WHY IS DISSEMINATION DIFFICULT?
Dissemination is hard work for several reasons. First, investigators may not have the skill set and/or time needed for engaging in dissemination activities. The skills used to create and rigorously test an intervention are distinct from those needed to disseminate a proven intervention. For example, understanding market conditions, developing key messages, naming and framing the value of an intervention for different stakeholders, and building a business plan are a few of the key activities conducted in a dissemination phase. Most investigators have not had formal training in these areas or ways of thinking or been exposed to what it takes to disseminate a proven intervention.
Moreover, dissemination requires dedicated time that an investigator may not have owing to other professional commitments and responsibilities. Dissemination may deter an investigator from pursuing other important activities such as conducting further research on the intervention or investigating new related scientific questions. In this regard, participating in the dissemination of a proven program needs to be a conscious decision on the part of an investigator and investigative team that is linked to professional and career goals.
A second factor contributing to the challenge of dissemination is that investigators may find it difficult to raise the funds or capital needed for this phase. Developing and carrying out a dissemination plan can be costly. Unlike other industries such as pharmaceuticals, there is not a dedicated channel or industry for disseminating a behavioral intervention; thus, investigators are on their own to figure out appropriate mechanisms for moving their programs forward from a testing environment to the public and into practice settings. In the United States, traditional funding mechanisms such as the NIH have demonstrated some interest in researching the relative effectiveness of different dissemination approaches, although few funds are allocated for research in this area, and there is no support for ongoing dissemination efforts of any one particular intervention.
A third issue in dissemination is that agencies, stakeholders, and individuals may not be ready to accept a particular intervention even when its benefits are proven and of interest (see the examples discussed in Chapter 20). Market conditions, including economic considerations and other programs competing for limited organizational resources, community readiness, or the lack of an apparent fit of the program with perceived community needs may hamper dissemination. Furthermore, agencies may not have the right staffing or resources for delivering a program or the sustained funding to train staff, implement a program, and sustain it as is discussed in previous chapters. There may not be funding or reimbursement mechanisms to support and sustain the adoption of an intervention making dissemination ineffective or unrealistic (see discussion in Chapter 20 of the Get Busy Get Better intervention [Gitlin et al., 2012] and also the initial reaction to Hospital at Home [Leff et al., 2005]).
Yet another reason why dissemination is challenging is that investigators may not be aware of, and consequently use, evidence-based approaches for this activity. Kerner, Rimer, and Emmons (2005) note that “Efforts to move effective preventive strategies into widespread use too often have been unsystematic, uncoordinated, and insufficiently capitalized, and little is known about the best strategies to facilitate active dissemination and rapid implementation of evidence-based practices.” (p. 443). The science of dissemination, an aspect of implementation science, is emerging; however, as of yet, dissemination activities are not well studied or understood. Knowledge of best practices and what works or not for specific types of interventions, organizations, communities, stakeholders, and individuals is only in an incipient stage.