What is the comparative effectiveness of dissemination strategies to promote the use of health and health care evidence for patients and clinicians? National Institutes of Health. We will hand search bibliographies of included articles. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. U.S. Department of Health & Human Services, Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence, https://effectivehealthcare.ahrq.gov/about/, www.health.gov/communication/resources/Default.asp, USA.gov: The U.S. Government's Official Web Portal. In addition, we expect a fair amount of heterogeneity across studies. PMID: 17934940. Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net benefit. Personal stories, case studies, anecdotes, testimonials, and experiential sharing (e.g., a personal account of an individual’s experience in donating an organ to a sibling), Entertainment education (e.g., talking about an issue in a soap opera storyline) and photo novellas, Messages that emphasize the positive consequences of compliance are referred to as a, Positive (gain) frame: “Get active! Designing health messages. Your dissemination report should be divided into the following sections: Section Notes Introduction Please provide the following information: Description of your institution and the reason why it became involved in the project. The effects of information framing on the practices of physicians. For KQ 3, we will also include the following experimental study types in MEDLINE: comparative studies, controlled clinical trials, or cross-over studies. The synthesis of the scientific literature presented in the final report does not necessarily represent the views of individual reviewers. We will systematically search, review, and synthesize the scientific evidence for each KQ. Washington, DC: Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. An example of a template that you can use to help prepare a dissemination plan is at Appendix 1. Med Decis Making 2008 May-Jun;28(3):377-84. life-cycle; for example, consider timings for sharing findings. Grimshaw JM, Shirran L, Thomas R, et al. Third, it examines the comparative effectiveness of various ways of communicating uncertainty associated with health and health care evidence to different target audiences. For studies without adequate information to determine inclusion or exclusion, we will retrieve the full text and then make the determination. Implementation processes to improve health outcomes are beyond the scope of this review. The consistency of a body of evidence reflects the degree to which studies present similar findings—in both direction and magnitude of effect. What is the comparative effectiveness of different ways of explaining uncertain health and health care evidence to patients and clinicians? PMID: 18070335. Example of good dissemination plans in grant applications. f?��3-���޲]�Tꓸ2�j)�,l0/%��b� The following example, adapted from CDC’s Framework, may help guide plans for reaching the various target audiences.v EXHIBIT 6: SAMPLE DISSEMINATION APPROACH AND RECOMMENDATIONSvi When to Disseminate Dissemination of information can and should occur throughout all phases of program implementation to Advances in Patient Safety: From Research to Implementation. We will focus the content on original research articles that are available in full-text form, are published in English, and involve randomized trials with at least 100 total individuals in the study (e.g., 50 individuals per arm in a study with two arms). What is the comparative effectiveness of communication techniques to promote the use of health and health care evidence by patients and clinicians? Psychol Bull 2007 Jul;133(4):673-93. Messages framed as emphasizing the benefits of preventive action are significantly better than loss-framed messages, although the difference is small. In addition, for comparative effectiveness reviews, the KQs were posted for public comment and finalized by the EPC after review of the comments. Garcia-Retamero R, Galesic M. Communicating treatment risk reduction to people with low numeracy skills: a cross-culturalcComparison. Washington, DC: The National Academies Press; 2000. Information delivery via phone, Webinar, or in-person visits, including purposeful delivery of brochures/pamphlets; can include pharmacists, nurses, doctors, counselors, but does not include a motivational component. The committee would like to know what approaches to conveying uncertainty increase the likelihood that audiences receiving such information will understand it and be able to factor it into their decisionmaking. �>v����.� �G2�X�t��B7�v�ݫ*�l^�c�w��)E��ws��I��G[��7�Ӆ������RS[ɪ!��-"�t@���W�J]V�����t^r��ȹ�q9�u�JK Risk Anal 2009 Feb;29(2):267-87. AHRQ series paper 5: grading the strength of a body of evidence when comparing medical interventions—Agency for Healthcare Research and Quality and the Effective Health-Care Program. Strategies to disseminate evidence that will: Techniques to explain uncertain evidence using: Intermediate outcomes for all target audiences. Aims and objectives. J Health Commun 2001 Jan-Mar;6(1):61-82. Evidence dissemination has several very broad goals: (1) to increase the reach of evidence; (2) to increase people’s motivation to use and apply evidence; and (3) to increase people’s ability to use and apply evidence. Greenhalgh T, Robert G, Macfarlane F, et al. The most effective dissemination outreach efforts are not designed in broad-brush fashion to equally reach any and all of your designated target audiences through a single training event or product. Uncertainty is inherent in health and health care evidence and can limit its use. We will determine whether quantitative synthesis using meta-analysis is appropriate. R�y0Q�wi�K��01h��^�>�ܪ0�*N��6'?~�x/ˠ��zq��W^��/�6 ��T���� Objectives Identify the key strategies to implementation of evidence-based practice. Low confidence that the evidence reflects the true effect. ��i�� Gu word/document.xml�]�rIv�;������������Fn��")�v����ptt8U ��U�5� �Y�?���z�������{3��)�z��$�B������t���U�: ulS�jgn���^��?|;{ڠJLZ*�EZ��e���IYf/���`b]�(�maG� �ɾ�����l��_YnS���Nu��n�,��f&�G6OtI/��~��*{Lw�t �8*�t�o�m쫝*O_�[��������(k��w�'�&ӻ1Mb�,;|��Ns=�_� �C~(_Jb���;�C"�E�����}��$�Q��x=��m�5w�ֻ�EzS����{9!��V�G��Dgd�I��b��\c��D��� PMID: 10535437. The following example, adapted from CDC’s Framework, may help guide plans for reaching the various target audiences.v EXHIBIT 6: SAMPLE DISSEMINATION APPROACH AND RECOMMENDATIONSvi When to Disseminate Dissemination of information can and should occur throughout all phases of program implementation to Multicomponent techniques seek to increase the overall impact of evidence across geographic and practice settings and across target audiences. Politi et al.29 suggest using subjective descriptions, various depictions of numbers, or visual aids to represent uncertainty and its degree. These include (1) patients and the general public and (2) clinical service providers, including physicians, nurses, mid-level providers, and/or pharmacists who deliver health care. To our knowledge, there is no overarching framework of communication strategies to guide our review. Further research may change our confidence in the estimate of the effect and may change the estimate. Peer Reviewers who disclose potential business or professional conflicts of interest may submit comments on draft reports through the public comment mechanism. Two reviewers will independently assess each domain for each key outcome listed in the analytic framework, and conflicts will be resolved by consensus or, if necessary, by adjudication by a third, senior investigator. Resources to Learn More Dissemination Planning Tool Website A tool that can be used to frame the objectives for dissemination, which will guide the materials that need to be created and the method of dissemination. Below we describe the population, intervention, comparators, outcomes, and settings (PICOTS) for our review (see Table 3). PMID: 21768582. The intent is to spread knowledge and the associated evidence-based interventions.4,5 Dissemination occurs through a variety of channels, social contexts, and settings. O����X� �*��V$:�B~���^�K����ڃ /P��I��~7$��i��J&B0Z�Du�t�OJ�K(H����xG �L�+�v����dcӻ���W>*��\XR�mp���Z}����HwnM�V��n���-�")/�ZwB`���4��� ��s�DX���j��;A*ʝ����c�֝�� 4���[�S��9�> ������{�V�4p����W�&����A����|�d�? Strategy: Process for Dissemination: Pros and Cons: Tools Needed: Social networks: The information will be disseminated through such social networks as Facebook and Twitter. For our review, we define the concept of uncertainty relative to the schemes for grading the strength of evidence for AHRQ’s Evidence-based Practice Center (EPC) Program. Agency for Healthcare Research and Quality. PMID: 15595944. We present our analytic framework in Figure 1. We will exclude Federal and State policymakers because they have less direct impact on clinical decisionmaking when compared with patients and providers. For each outcome and, within each outcome, each comparison type, we will examine the consistency and precision of effect. We will retrieve and review the full text of all articles included during the title/abstract review phase. We will not examine interventions designed to help individuals cope with uncertainty. Lustria et al., in press8 We will focus on studies examining the adult population 19 years of age and older, including the general public or patients and clinicians of all races and ethnicities and all levels of income, insurance coverage, and literacy. Examples of the sources of evidence that we will consider acceptable are: We will only include research-based evidence that is health related. They use various techniques to communicate evidence so that target audiences can understand it better. j���/Nw�[�f���\�����2�_W�<6t�Tǯv΍��;����~} �(_�}�IF�ڑ[�0* Although we have not found a systematic review on this approach, meta-analysis shows its practice is more common in large-scale communication efforts due to its potential effectiveness. Data synthesis and analysis is a core step in developing a systematic review. Techniques of interest include tailored communication, communication targeted at audience segments; use of narratives; and message framing (see Table 5). Chapters available at. Common methods of dissemination include: Publishing program or policy briefs; Publishing project findings in national journals and statewide publications 2�oWf � [Content_Types].xml �(� ���j�0E����Ѷ�J�(��ɢ�eh��4ND�B�����81�$14�� ��{�1��ښl �w%�=���^i7+���-d&�0�A�6�l4��L60#�Ò�S Appreciate the value of developing of a comprehensive dissemination strategy as an integral part of a research project. Appreciate the value of developing of a comprehensive dissemination strategy as an integral part of a research project. What funds will you need to deliver your planned dissemination activity? Available at. J Psychosoc Oncol 2002;20:69-84. The strength of the evidence represents the degree of confidence that the estimates of effects underlying evidence are correct and is used to provide a comprehensive evaluation of the evidence and an assessment of whether additional evidence might change conclusions. Search results will be limited to studies on humans published from 01/01/2000 onward for communication and dissemination given the previous systematic reviews and from 01/01/1966 onward for uncertainty given the lack of previous reviews on the latter. Other moderators will vary by KQ (communication, dissemination, uncertainty) and may include the following: For our review of communication techniques: For our review of dissemination techniques: For our review of techniques for communicating uncertainty: We will grade the strength of evidence on the basis of guidance established for the EPC Program.38,41 Developed to grade the overall strength of a body of evidence, this approach incorporates four key domains: risk of bias (including study design and aggregate quality), consistency, directness, and precision of the evidence. Kick EL, McKinney LA, McDonald S, et al. Multiple systematic evidence reviews and randomized trials18-22 have demonstrated that: Little work has focused on other types of uncertainty, although some conceptual pieces have offered a framework for study. Background information on the region where the dissemination takes place. Communication of uncertainty regarding individualized cancer risk estimates: effects and influential factors. PMID: 20459779. Evidence reports are typically targeted at scientific researchers in related fields, rather than the patients or clinicians who ultimately make health care decisions. ��� � word/_rels/document.xml.rels �(� ���j�0���{-;mC �s)�\[�d{�C�c�MZ�}EJ�Ӄ�3bg���z�;��5�$���uoZ����'ij��A#z���w�7T������b���hXq���Є��:-)H��AV��E�H�%w�ȯ2ٮ�v�#�b�?ٶi� If both reviewers agree that a study does not meet the eligibility criteria, the study will be excluded. The description of the project details will be posted on a Facebook page. The authors of this report are responsible for its content. Ann Intern Med 2007 Dec 18;147(12):871-5. Why don't physicians follow clinical practice guidelines? We will conduct quality checks to ensure that our main searches identify “known studies.” To limit KQ 1 and KQ 2 searches to relevant comparative effectiveness literature, we will further limit searches to comparative effectiveness studies by including only studies that have any of the following keywords throughout their citation in EndNote (Thomson Reuters, Philadelphia, PA): comparative effectiveness, evidence based, evidence-based, and recommendation or recommendations. The relative persuasiveness of gain-framed and loss-framed messages for encouraging disease prevention behaviors: a meta-analytic review. The Agency for Healthcare Research and Quality (AHRQ) Effective Healthcare (EHC) Program funds individual researchers, research centers, and academic organizations to work with AHRQ to produce effectiveness and comparative effectiveness research for clinicians and consumers.1 Comparative effectiveness research (CER) compares the benefits, harms, and effectiveness of health interventions for the prevention, diagnosis, treatment, and management of clinical conditions and the improvement of he… We will design data abstraction forms to gather pertinent information from each article, including characteristics of study populations, settings, interventions, comparators, study designs, methods, and results. Within each chapter, we will organize our results first by outcome and subsequently by the types of interventions compared. To identify articles relevant to each KQ, the EPC librarian will begin with three focused PubMed-MEDLINE searches on the comparative effectiveness of: (1) communication techniques to promote the use of health and health care evidence, (2) dissemination strategies to promote the use of health and health care evidence, and (3) different methods used to explain uncertain evidence. Possible moderators of interest for all key questions include: risk of bias, study size, and target audience. Further, she will search Web-of-Science to trace citations of known uncertainty frameworks and capture articles on uncertainty, and search PsychINFO for communication and uncertainty articles given the high likelihood of relevant publications in the psychological literature. Dissemination Plan Examples; Dissemination Plan Template. Owens DK, Lohr KN, Atkins D, et al. (2010)41 and AHRQ (2011). Multiple systematic reviews on communication and dissemination have been published since 2000. Patricia Carcaise-Edinboro, PhD. Develop a dissemination plan for your research. Examples include posting information to an evidence developer’s Web site and posting scientific publications in a searchable database. itical science), (2) current practices among researchers, (3) key audience characteristics, (4) available tools for dissemination, and (5) measures of impact. We will specifically examine studies that compare ways to explain the following components of uncertainty: overall grade for strength of evidence, risk of bias, consistency, precision, and directness (see Table 7). N = 20,180 2012 Feb;65(2):163-78. PMID: 18087058. We plan to exclude studies that compare the above strategies to “usual care” (i.e., meaning passive, uncontrolled spread of information of evidence or no spread of information such as posting information to an evidence developer’s Web site and posting scientific publications in a searchable database), because passive dissemination strategies are generally not effective.16 We plan to exclude studies in which the primary purpose of the intervention is implementation (see the definition in section I), even when the intervention has an effect of raising awareness and educating patients or clinicians (such as reminders and audit-and-feedback). Moderate confidence that the evidence reflects the true effect. We will define research-based evidence as evidence that has been assembled, reviewed, and presented by evidence developers and has been used to make recommendations. AHRQ Publication No. Visschers VH, Meertens RM, Passchier WW, et al. dissemination and utilization of research results. PMID: 8192299. Lomas J. Diffusion, dissemination, and implementation: who should do what? Hinyard LJ, Kreuter MW. High confidence that the evidence reflects the true effect. Steginga SK, Occhipinti S. Decision making about treatment of hypothetical prostate cancer: is deferring a decision an expert-opinion heuristic? 1999 Oct;14(10):633-42. We distinguish dissemination strategies from implementation strategies, with the latter focusing on actually undertaking the process to institutionalize the new evidence in clinical practice. PMID: 17592961. Today, I want to give you some hints on how to complete the dissemination and evaluation of project’s results boxes.. First of all, its important to underline that the Erasmus+ programme has a renewed interest in dissemination.Therefore, it’s not only about the IDEA, the PROBLEM, the ACTIVITIES you plan in … The steps that we will take to accomplish the literature review are described below. Med Care 2001 Aug;39(8 Suppl 2):II2-45. How does the comparative effectiveness of communication techniques vary by patients and clinicians? Strategies for Disseminating Qualitative Research Findings: Three Exemplars. Dissemination Plan. Institute of Medicine. For purposes of our review, communication techniques fall into the broad area of “health communication” and focus on making evidence interpretable, persuasive, and actionable. As described above, evidence dissemination has several broad goals. Specific Institutes of the National Institutes of Health (e.g., National Heart, Lung and Blood Institute; National Institute of Diabetes and Digestive and Kidney Diseases; National Cancer Institute); Scottish Intercollegiate Guidelines Network, AHRQ-funded Evidence-based Practice Centers, 01/01/2000 to present for communication and dissemination, Studies with no original data (i.e., no experimental data), Editorials, letters to editors, and similar publications, Alternate presentations of specified interventions, Comparisons with usual practice (except for KQ 3 when the evidence is sparse), Community-based settings such as churches, fraternal organizations, professional or social clubs, pharmacies, and homes, France, Germany, Italy, The Netherlands, the United Kingdom, the United States, Austria, Belgium-Luxembourg, Brazil, Denmark, Finland, Greece, Ireland, Israel, Norway, Poland, Portugal, Spain, Sweden, Switzerland, Turkey, Australia, Canada, Japan, and South Africa, Computerized database of messages that can be combined in response to answers to preprogrammed questions asked of an individual, Electronic algorithm to design messages based on individual input regarding a limited number of questions, Attempts to direct messages to individuals’ status on key theoretical determinants (knowledge, outcome expectations, normative beliefs, efficacy, and/or skills) of the behavior of interest, Incorporating recognizable aspects of participants to convey (implicitly or explicitly) that the messages are specifically designed for them. Existing systematic reviews and dissemination research show that passive dissemination strategies are not as effective as active strategies. One EHC goal is to make CER accessible to these decisionmakers. To recap, our review has three Key Questions (KQs), listed below. In addition, we will exclude studies that address uncertainty arising from any of the following circumstances: multiple causes of illness, changes in risks over time, lack of knowledge about evidence that is available, unclear patient values, trade-offs between benefits and harms in limited-resource settings, concerns about clinicians’ competence, concerns about how a medical illness will affect family and friends, imperfect diagnostic testing, or uncertain prognosis. Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. Overall there may be net benefit, clinical equipoise (benefit that is too close to call at the population level), or net harm. Evidence either is unavailable or does not permit estimation of an effect. We focus this review on uncertainty in a body of evidence and how to effectively communicate this uncertainty to target audiences in ways that allow informed decisions. These can be awareness of the evidence; knowledge of the evidence; discussions about the evidence; self-efficacy about the evidence; and behavioral intentions to use or apply the evidence. Proponents of innovation are often dismayed that despite the millions of dollars and the years of effort spent in the development and evaluation of treatments for people with mental illness, service providers may take a decade or more to incorporate these treatments into their day-to-day service armamentarium (7,8). In order to evaluate the success of the implemented strategy, the execution of a strategic evaluation plan can be dully accepted. PMID: 19833983.. Han PK, Klein WM, Lehman T, et al. Health.gov. These strategies are designed to make information clearer, easier to understand, and more relevant to end-users. PMID: 10571710. We will also examine relevant communication techniques described, including the ones for KQ 1 and hypothetical situations, if the technique is used to communicate uncertainty. An example of implementation is when a clinical practice adopts or tries out a new treatment approach that is based on newly available health or health care evidence. We will assess clinical heterogeneity by comparing studies on their PICOTS characteristics. Therefore, we will integrate the information qualitatively into understandable text and summary tables. Risk of bias is analogous to the quality of the evidence: good/fair/poor. 17 – September 2007 . 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