Evaluating Fit Between the Intervention and a Practice Setting
Another aspect that influences the potential of, and approach to, dissemination is the fit of a context and an intervention (again, discussed in more detail in Chapter 20). Here, several key attributes need to be considered: centrality of the intervention to the day-to-day work of an organization, agency, or individual; pervasiveness or behaviors expected to be affected by the intervention; and the degree to which the intervention challenges or changes accepted behaviors, cultural norms, or daily routines (Wolfe, 1994; also see Chapter 20 for other contextual elements). The perceived feasibility and ease of implementation of an intervention will influence how the intervention needs to be disseminated (Bradley et al., 2004). It is important to clearly describe how an organization can integrate a new program. For example, Care Management Plus (caremanagementplus.org/impsteps.html), a patient-centered medical home model developed at the Oregon Health & Science University, provides a clear step-by-step approach to integrating the intervention in a primary care clinic.