through certain channels and adopted over time among members of a social system" (Rogers, 2003).


"Planned, systematic efforts designed to make a program or innovation more widely available to a target audience or members of a social system" (Rogers, 2003).

Implementation science

"The study of methods to promote the integration of research findings and evidence into healthcare policy and practice" (Fogarty International Center of NIH, n.d.).

Social marketing

"The design, implementation, and control of programs calculated to influence the acceptability of social ideas and involving considerations of product planning, pricing, communication, distribution, and marketing research" (Kotler & Zaltman, 1971).

Scalability/going to scale

"The capacity of a practice to replicate design or strategic elements in a magnified, sustainable form" (Bondi, 2000).

Value proposition

"A clear, simple statement of the benefits, both tangible and intangible, that [a] company will provide, along with the approximate price it will charge each customer segment for those benefits" (Golub et al., 2000).

systems. As discussed in Chapter 2, we suggest that there needs to be some proof that an intervention can be implemented in a particular setting prior to investing in its dissemination for widespread adoption. While dissemination, adoption, and implementation are highly interrelated activities, we find it helpful, for heuristic purposes, to view dissemination as supporting adoption of an intervention by various settings following some proof of the implementation potential of an intervention (as previously illustrated in Chapters 19 and 20).

The dissemination of evidence is challenging in any industry, but the challenges are particularly pronounced for behavioral interventions where the knowledge-practice gaps exist across all areas of medical, public health, and human service practices (Institute of Medicine, 2001). While academic researchers are skilled in generating scientific reports that systematically relay findings of intervention studies, merely reporting the evidence to largely academic audiences has been shown to be an insufficient form of dissemination and one that does not lead to adoption of interventions. McCannon, Berwick, and Massoud (2007, p. 1937) observe that “good ideas, even when their value is thoroughly demonstrated in one place, will not reliably spread into action through normal communication channels at a pace truly responsive to enormous health care challenges . . .” Therefore, disseminating effective behavioral interventions is a significant challenge requiring thoughtful and purposeful thinking, planning, and actions by an investigator and/or investigative team.

This chapter focuses on what it takes to disseminate a proven intervention. We first discuss the key reasons why dissemination and subsequent adoption or uptake of an intervention may be challenging. Next, we consider ways to determine if a proven intervention is ready to be disseminated. Finally, we describe the core elements of a robust plan for dissemination. Even if an investigator does not want to personally disseminate his or her or another proven intervention, knowledge of the thinking and action processes involved for doing so can help inform how an intervention is developed early on in the pipeline. In this respect, understanding dissemination considerations is important to all behavioral intervention researchers seeking to advance programs that eventually can be used by communities, practice settings, and end user beneficiaries. As there are various terms related specifically to the process of dissemination, these are summarized in Table 21.1 and are referred to throughout this chapter. Although there is no consensus as to the meaning and usage of terms, Table 21.1 provides working definitions that can serve as a guide to this particular phase along the intervention pipeline.

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